FREQUENTLY ASKED QUESTIONS ABOUT INFLUENZA A(H1N1) FOR HEALTHWORKERS What is Influenza A (H1N1)?

? Influenza A(H1N1) is caused by a novel virus that resulted from the reassortment of 4 viruses from pigs, human and
birds It is a new virus causing illness in people It was first detected in people in April 2009 in the United States This virus is spreading from person-to-person, probably in much the same way that regular seasonal influenza viruses spread There is no vaccine yet to protect humans from this virus There are existing and recommended medicines that are effective in treating these Influenza A(H1N1) Influenza A(H1N1) can be fatal to humans due to severe respiratory distress (pneumonia)

Why this new Influenza A(H1N1) virus is sometimes called "swine flu"? This virus was originally referred to as "swine flu" because laboratory tests showed that many of the genes in this new virus
were very similar to influenza viruses that normally occur in pigs in North America. But further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and avian genes and human genes. Scientists call this a "quadruple reassortant" virus.

Do pigs carry this virus and can people catch this virus from a pig? At this time, there is no evidence that swine in the United States are infected with this new virus. However, there are flu
viruses that commonly cause outbreaks of illness in pigs. Most of the time, these viruses do not infect people, but influenza viruses can spread back and forth between pigs and people.

Are there human infections with this virus? Yes. Cases of human infection with this virus were first confirmed in the U.S. in Southern California and near Guadalupe
Country, Texas. The outbreak intensified rapidly from that time and more and more states have been reporting cases of illness from this yirus. Other countries with confirmed cases include Mexico, United States, Canada, Australia, Austria, New Zealand, Japan, Korea, China (Mainland China, Hongkong), Portugal, Poland. Guatemala, Spain, Costa Rica, Colombia, Denmark, El Salvador, France, Germany, Ireland, Israel, Italy, Netherlands, Norway, Sweden, Switzerland, United Kingdom, Brazil, Argentina, Panama. Is this new virus contagious? Yes, Influenza A(H1N1) virus is contagious and is spreading from human to human. However, at this time, it is not known how easily the virus spreads between people. What are the signs and symptoms of this virus in humans? Similar to the symptoms of regular flu such as: Fever, Headache, Fatigue, Muscle or joint pains, Lack of appetite, Runny nose, Sore throat, Cough Some cases have reported diarrhea, nausea and vomiting.

How severe is illness associated with this virus? It is not known at this time how severe this virus will be in the general population. Experts are studying the medical histories of people who have been infected with this virus to determine whether some people may be at greater risk from infection, serious illness, or hospitalization from the virus. How does Influenza A(H1N1) virus spread? Coughing or sneezing by people with influenza Touching things with flu viruses on it and then touching one's mouth, nose or eyes Can I get infected with Influenza A(H1N1) from eating or preparing pork? No, you can't get influenza A(H1N1) by eating properly handled and thorough cooked port; and pork products The virus is killed by cooking temperatures of 160 F/70 C. What is the incubation period? 7 to 10 days from the time of exposure to the first onset of signs and symptoms How long can an infected person spread Influenza A(H1N1) to others? Infected person maybe contagious from one day before they develop symptoms to up to 7 days after they get sick. Children might potentially be contagious for longer periods. Are there medicines to treat infection with AH1N1? Yes. Oseltamivirr or zanamivir are the recommended drugs to treat and or prevent infection with this virus. You have to consult a doctor before using these drugs to avoid resistance.

 Is there prophylaxis for the Influenza A(H1N1)? Yes. For further information refer to Interim Guideline # 1. Is vaccine available to protect people from getting infected with AH1N1? No, at present there is no vaccine against this virus. How can we prevent the spread of the virus? Observe proper personal hygiene: Cover your nose and mouth when coughing or sneezing Wash hands regularly with soap and water, at least for 20 seconds (or use alcohol-based hand sanitizers) especially after handling patients and specimen, before and after eating, after using the toilet and as necessary. Avoid touching your eyes, nose or mouth. Germs spread this way. Increase your body's resistance Have at least 8 hours of sleep Be physically active Manage your stress Drink plenty of fluids Eat nutritious food, especially fruits and vegetables 3.Social distancing. Avoid crowded places. Avoid close contact with sick people. Stay home if you are sick until you are free from symptoms to prevent the spread of the virus.

What to do if somebody gets sick? If there is flu like symptoms, consult the doctor immediately. Report to the proper health authorities . Is there a pandemic risk on Influenza A(H1N1)? Yes. If the Influenza A(H1N1) establishes efficient and sustained human-to-human transmission then it can cause an influenza pandemic. The impact of a pandemic is difficult to predict. It depends on virulence of the virus, existing immunity among people, cross protection by antibodies acquired from seasonal influenza infection and host factors Health Emergency Management Structure

CENTRAL COMMAND Safety Team (Infection Control Committee) PLANNING (EXECOM) OPERATIONS (CAPS (Hospital & Comm) & Nursing Service Surveillance Office Quarantine Directors Field Operations Communicati on Directors Etc. Hospital Operations Secretariat & Laison

LOGISTICS (Admin Service)

FINANCE (Budget Officer)

DOH Central Office Directors CHD Directors DOH Hospitals Expert Panel

Admin Procurement CoBAC MMD Transport

HELP KEEP PHILIPPINES FLU-FREE! Do 1,2,3! Upon Arrival, immediate proceed to Quarantine Counter for Screening. STEP 1 Submit completely filled-up Health Checklist to Quarantine Officer and pass through Thermal Scan.

 STEP 2 Submit yourself to attending physician for further screening to confirm your temperature and review your travel history. STEP 3 At home / destination, observe for flu like symptoms for 10 days. o If no symptoms after 10 days, confinement lifted. o If signs and symptoms develop within 10 days of arrival, immediately contact your nearest health care facility. NURSES ASSIGNED IN RURAL SERVICE (Project NARS) Training cum Deployment Project Jointly implemented by the the following: Department of Labor and Employment (DOLE) Department of Health (DOH) Professional Regulation Commission, Board of Nursing (PRC-BON), Designed to mobilize unemployed registered nurses to the 1,000 poorest municipalities of the country to improve the delivery of health care services Built within the frameworks of the Economic Resiliency Plan of the Arroyo Administration and the Department of Health's "Fourmula One for Health" Aims to mitigate the impact of the global financial crisis, to save and create as many jobs as possible and expand social protection and help achieve better health service and care for the people, especially those in the poorest municipalities of the country. Launched by President Gloria Macapagal-Arroyo on 9 February 2009 during the Multi-Sectoral Summit on "Joining Hands Against the Global Crisis" in Malacahan, Palace, Manila Nurses will be mobilized in their hometowns as warriors for wellness to do the three I's: Initiate primary health, school nutrition, maternal health programs, first line diagnosis; Inform about community water sanitation, practices and also do health surveillance; Immunize children and mothers They shall likewise serve as roving nurses for rural schools

General Objectives To improve delivery of health care services to our population; and To create a pool of registered nurses with enhanced clinical and preventive health management competencies for national public and private sector employment. Specific Objectives Provide registered nurses with necessary competencies that encompass both community health practice as well as clinical skills Address the shortage of skilled and experienced nurses, both domestic and overseas, through structured competency development program Provide deployment opportunities for nurses in rurai areas and underserved communities Augment the nursing workforce of hospitals and rural health units in identified poor municipalities of needed clinical and public health nurses. Delivery Mechanism Nurses will be deployed at an average of 5 per town in the 1,000 poorest municipalities, for a six-months tour of duty. Another batch will be deployed for the second half of the year. These nurses will undergo training and development for competency enhancement in accordance with the training program designed by the PRC-BON in collaboration with DOH. The training program will cover both the clinical and public health functions Nurses trainees will rotate in their assigned hospital or rural unit for a period of three (3) months At the end of the third month, nurses who have completed their rotation in the hospital will be re-assigned to a rural unit and vice-versa A Certificate of Completion/Competency shall be issued jointly by the DOLE, DOH and PRC after an assessment of the gained competencies of nurse trainees While on training, nurses will be given a stipend/allowance of P8,000.00 per month. This translates to about P366.00 per day for forty (40) hours training/workweek As these nurses are already in their hometowns, transportation expenses will no longer be a problem. The stipend of P8,000 may be increased if the host LGUs will offer a counterpart of say P2.000. LGUs may provide Philhealth coverage to nurse-trainees. Corporations may chip in by providing shirts, insurance, vitamins, etc., making the project a national enterprise with private equity

Expected Outcomes The NARS Project will: Create a pool of 10,000 nurses who are adequately trained with enhanced clinical and public health competencies and readily available for local and overseas employment;

 Provide income of P8,000 per month to 5,000 unemployed nurses for the first six months and to another 5,000 for the second half of the year, to help pump prime the economy Promote the health of the people through the improvement of the delivery of nursing and health care services, particularly in the 1,000 poorest municipalities; and Bring the government closer to the people. Recruitment and Selection Recruitment and selection shall be the responsibility of DOLE, through its Regional Offices Registered nurses who are physically and mentally fit and willing to serve in their hometowns and with the following qualifications: With valid nurse license issued by the PRC; Not over 35 years old; Resident of the identified municipalities / nearby municipalities; No nursing-related practice for the past 3 years. Nurse applicants who are dependents of workers affected by the Global Crisis (e.g. laid off/rotated, etc.,) shall be given priority in the selection o The selection of the 1,000 poorest municipalities shall be based on the City and Municipal Poverty Incidence based on Small Area Poverty Estimates (SAE), 2003 of the National Statistics and Coordination Board/World OBSTETRIC CARE (EmOC) Situationer: 514,000 per year (international) Causes of maternal mortality: Pregnancy-induced hypertension Post-partum hemorrhage Obstructed labor Infection Goal: To reduce maternal mortality Strategies: Family planning - to ensure that every birth is wanted, reducing unwanted pregnancies Skilled care by a health professional with midwifery skills - to ensure safe motherhood EmOC - to ensure timely access to care for women experiencing complications Standards Basic EmOC (BEmOC) Performed in a health center without the need for an operating room Functions (AMOR) Antibiotics Anticonvulsants Assisted vaginal delivery, with forceps or preferably with vacuum extractor Manual removal of placenta Oxytoxics Removal of retained products Comprehensive EmOC (CEmOC) Performed in a district hospital, requires an operating room Functions (ABC) All Six BEmOC Functions Blood transfusion Caesarean Section EmOC Facilities Four BEmOC facilities for every 500,000 people One CEmOC facility for every 500,000 people Each facility must have a trained staff and a functional operating room, and must be able to administer blood transfusion and anesthesia Reducing Life-Threatening Delays The "Three Delays Model" - tool used to identify the points at which delays can occur in the Maternal mortality 172 per 100,000 (Philippines, 1998) Unsafe abortion Indirect causes like malaria, HIV, anemia Management of obstetric complications, and to design programs to address these delays First: delay in deciding to seek care Second: delay in reaching appropriate care Third: delay in receiving care at health facilities The first two "delays" relate directly to the issue of access to care, encompassing factors in the family and the community, including transportation The third "delay" relates to factors in the health facility In practice, it is crucial to address the third delay first, for it would be useless to facilitate access to a health facility if it is not available, well-staffed, well equipped, and providing good quality care.

 Quality Improvement for EmOC A state of readiness that will enable the health worker and the health team to respond appropriately to obstetric emergencies in a way that fulfills the needs and rights of the clients Readiness - achieving and maintaining a state of preparedness in the facility to provide quality EmOC. This includes staff available with requisite skills and a willingness to respond to clients 24 hours a day, 7 days a week, available and functional equipment/supplies, adequate infrastructure Response - providing prompt, appropriate care when emergencies arise, according to accepted clinical standards and protocols Rights - providing services in a manner corresponding to the rights and needs of all clients Rights of Clients to Quality Care Access to EmOC services and continuity Safe (competent) EmOC Information and informed choice Privacy and confidentiality, dignity, comfort, and expression of opinion METRO MANILA DEVELOPMENTAL SCREENING TEST (MMDST) Screening - presumptive identification of an unrecognized disease or defect by the application of tests or other procedures MMDST - an early detection model that applies to the screening of developmental disabilities or delays in children aged 6 VS years old and younger Developed by Dr. Phoebe D. Williams A modification and standardization of the original Denver Developmental Screening Test (DDST) by Dr. William K. Frankenburg and his associates in 1970 It was developed for health professionals such as nurses, doctors and other health workers due to the following reasons: o To recognize slow development among children o To make necessary referrals o To apply appropriate therapy prescribed as soon as possible It is NOT an intelligence test, it only determines whether a child's development is within normal range Fine Motor-Adaptive tasks which indicate the child's ability to see and use his hands to pick up objects and to draw Language - tasks which indicate the child's ability to hear, follow directions and to speak Gross Motor - tasks which indicate the child's ability to sit, walk, and jump Materials: Bright red yarn pom-porn Rattle with a narrow handle Eight 1-inch colored wooden blocks (red, blue, yellow, green) Small clear glass/bottle with 5/8 inch opening Small bell with 2-4 inch diameter Rubber ball 12 VS inch-circumference Cheese curls Pencil Bond paper Procedure: 1. Calculate the child's age - this will be the basis for drawing the age line and determining the test item to be administered (initial step, most important) > Formula: date of test minus birth date equals age of child (in year, month, day)Example 1: Year Month Day Date of test 2007 12 02 Birth date 2005 05 01 Age of Child 2 07 01 > Sometimes it is necessary to "borrow" in the subtraction. Make sure 30 days are borrowed from the month column and 12 months from the year column. For example, if the birth date is March 10, 2007 and the date of test is February 05, 2009, then: Example 2 Year Month Day (2008) (13) (35) Date of test 2009 02 5 Birth date 2007 03 10 Age of Child 1 10 25 > Step 1 Convert the date of test from 2009 years, 2 months and 5 days into 2008 years (2009-1 ) 1 3 months (12+1) and 35 days (30+5). > Step 2: Subtract the birth date from the converted date of test. 2. Use the age scale shown at the top and bottom of the test form as a guide and mark the calculated age of the child on the scale and draw a line passing through the four sectors of the test form. 3. Select items to be administered: > All items crossing the line should be administered > The child should have a minimum of 3 passes to the left of any failures > Each sector should have at least 3 passes and 3 failures 4. Preliminary Phase:

> Establish rapport with the mother/caregiver - state that this is a screening test, not an IQ test; reassure that the child is not expected to be able to do all that the child is asked or pass all the items to be administered. > Make the child as comfortable as possible - sitting on the mother's or caregiver's lap is the best position for the infant or toddler 5. Every effort is made to observe what the child CAN DO rather than simple asking the parent. Score "R" instead of "F" only if you feel that the child can perform the item but refuses to do so at the time of the test and this can be validated by asking the parent. 6. Scoring: > P - Pass > F - Failure (means DELAY) > R - Refusal > NO - No Opportunity to demonstrate the behavior (example is the item "pedals tricycle", if the child has never had to try a tricycle before). Items scored as NO are not considered in the overall test scores. 7. Interpreting Results: 1. Mark each delay by heavily shading the right end of the bar 2. Count the number of sectors that have 2 or more delays. 3. Count the number of sectors that have 1 delay with no passes intersecting the age line in the same sector 4. Interpret the result using the following criteria: I Criteria 2 or more sectors with 2 or more delays 1 sector with 2 or more delays plus 1 or more sectors with 1 delay and in that same sector, no passes intersecting the age line 1 sector with 2 or more delays 1 or more sectors with 1 delay and in that same sector, no passes intersecting the age line When REFUSALS occur in numbers large enough to cause the test result to be QUESTIONABLE or ABNORMAL if these were scored as failures Any condition not listed above Interpretation ABNORMAL ABNORMAL

QUESTIONABLE QUESTIONABLE UNTESTABLE

NORMAL

NURSING PRACTICE III - CARE WITH THE CLIENT WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS - PART A

SITUATION 1: Leo lives in the squatter area, he goes to nearby school, he helps his mother gather molasses after school. One day, he was absent because of fever, malaise, anorexia and abdominal discomfort. 1. Upon assessment, Leo was diagnosed to have hepatitis A. Which mode of transmission has the infection agent taken A. Fecal Oral C. Airborne B. Droplet D. Sexual contact 2. Which of the following is concurrent disinfection in the case of Leo? A. Investigation of contact B. Sanitary disposal of feces, urine and blood C. Quarantine of sick individual D. Removing all detachable objects in the room, cleaning lighting and air duct surfaces in the ceiling and cleaning everything down to the floor. 3. Which of the following must be emphasized during mothers class to Leos mother? A. Administration of immunoglobulin to the families B. Thorough hand washing before and after eating and toileting. C. Use of attenuated vaccines. D. Boiling of food specially meat.

4. Disaster control must be undertaken when there are 3 or more hepatitis A cases. Which of these measures is a priority? A. Eliminates fecal contamination. B. Mass vaccination of uninfected individuals. C. Health promotion and education to families and communities about the disease, its cause and transmission. D. Mass administration of immunoglobulin. 5. What is the average incubation period of hepatitis A? A. 30 days B. 60 days C. 50 Days D. 14 Days SITUATION 3: Mrs. Pichay is admitted to your ward. The MD ordered prepare for thorecentesis this PM to remove excess air from the pleural cavity. 6. Which of the following nursing responsibilities is essential to Mrs. Pichay will undergo thorecentesis? A. Support and rescue the client during the procedure B. Ensure that informed consent has been signed C. Determine if the client has allergic reaction to local anesthesia D. Ascertain if chest x-ray and other test have been prescribed and completed. 7. Mrs. Pichay who is for thorecentesis is assigned by the nurse to which of the following positions? A. Trendelenburg position B. Supine position C. Dorsal recumbent position D. Orthopneic position 8. During thorecentesis, which of the following nursing intervention will be most crucial? A. Place patient in a quiet and cool room B. Maintain strict aseptic technique C. Advice patient to sit perfectly still during needle insertion until it has been withdrawn from the chest D. Apply pressure over the puncture site as soon as the needle is withdrawn. 9. To prevent leakage of fluid in the thoracic cavity, how will you position the client after thorecentesis? A. Place flat in bed C. Turn on the affected side B. Turn on the unaffected side D. On bed rest 10.Chest x-ray was ordered after thorecentesis. When your client asks what is the reason for another chest x-ray, you will explain: A. To rule out pneumothorax B. To rule out any possible perforation C. To decongest D. D. To rule out any foreign body SITUATION 4: A computer analyst, Mr. Ricardo J. Santos, 25 was brought to the hospital for diagnostic workup after he had experienced seizure in his office.

11.Just as the nurse was entering the room, the patient who was sitting on his chair begins to have a seizure. Which of the following must the nurse do first? A. Ease the patient to the floor B. Lift the patient and put him on the bed C. Insert a padded tongue depressor between his jaws. D. Restraint patients body movement. 12.Mr. Santos is scheduled for a CT SCAN for the next day, noon time. Which of the following is the correct preparation as instructed by the nurse? A. Shampoo hair thoroughly to remove oil and dirt. B. No special preparations needed. Instruct the patient to keep his head still and steady. C. Give a cleansing enema and give fluids until 8 am D. Shave the scalp and securely attach electrodes to it 13.Mr. Santos is placed on seizure precaution. Which of the following would be contraindicated? A. Obtain his oral temperature. B. Encourage to perform his own personal hygiene. C. Allow him to wear his own clothing. D. Encourage him to be out of bed. 14.Usually, how does the patient behave after his seizure has subsided? A. Most comfortable walking and moving about B. Becomes restless and agitated C. Sleeps for a period of time D. Say he is thirsty and hungry. 15.Before, during and after seizure. The nurse knows that the patient is ALWAYS placed in what position? A. Low fowlers C. Side lying B. Modified Trendelenburg D. Supine SITUATION 5: Mrs. Damian an immediate post op cholecystectomy and choledocholithotomy patient, complained on severe pain at the wound site. 16.Choledocholithotomy is A. The removal of gallbladder B. The removal of the stones in the gallbladder C. The removal of the stones in the common bile duct. D. The removal of the stones in the kidney. 17.The simplest pain relieving technique is A. Distraction C. Deep breathing exercise B. Taking aspirin D. Positioning 18.Which of the following statement of pain is TRUE? A. Culture and pain are not associated B. Pain accompanies acute illness C. Patients reaction to pain varies D. Pain produces the same reaction such as groaning and moaning 19. A. B. C. D. In pain assessment, which of the following condition is a more reliable indicator? Pain rating scale of 1-10 Facial expression and gestures Physiologic responses Patients description of the pain sensation

20.When a client complains of pain, your initial response is: A. Record the description of pain B. Verbally acknowledge the pain C. Refer the complaint to the doctor D. Change to a more comfortable position SITUATION 6: You are assigned at the surgical ward and the clients have been complaining of post pain at varying degrees. Pain as you know is very subjective. 21. A one-day post-operative abdominal surgery client has been complaining of severe throbbing abdominal pain describes as 9 in a 1-10 pain rating. Your assessment reveals bowel sounds on all quadrants and the dressing is dry and intact. What nursing intervention would you take? A. Medicate the client as prescribed

B. Encourage the client to do imagery C. Encourage deep breathing and turning D. Call surgeon 22.Pentoxidone 5mg IV every 8 hrs was prescribed for post abdominal pain. Which will be your priority nursing action? A. Check abdominal dressing for possible swelling B. Explain the proper use of PCA to alleviate anxiety C. Avoid overdosing to prevent dependence/tolerance D. Monitor V/S, more importantly RR 23.The client complained of abdominal distension and pain. Your nursing intervention that can alleviate pain is: A. Instruct the client to go to sleep and relax B. Advice the client to close the lips and avoid deep breathing and talking C. Offer hot and clear soup D. Turn to the sides frequently and avoid too much talking. 24.Surgical pain might be minimized by which nursing action in the O.R.? A. Skill of the surgical team and lesser manipulation B. Appropriate preparation for the scheduled procedure C. Use of modern technology in closing the wound D. Proper positioning and draping of clients. 25.Inadequate anaesthesia is said to be one of the common causes of pain both in intra and post op patients. If general anesthesia is desired, it will involve loss of consciousness. Which of the following are the 2 general types of G.A.? A. Epidural and spinal B. Subarachnoid block and intravenous C. Inhalation and regional D. Intravenous and inhalation SITUATION 7: Nurses attitudes toward the pain influence the way they perceive and interact with clients in pain. 26.Nurses should be aware that older adults are at risk of underrated pain. Nursing assessment and management of pain should address the following beliefs EXEPT; A. Older patients seldom tend to report pain than the younger ones B. Pain is a sign of weakness C. Older patients do not believe in analgesics, they are tolerant D. Complaining of pain will lead to being labelled a bad patient 27.Nurses should understand that when a client responds favourably to a placebo it is known as the placebo effect. Placebo do not indicate whether or not a client has: A. Conscience C. Disease B. Real pain D. Drug tolerance 28.You are the nurse in the pain clinic where you have client who has difficult specifying the location of pain. How can you assist such client? A. The pain is vague. B. By charting it hurts all over. C. Identify the absence and the presence of pain. D. Ask the client to point to the painful area by just one finger. 29. What symptom more distressing than pain, should the nurse monitor when giving opioids especially among elderly clients who are in pain? A. Forgetfulness C. Drowsiness B. Constipation D. Allergic reactions like pruritus 30. Physical dependence occurs in anyone who takes opioids over a period of time. What do you tell a mother of a dependent when asked for advice? A. Start another drug and slowly lessen the opioids dosage. B. Indulge in recreational outdoor activities. C. Isolate opioids dependent to a restful resort D. Instruct slow tapering of the drug dosage and alleviate physical withdrawal symptoms. SITUATION 8: The nurse is performing health education activities for Janevi Segovia, a 30 year old dentist with insulin dependent diabetes mellitus. 31.Janevi is preparing a mixed dose of insulin. The nurse is satisfied with her performance when she:

A. Draw insulin from the vial of clear insulin first B. Draw insulin from the vial of the intermediate acting insulin first C. Fill both syringes with the prescribed insulin dosage then shake the bottle vigorously. D. Withdrawal the intermediate acting insulin first before withdrawing the short acting insulin first. 32.Janevi complains of nausea, vomiting, diaphoresis and headache. Which of the following nursing intervention are you going to carry out first? A. Withhold the clients next insulin injection. B. Test the clients blood glucose level. C. Administer Tylenol as ordered as ordered. D. Offer fruit juice gelatine and chicken bouillon. 33.Janevi administered regular insulin at 7am and the nurse should instruct Janevi to void exercising at around: A. 9am to 11am C. Between 8am to 9am B. After 8 hours D. In the afternoon, after taking lunch

34.Janevi was brought at the emergency room after four month because she fainted in her clinic. The nurse should monitor which of the following test to evaluate the overall therapeutic compliance of a diabetic patient? A. Glycosylated haemoglobin C. Ketone level B. Fasting blood glucose D. Urine glucose level 35.Upon the assessment of Hbg 1c of Mrs Segovia, the nurse has been informed of a 9% Hba1c result. In this case, she will teach the patient to: A. Avoid infection B. Take adequate food and nutrition C. Prevent and recognize hyperglycaemia D. Prevent and recognize hypoglycaemia 36.The nurse is teaching plan of care for Jane with regards to proper foot care. Which of the following should be included in plan? A. Soak feet in hot water. B. Avoid using mild soap on the feet. C. Apply a moisturizing lotion to dry feet but not between the toes. D. Always have a podiatrist to cut your toe nails; never cut them yourself. 37.Another patient was brought to the emergency room in an unresponsive state and a diagnosis of hyperglycaemic hyperosmolar nonketotic syndrome is made. The nurse immediately prepare to initiate which of the following anticipated physicians order? A. Endotracheal intubation B. 100 units of NPH insulin C. Intravenous infusion of normal saline D. Intravenous infusion of sodium bicarbonate 38.Jane eventually developed DKA and is being treated in the emergency room. Which finding would the nurse expect to note as confirming this diagnosis? A. Comatose state. B. Decreased urine output. C. Increased respiration and an increase in ph. D. Elevated blood glucose level and low plasma bicarbonate level. 39.The nurse teaches Jane to know the difference between hypoglycaemia and ketoacidosis. Jane demonstrates understanding of the teaching by stating that glucose will be taken if which of the following symptoms develops? A. Polyuria C. Blurred vision B. shakiness D. Fruit breath odor 40.Jane has been scheduled to have FBS taken in the morning. The nurse tells Jane not to eat or drink after midnight. Prior to taking the blood specimen, the nurse notice that Jane is holding a bottle of distilled water. The nurse asks Jane if she drink any, and she said yes. Which of the following is the best nursing action? A. Administer syrup of ipecac to remove the distilled water from the stomach. B. Suction the stomach content using NGT prior to specimen collection. C. Advice the physician to reschedule to diagnostic examination next day. D. Continue as usual and have the FBS analysis performed and specimen be taken.

SITUATION 9: Elderly clients usually produce unusually produce unusual signs when it comes to different diseases. The ageing process is a complicated process and the nurse should understand that it is inevitable fact and she must be prepared to care for the growing elderly population. 41. Hypoxia may occur in the older patients because of which of the following physiologic changes associated with aging. A. Ineffective airway clearance B. Decrease alveolar surfaced area C. Decreased anterior posterior chest diameter D. Hyperventilation 42.The older patient is at high risk for incontinence because of: A. Dilated urethra B. Increased glomerular filtration rate C. Diuretic use D. Decreased bladder capacity 43.Merly, age 86, is complaining of dizziness when she stand may indicate: A. Dementia C. Functional decline B. A visual problem D. Drug toxicity 44.Cardiac ischemia in an older patient usually produces; A. ST-T wave changes B. Very high creatinine kinase level C. Chest pain radiating to the left arm D. Acute confusion 45.The most dependable sign of infection in the older patient is: A. Change in mental status B. Fever C. Pain D. Decreased breath sounds with crackles SITUATION 11: Sterilization is the process of removing ALL lying microorganism. To be free of living microorganism is sterility. 46.There are 3 general types of sterilization use in the hospital which one is NOT included? A. Steam sterilization C. DRY HEAT STERILIZATION B. Chemical sterilization D. Sterilization by boiling 47.Autoclave or steam under pressure is the most common method of sterilization in the hospital. The nurse knows that the temperature and time is set to the optimum level to destroy not only micro organism, but also the spores. Which of the following is the ideal setting of the autoclave machine? A. 10,000 c for 1 hour C. 37c for 15 minutes B. 5,000 c for 30 minutes D. 121c c for 15 minutes 48. It is important that before a nurse prepares the material to be sterilized, a chemical indicator strip should be placed above the package, preferably, muslin sheet. What is the colour of the striped produced after autoclaving? A. Black B. Blue C. Gray D. Purple 49.Chemical indicators communicate that: A. The items are sterile B. That the items had undergone sterilization process but not necessarily sterile. C. The items are disinfected D. That the items had undergone disinfection process but not necessarily disinfected 50.If a nurse will sterilize a heat and moisture label instruments, it is according to AORN recommendation to use which of the following method of sterilization? A. Ethylene oxide gas C. Flash sterilizer B. Autoclaving D. Alcohol immersion Situation 13: The preoperative nurse collaborates with the client significant others, and healthcare providers. 51.To control environmental hazards in the O.R, the nurse collaborates with departments EXCEPT: A. Biomedical division C. Infection control committee the following ALL

B. Chaplaincy services

D. Pathology department

52.An air crashed occurred near the hospital leading to a surge of trauma patient. One of the last patients will need surgical amputation but there are no sterile surgical equipments. In this case, which of the following will the nurse expect? A. Equipments needed for surgery need not be sterilized if this is an emergency necessitating life saving measures B. Forwarding the trauma client to the nearest hospital that has available sterile equipments is appropriate C. The nurse will need to sterilize the item before using it to the client using the regular sterilization setting at 121degree Celsius in 15 minutes D. In such cases, flash sterilizer will be use at 132 degree Celsius in 3 minutes 53.Tess, the PACU nurse, discovered that Malou, who weighs 110 lbs prior to surgery, is in severe pain 3 hrs after cholecystectomy. Upon checking the chart, Malou found out that she has an order if Demerol 100 mg I.M. PRN for pain. Tess should verify the order with: A. Nurse supervisor C. Surgeon B. Anesthesiologist D. Intern on duty 54. Rosie, 57, who is diabetic is for debridement of incision wound. When the circulating nurse checked the present IV fluid, she found out that there is no insulin incorporated as ordered. What should the circulating nurse do? A. Double check the doctors order and call the attending MD B. Communicate with the ward nurse to verify if insulin was incorporated or not C. Communicate with the client to verify if insulin was incorporated D. Incorporate insulin as ordered 55.The documentation of all nursing activities performed is legally and professionally vital. Which of the following should NOT be included in the patients chart A. Presence of prosthetoid devices such as dentures, artificial limbs, hearing aids, etc. B. Baseline physical, emotional, psychosocial data C. Arguments between nurses and patients regarding treatments D. Observed untoward signs and symptoms and interventions including contaminant intervening factors. Situation 15- Basic knowledge on Intravenous solution is necessary for care of clients with problems with fluids and electrolytes. 56.A client involve in a motor vehicle crash presents to the emergency department with severe internal bleeding. The client is severely hypotensive and unresponsive. The nurse anticipates which of the following intravenous solutions will most likely be prescribed to increase intravascular volume, replace immediate blood loss and increase blood pressure? A. 0.45% sodium chloride C. 0.33% sodium chloride B. Normal saline solution D. Lactated Ringers solution 57.The physician orders the nurse to prepare an isotonic solution. Which of the following IV solution would the nurse expect the intern to prescribe? A. 5% dextrose in water C. 0.45% NaCl B. 10% dextrose in water D. 5% dextrose in 0.9% NaCl 58. The nurse is making initial rounds on the nursing unit to assess the condition of assigned clients. The nurse notes that the clients IV site is cool, pale and swollen and the solution is not infusing. The nurse concludes that which of the following complications has been experienced by the client? A. Infection C. Infiltration B. Phlebitis D. Thrombophlebitis 59.A nurse reviews the clients electrolyte laboratory report and notes that the potassium level is 3.2 meq/L. Which of the following would the nurse note on the electrocardiogram as a result of the laboratory value? A. U waves C. Elevated T waves B. Absent p waves D. Elevated ST segment 60.One patient had a runaway IV of 50% dextrose. To prevent temporary excess of insulin or transient hyperinsulin reaction, what solution you prepare in anticipation of the doctors order? A. Any IV solution available to KVO B. Isotonic solution C. Hypertonic solution D. Hypotonic solution 61.An informed consent is required for:

A. Closed reduction of a fracture B. Insertion of intravenous catheter C. Irrigation of the external ear canal D. Urethral catheterization 62.Which of the following is not true with regards to the informed consent? A. It should describe different treatment alternatives B. It should contain a thorough and detailed explanation of the procedure to be done C. It should be describe the clients diagnosis] D. It should give an explanation of the clients prognosis 63. You know that the hallmark of nursing accountability is the: A. Accurate documentation and reporting B. Admitting your mistakes C. Filing an incidence report D. Reporting a medication error 64.A nurse is assigned to care for a group of clients. On review of the clients medical records, the nurse determines that which client is at risk for excess fluid volume? A. The client taking diuretics B. The client with renal failure C. The client with an ileostomy D. The client who requires gastrointestinal suctioning 65.A nurse is assigned to care for a group of clients. On review of the clients medical records, the nurse determines that which client is at risk for deficient fluid volume? A. A client with colostomy B. A client with congestive heart failure C. A client with decreased kidney function D. A client receiving frequent wound irrigation Situation 16: As a perioperative nurse, you are aware of the correct processing methods for preparing instruments and other devices for patient use to prevent infection. 66. As an OR nurse, what are your foremost considerations for selecting chemical agents for disinfection? A. Material compatibility and efficiency B. Odor and availability C. Cost and duration D. Duration of disinfection and efficiency 67. Before you use a disinfected instrument, it is essential that you: A. Rinse with tap water followed by alcohol B. Wrap the instrument with sterile water C. Dry the instrument thoroughly D. Rinse with sterile water 68. You have a critical heatable instrument to sterilize and are considering using high level disinfectant. What should you do? A. Cover the soaking vessel to contain the vapour B. Double the amount of high level disinfectant C. Test the potency of the high level disinfectant D. Prolong the exposure time according to manufacturers direction. 69. To achieve sterilization using disinfectants, which of the following is used? A. Low level disinfectants immersion in 24 hours B. Intermediate level disinfectants immersion in 12 hours. C. High level disinfectants immersion in 1 hour. D. High level disinfectant immersion in 10 hours. 70. Bronchoscope, thermometer, endoscope, ET tube, cystoscope are all BEST using which of the following? A. Autoclaving at 121 degree Celsus in 15 minutes. B. Flash sterilizer at 132 degree Celsus in 3 minutes. C. Ethylene oxide gas aeration for 20 hours. D. 2% Glutaraldehyde immersion for 10 hours.

Situation 17: The OR is divided into three zones to control traffic flow and contamination. 71. What OR attires are worn in the restricted area?

A. B. C. D.

Scrub suit, OR shoes, head cap Head cap, scrub suit, mask, OR shoes Mask, OR shoes, scrub suit Cap, Mask, gloves, shoes

72. Nursing intervention for a patient on low dose IV insulin therapy includes the following EXCEPT: A. Elevation of serum ketones to monitor ketosis B. Vital signs including BP. C. Estimate serum potassium D. Elevation of blood glucose levels. 73. The doctor ordered to incorporate 1000 u insulin to the remaining on going IV. The strength is 500/ml. How much should you incorporate into the IV solution? A. 10 ml C. 0.5 ml B. 2 ml D. 5 ml 74. Multiple vial-dose-insulin when in use should be A. kept in room temperature B. kept in refrigerator C. kept in narcotic cabinet D. store in freezer 75. Insulin using insulin syringe are given using how many degrees of needle insertion? A. 45 C. 90 B. 180 D. 15 Situation 18: Maintenance of sterility is an important function a nurse should perform in any OR setting. 76. Which of the following is true with regards to sterility? A. Sterility is time related items are not considered sterile after a period of 30 days of being not use. B. for 9 months, sterile items are considered sterile as long as they are covered with sterile muslin cover and stored in a dust proof covers. C. Sterility is event related, not time related. D. For 3 weeks, items double covered with muslin are considered sterile as long as they have undergone the sterilization process. 77. Two organizations endorsed that sterility are affected by factors other than the time itself, there are: A. The PNA and the PRC C. ORNAP nad MCNAP B. AORN and JCAHO D. MMDA and DILG 78. All of these factors affect the sterility of the OR requirements, these are the following except: A. The material used for packaging. B. The handling of materials as well as its transport. C. Storage D. The chemical or processes used in sterilizing the material. 79. When you say sterile, it means: A. The material is clean. B. The material as well as the equipments are sterilized and had undergone a rigorous sterilization process. C. There is a black stripe on the paper indicator. D. The material has no microorganism nor spores present that might cause an infection. 80. In using liquid sterilizer versus autoclave machine, which of the following is true? A. Autoclave is better in sterilizing OR supplies versus liquid sterilizer. B. They are both capable of sterilizing the equipment, however, it is necessary to soak. C. Sharps are sterilized using autoclave and not Cidex. D. If liquid sterilizer is use, rinsing it before using is not necessary. ***** END OF EXAMINATION ***** NURSING PRACTICE IV- CARE OF THE CLIENT WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONSPART B Situation 1: After an abdominal surgery, the circulating and scrub nurses have critical responsibility about sponge and instrument count.

1. Counting is performed thrice: During the pre incision phase, the operative phase and closing phase. Who counts the sponges and instrument count. A. The scrub nurse only B. The circulating nurse only C. The surgeon and the assistant surgeon D. The scrub nurse and the circulating nurse 2. The layer of the abdomen is divided into 5. Arrange the following from the first layer going to the deepest layer: 1. Fascia 3. Peritoneum 2. Muscle 4. Subcutaneous/ Fat 5. Skin A. 5,4,3,2,1 C. 5,4,1,3,2 B.5,4,2,1,3 D. 5,4,1,2,3 3. When is the first sponge instrument count reported? A. Before closing the subcutaneous layer B. Before peritoneum is closed C. Before closing the skin D. Before the fascia is sutured 4. Like any nursing interventions, counts should be documented. To whom does the scrub nurse report any discrepancy of counts so that immediate and appropriate action is instituted? A. Anaesthesiologists C. OR nurse supervisor B. Surgeon D. Circulating nurse 5. Which of the following are 2 interventions of the surgical team when an instrument was confirmed missing? A. MRI and Incidence report B. CT Scan, MRI, Incidence report C. X-RAY and Incidence report D. CT Scan and Incidence report Situation 2: An entry level nurse should be able to apply theoretical knowledge in the performance of the basic nursing skills. 6. A client has an indwelling urinary catheter and she is suspected of having urinary infection. How should you collect a urine specimen for culture and sensitivity? A. clamp tubing for 60 minutes and insert a sterile needle into the tubing above the clamp to aspirate urine B. drain urine from the drainage bag into sterile container C. disconnect the tubing from the urinary catheter and let urine flow into a sterile container D. wipe self-sealing aspiration port with antiseptic solution and insert a sterile needle into the self sealing port To obtain specimen for sputum culture and sensitivity, which of the following instruction is best? A. Upon waking up, cough deeply and expectorate into container B. Cough after pursed lip breathing C. Save sputum for two days in covered container D. After respiratory treatment, expectorate into a container 8. The best time for collecting the sputum specimen for culture: A. Before retiring at night B. Upon waking up in the morning C. Anytime of the day D. Before meal When suctioning the endotracheal tube, the nurse should: A. Explain procedure to patient: insert catheter gently applying suction. Withdrawn using twisting motion B. Insert catheter until resistance is met, then withdraw slightly, applying suction intermittently as catheter is withdrawn C. Hyperoxygenate client insert catheter using back ad forth motion D. Insert suction catheter four inches into the tube, suction 30 seconds using twirling motion as catheter is withdrawn 9. The purpose of NGT IMMEDIATELY after an operation is: A. For feeding or gavage B. For gastric decompression C. For lavage, or the cleansing of the stomach content D. For the rapid return of peristalsis

Situation 3: Mr. Santos, 50, is to undergo cystoscopy due to multiple problems like scantly urination, hematuria and dysuria. 10.You are the nurse in charge in Mr. Santos. When asked what are the organs to be examined during cystoscopy, you will enumerate as follows: A. Urethra, kidney, bladder, urethra B. Urethra, bladder wall, trigone, ureteral opening C. Bladder wall, uterine wall, and urethral opening D. Urethral opening, ureteral opening bladder 11.In the OR, you will position Mr. Santos who is cystoscopy in: A. Supine C. Semi-fowlers B. Lithotomy D. Trendelenburg 12.After cystoscopy, Mr. Santos asked you to explain why there is no incision of any kind. What do you tell him? A. Cystoscopy is direct visualization and examination by urologist B. Cystoscopy is done by x-ray visualization of the urinary tract C. Cystoscopy is done by using lasers on the urinary tract D. Cystoscopy is an endoscopic procedure of the urinary tract 13.Within 24-48 hours post cystoscopy, it is normal to observe one of the following: A. Pink-tinged urine C. Signs of infection B. Distended bladder D. Prolonged hematuria 14.Leg cramps are NOT uncommon post cystoscopy. Nursing intervention includes: A. Bed rest C. Early ambulation B. Warm moist soak D. Hot sitz bath Situation 4- Mang Felix, a 79 year old man who is brought to the Surgical Unit from PACU after a transurethral resection. You are assigned to receive him. You noted that he has a 3 way indwelling urinary catheter for continuous fast drip bladder irrigation which is connected to a straight drainage. 15.Immediately after surgery what would you expect his urine to be? A. Light yellow C. Bright red B. Amber D. Pinkish to red 16.The purpose of the continuous bladder irrigation is to: A. Allow continuous monitoring of the fluid output status. B. Provide continuous flushing of clots and debris from the bladder. C. Allow for proper exchange of electrolytes and fluid. D. Ensure accurate monitoring of intake and output. 17.Mang Felix informs you that he feels some discomfort on the hypogastric area and he has to void. What will be your most appropriate action? A. Remove his catheter then allow him to void o his own B. Irrigate his catheter C. Tell him to Go ahead and void. You have an indwelling catheter. D. Assess color and rate of outflow, if there is a change, refer to urologist for possible irrigation. 18.You decided to check on Mang Felixs IV fluid infusion. You noted a change in flow rate, pallor and coldness around the insertion site. What is your assessment finding? A. Phlebitis C. Pyrogenic reaction B. Infiltration to subcutaneous tissue D. Air embolism 19.Knowing that proper documentation of assessment findings and interventions are important responsibilities of the nurse during first post operative day, which of the following is the LEAST relevant to document in the case of Mang Felix? A. Chest pain ad vital signs B. Intravenous infusion rate C. Amount, color, and consistency of bladder irrigation drainage D. Activities of daily living started Situation 5: Melamine contamination in milk has brought world wide crisis both in the milk production sector as well as the health and economy. Being aware of the current events is one quality that a nurse should possess to prove that nursing is a dynamic profession that will adapt depending on the patients needs.

20.Melamine is a synthetic resin used for whiteboards, hard plastics and jewellery box covers due to its fire retardant properties. Milk and food manufacturers add melamine in order to: A. It has a bacteriostatic properties leading to increase food and milk life as a way of preserving the foods B. Gives a glazy and more edible lock on foods C. Make milks more tasty and creamy D. Create an illusion of a high protein content on their products 21.Most of the milks contaminated by Melamine came from which country? A. India C. Philippines B. China D. Korea 22.Which government agency is responsible for testing the melamine content of foods and food products? A. DOH C. NBI B. MMDA D. BFAD 23.Infants are the most vulnerable to melamine poisoning. Which of the following is NOT a sign of melamine poisoning? A. Irritability, Backache, Urolithiasis B. High blood pressure, fever C. Anuria, Oliguria or Hematuria D. Fever, irritability and a large output of diluted urine. 24.What kind of renal failure can melamine poisoning cause? A. Chronic, Prerenal C. Chronic, Intrarenal B. Acute, Postrenal D. Acute, Prerenal Situation 6: Leukemia is the most common type of childhood cancer. Acute Lymphoid Leukemia is the cause of almost 1/3 of all cancer that occurs in children under age 15.

25.The survival rate for Acute Lymphoid Leukemia is approximately: A. 25% C. 75% B. 40% D. 95% 26.Whereas Acute Nonlymphoid Leukemia has a survival rate of: A. 25% C. 75% B. 40% D. 95% 27.The three main consequence of leukemia that cause the most danger is: A. Neutropenia causing infection, anemia causing impaired oxygenation thrombocytopenia leading to bleeding tendencies B. Central nervous system infiltration, anemia causing impaired oxygenation thrombocytopenia leading to bleeding tendencies C. Splenomegaly, hepatomegaly, fractures D. Invasion by the leukemic cells to the bone causing severe bone pain 28.Gold standard in the diagnosis of leukemia is by which of the following? A. Blood culture and sensitivity B. Bone marrow biopsy C. Blood biopsy D. NONE OF THE ABOVE 29.Adriamycin, Vincristine, Prednisone and L asparaginase are given to the client for long term therapy. One common side effect, especially of adriamycin is alopecia. The child asks: Will I get my hair back once again? The nurse best respond is by saying: A. Dont be silly, of course you will get your hair back B. We are not sure, lets hope itll grow C. This side effect is usually permanent, But I will get the doctor to discuss it for you D. Your hair will regrow 3 to 6 months but of different color, usually darker and of different texture Situation 7: Breast Cancer is the 2nd most common type of cancer after lung cancer and 99% of which, occurs in women. Survival rate is 98% if this is detected early and treated promptly. Carmen is a 53 year old patient in the high risk group for breast cancer was recently diagnosed with Breast cancer. and and

All of the following are factors that said to contribute to the development of breast cancer except: A. Prolonged exposure to estrogen such as an early menarche or late menopause, nulliparity and childbirth after age 30 B. Genetics C. Increasing Age D. Prolonged intake of Tamoxifen (Nolvadex) 31.Protective factors for the development of breast cancer includes which of the following except: A. Exercise C. Breast feeding B. Prophylactic Tamoxifen D. Alcohol intake 32.A patient diagnosed with breast cancer has been offered the treatment choices of breast conservation surgery with radiation or a modified radical mastectomy. When questioned by the patient about these options, the nurse informs the patient that the lumpectomy with radiation: A. reduces the fear and anxiety that accompany the diagnosis and treatment of cancer B. has about the same 10-year survival rate as the modified radical mastectomy C. provides a shorter treatment period with a fewer long term complications D. preserves the normal appearance and sensitivity of the breast 33.Carmen, who is asking the nurse the most appropriate time of the month to do her self- examination of the breast. The MOST appropriate reply by the nurse would be: A. the 26th day of the menstrual cycle B. 7 to 8 days after conclusion of the menstrual period C. During her menstruation D. The same day each month 34.Carmen being treated with radiation therapy. What should be included in the plan of care to minimize skin damage from the radiation therapy? A. Cover the areas with thick clothing materials B. Apply a heating pad to the site C. Wash skin with water after the therapy D. Avoid applying creams ad powders to the area 35.Based on the DOH and World Health Organization (WHO) guidelines, the mainstay for early detection method for breast cancer that is recommended for developing countries is: A. a monthly breast self examination (BSE) and an annual health worker breast examination (HWBE) B. an annual receptor assay C. an annual mammogram D. a physician conduct a breast clinical examination every 2 years 36.The purpose of performing the breast self examination (BSE) regularly is to discover: A. fibrocystic masses B. cancerous lump C. areas of thickness and fullness D. changes from previous BSE 37.If you are to instruct a postmenopausal woman about BSE, when would you tell her to do BSE: A. on the same day each month B. right after the menstrual period C. on the first day of her menstruation D. on the last day of her menstruation 38.During breast self-examination, the purpose of standing in front of the mirror is to observe the breast for: A. thickening of the tissue B. axillary lymph nodes C. lumps in the breast tissue D. change in size and contour 39.When preparing to examine the left breast in a reclining position, the purpose of placing a small folded tower under the clients left shoulder is to: A. bring the breast closer to the examiners right hand B. tense the pectoral muscle C. balance the breast tissue more evenly on the chest wall D. facilitate lateral positioning of the breast Situation 8: Radiation therapy is another modality of cancer management. With emphasis on multidisciplinary management you have important responsibilities as nurse.

40.Albert is receiving external radiation therapy and he complains of fatigue and malaise. Which of the following nursing interventions would be most helpful for Albert? A. Tell him that sometimes these feelings can be psychogenic B. Refer him to the physician C. Reassure him that these feelings are normal D. Help him plan his activities

41.Immediately following radiation teletherapy, Albert is: A. Considered radioactive for 24 hrs B. Given a complete bath C. Placed on isolation for 6 hrs D. Free from radiation 42.Albert is admitted with a radiation induced thrombocytopenia. As a nurse you should observe the following symptoms: A. Petechiae, ecchymosis, epistaxis B. Weakness, easy fatigability, pallor C. Headache, dizziness, blurred vision D. Severe soar throat, bacteremia, hepatomegaly 43.What nursing diagnosis should be of highest priority? A. Knowledge deficit regarding thrombocytopenia precautions B. Activity intolerance C. Impaired tissue integrity D. Ineffective tissue perfusion, peripheral, cerebral, cardiovascular, gastrointestinal, renal 44.What intervention should you include in your care plan? A. Inspect his skin for petechiae, bruising, GI bleeding regularly B. Place Albert on strict isolation precautions C. Provide rest in between activities D. Administer antipyretics if his temperature exceeds 38C Situation 9: Burns are caused by transfer of heat source to the body. It can be thermal, electrical, radiation or chemical. 45.A burn characterized by pale white appearance, charred or with fat exposed and painlessness is: A. Superficial partial thickness burn B. Deep partial thickness burn C. Full thickness burn D. Deep full thickness burn 46.Which of the following BEST describes superficial partial thickness burn? A. Structures beneath the skin are damage B. Dermis is partially damaged C. Epidermis and dermis are both damaged D. Epidermis is damaged 47.A burn that is said to be WEEPING is classified as A. Superficial partial thickness burn B. Deep partial thickness burn C. Full thickness burn D. Deep full thickness burn 48.During the Acute phase of the burn injury, which of the following is a priority? A. wound healing C. emotional support B. reconstructive surgery D. fluid resuscitation 49.While in the emergent phase, the knows that the priority is to: A. Prevent infection B. Control pain C. Prevent deformities and contractures D. Return the hemodynamic stability via fluid resuscitation 50.The MOST effective method of delivering pain medication during the emergent phase is: A. intramuscularly C. orally

B. subcutaneously D. intravenously 51.When a client accidentally splashes chemicals to his eyes, the initial priority care following the chemical burn is to: A. irrigate with normal saline for 1 to 15 minutes B. transport to a physician immediately C. irrigate with water for 15 minutes or longer D. cover the eyes with sterile gauze

52.Which of the following can be a fatal complication of upper airway burns? A. Stress Ulcers C. Shock B. Hemorrhage D. Laryngeal spasms and swelling 54. When a client will rush towards you and has burning clothes on, it is your priority to do which of the following first? A. log roll on the grass/ground B. slap the flames with his hands C. try to remove the burning clothes D. Splash the client with 1 bucket of cool water 55. Once the flames are extinguished, it is most important to: A. Cover client with a warm blanket B. Give him slips of water C. Calculate the extent of his burn D. Asses the Sergios breathing 56. During the 24 hours after the thermal injury, you should asses Sergio for. A. Hypokalemia and hypernatremia B. Hypokalemia and hyponatremia C. Hyperkalemia and hyponatremia D. Hyperkalemia and hypernatremia 57. A client who sustained deed partial thickeness and full thickness burns of the face whole anterior chest and both upper extremities two days ago begins to exhibit extremely stressness. You recognize that this most likely indicate that the client is developing. A. Cerebral hypoxia C. Metabolic acidosis B. Hypervolemia D. Renal failure 58. A 165 lbs trauma client was rushed to the emergency room with full thickness burns on the whole face right and left arm, and at the anterior chest sparing the abdominal area. He also has superficial partial thickness burn at the posterior trunk and the half upper portion of the left leg. He left the emergence phase of burn. Using the parklands formula, you know that during the first 8 hours of burn, the amount of fluid will given is: (TBSA% (rule of nines) x Wt in kg x 4ml) 165 lbs = 75 kgs x (choose the more severe form of burns) full thickness burns face 9%, R/L arm 18%, ant. Chest 9% - 36% 75 x 36 x 4 = 10,800 ml of 10,800 given in the first 8h of 10.800 given in the next 16h A. 5,400 ml C. 9,450 ml B. 10,800 ml D. 6,750 ml 59. The doctor incorporated insulin on the clients fluid during the emergent phase. The nurse knows that insulin is given because A. Clients with burn also develops Metabolic acidosis B. Clients with burn develops hyperglycemia C. Insulin is needed for additional energy and glucose burning after the stressful incidence to hasten wound healing, regain of consciousness and rapid return of hemodynamic stability D. For hyperkalemia 60. The IV fluid of choice for burn as well as dehydration is: A. 0.45% NaCl C. Sterile water B. NSS D. D5LR Situation 10: ENTEROSTOMAL THERAPY is now considered a specialty in nursing. You are participating in the OSTOMY CARE CLASS. 61 You plan to teach Fermin how to irrigate the colostomy when:

A. B. C. D.

The perineal wound heals and Fermin can sit comfortably on the commode Fermin can lie on the side comfortably, about the 3rd postoperative day The abdominal incision is closed and contamination is no longer a danger The stools starts to become formed, around the 7th postoperative day

62. When preparing to teach Fermin how to irrigate colostomy, you should plan to do the procedure: A. When Fermin would have normal bowel movement B. At least 2 hours before visiting hours C. Prior to breakfast and morning care D. After Fermin accepts alteration in body image 63. When observing a return demonstration of a colostomy irrigation, you know that more teaching is required if Fermin: A. Lubricates the tip of the catheter prior to inserting into the stoma B. Hangs the irrigating bag on the bathroom door cloth hook during fluid insertion C. Discontinues the insertion of fluid after 500 ml of fluid has been instilled D. Clamps off the flow of fluid when feeling uncomfortable 64. You are aware that teaching about colostomy care is understood when Fermin states, I will contact my physician and report: A. If I have any difficulty inserting the irrigating tub into the stoma. B. If I noticed a loss of sensation to touch in the stoma tissue. C. The expulsion of flatus while the irrigating fluid is running out. D. When mucus is passed from the stoma between the irrigation. 65. You would know after teaching Fermin that dietary instruction for him is effective when he states, It is important that I eat: A. Soft food that is easily digested and absorbed by my large intestines. B. Bland food so that my intestines do not become irritated. C. Food low in fiber so that there are fewer stools. D. Everything that I ate before the operation, while avoiding foods that cause gas. Situation 11: Based on studies of nurses working in special units like the intensive care unit and coronary care unit, it is important for nurses to gather as much information to be able to address their needs for nursing care 66. Critically ill patients frequently complain about which of the following when hospitalized? A. Hospital food C. Lack of privacy B. Lack of blankets D. Inadequate nursing staff 67. Who of the following is at greatest risk of developing sensory problem? A. Female patient C. Transplant Patient B. Adolescent D. Unresponsive patient 68. Which of the following factors may inhibit learning in critically ill patients? A. Gender C. Educational level B. Medication D. Previous knowledge of illness 69. Which of the following statements does not apply to critically ill patients? A. Majority need extensive rehabilitation B. All have been hospitalized previously C. Are physically unstable D. Most have chronic illness 70. Families of critically ill patients desire which of the following needs to be met first by the nurse? A. Provision of comfortable space B. Emotional support C. Updated information D. Spiritual counselling Situation 12: Johnny, sought consultation to the hospital because of fatigability, irritability, jittery and he ahs been experiencing this sign and symptoms or the past 5 months. 71. His diagnosis was hyperthyroidism, the following are expected symptoms except: A. Anorexia C. Fine tremors of the hand B. Palpitation D. Hyper alertness 72. She has to take drugs to treat her hyperthyroidism. Which of the following will you expect that the doctor will prescribe? A. Colace (Docusate) C. Tapazole (Methimazole)

B. Cytomel (Llothyronine) D. Synthroid (Levothyroxine) 73. The nurse knows that Tapazole has which of the following side effect that will warrant immediate withholding of the medication? A. Death C. Hyperthermia B. Sore throat D. Thrombocytosis 74. You asked questions as soon as she regained consciousness from thyroidectomy primarily to assess the evidence of: A. Thyroid storm C. Damage to the laryngeal nerve B. Mediastinal shift D. Hypocalcemia tetany 75. Should you check for hemorrhage, you will: A. Slip your hand under the nape of her neck B. Check for hypotension C. Apply neck collar to prevent hemorrhage D. Observe the dressing if it is soaked with blood 76. Basal Metabolic Rate is assessed on Johnny to determine his metabolic rate. In assessing the BMR using the standard procedure, you need to tell Johnny that: A. Obstructing his vision B. Restraining his upper and lower extremities C. Obstructing his hearing D. Obstructing his nostrils with a clamp 77. The BMR is based on the measurement that: A. Rate of respiration under different condition of activities and rest B. Amount of oxygen consumption under resting condition over a measured period of time C. Amount of oxygen consumption under stressed condition over a measured period of time D. Ratio of respiration to pulse rate over a measured period of time 78. Her physician ordered Lugols solution in order to: A. Decrease the vascularity and size of the thyroid gland B. Decrease the size of the thyroid gland only C. Increase the vascularity and size of the thyroid gland D. Increase the size of the thyroid gland only 79. Which of the following is a side effect of Lugols solution? A. Hypokalemia C. Enlargement of the thyroid gland B. Nystagmus D. Excessive salivation 80. In administering Lugols solution, the precautionary measure should include: A. Administer with glass only B. Dilute the juice and administer with a straw C. Administer with milk and drink it D. Follow it with milk of magnesia Situation 13: Pharmacological treatment was not effective for Johnnys hyperthyroidism and now he is scheduled for Thyroidectomy. 81. Instruments in the surgical suite for surgery is classified as either CRITICAL, SEMI- CRITICAL and NON CRITICAL: If the instrument are introduced directly into the blood stream or into any normally sterile cavity or area of the body it is classified as: A. Critical C. Non Critical B. Semi Critical D. Ultra Critical 82. Instruments that do not touch the patient or have contact only to intact skin is classified as: A. Critical C. Non Critical B. Semi Critical D. Ultra Critical 83. If an instrument is classified as Semi Critical, an acceptable method of making the instrument ready for surgery is through: A. Sterilization C. Disinfection B. Decontamination D. Cleansing 84. While critical items should be: A. Clean C. Sterilized B. Decontaminated D. Disinfected

85. As a nurse, you know that intact skin acts as an effective barrier to most microorganisms. Therefore, items that come in contact with the intact skin or mucus membranes should be: A. Disinfected C. Clean B. Sterile D. Alcoholized 86. You are caring for Johnny who is scheduled to undergo total thyroidectomy because of a diagnosis of thyroid cancer. Prior to total thyroidectomy, you should instruct Johnny to: A. Perform range of motion exercise on the head and neck B. Apply gentle pressure against the incision when swallowing C. Cough and deep breath every 2 hours D. Support head with the hands when changing position 87. As Johnnys nurse, you plan to set up an emergency equipment at her bedside following thyroidectomy. You should include: A. An airway and rebreathing tube B. A tracheostomy set and oxygen C. A crush cart with bed board D. Two ampules of sodium bicarbonate 88. Which of the following nursing interventions is appropriate after a total thyroidectomy? A. Place pillow under your patients shoulders B. Raise the knee-gatch to 30 degrees C. Keep your patient in high fowlers position D. Support the patients head and neck with pillows and sandbags 89. If there is an accidental injury to the parathyroid gland during a thyroidectomy which of the following might lead to develop postoperatively? A. Cardiac arrest C. Respiratory failure B. Dyspnea D. Tetany 90. After surgery Johnny develops peripheral numbness, tingling and muscle twitching and spasm. What would you anticipate to administer? A. Magnesium sulfate C. Potassium iodide B. Calcium Gluconate D. Potassium chloride Situation 15: Andrea is admitted to the ER following an assault where she was hit in the face and head. She was brought to the ER by a police woman. Emergency measures were started. 96. Andreas respiration is described as waxing and waning. You know that this rhythm of respiration is defined as: A. Biots C. Cheyne stokes B. Kussmauls D. Eupnea 97. What do you call the triad of sign and symptoms seen in client with increasing ICP? A. Virchows Triad C. Cushings Triad B. The Chinese Triad D. Charcots Triad 98. Which of the following is true wit the Triad seen in head injuries? A. Narrowing of Pulse pressure, Cheyne stokes respiration, Tachycardia B. Widening Pulse pressure, Irregular respiration, Bradycardia C. Hypertension, Kussmauls respiration, Tachycardia D. Hypotension, Irregular respiration, Bradycardia 99. In a client with Cheyne stokes respiration, which of the following is the most appropriate nursing diagnosis? A. Ineffective airway clearance B. Ineffective breathing pattern C. Impaired gas exchange D. Activity intolerance 100. You know that apnea is seen in clients with Cheyne stokes respiration, APNEA is defined as: A. Inability to breath in a supine position so the patient sits up in bed to breathe B. The patient is dead, the breathing stops C. There is an absence of breathing for a period of time, usually 15 seconds or more D. A period of hypercapnea and hypoxia due to the cessation of respiratory effort inspite of normal respiratory functioning.

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