NURSING PRACTICE I – Foundation of PROFESSIONAL Nursing Practice SITUATIONAL Situation 1 – Mr.

Ibarra is assigned to the triage area and while on duty, he assesses the condition of Mrs. Simon who came in with asthma. She has difficulty breathing and her respiratory rate is 40 per minute. Mr. Ibarra is asked to inject the client epinephrine 0.3 mg subcutaneously. 1. The indication for epinephrine injection for Mrs. Simon is to: A. B. C. D. Reduce anaphylaxis Relieve hypersensitivity to allergen Relieve respiratory distress due to bronchial spasm Restore client’s cardiac rhythm

2. When preparing the epinephrine injection from an ampule, the nurse initially: A. B. C. D. Taps the ampule at the top to allow fluid to flow to the base of the ampule Checks expiration date of the medication ampule Removes needle cap of syringe and pulls plunger to expel air Breaks the neck of the ampule with a gauze wrapped around it

3. Mrs. Simon is obese. When administering a subcutaneous injection to an obese patient, it is best for the nurse to: A. B. C. D. Inject needle at a 15 degree angle over the stretched skin of the client Pinch skin at the injection site and use airlock technique Pull skin of patient down to administer the drug in a Z track Spread skin or pinch at the injection site and inject needle at a 45-90 degree angle

4. When preparing for a subcutaneous injection, the proper size of syringe and needle would be: A. B. C. D. Syringe 3-5 ml and needle gauge 21 to 23 Tuberculin syringe 1 ml with needle gauge 26 or 27 Syringe 2 ml and needle gauge 22 Syringe 1-3 ml and needle gauge 25 to 27

5. The rationale for giving medications through the subcutaneous route is: A. B. C. D. There are many alternative sites for subcutaneous injection Absorption time of the medicine is slower There are less pain receptors in this area The medication can be injected while the client is in any position

Situation 2 – The use of massage and meditation to help decrease stress and pain have been strongly recommended based on documented testimonials. 6. Martha wants to do a study on this topic: “Effects of massage and meditation on stress and pain”. The type of research that best suits this topic is:

A. B. C. D.

Applied research Qualitative research Basic research Quantitative research

7. The type of research design that does not manipulate independent variable is: A. B. C. D. Experimental design Quasi-experimental design Non-experimental design Quantitative design

8. This research topic has the potential to contribute to nursing because it seeks to A. B. C. D. include new modalities of care resolve a clinical problem clarify an ambiguous modality of care enhance client care

9. Martha does review of related literature for the purpose of A. determine statistical treatment of data research B. gathering data about what is already known or unknown about the problem C. to identify if problem can be replicated D. answering the research question 10. Client’s rights should be protected when doing research using human subjects. Martha identifies these rights as follows EXCEPT: A. B. C. D. right of self-determination right to compensation right of privacy right not to be harmed

Situation 3 – Richard has a nursing diagnosis of ineffective airway clearance related to excessive secretions and is at risk for infection because of retained secretions. Part of Nurse Mario’s nursing care plan is to loosen and remove excessive secretions in the airway. 11. Mario listens to Richard’s bilateral sounds and finds that congestion is in the upper lobes of the lungs. The appropriate position to drain the anterior and posterior apical segments of the lungs when Mario does percussion would be: A. Client lying on his back then flat on his abdomen on Trendelenburg position B. Client seated upright in bed or on a chair then leaning forward in sitting position then flat on his back and on his abdomen C. Client lying flat on his back and then flat on his abdomen D. Client lying on his right then left side on Trendelenburg position 12. When documenting outcome of Richard’s treatment Mario should include the following in his recording EXCEPT: A. Color, amount and consistency of sputum

B. Character of breath sounds and respiratory rate before and after procedure C. Amount of fluid intake of client before and after the procedure D. Significant changes in vital signs 13. When assessing Richard for chest percussion or chest vibration and postural drainage, Mario would focus on the following EXCEPT: A. B. C. D. Amount of food and fluid taken during the last meal before treatment Respiratory rate, breath sounds and location of congestion Teaching the client’s relatives to perform the procedure Doctor’s order regarding position restrictions and client’s tolerance for lying flat

14. Mario prepares Richard for postural drainage and percussion. Which of the following is a special consideration when doing the procedure? A. B. C. D. Respiratory rate of 16 to 20 per minute Client can tolerate sitting and lying positions Client has no signs of infection Time of last food and fluid intake of the client

15. The purpose of chest percussion and vibration is to loosen secretions in the lungs. The difference between the procedures is: A. Percussion uses only one hand while vibration uses both hands B. Percussion delivers cushioned blows to the chest with cupped palms while vibration gently shakes secretion loose on the exhalation cycle C. In both percussion and vibration the hands are on top of each other and hand action is in tune with client’s breath rhythm D. Percussion slaps the chest to loosen secretions while vibration shakes the secretions along with the inhalation of air Situation 4 – A 61 year old man, Mr. Regalado, is admitted to the private ward for observation after complaints of severe chest pain. You are assigned to take care of the client. 16. When doing an initial assessment, the best way for you to identify the client’s priority problem is to: A. B. C. D. Interview the client for chief complaints and other symptoms Talk to the relatives to gather data about history of illness Do auscultation to check for chest congestion Do a physical examination while asking the client relevant questions

17. Upon establishing Mr. Regalado’s nursing needs, the next nursing approach would be to: A. B. C. D. Introduce the client to the ward staff to put the client and family at ease Give client and relatives a brief tour of the physical set up the unit Take his vital signs for a baseline assessment Establish priority needs and implement appropriate interventions

18. Mr. Regalado says he has “trouble going to sleep”. In order to plan your nursing intervention you will:

A. B. C. D.

Observe his sleeping patterns in the next few days Ask him what he means by this statement Check his physical environment to decrease noise level Take his blood pressure before sleeping and upon waking up

19. Mr. Regalado’s lower extremities are swollen and shiny. He has pitting pedal edema. When taking care of Mr. Regalado, which of the following interventions would be the most appropriate immediate nursing approach? A. B. C. D. Moisturize lower extremities to prevent skin irritation Measure fluid intake and output to decrease edema Elevate lower extremities for postural drainage Provide the client a list of food low in sodium

20. Mr. Regalado will be discharged from your unit within the hour. Nursing actions when preparing a client for discharge include all EXCEPT: A. B. C. D. Making a final physical assessment before client leaves the hospital Giving instructions about his medication regimen Walking the client to the hospital exit to ensure his safety Proper recording of pertinent data

Situation 5 – Nancy, mother of 2 young kids, 36 years old, had a mammogram and was told that she has breast cysts and that she may need surgery. This causes her anxiety as shown by increase in her pulse and respiratory rate, sweating and feelings of tension. 21. Considering her level of anxiety, the nurse can best assist Nancy by: A. B. C. D. Giving her activities to divert her attention Giving detailed explanations about the treatments she will undergo Preparing her and her family in case surgery is not successful Giving her clear but brief information at the level of her understanding

22. Nancy blames God for her situation. She is easily provoked to tears and wants to be left alone, refusing to eat or talk to her family. A religious person before, she now refuses to pray or go to church stating that God has abandoned her. The nurse understands that Nancy is grieving for her self and is in the stage of: A. B. C. D. bargaining denial anger acceptance

23. The nurse visits Nancy and prods her to eat her food. Nancy replies “what’s the use? My time is running out.” The nurse’s best response would be: A. “The doctor ordered full diet for you so that you will be strong for surgery” B. “I understand how you feel but you have to try for your children’s sake” C. “Have you told your doctor how you feel? Are you changing your mind about your surgery?” D. “You sound like you are giving up.”

24. The nurse feels sad about Nancy’s illness and tells her head nurse during the end of shift endorsement that “it’s unfair for Nancy to have cancer when she is still so young and with two kids”. The best response of the head nurse would be: A. Advise the nurse to “be strong and learn to control her feelings” B. Assign the nurse to another client to avoid sympathy for the client C. Reassure the nurse that the client has hope if she goes through all treatments prescribed for her D. Ask the other nurses what they feel about the patient to find out if they share the same feelings 25. Realizing that she feels angry about Nancy’s condition, the nurse learns that being selfaware is a conscious process that she should do in any situation like this because: A. This is a necessary part of the nurse – client relationship process B. The nurse is a role model for the client and should be strong C. How the nurse thinks and feels affect her actions towards her client and her work D. The nurse has to be therapeutic at all times and should not be affected Situation 6 – Mrs. Seva, 52 years old, asks you about possible problems regarding her elimination now that she is in the menopausal stage. 26. Instruction on health promotion regarding urinary elimination is important. Which would you include? A. Hold urine as long as she can before emptying the bladder to strengthen her sphincter muscles B. If burning sensation is experienced while voiding, drink pineapple juice C. After urination, wipe from anal area up towards the pubis D. Tell client to empty the bladder at each voiding 27. Mrs. Seva also tells the nurse that she is often constipated. Because she is aging, what physical changes predispose her to constipation? A. B. C. D. inhibition of the parasympathetic reflex weakness of sphincter muscles of anus loss of tone of the smooth muscles of the colon decreased ability to absorb fluids in the lower intestines

28. The nurse understands that one of these factors contributes to constipation: A. B. C. D. excessive exercise high fiber diet no regular time for defecation daily prolonged use of laxatives

29. Mrs. Seva talks about fear of being incontinent due to a prior experience of dribbling urine when laughing or sneezing and when she has a full bladder. Your most appropriate instruction would be to: A. tell client to drink less fluids to avoid accidents B. instruct client to start wearing thin adult diapers

C. ask the client to bring change of underwear “just in case” D. teach client pelvic exercise to strengthen perineal muscles 30. Mrs. Seva asked for instructions for skin care for her mother who has urinary incontinence and is almost always in bed. Your instruction would focus on prevention of skin irritation and breakdown by: A. B. C. D. Using thick diapers to absorb urine well Drying the skin with baby powder to prevent or mask the smell of ammonia Thorough washing, rising and drying of skin area that get wet with urine Making sure that linen are smooth and dry at all times

Situation 7 – Using Maslow’s need theory, Airway, Breathing and Circulation are the physiological needs vital to life. The nurse’s knowledge and ability to identify and immediately intervene to meet these needs is important to save lives. 31. Which of these clients has a problem with the transport of oxygen from the lungs to the tissues: A. B. C. D. Carol with tumor in the brain Theresa with anemia Sonnyboy with a fracture in the femur Brigitte with diarrhea

32. You noted from the lab exams in the chart of M. Santos that he has reduced oxygen in the blood. This condition is called: A. B. C. D. Cyanosis Hypoxia Hypoxemia Anemia

33. You will do nasopharyngeal suctioning on Mr. Abad. Your guide for the length of insertion of the tubing for an adult would be: A. B. C. D. tip of the nose to the base of the neck the distance from the tip of the nose to the middle of the neck the distance from the tip of the nose to the tip of the ear lobe eight to ten inches

34. While doing nasopharyngeal suctioning on Mr. Abad, the nurse can avoid trauma to the area by: A. Apply suction for at least 20-30 seconds each time to ensure that all secretions are removed B. Using gloves to prevent introduction of pathogens to the respiratory system C. Applying no suction while inserting the catheter D. Rotating catheter as it is inserter with gentle suction 35. Myrna has difficulty breathing when on her back and must sit upright in bed to breath effectively and comfortably. The nurse documents this condition as: A. Apnea

B. Orthopnea C. Dyspnea D. Tachypnea Situation 8 – You are assigned to screen for hypertension. Your task is to take blood pressure readings and you are informed about avoiding the common mistakes in BP taking that lead to false or inaccurate blood pressure readings. 36. When taking blood pressure reading the cuff should be: A. deflated fully then immediately start second reading for same client B. deflated quickly after inflating up to 180 mmHg C. large enough to wrap around upper arm of the adult client 1 cm above brachial artery D. inflated to 30 mmHg above the estimated systolic BP based on palpation of radial or bronchial artery 37. Chronic Obstructive Pulmonary Disease (COPD) in one of the leading causes of death world wide and is a preventable disease. The primary cause of COPD is A. B. C. D. tobacco hack bronchitis asthma cigarette smoking

38. In your health education class for clients with diabetes you teach them the areas for control of Diabetes which include all EXCEPT A. B. C. D. regular physical activity thorough knowledge of foot care prevention nutrition proper nutrition

39. You teach your clients the difference between, Type I (IDDM) and Type II (NDDM) diabetes. Which of the following is true? A. both types diabetes mellitus clients are all prone to developing ketosis B. Type II (NIDDM) is more common and is also preventable compared to Type I (IDDM) diabetes which is genetic in etiology C. Type I (IIDM) is characterized by fasting hyperglycemia D. Type II (NIDDM) is characterized by abnormal immune response 40. Lifestyle-related diseases in general share areas common risk factors. These are the following except: A. B. C. D. physical activity smoking genetics nutrition

Situation 9 – Nurse Rivera witnesses a vehicular accident near the hospital where she works. She decides to get involved and help the victims of the accident

41. Her priority nursing action would be to: A. B. C. D. Assess damage to property Assist in the police investigation since she is a witness Report the incident immediately to the local police authorities Assess the extent of injuries incurred by the victims of the accident

42. Priority attention should be given to which of these clients? A. B. C. D. Linda who shows severe anxiety due to trauma of the accident Ryan who has chest injury, is pale and with difficulty breathing Noel who has lacerations on the arms with mild bleeding Andy whose left ankle swelled and has some abrasions

43. In the emergency room, Nurse Rivera is assigned to attend to the client with lacerations on the arms. While assessing the extent of the wound the nurse observes that the wound is now starting to bleed profusely. The most immediate nursing action would be to: A. B. C. D. Apply antiseptic to prevent infection Clean the wound vigorously of contaminants Control and reduce bleeding of the wound Bandage the wound and elevate the arm

44. The nurse applies dressing on the bleeding site. This intervention is done to: A. B. C. D. Reduce the need to change dressing frequently Allow the pus to surface faster Protect the wound from microorganisms in the air Promote hemostasis

45. After the treatment, the client is sent home and asked to come back for follow-up care. Your responsibilities when the client is to be discharged include the following EXCEPT: A. B. C. D. Encouraging the client to go to the outpatient clinic for follow up care Accurate recording of treatment done and instructions given to client Instructing the client to see you after discharge for further assistance Providing instructions regarding wound care

Situation 10 – While working in the clinic, a new client, Geline, 35 years old, arrives for her doctor’s appointment. As the clinic nurse, you are to assist the client fill up forms, gather data and make an assessment. 46. The purpose of your initial nursing interview is to: A. Record pertinent information in the client’s chart for health team to read B. Assist the client find solutions to he her health concerns C. Understand her lifestyle, health needs and possible problems to develop a plan of care D. Make nursing diagnoses for identified health prob;ems 47. While interviewing Geline, she starts to moan and doubles up in pain. She tells you that this pain occurs about an hour after taking black coffee without breakfast for three weeks now. You will record this as follows:

A. B. C. D.

Claims to have abdominal pains after intake of coffee unrelieved by analgesics After drinking coffee, the client experienced severe abdominal pain Client complained of intermittent abdominal pain an hour after drinking coffee Client reported abdominal pain an hour after drinking black coffee for three weeks now.

48. Geline tells you that she drinks black coffee frequently within the day to “have energy and be wide awake” and she eats nothing for breakfast and eats strictly vegetable salads for lunch and dinner to lose weight. She has lost weight during the past two weeks. In planning a healthy balanced diet with Geline, you will: A. Start her off with a cleansing diet to free her body of toxins then change to a vegetarian diet and drink plenty of fluids B. Plan a high protein diet, low carbohydrate diet for her considering her favorite food. C. Instruct her to attend classes in nutrition to find food rich in complex carbohydrates to maintain daily high energy level. D. Discuss with her the importance of eating a variety of food from major food groups with plenty of fluids. 49. Geline tells you that she drinks 4-5 cups of black coffee and diet cola drinks. She also smokes up to a pack of cigarettes daily. She confesses that she is in her 2nd month of pregnancy but does not want to become fat that is why she limits her food intake. You warn or caution her about which of the following? A. Caffeine products affect the central nervous system and may cause the mother to have a “nervous breakdown” B. Malnutrition and its possible effects on growth and development problems in the unborn fetus C. Caffeine causes a stimulant effect on both mother and the baby D. Studies show conclusively that caffeine causes mental retardation 50. Your health education plan for Geline stresses proper diet for a pregnant woman and the prevention of non-communicable diseases that are influenced by her lifestyle. These include the following EXCEPT: A. B. C. D. Cardiovascular diseases Cancer Diabetes Mellitus Osteoporosis

Situation 11 – Management of nurse practitioners is done by qualified nursing leaders who had clinical experience and management experience. 51. An example of a management function of a nurse is: A. B. C. D. Teaching patient do breathing and coughing exercises Preparing for a surprise party for a client Performing nursing procedures for clients Directing and evaluating the staff nurses

52. Your head nurse in the unit believes that the staff nurses are not capable of decision making so she makes the decisions for everyone without consulting anybody. This type of leadership is: A. B. C. D. Laissez faire leadership Democratic leadership Autocratic leadership Managerial leadership

53. When the head nurse in your ward plots and approves your work schedules and directs your work, she is demonstrating: A. B. C. D. Responsibility Delegation Accountability Authority

54. The following tasks can be safely delegated by a nurse to a non-nurse health worker EXCEPT: A. B. C. D. Transfer a client from bed to chair Change IV infusions Irrigation of a nasogastric tube Take vital signs

55. You made a mistake in giving the medicine to the wrong client. You notify the client’s doctor and write an incident report. You are demonstrating: A. B. C. D. Responsibility Accountability Authority Autocracy

Situation 12 – Mr. Dizon, 84 years old, brought to the Emergency Room for complaint of hypertension, flushed face, severe headache, and nausea. You are doing the initial assessment of vital signs. 56. You are to measure the client’s initial blood pressure reading by doing all of the following EXCEPT: A. Take the blood pressure reading on both arms for comparison B. Listen to and identify the phases of Korotkoff’s sound C. Pump the cuff to around 50 mmHg above the point where the pulse is obliterated D. Observe procedures for infection control 57. A pulse oximeter is attached to Mr. Dizon’s finger to: A. B. C. D. Determine if the client’s hemoglobin level is low and if he needs blood transfusion Check level of client’s tissue perfusion Measure the efficacy of the client’s anti-hypertensive medications Detect oxygen saturation of arterial blood before symptoms of hypoxemia develops

58. After a few hours in the Emergency Room, Mr. Dizon is admitted to the ward with an order of hourly monitoring of blood pressure. The nurse finds that the cuff is too narrow and this will cause the blood pressure reading to be: A. B. C. D. inconsistent low systolic and high diastolic higher than what the reading should be lower than what the reading should be

59. Through the client’s health history, you gather that Mr. Dizon smokes and drinks coffee. When taking the blood pressure of a client who recently smoked or drank coffee, how long should the nurse wait before taking the client’s blood pressure for accurate reading? A. B. C. D. 15 minutes 30 minutes 1 hour 5 minutes

60. While the client has pulse oximeter on his fingertip, you notice that the sunlight is shining on the area where the oximeter is. Your action will be to: A. B. C. D. Set and turn on the alarm of the oximeter Do nothing since there is no identified problem Cover the fingertip sensor with a towel or bedsheet Change the location of the sensor every four hours

Situation 13 – The nurse’s understanding of ethico-legal responsibilities will guide his/her nursing practice. 61. The principles that govern right and proper conduct of a person regarding life, biology and the health professionals is referred to as: A. B. C. D. Morality Religion Values Bioethics

62. The purpose of having a nurses’ code of ethics is: A. B. C. D. Delineate the scope and areas of nursing practice Identify nursing action recommended for specific health care situations To help the public understand professional conduct expected of nurses To define the roles and functions of the health care givers, nurses, clients

63. The most important nursing responsibility where ethical situations emerge in patient care is to: A. B. C. D. Act only when advised that the action is ethically sound Not takes sides, remain neutral and fair Assume that ethical questions are the responsibility of the health team Be accountable for his or her own actions

64. You inform the patient about his rights which include the following EXCEPT: A. B. C. D. Right to expect reasonable continuity of care Right to consent to or decline to participate in research studies or experiments Right to obtain information about another patient Right to expect that the records about his care will be treated as confidential

65. This principle states that a person has unconditional worth and has the capacity to determine his own destiny: A. B. C. D. Bioethics Justice Fidelity Autonomy

Situation 14 – Your director of nursing wants to improve the quality of health care offered in the hospital. As a staff nurse in that hospital you know that this entails quality assurance programs. 66. The following mechanisms can be utilized as part of the quality assurance program of your hospital EXCEPT: A. B. C. D. Patient satisfaction surveys Peer review to assess care provided Review of clinical records of care of client Use of Nursing Interventions Classification

67. The use of the Standards of Nursing Practice is important in the hospital. Which of the following statements best describes what it is? A. These are statements that describe the maximum or highest level of acceptable performance in nursing practice B. It refers to the scope of nursing practice as defined in Republic Act 9173 C. It is a license issued by the Professional Regulation Commission to protect the public from substandard nursing practice D. The Standards of Care includes the various steps of the nursing process and the standards of professional performance 68. you are taking care of critically ill client and the doctor in charge calls to order a DNR (do not resuscitate) for the client. Which of the following is the appropriate action when getting DNR order over the phone? A. Have the registered nurse, family spokesperson, nurse supervisor and doctor sign B. Have 2 nurse validate the phone order, both nurses sign the order and the doctor should sign his order within 24 hours C. Have the registered nurse, family and doctor sign the order D. Have 1 nurse take the order and sign it and have the doctor sign it within 24 hours 69. To ensure client safety before starting blood transfusions the following are needed before the procedure can be done EXCEPT:

A. take baseline vital signs B. blood should be warmed to room temperature for 30 minutes before blood transfusions is administered C. have two nurses verify client identification, blood type, unit number and expiration date of blood D. get consent signed for blood transfusion 70. Part of standards of care has to do with the use of restraints. Which of the following statements is NOT true? A. B. C. D. Doctor’s order for restraints should be signed within 24 hours Remove and reapply restraints every 2 hours Check client’s pulse, blood pressure and circulation every 4 hours Offer food and toileting every 2 hours

Situation 15 – During the NUTRITION EDUCATION class discussion a 58 year old man, Mr. Bruno, shows increased interest. 71. Mr. Bruno asks what the “normal” allowable salt intake is. Your best response to Mr. Bruno is: A. B. C. D. 1 tsp of salt/day with iodine and sprinkle of MSG 5 gms per day or 1 tsp of table salt/day 1 tbsp of salt/day with some patis and toyo 1 tsp of salt/day but no patis and toyo

72. Your instructions to reduce or limit salt intake include all the following EXCEPT: A. B. C. D. eat natural food with little or no salt added limit use of table salt and use condiments instead use herbs and spices limit intake of preserved or processed food

73. Teaching strategies and approaches when giving nutrition education is influenced by age, sex and immediate concerns of the group. Your presentation for a group of young mothers would be best if you focus on: A. B. C. D. diets limited in salt and fat harmful effects of drugs and alcohol intake commercial preparation of dishes cooking demonstration and meal planning

74. Cancer cure is dependent on A. B. C. D. use of alternative methods of healing watching out for warning signs of cancer proficiency in doing breast self-examination early detection and prompt treatment

75. The role of the health worker in health education is to A. report incidence of non-communicable diseases to community health center

B. educate as many people about warning signs of non-communicable diseases C. focus on smoking cessation projects D. monitor clients with hypertension Situation 16 – You are assigned to take care of 10 patients during the morning shift. The endorsement includes the IV infusion and medications for these clients. 76. Mr. Felipe, 36 years old is to be given 2700 ml of D5LR to infuse for 18 hours starting at 8 am. At what rate should the IV fluid be flowing hourly? A. B. C. D. 100 ml per hour 210 ml per hour 150 ml per hour 190 ml per hour

77. Mr. Atienza is to receive 150 ml/hour of D% W IV infusion for 12 hours for a total of 1800ml. He is also losing gastric fluid which must be replaced every two hours. Between 8 am and 10 am, Mr. Atienza has lost 250 ml of gastric fluid. How much fluid should he receive at 11 am? A. B. C. D. 350 ml/hour 275 ml/hour 400 ml/hour 200 ml/hour

78. You are to apply a transdermal patch of nitoglycerin to your client. The following are important guidelines to observe EXCEPT: A. B. C. D. Apply to hairless clean area of the skin not subject to much wrinkling Patches may be applied to distal part of the extremities like forearm Change application and site regularly to prevent irritation of the skin Wear gloves to avoid any medication on your hand

79. You will be applying eye drops to Miss Romualdez. After checking all the necessary information and cleaning the affected eyelid and eyelashes, you administer the ophthalmic drops by instilling the eye drops: A. B. C. D. directly onto the cornea pressing the lacrimal duct into the outer third of the lower conjunctival sac from the inner canthus going towards the side of the eye

80. When applying eye ointment, the following guidelines apply EXCEPT: A. squeeze about 2 cm of ointment and gently close but not squeeze the eye B. apply the ointment from the inner canthus going outward of the affected eye C. discard the first bead of the eye ointment before application because the tube is likely to expel more than desired amount of ointment D. hold the tube above the conjunctival sac, do not let tip touch the conjunctiva

Situation 17 – The staff nurse supervisor requests all the staff nurses to “brainstorm” and learn ways to instruct diabetic clients on self-administration of insulin. She wants to ensure that there are nurses available daily to do health education classes. 81. The plan of the nurse supervisor is an example of A. B. C. D. in service education process efficient management of human resources increasing human resources primary prevention

82. When Mrs. Guevarra, a nurse, delegates aspects of the clients care to the nurse-aide who is an unlicensed staff, Mrs. Guevarra A. makes the assignment to teach the staff member B. is assigning the responsibility to the aide but not the accountability for those tasks C. does not have to supervise or evaluate the aide D. most know how to perform task delegated 83. Connie, the new nurse, appears tired and sluggish and lacks the enthusiasm she had six weeks ago when she started the job. The nurse supervisor should A. B. C. D. empathize with the nurse and listen to her tell her to take the day off discuss how she is adjusting to her new job ask about her family life

84. Process of formal negotiations of working conditions between a group of registered nurses and employer is A. B. C. D. grievance arbitration collective bargaining strike

85. You are attending a certification on cardiopulmonary resuscitation (CPR) offered and required by the hospital employing you. This is A. B. C. D. professional course towards credits inservice education advance training continuing education

Situation 18 – There are various developments in health education that the nurse should know about: 86. The provision of health information in the rural areas nationwide through television and radio programs and video conferencing is referred to as: A. Community health program B. Telehealth program C. Wellness program

D. Red Cross program 87. A nearby community provides blood pressure screening, height and weight measurement, smoking cessation classes and aerobics class services. This type of program is referred to as A. B. C. D. outreach program hospital extension program barangay health program wellness program

88. Part of teaching client in health promotion is responsibility for one’s health. When Danica states she needs to improve her nutritional status this means: A. Goals and interventions to be followed by client are based on nurse’s priorities B. Goals and intervention developed by the nurse and client should be approved by the doctor C. Nurse will decide goals and interventions needed to meet client goals D. Client will decide the goals and interventions required to meet her goals 89. Nurse Beatrice is providing tertiary prevention to Mrs. De Villa. An example of tertiary provestion is A. B. C. D. Marriage counseling Self-examination for breast cancer Identifying complication of diabetes Poison Control

90. Mrs. Ostrea has a schedule for Pap Smear. She has a strong family history of cervical cancer. This is an example of A. B. C. D. tertiary prevention secondary prevention health screening primary prevention

Situation 19 – Ronnie was in a vehicular accident where he sustained injury to his left ankle. In the Emergency Room, you notice how anxious he looks. 91. You establish rapport with him and to reduce his anxiety you initially: A. B. C. D. Take him to the radiology section for X-ray of affected extremity Identify yourself and state your purpose in being with the client Talk to the physician for an order of Valium Do inspection and palpation to check extent of his injuries

92. While doing your assessment, Ronnie asks you “Do I have a fracture? I don’t want to have a cast.” The most appropriate nursing response would be: A. B. C. D. “You have to have an x ray first to know if you have a fracture”. “Why do you sound so scared? It is just a cast and it’s not painful”. “You seem to be concerned about being in a cast”. “Based on my assessment, there doesn’t seem to be a fracture”.

93. Ronnie is very anxious and is unaware of the extent of his injury. The nurse can best assist him by: A. Asking the doctor to give an order for a sedative to call him down B. Informing him that he is being treated by a very competent health team so he has nothing to worry about C. Identifying his level of anxiety to determine how much information he can understand D. Allaying his anxiety by telling him that he only sustained a minor injury 94. After cleaning the abrasions and applying antiseptic, the nurse applies cold compress to the swollen ankle as ordered by the physician. This statement shows that the nurse has correct understanding of the use of cold compress: A. B. C. D. Cold compress reduces blood viscosity in the affected area It is safer to apply than hot compress Cold compress prevents edema and reduces pain It eliminates toxic waste products due to vasodilation

95. After receiving prescription for pain medication, Ronnie is instructed to continue applying 30 minute cold at home and start 30 minute hot compress the next day. You explain that the use of hot compress: A. B. C. D. Produces anesthetic effect Increases nutrition in the blood to promote wound healing Increase oxygenation to the injured tissues for better healing Induces vasoconstriction to prevent infection

Situation 20 – A nursing professor assigns a group of students to do data gathering by interviewing their classmates as subjects. 96. She instructed the interviewees not to tell the interviewees that the data gathered are for her own research project for publication. This teacher has violated the student’s right to: A. B. C. D. Not be harmed Disclosure Privacy Self-determination

97. A nurse preceptor observes that many clients are being readmitted in the ward for postoperative infections. She suggests to the students that they do a research on this topic. What research activity is this? A. B. C. D. Sharing research results with colleagues Identifying clinical problem Developing guidelines for patient care Data collection

98. Quantitative research involves numerical data. Which of the following is based on quantitative research?

A. A study on the effects of the white uniform of hospital personnel on pediatric patients B. The effects of regular nurse visits to client’s bedside on the number of client’s calls to the nurse C. A study on benefits of pre-operative health instructions to client’s feeling of anxiety D. A study on the effects of touch on the client’s feelings of isolation 99. Before the nurse researcher starts her study, she analyzes how much time, money, materials and people she will need to complete the research project. This analysis prior to beginning the study is called: A. B. C. D. Validity Feasibility Reliability Researchability

100. Data analysis is to be done and the nurse researcher wants to include variability. These include the following EXCEPT: A. B. C. D. Variance Range Standards of Deviation Mean

NURSING PRACTICE II – Community Health Nursing and Care of the Mother and Child SITUATIONAL Situation 1 – Nurse Minette is an Independent Nurse Practitioner following-up referred clients in their respective homes. Here she handles a case of POSTPARTIAL MOTHER AND FAMILY focusing on HOME CARE. 1. Nurse Minette needs to schedule a first home visit to OB client Leah. When is a first home-care visit typically made? A. B. C. D. Within 4 days after discharge Within 24 hours after discharge Within 1 hour after discharge Within 1 week of discharge

2. Leah is developing constipation from being on bed rest. What measures would you suggest she take to help prevent this? A. B. C. D. Eat more frequent small meals instead of three large one daily Walk for at least half an hour daily to stimulate peristalsis Drink more milk, increased calcium intake prevents constipation Drink eight full glasses of fluid such as water daily

3. If you were Minette, which of the following actions would alert you that a new mother is entering a postpartal taking-hold phase? A. B. C. D. She urges the baby to stay awake so that she can breast-feed him or her She tells you she was in a lot of pain all during labor She says that she has not selected a name for the baby as yet She sleeps as if exhausted from the effort of labor

4. At 6-week postpartum visit what should this postpartal mother’s fundic height be? A. B. C. D. Inverted and palpable at the cervix Six fingerbreadths below umbilicus No longer palpable on her abdomen One centimeter above the symphysis pubis

5. This postpartal mother wants to loose the weight she gained in pregnancy, so she is reluctant to increase her caloric intake for breast-feeding. By how much should a lactating mother increase her caloric intake during the first 6 months after birth? A. B. C. D. 350 kcal/day 500 kcal/day 200 kcal/day 1000 kcal/day

Situation 2 – As the CPE is applicable for all professional nurse, the professional growth and development of Nurses with specialties shall be addressed by a Specialty Certification Council. The following questions apply to these special groups of nurses. 6. Which of the following serves as the legal basis and statute authority for the Board of Nursing to promulgate measures to effect the creation of a Specialty Certification Council and promulgate professional development programs for this group of nurse-professionals? A. B. C. D. R.A. 7610 P.D. 223 R.A. 9173 R.A. 7164

7. By force of law, therefore, the PRC-Board of Nursing released Resolution No. 14 Series of 1999 entitled: “Adoption of a Nursing Specialty Certification Program and Creation of Nursing Specialty Certification Council.” This rule-making power is called: A. B. C. D. Quasi-Judicial Power Regulatory Power Quasi-Legislative Power Executive/Promulgating Power

8. Under the PRC-Board of Nursing Resolution promulgating the adoption of a Nursing Specialty Certification Program and Council, which two (2) of the following serves as the strongest for its enforcement? (a) Advances made in Science and Technology have provided the climate for specialization in almost all aspects of human endeavor; and

(b) As necessary consequence, there has emerged a new concept known as globalization which seeks to remove barriers in trade, industry and services imposed by the national laws of countries all over the world; and (c) Awareness of this development should impel the nursing sector to prepare our people in the services sector to meet the above challenge; and (d) Current trends of specialization in nursing practice recognized by the International Council of Nurses (ICN) of which the Philippines is a member for the benefit of the Filipino in terms of deepening and refining nursing practice and enhancing the quality of nursing care. A. B. C. D. b & c are strong justifications a & b are strong justifications a & c are strong justifications a & d are strong justifications

9. Which of the following IS NOT a correct statement as regards Specialty Certification? A. The Board of Nursing intended to create the Nursing Specialty Certification Program as a means of perpetuating the creation of an elite force of Filipino Nurse Professionals. B. The Board of Nursing shall oversee the administration of the NSCP through the various Nursing Specialty Boards which will eventually be created C. The Board of Nursing at the time exercised their powers under R.A. 7164 in order to adopt the creation of the Nursing Specialty Certification Council and Program D. The Board of Nursing consulted nursing leaders of national nursing associations and other concerned nursing groups which later decided to ask a special group of nurses of the program for nursing specialty Certification. 10. The NSCC was created for the purpose of implementing the Nursing Specialty policy under the direct supervision and stewardship of the Board of Nursing. Who shall comprise the NSCC? A. A Chairperson who is the current President of the APO; a member from the Academe; and the last member coming from the Regulatory Board B. The chairperson and members of the Regulatory Board ipso facto acts as the CPE Council C. A Chairperson, chosen from among the Regulatory Board members; a Vice Chairperson appointed by the BON at-large; two other members also chosen atlarge; and one representing the consumer group; D. A Chairperson who is the President of the Association from the Academe; a member from the Regulatory Board; and the last member coming from the APO Situation 3 –Nurse Anna is a new BSN graduate and has just passed her Licensure Examination for Nurses in the Philippines. She has likewise been hired as a new Community Health Nurse in one of the Rural Health Units in their City, which of the following conditions may be acceptable TRUTHS applied to Community Health Nursing Practice. 11. Which of the following is the primary focus of community health nursing practice? A. B. C. D. Cure of illnesses Prevention of illnesses Rehabilitation back to health Promotion of health

12. In community health nursing, which of the following is our unit of service as nurses? A. B. C. D. The community The extended members of every family The individual members of the Barangay The Family

13. A very important part of the Community Health Nursing Assessment Process includes: A. the application of professional judgment in estimating importance of facts to family and community B. evaluation structures and qualifications of health center team C. coordination with other sectors in relation to health concerns D. carrying out nursing procedures as per plan of action 14. In community health nursing it is important to take into account the family health data coupled with an equally important need to perform ocular inspection of the area as activities which are powerful elements of: A. B. C. D. evaluation assessment implementation planning

15. The initial step in PLANNING process in order to engage in any nursing project or activities at the community level involves A. B. C. D. goal-setting monitoring evaluation of data provision of data

Situation 4 – Please continue responding as a professional nurse in these other health situations through the following questions. 16. Transmission of HIV from an infected individual to another person occurs: A. B. C. D. Most frequently in nurses with needlesticks Only if there is a large viral load in the blood Most commonly as a result of sexual contact In all infants born to women with HIV infection

17. The medical record of a client reveals a condition in which the fetus cannot pass through the maternal pelvis. The nurse interprets this as: A. B. C. D. Contracted pelvis Maternal disproportion Cervical insufficiency Fetopelvic disproportion

18. The nurse would anticipate a cesarean birth for a client who has which infection present at the onset of labor?

A. B. C. D.

Herpes-simplex virus Human papilloma virus Hepatitis Toxoplasmosis

19. After a vaginal examination, the nurse determines that the client’s fetus is in an occiput posterior position. The nurse would anticipate that the client will have: A. B. C. D. A precipitous birth Intense back pain Frequent leg cramps Nausea and vomiting

20. The rationales for using a prostaglandin gel for a client prior to the induction of labor is to: A. B. C. D. Soften and efface the cervix Numb cervical pain receptors Prevent cervical lacerations Stimulate uterine contractions

Situation 5 – Nurse Lorena is a Family Planning and Infertility Nurse Specialist and currently attends to FAMILY PLANNING CLIENTS AND INFERTILE COUPLES. The following conditions pertain to meeting the nursing needs of this particular population group. 21. Dina, 17 years old, asks you how a tubal ligation prevents pregnancy. Which would be the best answer? A. Prostaglandins released from the cut fallopian tubes can kill sperm B. Sperm can not enter the uterus because the cervical entrance is blocked. C. Sperm can no longer reach the ova, because the fallopian tubes are blocked D. The ovary no longer releases ova as there is no where for them to go. 22. The Dators are a couple undergoing testing for infertility. Infertility is said to exist when: A. B. C. D. a woman has no uterus a woman has no children a couple has been trying to conceive for 1 year a couple has wanted a child for 6 months

23. Another client named Lilia is diagnosed as having endometriosis. This condition interferes with fertility because: A. B. C. D. endometrial implants can block the fallopian tubes the uterine cervix becomes inflamed and swollen the ovaries stop producing adequate estrogen pressure on the pituitary leads to decreased FSH levels

24. Lilia is scheduled to have a hysterosalphingogram. Which of the following instructions would you give her regarding this procedure?

A. B. C. D.

She will not be able to conceive for 3 months after the procedure The sonogram of the uterus will reveal any tumors present Many women experience mild bleeding as an after effect She may feel some cramping when the dye is inserted

25. Lilia’s cousin on the other hand, knowing nurse Lorena’s specialization asks what artificial insemination by donor entails. Which would be your best answer if you were Nurse Lorena? A. B. C. D. Donor sperm are introduced vaginally into the uterus or cervix Donor sperm are injected intra-abdominally into each ovary Artificial sperm are injected vaginally to test tubal patency The husband’s sperm is administered intravenously weekly

Situation 6 – There are other important basic knowledge in the performance of our task as Community Health Nurse in relation to IMMUNIZATION, these include: 26. The correct temperature to store vaccines in a refrigerator is: A. B. C. D. between -4 deg C and +8 deg C between 2 deg C and +8 deg C between -8 deg C and 0 deg C between -8 deg C and +4 deg C

27. Which of the following vaccines is not done by intramuscular (IM) injection? A. B. C. D. Measles vaccine DPT Hepa-B vaccine Tetanus toxoids

28. This vaccine content is derived from RNA recombinants. A. B. C. D. Measles Tetanus toxoids Hepatitis B vaccines DPT

29. This is the vaccine needed before a child reaches one (1) year in order for him/her to qualify as a :fully immunized child”. A. B. C. D. DPT Measles Hepatitis B BCG

30. Which of the following dose of tetanus toxoid is given to the mother to protect her infant from neonatal tetanus and likewise provide 10 years protection for the mother? A. Tetanus toxoid 3 B. Tetanus toxoid 2 C. Tetanus toxoid 1

D. Tetanus toxoid 4 Situation 7 – Records contain those comprehensive descriptions of patient’s health conditions and needs and at the same serve as evidences of every nurse’s accountability in the care giving process. Nursing records normally differ from institution to institution nonetheless they follow similar patterns of meeting needs for specific types of information. The following pertains to documentation/records management. 31. This special form is used when the patient is admitted to the unit. The nurse completes the information in this record particularly his/her basic personal data, current illness, previous health history, health history of the family, emotional profile, environmental history as well as physical assessment together with nursing diagnosis on admission. What do you call this record? A. B. C. D. Nursing Kardex Nursing Health History and Assessment Worksheet Medicine and Treatment Record Discharge Summary

32. These are sheets/forms which provide an efficient and time saving way to record information that must be obtained repeatedly at regular and/or short intervals of time. This does not replace the progress notes; instead this record of information on vital signs, intake and output, treatment, postoperative care, post partum care, and diabetic regimen, etc. This is used whenever specific measurements or observations are needed to be documented repeatedly. What is this? A. B. C. D. Nursing Kardex Graphic Flow Sheets Discharge Summary Medicine and Treatment Record

33. These records show all medications and treatment provided on a repeated basis. What do you call this record? A. B. C. D. Nursing Health History and Assessment Worksheet Discharge Summary Nursing Kardex Medicine and Treatment Record

34. This flip-over card is usually kept in a portable file at the Nurse’s Station. It has 2-parts: the activity and treatment section and a nursing care plan section. This carries information about basic demographic data, primary medical diagnosis, current orders of the physician to be carried out by the nurse, written nursing care plan, nursing orders, scheduled tests and procedures, safety precautions in patient care and factors related to daily living activities. This record is used in the charge-of-shift reports or during the bedside rounds or walking rounds. What record is this? A. B. C. D. Discharge Summary Medicine and Treatment Record Nursing Health History and Assessment Worksheet Nursing Kardex

35. Most nurses regard this conventional recording of the date, time, and mode by which the patient leaves a healthcare unit but this record includes importantly, directs of planning for discharge that starts soon after the person is admitted to a healthcare institution. It is accepted that collaboration or multidisciplinary involvement (of all members of the health team) in discharge results in comprehensive care. What do you call this? A. B. C. D. Discharge Summary Nursing Kardex Medicine and Treatment Record Nursing Health History and Assessment Worksheet

Situation 8 – As Filipino Professional Nurses we must be knowledgeable about the Code of Ethics for Filipino Nurse and practice these by heart. The next questions pertain to this Code of Ethics. 36. Which of the following is TRUE about the Code of Ethics of Filipino Nurses? A. The Philippine Nurses Association for being the accredited professional organization was given the privilege to formulate a Code of Ethics for Nurses which the Board of Nursing promulgated B. Code for Nurses was first formulated in 1982 published in the Proceedings of the Third Annual Convention of the PNA House of Delegates C. The present code utilized the Code of Good Governance for the Professions in the Philippines D. Certificates of Registration of registered nurses may be revoked or suspended for violations of any provisions of the Code of Ethics. 37. Based on the Code of Ethics for Filipino Nurses, what is regarded as the hallmark of nursing responsibility and accountability? A. B. C. D. Human rights of clients, regardless of creed and gender The privilege of being a registered professional nurses Health, being a fundamental right of every individual Accurate documentation of actions and outcomes

38. Which of the following nurses behavior is regarded as a violation of the Code of Ethics of Filipino Nurses? A. B. C. D. A nurse withholding harmful information to the family members of a patient A nurse declining commission sent by a doctor for her referral A nurse endorsing a person running for congress. Nurse Reviewers and/or nurse review center managers who pays a considerable amount of cash for reviewees who would memorize items from the licensure exams and submit these to them after the examination.

39. A nurse should be cognizant that professional programs for specialty certification by the Board of Nursing accredited through the: A. Professional Regulation Commission B. Nursing Specialty Certification Council C. Association of Deans of Philippine Colleges of Nursing

D. Philippine Nurse Association 40. Mr. Santos, R.N. works in a nursing home, and he knows that one of his duties is to be an advocate for his patients. Mr. Santos knows a primary duty of an advocate is to; A. B. C. D. act as the patient’s legal representative complete all nursing responsibilities on time safeguard the well being of every patient maintain the patient’s right to privacy

Situation 9 – Nurse Joanna works as an OB-Gyne Nurse and attends to several HIGH-RISK PREGNANCIES: Particular women with preexisting or Newly Acquired illness. The following conditions apply 41. Bernadette is a 22-year old woman. Which condition would make her more prone than others to developing a Candida infection during pregnancy? A. B. C. D. Her husband plays golf 6 days a week She was over 35 when she became pregnant She usually drinks tomato juice for breakfast She has developed gestational diabetes

42. Bernadette develops a deep vein thrombosis following an auto accident and is prescribed heparin sub-Q. What should Joanna educate her about in regard to this? A. B. C. D. Some infants will be born with allergic symptoms to heparin Her infant will be born with scattered petechiae on his trunk Heparin can cause darkened skin in newborns Heparin does not cross placenta and so does not affect a fetus

43. The cousin of Bernadette with sickle-cell anemia alerted Joanna that she may need further instruction on prenatal care. What statement signifies this fact? A. B. C. D. I’ve stopped jogging so I don’t risk becoming dehydrated. I take an iron pill every day to help grow new red blood cells I am careful to drink at least eight glasses of fluid every day I understand why folic acid is important for red cell formation

44. Bernadette routinely takes acetylsalicylic acid (aspirin) for arthritis. Why should she limit or discontinue this toward the end of pregnancy? A. B. C. D. Aspirin can lead to deep vein thrombosis following birth Newborns develop a red rash from salicylate toxicity Newbors develop withdrawal headaches from salicylates Salicylates can lead to increased maternal bleeding at childbirth

45. Bernadette received a laceration on her leg from her automobile accident. Why are lacerations of lower extremities potentially more serious in pregnant women than others? A. B. C. D. Lacerations can provoke allergic responses because of gonadothropic hormone Increased bleeding can occur from uterine pressure on leg veins A woman is less able to keep the laceration clean because of her fatigue Healing is limited during pregnancy, so these will not heal until after birth.

Situation 10 – Still in your self-managed Child Health Nursing Clinic, you encounter these cases pertaining to the CARE OF CHILDREN WITH PULMONARY AFFECTIONS. 46. Josie brought her 3 months old child to your clinic because of cough and colds. Which of the following is your primary action? A. Give cotrimoxazole tablet or syrup B. Assess the patient using the chart on management of children with cough C. Refer to the doctor D. Teach the mother how to count her child’s breathing 47. In responding to the care concerns of children with severe disease, referral to the hospital is of the essence especially if the child manifests which of the following? A. B. C. D. Wheezing Stop feeding well Fast breathing Difficulty to awaken

48. Which of the following is the most important responsibility of a nurse in the prevention of unnecessary deaths from pneumonia and other severe diseases? A. B. C. D. Giving antibiotics Taking of the temperature of the sick child Provision of Careful Assessment Weighing of the sick child

49. You were able to identify factors that lead to respiratory problems in the community where your health facility serve. Your primary role therefore in order to reduce morbidity due to pneumonia is to: A. B. C. D. Teach mothers how to recognize early signs and symptoms of pneumonia Make home visits to sick children Refer cases to hospitals Seek assistance and mobilize the BHWs to have a meeting with mothers

50. Which of the following is the principal focus of the CARI program of the Department of Health? A. B. C. D. Enhancement of health team capabilities Teach mothers how to detect signs and where to refer Mortality reduction through early detection Teach other community health workers how to assess patients.

Situation 11 – You are working as a Pediatric Nurse in you own Child Health Nursing Clinic. The following cases pertain to ASSESSMENT AND CARE OF THE NEWBORN AT RISK conditions. 51. Theresa, a mother with a 2 year old daughter asks, “at what age can I be able to take the blood pressure of my daughter as a routine procedure since hypertension is common in the family?” Your answer to this is:

A. B. C. D.

At 2 years you may As early as 1 year old When she’s 3 years old When she’s 6 years old

52. You typically gag children to inspect the back of their throat. When is it important NOT to elicit a gag reflex? A. B. C. D. when a girl has a geographic tongue When a boy has a possible inguinal hernia When a child has symptoms of epiglottitis When children are under 5 years of age

53. Baby John was given a drug at birth to reverse the effects of a narcotic given to his mother in labor. What drug is commonly used for this: A. B. C. D. Naloxone (Narcan) Morphine Sulfate Sodium Chloride Penicillin G

54. Why are small-for-gestational-age newborns at risks for difficulty maintaining body temperature? A. B. C. D. They do not have as many fat stores as other infants They are more active than usual so throw off covers Their skin is more susceptible to conduction of cold They are preterm so are born relatively small in size

55. Baby John develops hyperbilirubinemia. What is a method used to treat hyperbilirubinemia in a newborn? A. B. C. D. Keeping infants in a warm and dark environment Administration of cardiovascular stimulant Gentle exercise to stop muscle breakdown Early feeding to speed passage of meconium

Situation 12 – You are the nurse in the Out-Patient Department and during your shift you encountered multiple children’s condition. The following questions apply. 56. You assessed a child with visible severe wasting, he has: A. B. C. D. edema LBM Kwashiorkor Marasmus

57. Which of the following conditions is NOT true about contraindication to immunization? A. do not give DPT2 or DPT3 to a child who has had convulsions within 3 days of DPT1 B. do not give BCG if the child has known hepatitis

C. do not give DPT to a child who has recurrent convulsion or active neurologic disease D. do not give BCG if the child has known AIDS 58. Which of the following statements about immunization is NOT true: A. A child with diarrhea who is due for OPV should receive the OPV and make extra dose on the next visit B. There is no contraindication to immunization if the child is well enough to go home C. There is no contraindication to immunization if the child is well enough to go home and a child should be immunized in the health center before referral are both correct D. A child should be immunized in the health center before referral 59. A child with visible severe wasting or severe palmar pallor may be classified as: A. B. C. D. moderate malnutrition/anemia severe malnutrition/anemia not very low weight no anemia anemia/very low weight

60. A child has some palmar pallor can be classified as: A. B. C. D. moderate anemia/normal weight severe malnutrition/anemia anemia/very low weight not very low weight no anemia

Situation 13 – Nette, a nurse palpates the abdomen of Mrs. Medina, a primigravida. She is unsure of the date of her last menstrual period. Leopold’s Maneuver is done. The obstetrician told that she appears to be 20 weeks pregnant. 61. Nette explains this because the fundus is: A. At the level of the umbilicus, and the fetal heart can be heard with a fetoscope B. 18 cm, and the baby is just about to move C. Is just over the symphisis, and fetal heart cannot be heard D. 28 cm, and fetal heart can be heard with a Doppler 62. In doing Leopold’s Maneuver palpation which among the following IS NOT considered a good preparation: A. The woman should lie in a supine position with her knees flexed slightly B. The hands of the nurse should be cold so that abdominal muscles would contract and tighten C. Be certain that your hands are warm (by washing them in warm water first if necessary) D. The woman empties her bladder before palpation 63. In her pregnancy, she experienced fatigue and drowsiness. This probably occurs because:

A. B. C. D.

of high blood pressure she is expressing pressure the fetus utilizes her glucose stores and leaves her with a low blood glucose of the rapid growth of the fetus

64. The nurse assesses the woman at 20 weeks gestation and expects the woman to report: A. B. C. D. Spotting related to fetal implantation Symptoms of diabetes as human placental lactogen is released Feeling fetal kicks Nausea and vomiting related HCG production

65. Mrs. Medina comes to you for check-up on June 2, her EDC is June 11, what do you expect during assessment? A. B. C. D. Fundic ht. 2 fingers below xyphoid process, engaged Cervix close, uneffaced, FH-midway between the umbilicus and symphysis pubis Cervix open, fundic ht. 2 fingers below xyphoid process, floating Fundic height at least at the level of the xyphoid process, engaged

Situation 14 – Please continue responding as a professional nurse in theses varied health situations through the following questions. 66. Which of the following medications would the nurse expect the physician to order for recurrent convulsive seizures of a 10-year old child brought to your clinic? A. B. C. D. Phenobarbital Nifedipine Butorphanol Diazepam

67. RhoGAM is given to Rh-negative women to prevent maternal sensitization from occurring. The nurse is aware that in addition to pregnancy, Rh-negative women would also receive this medication after which of the following? A. B. C. D. Unsuccessful artificial insemination procedure Blood transfusion after hemorrhage Therapeutic or spontaneous abortion Head injury from a car accident

68. Which of the following would the nurse include when describing the pathophysiology of gestational diabetes? A. B. C. D. Glucose levels decrease to accommodate fetal growth Hypoinsulinemia develops early in the first trimester Pregnancy fosters the development of carbohydrate cravings There is progressive resistance to the effects of insulin

69. When providing prenatal education to a pregnant woman with asthma, which of the following would be important for the nurse to do? A. Demonstrate how to assess her blood glucose levels

B. Teach correct administration of subcutaneous bronchodilators C. Ensure she seeks treatment for any acute exacerbation D. Explain that she should avoid steroids during her pregnancy 70. Which of the following conditions would cause an insulin-dependent diabetic client the most difficulty during her pregnancy? A. B. C. D. Rh incompatibility Placenta Previa Hyperemesis Gravidarum Abruprtion Placenta

Situation 15 – One important tool a community health nurse uses in the conduct of his/her activities is the CHN Bag. Which of the following BEST DESCRIBES the use of this vital facility for our practice? 71. The community/Public Health Bag is: A. B. C. D. a requirement for home visits an essential and indispensable equipment of the community health nurse contains basic medications and articles used by the community health nurse a tool used by the Community health nurse is rendering effective nursing procedures during a home visit

72. What is the rationale in the use of bag technique during home visits? A. It helps render effective nursing care to clients or other members of the family B. It saves time and effort of the nurse in the performance of nursing procedures C. It should minimize or prevent the spread of infection from individuals to families D. It should not overshadow concerns for the patient 73. Which among the following is important in the use of the bag technique during home visit? A. Arrangement of the bag’s contents must be convenient to the nurse B. The bag should contain all necessary supplies and equipment ready for use C. Be sure to thoroughly clean your bag especially when exposed to communicable disease cases D. Minimize if not totally prevent the spread of infection 74. This is an important procedure of the nurse during home visits. A. B. C. D. protection of the CHN bag arrangement of the contents of the CHN bag cleaning of the CHN bag proper hand washing

75. In consideration of the steps in applying the bag technique, which side of the paper lining of the CHN bag is considered clean to make a non-contaminated work area? A. The lower lip B. The outer surface

C. The upper tip D. The inside surface Situation 16 – As a Community Health Nurse relating with people in different communities, and in the implementation of health programs and projects you experience vividly as well the varying forms of leadership and management from the Barangay Level to the Local Government/Municipal or City Level. 76. The following statements can correctly be made about Organization and management: A. An organization (or company) is people. Values make people persons; values give vitality, meaning and direction to a company. As the people of an organization value, so the company becomes. B. Management is the process by which administration achieves its mission, goals, and objectives. C. Management effectiveness can be measured in terms of accomplishment of the purpose of the organization while management efficiency is measured in terms of the satisfaction of individual motives. D. Management principles are universal therefore, one need not be concerned about peoples, culture, values, traditions and human relations. A. B and C only B. A, B and D only C. A and D only D. B, A and C only

77. Management by Filipino values advocate the consideration of the Filipino goals trilogy according to the Filipino priority-values which are: A. B. C. D. Family goals, national goals, organizational goals Organizational goals, national goals, family goals National goals, organizational goals, family goals Family goals, organizational goals, national goals

78. Since the advocacy for the utilization of Filipino value-system in management has been encouraged, the Nursing sector is no except, management needs to examine Filipino values and discover its positive potentials and harness them to achieve: A. B. C. D. Employee satisfaction Organizational commitments, organizational objectives and employee satisfaction Employee objectives/satisfaction, commitments and organizational objectives Organizational objectives, commitments and employee objective/satisfaction/

79. The following statements can correctly be made about an effective and efficient community or even agency managerial-leader. A. Considers the achievement and advancement of the organization she/he represents as well as his people B. Considers the recognition of individual efforts toward the realization of organizational goals as well as the welfare of his people C. Considers the welfare of the organization above all other consideration by higher administration D. Considers its own recognition by higher administration for purposes of promotion and prestige.

A. Only C and are correct B. A, C and D are correct

C. B, C and D are correct D. Only A and B are correct

80. Whether management at the community or agency level, there are 3 essential types of skills managers must have, these are: A. B. C. D. Human relation skills, technical skills, and cognitive skills Conceptual skills, human relation/behavioral skills, and technical skills Technical skills, budget and accounting skills, skills in fund-raising Manipulative skills, technical skill, resource management skills A. A and D are correct B. B is correct C. A is correct D. C and D are correct

Situation 17 – You are actively practicing nurse who just finished your Graduate Studies. You learned the value of Research and would like to utilize the knowledge and skills gained in the application of research to Nursing service. The following questions apply to research. 81. Which type of research inquiry investigates the issues of human complexity (e.g. understanding the human expertise)? A. B. C. D. Logical position Naturalistic inquiry Positivism Quantitative Research

82. Which of the following studies is based on quantitative research? A. A study examining the bereavement process in spouses of clients with terminal cancer B. A study exploring factors influencing weight control behavior. C. A study measuring the effects of sleep deprivation on wound healing D. A study examining client’s feeling before, during and after a bone marrow aspiration 83. Which of the following studies is based on qualitative research? A. B. C. D. A study examining clients reactions to stress after open heart surgery A study measuring nutrition and weight loss/gain in clients with cancer A study examining oxygen levels after endotracheal suctioning A study measuring differences in blood pressure before, during and after a procedure

84. An 85 year old client in a nursing home tells a nurse, “I signed the papers for that research study because the doctor was so insistent and I want him to continue taking care of me”. Which client right is being violated? A. B. C. D. Right of self determination Right to privacy and confidentiality Right to full disclosure Right not to be harmed

85. “A supposition or system of ideas that is proposed to explain a given phenomenon”, best defines: A. B. C. D. a paradigm a concept a theory a conceptual framework

Situation 18 – Nurse Michelle works with a Family Nursing Team in Calbayog Province specifically handling a UNICEF Project for Children. The following conditions pertain to CARE OF THE FAMILIES WITH PRESCHOOLERS. 86. Ronnie asks constant questions. How many does a typical 3-year-old ask in a day’s time? A. B. C. D. 1,200 or more Less than 50 100-200 300-400

87. Ronnie will need to change to a new bed because his baby sister will need Ronnie’s old crib. What measure would you suggest that his parents take to help decrease sibling rivalry between Ronnie and his new sister? A. B. C. D. Move him to the new bed before the baby arrives Explain that new sisters grow up to become best friends Tell him he will have to share with the new baby Ask him to get his crib ready for the new baby

88. Ronnie’s parents want to know how to react to him when he begins to masturbate while watching television. What would you suggest? A. B. C. D. They refuse to allow him to watch television They schedule a health check-up for sex-related disease They remind him that some activities are private They give her “timeout” when this begins

89. How many words does a typical 12-month-old infant use? A. B. C. D. About 12 words Twenty or more words About 50 words Two, plus “mama” and “papa”

90. As a nurse. You reviewed infant safety procedures with Bryan’s mother. What are two of the most common types of accidents among infants? A. B. C. D. Aspiration and falls Falls and auto accidents Poisoning and burns Drowning and homicide

Situation 19 – Among common conditions found in children especially among poor communities are ear infections/problems. The following questions apply. 91. A child with ear problem should be assessed for the following, EXCEPT: A. B. C. D. is there any fever? Ear discharge If discharge is present for how long? Ear pain

92. If the child does not have ear problem, using IMCI, what should you as the nurse do? A. B. C. D. Check Check Check Go to for ear discharge for tender swellings behind the ear for ear pain the next question, check for malnutrition

93. A ear discharge that has been present for more than 14 days can be classified as: A. B. C. D. mastoiditis chronic ear infection acute ear infection complicated ear infection

94. An ear discharge that has been present for less than 14 days can be classified as: A. B. C. D. chronic ear infection mastoiditis acute ear infection complicate ear infection

95. If the child has severe classification because of ear problem, what would be the best thing that you as the nurse can do? A. B. C. D. instruct mother when to return immediately refer urgently give an antibiotic for 5 days dry the ear by wicking

Situation 20 – If the child with diarrhea registers one sign in the pink row and one in the yellow row in the IMCI Chart – 96. We can classify the patient as: A. B. C. D. moderate dehydration some dehydration no dehydration severe dehydration

97. The child with no dehydration needs home treatment. Which of the following is not included in the rules for home treatment in this case: A. continue feeding the child

B. gives oresol every 4 hours C. know when to return to the health center D. give the child extra fluids 98. A child who has had diarrhea for 14 days but has no sign of dehydration is classified as: A. B. C. D. severe persistent diarrhea dysentery severe dysentery persistent diarrhea

99. If the child has sunken eyes, drinking eagerly, thirsty and skin pinch goes back slowly, the classification would be: A. B. C. D. no dehydration moderate dehydration some dehydration severe dehydration

100. Carlo has had diarrhea for 5 days. There is no blood in the stool, he is irritable. His eyes are sunken, the nurse offers fluid to Carlo and he drinks eagerly. When the nurse pinched the abdomen, it goes back slowly. How will you classify Carlo’s illness? A. B. C. D. severe dehydration no dehydration some dehydration moderate dehydration

NURSING PRACTICE III – Care of Clients with Physiologic and Psychosocial Alterations (Part A) SITUATIONAL Situation 1 – Concerted work efforts among members of the surgical team is essential to the success of the surgical procedure. 1. The sterile nurse or sterile personnel touch only sterile supplies and instruments. When there is a need for sterile supply which is not in the sterile field, who hands out these items by opening its outer cover? A. B. C. D. Circulating Nurse Anaesthesiologist Surgeon Nursing Aide

2. The OR team performs distinct roles for one surgical procedure to be accomplished within a prescribed time frame and deliver a standard patient outcome. While the surgeon performs the surgical procedure, who monitors the status of the client like urine output, blood loss? A. Scrub Nurse B. Surgeon

C. Anaesthesiologist D. Circulating Nurse 3. Surgery schedules are communicated to the OR usually a day prior to the procedure by the nurse of the floor or ward where the patient is confined. For orthopedic cases, what department is usually informed to be present in the OR? A. B. C. D. Rehabilitation department Laboratory department Maintenance department Radiology department

4. Minimally invasive surgery is very much into technology. Aside from the usual surgical team, who else has to be present when a client undergoes laparoscopic surgery? A. B. C. D. Information technician Biomedical technician Electrician Laboratory technician

5. In massive blood loss, prompt replacement of compatible blood is crucial. What department needs to be alerted to coordinate closely with the patient’s family for immediate blood component therapy? A. Security Division B. Chaiplaincy C. Social Service Section D. Pathology department Situation 2 – You are assigned in the Orthopedic Ward where clients are complaining of pain in varying degrees upon movement of body parts. 6. Troy is a one day post open reduction and internal fixation (ORIF) of the left hip and is in pain. Which of the following observation would prompt you to call the doctor? A. B. C. D. Dressing is intact but partially soiled Left foot is cold to touch and pedal pulse is absent Left leg in limited functional anatomic position BP 114/78, pulse of 82 beats/minute

7. There is an order of Demerol 50 mg I.M. now and every 6 hours p r n. You injected Demerol at 5 pm. The next dose of Demerol 50 mg I.M. is given: A. B. C. D. When the client asks for the next dose When the patient is in severe pain At 11 pm At 12 pm

8. You continuously evaluate the client’s adaptation to pain. Which of the following behaviors indicate appropriate adaptation? A. The client reports pain reduction and decreased activity B. The client denies existence of pain

C. The client can distract himself during pain episodes D. The client reports independence from watchers 9. Pain in ortho cases may not be mainly due to the surgery. There might be other factors such as cultural or psychological that influence pain. How can you alter these factors as the nurse? A. B. C. D. Explain all the possible interventions that may cause the client to worry Establish trusting relationship by giving his medication on time Stay with the client during pain episodes Promote client’s sense of control and participation in control by listening to his concerns

10. In some hip surgeries, an epidural catheter for Fentanyl epidural analgesia is given. What is your nursing priority care in such a case? A. B. C. D. Instruct client to observe strict bed rest Check for epidural catheter drainage Administer analgesia through epidural catheter as prescribed Assess respiratory rate carefully

Situation 3 – Records are vital tools in any institution and should be properly maintained for specific use and time. 11. The patient’s medical record can work as a double edged sword. When can the medical record become the doctor’s/nurse’s worst enemy? A. B. C. D. When the record is voluminous When a medical record is subpoenaed in court When it is missing When the medical record is inaccurate, incomplete, and inadequate

12. Disposal of medical records in government hospitals/institutions must be done in close coordination with what agency? A. B. C. D. Department of Interior and Local Government (DILG) Metro Manila Development Authority (MMDA) Records Management Archives Office (RMAO) Department of Health (DOH)

13. In the hospital, when you need the medical record of a discharged patient for research you will request permission through: A. B. C. D. Doctor in charge The hospital director The nursing service Medical records section

14. You readmitted a client who was in another department a month ago. Since you will need the previous chart, from whom do you request the old chart? A. Central supply section B. Previous doctor’s clinic

C. Department where the patient was previously admitted D. Medical records section 15. Records Management and Archives Office of the DOH is responsible for implementing its policies on record disposal. You know that your institution is covered by this policy if: A. B. C. D. Your hospital is considered tertiary Your hospital is in Metro Manila It obtained permit to operate from DOH Your hospital is PhilHealth accredited

Situation 4 – In the OR, there are safety protocols that should be followed. The OR nurse should be well versed with all these to safeguard the safety and quality of patient delivery outcome. 16. Which of the following should be given highest priority when receiving patient in the OR? A. B. C. D. Assess level of consciousness Verify patient identification and informed consent Assess vital signs Check for jewelry, gown, manicure, and dentures

17. Surgeries like I and D (incision and drainage) and debridement are relatively short procedures but considered ‘dirty cases’. When are these procedures best scheduled? A. B. C. D. Last case In between cases According to availability of anaesthesiologist According to the surgeon’s preference

18. OR nurses should be aware that maintaining the client’s safety is the overall goal of nursing care during the intraoperative phase. As the circulating nurse, you make certain that throughout the procedure… A. the surgeon greets his client before induction of anesthesia B. the surgeon and anesthesiologist are in tandem C. strap made of strong non-abrasive materials are fastened securely around the joints of the knees and ankles and around the 2 hands around an arm board. D. Client is monitored throughout the surgery by the assistant anesthesiologist 19. Another nursing check that should not be missed before the induction of general anesthesia is: A. B. C. D. check for presence underwear check for presence dentures check patient’s ID check baseline vital signs

20. Some lifetime habits and hobbies affect postoperative respiratory function. If your client smokes 3 packs of cigarettes a day for the past 10 years, you will anticipate increased risk for:

A. B. C. D.

perioperative anxiety and stress delayed coagulation time delayed wound healing postoperative respiratory function

Situation 5 – Nurses hold a variety of roles when providing care to a perioperative patient. 21. Which of the following role would be the responsibility of the scrub nurse? A. Assess the readiness of the client prior to surgery B. Ensure that the airway is adequate C. Account for the number of sponges, needles, supplies, used during the surgical procedure. D. Evaluate the type of anesthesia appropriate for the surgical client 22. As a perioperative nurse, how can you best meet the safety need of the client after administering preoperative narcotic? A. B. C. D. Put side rails up and ask the client not to get out of bed Send the client to OR with the family Allow client to get up to go to the comfort room Obtain consent form

23. It is the responsibility of the pre-op nurse to do skin prep for patients undergoing surgery. If hair at the operative site is not shaved, what should be done to make suturing easy and lessen chance of incision infection? A. B. C. D. Draped Pulled Clipped Shampooed

24. It is also the nurse’s function to determine when infection is developing in the surgical incision. The perioperative nurse should observe for what signs of impending infection? A. B. C. D. Localized heat and redness Serosanguinous exudates and skin blanching Separation of the incision Blood clots and scar tissue are visible

25. Which of the following nursing interventions is done when examining the incision wound and changing the dressing? A. B. C. D. Observe the dressing and type and odor of drainage if any Get patient’s consent Wash hands Request the client to expose the incision wound

Situation 6 – Carlo, 16 years old, comes to the ER with acute asthmatic attack. RR is 46/min and he appears to be in acute respiratory distress. 26. Which of the following nursing actions should be initiated first?

A. B. C. D.

Promote emotional support Administer oxygen at 6L/min Suction the client every 30 min Administer bronchodilator by nebulizer

27. Aminophylline was ordered for acute asthmatic attack. The mother asked the nurse, what is its indication, the nurse will say: A. B. C. D. Relax smooth muscles of the bronchial airway Promote expectoration Prevent thickening of secretions Suppress cough

28. You will give health instructions to Carlo, a case of bronchial asthma. The health instruction will include the following, EXCEPT: A. B. C. D. Avoid emotional stress and extreme temperature Avoid pollution like smoking Avoid pollens, dust, seafood Practice respiratory isolation

29. The asthmatic client asked you what breathing techniques he can best practice when asthmatic attack starts. What will be the best position? A. B. C. D. Sit in high-Fowler’s position with extended legs Sit-up with shoulders back Push on abdomen during exhalation Lean forward 30-40 degrees with each exhalation

30. As a nurse, you are always alerted to monitor status asthmaticus who will likely and initially manifest symptoms of: A. B. C. D. metabolic alkalosis respiratory acidosis respiratory alkalosis metabolic acidosis

Situation 7 – Joint Commission on Accreditation of Hospital Organization (JCAHO) patient safety goals and requirements include the care and efficient use of technology in the OR and elsewhere in the healthcare facility. 31. As the head nurse in the OR, how can you improve the effectiveness of clinical alarm systems? A. B. C. D. Limit suppliers to a few so that quality is maintained Implement a regular inventory of supplies and equipment Adherence to manufacturer’s recommendation Implement a regular maintenance and testing of alarm systems

32. Overdosage of medication or anesthetic can happen even with the aid of technology like infusion pumps, sphygmomanometer and similar devices/machines. As a staff, how can you improve the safety of using infusion pumps?

A. B. C. D.

Check the functionality of the pump before use Select your brand of infusion pump like you do with your cellphone Allow the technician to set the infusion pump before use Verify the flow rate against your computation

33. JCAHOs universal protocol for surgical and invasive procedures to prevent wrong site, wrong person, and wrong procedure/surgery includes the following, EXCEPT: A. B. C. D. Mark the operative site if possible Conduct pre-procedure verification process Take a video of the entire intra-operative procedure Conduct ‘time out’ immediately before starting the procedure

34. You identified a potential risk of pre-and postoperative clients. To reduce the risk of patient harm resulting from fall, you can implement the following, EXCEPT: A. B. C. D. Assess potential risk of fall associated with the patient’s medication regimen Take action to address any identified risks through Incident Report (IR) Allow client to walk with relative to the OR Assess and periodically reassess individual client’s risk for falling

35. As a nurse, you know you can improve on accuracy of patient’s identification by 2 patient identifiers, EXCEPT: A. B. C. D. identify the client by his/her wrist tag and verify with family members identify client by his/her wrist tag and call his/her by name call the client by his/her case and bed number call the patient by his/her name and bed number

Situation 8 – Team efforts is best demonstrated in the OR. 36. If you are the nurse in charge for scheduling surgical cases, what important information do you need to ask the surgeon? A. Who is your internist B. Who is your assistant and anesthesiologist, and what is your preferred time and type of surgery? C. Who are your anesthesiologist, internist, and assistant D. Who is your anesthesiologist 37. In the OR, the nursing tandem for every surgery is: A. B. C. D. Instrument technician and circulating nurse Nurse anesthetist, nurse assistant, and instrument technician Scrub nurse and nurse anesthetist Scrub and circulating nurses

38. While team effort is needed in the OR for efficient and quality patient care delivery, we should limit the number of people in the room for infection control. Who comprise this team? A. Surgeon, anesthesiologist, scrub nurse, radiologist, orderly

B. Surgeon, assistants, scrub nurse, circulating nurse, anesthesiologist C. Surgeon, assistant surgeon, anesthesiologist, scrub nurse, pathologist D. Surgeon, assistant surgeon, anesthesiologist, intern, scrub nurse 39. When surgery is on-going, who coordinates the activities outside, including the family? A. B. C. D. Orderly/clerk Nurse Supervisor Circulating Nurse Anesthesiologist

40. The breakdown in teamwork is often times a failure in: A. B. C. D. Electricity Inadequate supply Leg work Communication

Situation 9 – Colostomy is a surgically created anus. It can be temporary or permanent, depending on the disease condition. 41. Skin care around the stoma is critical. Which of the following is not indicated as a skin care barriers? A. B. C. D. Apply liberal amount of mineral oil to the area Use karaya paste and rings around the stoma Clean the area daily with soap and water before applying bag Apply talcum powder twice a day

42. What health instruction will enhance regulation of a colostomy (defecation) of clients? A. B. C. D. Irrigate after lunch everyday Eat fruits and vegetables in all three meals Eat balanced meals at regular intervals Restrict exercise to walking only

43. After ileostomy, which of the following condition is NOT expected? A. B. C. D. Increased weight Irritation of skin around the stoma Liquid stool Establishment of regular bowel movement

44. The following are appropriate nursing interventions during colostomy irrigation, EXCEPT: A. B. C. D. Increase the irrigating solution flow rate when abdominal cramps is felt Insert 2-4 inches of an adequately lubricated catheter to the stoma Position client in semi-Fowler Hang the solution 18 inches above the stoma

45. What sensation is used as a gauge so that patients with ileostomy can determine how often their pouch should be drained?

A. B. C. D.

Sensation of taste Sensation of pressure Sensation of smell Urge to defecate

Situation 10 – As a beginner in research, you are aware that sampling is an essential elements of the research process. 46. What does a sample group represent? A. B. C. D. Control group Study subjects General population Universe

47. What is the most important characteristic of a sample? A. B. C. D. Randomization Appropriate location Appropriate number Representativeness

48. Random sampling ensures that each subject has: A. B. C. D. Been selected systematically An equal chance of selection Been selected based on set criteria Characteristics that match other samples

49. Which of the following methods allows the use of any group of research subject? A. B. C. D. Purposive Convenience Snow-ball Quota

50. You decided to include 5 barangays in your municipality and chose a sampling method that would get representative samples from each barangay. What should be the appropriate method ofor you to use in this care? A. B. C. D. Cluster sampling Random sampling Startified ampling Systematic sampling

Situation 11 – After an abdominal surgery, the circulating and scrub nurses have critical responsibility about sponge and instrument count. 51. 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 52. What major supportive layer of the abdominal wall must be sutured with long tensile strength such as cotton or nylon or silk suture? A. B. C. D. Fascia Muscle Peritoneum Skin

53. Like sutures, needles also vary in shape and uses. If you are the scrub nurse for a patient who is prone to keloid formation and has low threshold of pain, what needle would you prepare? A. B. C. D. Round needle Atraumatic needle Reverse cutting needle Tapered needle

54. Another alternative “suture” for skin closure is the use of ____________ A. B. C. D. Staple Therapeutic glue Absorbent dressing Invisible suture

55. 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. B. C. D. Anesthesiologist Surgeon OR nurse supervisor Circulating nurse

Situation 12 – As a nurse, you should be aware and prepared of the different roles you play. 56. What role do you play when you hold all client’s information entrusted to you in the strictest confidence? A. B. C. D. Patient’s advocate Educator Patient’s Liaison Patient’s arbiter

57. As a nurse, you can help improve the effectiveness of communication among healthcare givers by: A. B. C. D. Use of reminders of ‘what to do’ Using standardized list of abbreviations, acronyms, and symbols One-on-one oral endorsement Text messaging and e-mail

58. As a nurse, your primary focus in the workplace is the client’s safety. However, personal safety is also a concern. You can communicate hazards to your co-workers through the use of the following EXCEPT: A. B. C. D. Formal training Posters Posting IR in the bulletin board Use of labels and signs

59. As a nurse, what is one of the best way to reconcile medications across the continuum of care? A. Endorse on a case-to-case basis B. Communicate a complete list of the patient’s medication to the next provider of service C. Endorse in writing D. Endorse the routine and ‘stat’ medications every shift 60. As a nurse, you protect yourself and co-workers from misinformation and misrepresentations through the following EXCEPT: A. Provide information to clients about a variety of services that can help alleviate the client’s pain and other conditions B. Advising the client, by virtue of your expertise, that which can contribute to the client’s well-being C. Health education among clients and significant others regarding the use of chemical disinfectant D. Endorsement thru trimedia to advertise your favorite disinfectant solution Situation 13 – You are assigned at the surgical ward and clients have been complaining of post pain at varying degrees. Pain as you know, is very subjective. 61. A one-day postoperative abdominal surgery client has been complaining of severe throbbing abdominal pain described as 9 in a 1-10 pain rating. Your assessment revelas bowel sounds on all quadrants and the dressing is dry and intact. What nursing intervention would you take A. B. C. D. Medicate client as prescribed Encourage client to do imagery Encourage deep breathing and turning Call surgeon stat

62. Pentoxidone 5 mg IV every 8 hours was prescribed for post abdominal pain. Which will be your priority nursing action? A. B. C. D. Check abdominal dressing for possible swelling Explain the proper use of PCA to alleviate anxiety Avoid overdosing to prevent dependence/tolerance Monitor VS, more importantly RR

63. The client complained of abdominal distention and pain. Your nursing intervention that can alleviate pain is:

A. B. C. D.

Instruct client to go to sleep and relax Advice the client to close the lips and avoid deep breathing and talking Offer hot and clear soup Turn to sides frequently and avoid too much talking

64. Surgical pain might be minimized by which nursing action in the O.R. A. B. C. D. Skill of surgical team and lesser manipulation Appropriate preparation for the scheduled procedure Use of modern technology in closing the wound Proper positioning and draping of clients

65. One very common cause of postoperative pain is: A. B. C. D. Forceful traction during surgery Prolonged surgery Break in aseptic technique Inadequate anesthetic

Situation 14 – You were on duty at the medical ward when Zeny came in for admission for tiredness, cold intolerance, constipation, and weight gain. Upon examination, the doctor’s diagnosis was hypothyroidism. 66. Your independent nursing care for hypothyroidism includes: A. B. C. D. administer sedative round the clock administer thyroid hormone replacement providing a cool, quiet, and comfortable environment encourage to drink 6-8 glasses of water

67. As the nurse, you should anticipate to administer which of the following medications to Zeny who is diagnosed to be suffering from hypothyroidism? A. B. C. D. Levothyroxine Lidocaine Lipitor Levophed

68. Your appropriate nursing diagnosis for Zeny who is suffering from hypothyroidism would probably include which of the following? A. B. C. D. Activity intolerance related to tiredness associated with disorder Risk to injury related to incomplete eyelid closure Imbalance nutrition to hypermetabolism Deficient fluid volume related to diarrhea

69. Myxedema coma is a life threatening complication of long standing and untreated hypothyroidism with one of the following characteristics. A. Hyperglycemia B. Hypothermia C. Hyperthermia

D. Hypoglycemia 70. As a nurse, you know that the most common type of goiter is related to a deficiency of: A. B. C. D. thyroxine thyrotropin iron iodine

Situation 15 – Mrs. Pichay is admitted to your ward. The MD ordered “Prepare for thoracentesis this pm to remove excess air from the pleural cavity.” 71. Which of the following nursing responsibilities is essential in Mrs. Pichay who will undergo thoracentesis? A. B. C. D. Support and reassure client during the procedure Ensure that informed consent has been signed Determine if client has allergic reaction to local anesthesia Ascertain if chest x-rays and other tests have been prescribed and completed

72. Mrs. Pichay who is for thoracentesis is assigned by the nurse to which of the following positions? A. B. C. D. Trendelenburg position Supine position Dorsal Recumbent position Orthopneic position

73. During thoracentesis, 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 74. To prevent leakage of fluid in the thoracic cavity, how will you position the client after thoracentesis? A. B. C. D. Place flat in bed Turn on the unaffected side Turn on the affected side On bed rest

75. Chest x-ray was ordered after thoracentesis. When your client asks what is the reason for another chest x-ray, you will explain: A. B. C. D. to rule out pneumothorax to rule out any possible perforation to decongest to rule out any foreign body

Situation 16 – In the hospital, you are aware that we are helped by the use of a variety of equipment / devices to enhance quality patient care delivery. 76. You are to initiate an IV line to your patient, Kyle, 5, who is febrile. What IV administration set will you prepare? A. B. C. D. Blood transfusion set Macroset Volumetric chamber Microset

77. Kyle is diagnosed to have measles. What will your protective personal attire include? A. B. C. D. Gown Eyewear Face mask Gloves

78. What will you do to ensure that Kyle, who is febrile, will have a liberal oral fluid intake? A. Provide a glass of fruit juice every meal B. Regulate his IV to 30 drops per minute C. Provide a calibrated pitcher of drinking water and juice at the bedside and monitor intake and output D. Provide a writing pad to record his intake 79. Before bedtime, you went to ensure Kyle’s safety in bed. You will do which of the following: A. B. C. D. Put the lights on Put the side rails up Test the call system Lock the doors

80. Kyle’s room is fully mechanized. What do you teach the watcher and Kyle to alert the nurses for help? A. B. C. D. How to lock side rails Number of the telephone operator Call system Remote control

Situation 17 – Tony, 11 years old, has ‘kissing tonsils’ and is scheduled for tonsillectomy and adenoidectomy or T and A. 81. You are the nurse of Tony who will undergo T and A in the morning. His mother asked you if Tony will be put to sleep. Your teaching will focus on: A. B. C. D. spinal anesthesia anesthesiologist’s preference local anesthesia general anesthesia

82. Mothers of children undergoing tonsillectomy and adenoidectomy usually ask what food to prepare and give their children after surgery. You as the nurse will say: A. B. C. D. balanced diet when fully awake hot soup when awake ice cream when fully awake soft diet when fully awake

83. The RR nurse should monitor for the most common postoperative complication of: A. B. C. D. hemorrhage endotracheal tube perforation osopharyngeal edema epiglottis

84. The PACU nurse will maintain postoperative T and A client in what position? A. B. C. D. Supine with neck hyperextended and supported with pillow Prone with the head on pillow and turned to the side Semi-fowler’s with neck flexed Reverse trendelenburg with extended neck

85. Tony is to be discharged in the afternoon of the same day after tonsillectomy and adenoidectomy. You as the RN will make sure that the family knows to: A. B. C. D. offer osterized feeding offer soft foods for a week to minimize discomfort while swallowing supplement his diet with Vitamin C rich juices to enhance healing offer clear liquid for 3 days to prevent irritation

Situation 18 – Rudy was diagnosed to have chronic renal failure. Hemodialysis is ordered so that an A-V shunt was surgically created. 86. Which of the following action would be of highest priority with regards to the external shunt? A. B. C. D. Avoid taking BP or blood sample from the arm with the shunt Instruct the client not to exercise the arm with the shunt Heparinize the shunt daily Change dressing of the shunt daily

87. Diet therapy for Rudy, who has acute renal failure is low-protein, low potassium and low sodium. The nutrition instructions should include: A. Recommend protein of high biologic value like eggs, poultry and lean meats B. Encourage client to include raw cucumbers, carrot, cabbage, and tomatoes C. Allowing the client cheese, canned foods and other processed food D. Bananas, cantaloupe, orange and other fresh fruits can be included in the diet 88. Rudy undergoes hemodialysis for the first time and was scared of disequilibrium syndrome. He asked you how this can be prevented. Your response is:

A. maintain a conducive comfortable and cool environment B. maintain fluid and electrolyte balance C. initial hemodialysis shall be done 30 minutes only so as not to rapidly remove the waste from the blood than from the brain D. maintain aseptic technique throughout the hemodialysis 89. You are assisted by a nursing aide with the care of the client with renal failure. Which delegated function to the aide would you particularly check? A. B. C. D. Monitoring and recording I and O Checking bowel movement Obtaining vital signs Monitoring diet

90. A renal failure patient was ordered for creatinine clearance. As the nurse you will collect… A. B. C. D. 48 hour urine specimen first morning urine 24 hour urine specimen random urine specimen

Situation 19 – Fe is experiencing left sharp pain and occasional hematuria. She was advised to undergo IVP by her physician. 91. Fe was so anxious about the procedure and particularly expressed her low pain threshold. Nursing health instruction will include: A. assure the client that the pain is associated with the warm sensation during the administration of the Hypaque by IV B. assure the client that the procedure painless C. assure the client that contrast medium will be given orally D. assure the client that x-ray procedure like IVP is only done by experts 92. What will the nurse monitor and instruct the client and significant others post IVP? A. B. C. D. Report signs and symptoms for delayed allergic reaction Observe NPO for 6 hours Increased fluid intake Monitor intake and output

93. Post IVP, Fe should excrete the contrast medium. You instructed the family to include more vegetables in the diet and: A. B. C. D. increase fluid intake barium enema cleansing enema gastric lavage

94. The IVP reveals that Fe has small renal calculus that can be passed out spontaneously. To increase the chance of passing the stones, you instructed her to force fluids and do which of the following?

A. B. C. D.

Balanced diet Ambulate more Strain all urine Bed rest

95. The presence of calculi in the urinary tract is called A. B. C. D. Colelithiasis Nephrolithiasis Ureterolithiasis Urolithiasis

Situation 20 – At the medical-surgical ward, the nurse must also be concerned about drug interactions. 96. You have a client with TPN. You know that in TPN like blood transfusion, these should be no drug incorporation. However the MD’s order read; incorporate insulin to present TPN. Will you follow the order? A. No, because insulin will induce hyperglycemia in patients with TPN B. Yes, because insulin is chemically stable with TPN and can enhance blood glucose level C. No, because insulin is not compatible with TPN D. Yes, because it was ordered by the MD 97. The RN should also know that some drugs have increased adsorption when infused in the PVC container. How will you administer drugs such as insulin, nitroglycerine hydralazine to promote better therapeutic drug effects? A. B. C. D. Administer by fast drip Inject the drugs as close to the IV injection site Incorporate to the IV solutions Use volumetric chamber

98. 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 doctor’s order? A. B. C. D. Any IV solution available to KVO Isotonic solution Hypertonic solution Hypotonic solution

99. How can nurses prevent drug interaction including adsorption? A. B. C. D. Always flush with NSS after IV administration Administering drugs with more diluents Improving on preparation techniques Referring to manufacturer’s guidelines

100. In insulin administration, it should be understood that our body normally releases insulin according to our blood glucose level. When is insulin and glucose level highest?

A. B. C. D.

After excitement After a good night’s rest After an exercise After ingestion of food NURSING PRACTICE IV – SET B NURSING PRACTICE IV – Care of Clients with Physiologic and Psychosocial Alterations (Part B)

GENERAL INSTRUCTIONS 1. This test booklet contains 100 test questions 2. Read INSTRUCTIONS TO EXAMINEES printed on your answer sheet. 3. Shade only one (1) box for each question on your answer sheets. Two or more boxes shaded will invalidate your answer. 4. AVOID ERASURES.

INSTRUCTIONS 1. Detach one (1) answer sheet from the bottom of your Examinee ID/Answer Sheet Set. 2. Write the subject title “Nursing Practice IV” on the box provided. 3. Shade Set Box A on your answer sheet if your test booklet is Set A; Set Box “B” if your test booklet is Set B. MULTIPLE CHOICE Situation 1 – Because of the serious consequences of severe burns, management requires a multidisciplinary approach. You have important responsibilities as a nurse. 1. While Sergio was lighting a barbecue grill with a lighter fluid, his shirt burns into flames. The most effective way to extinguish the flames with as little further damage as possible is to: A. B. C. D. log roll on the grass/ground slap the flames with his hands remove the burning clothes pour cold liquid over the flames

2. Once the flames are extinguished, it is most important to: A. B. C. D. cover Sergio with a warm blanket give him sips of water calculate the extent of his burns assess the Sergio’s breathing

3. Sergio is brought to Emergency Room after the barbecue grill accident. Based on the assessment of the physician, Sergio sustained superficial partial thickness burns on his trunk, right upper extremities and right lower extremities. His wife asks what that means? Your most accurate response would be: A. B. C. D. Structures beneath the skin are damage Dermis is partially damaged Epidermis and dermis are both damaged Epidermis is damaged

4. During the first 24 hours after the thermal injury, you should asses Sergio for: A. B. C. D. hypokalemia and hypernatremia hypokalemia and hyponatremia hyperkalemia and hyponatremia hyperkalemia and hypernatremia

5. Teddy, who sustained deep partial thickness and full thickness burns of the face, whole anterior chest and both upper extremities two days ago begins to exhibit extreme restlessness. You recognize that this most likely indicates that Teddy is developing: A. Cerebral hypoxia B. Hypervolemia C. metabolic acidosis D. Renal failure

Situation 2 – You are now working as a staff nurse in a general hospital. You have to be prepared to handle situations with ethico-legal and moral implifications. 6. You are in night duty in surgical ward. One of your patients Martin is a prisoner who sustained an abdominal gunshot wound. He is being guarded by policeman from the local police unit. During your rounds you heard a commotion. You saw the policeman trying to hit Martin. You asked why he was trying to hit Martin. He denied the matter. Which among the following activities will you do first? A. B. C. D. Write an accident report Call security officer and report the incident Call your nurse supervisor and report the incident Call the physician on duty

7. You are on morning duty in the medical ward. You have 10 patients assigned to you. During your endorsement rounds, you found out that one of your patients was not in bed. The patient next to him informed you that he went home without notifying the nurses. Which among the following will you do first? A. Make an incident report B. Call security to report the incident

C. Wait for 2 hours before reporting D. Report the incident to your supervisor 8. You are on duty in the medical ward. You were asked to check the narcotics cabinet. You found out that what is on record does not tally with the drugs used. Which among the following will you do first? A. B. C. D. Write an incident report and refer the matter to the nursing director Keep your findings to yourself Report the matter to your supervisor Find out from the endorsement any patient who might have been given narcotics

9. You are on duty in the medical ward. The mother of your patient who is also a nurse, came running to the nurses station and informed you that Fiolo went into cardiopulmonary arrest. A. B. C. D. Start basic life support measures Call for the Code Bring the crush cart to the room Go to see Fiolo and assess for airway patency and breathing problems

10. You are admitting Jorge to the ward and you found out that he is positive for HIV. Which among the following will you do first? A. B. C. D. Take note of it and plan to endorse this to next shift Keep this matter to yourself Write an incident report Report the matter to your head nurse

Situation 3 - Colorectal cancer can affect old and younger people. Surgical procedures and other modes of treatment are done to ensure quality of life. You are assigned in the cancer institute to care of patients with this type of cancer. 11. Larry, 55 years old, who is suspected of having colorectal cancer, is admitted to the CI. After taking the history and vital signs the physician does which test as a screening test for colorectal cancer. A. B. C. D. Barium enema Carcinoembryonic antigen Annual digital rectal examination Proctosigmoidoscopy

12. To confirm his impression of colorectal cancer, Larry will require which diagnostic

study? A. B. C. D. Carcinoembryonic antigen Proctosigmoidoscopy Stool hematologic test Abdominal computed tomography (CT) test

13. The following are risk factors for colorectal cancer, EXCEPT: A. B. C. D. Inflammatory bowels High fat, high fiber diet Smoking Genetic factors-familial adenomatous polyposis

14. Symptoms associated with cancer of the colon include: A. B. C. D. constipation, ascites and mucus in the stool diarrhea, heart burn and eructation blood in the stools, anemia, and “pencil shaped” stools anorexia, hematemesis, and increased peristalasis

15. Several days prior to bowel surgery, Larry may be given sulfasuxidine and neomycin primarily to: A. B. C. D. promote rest of the bowel by minimizing peristalsis reduce the bacterial content of the colon empty the bowel of solid waste soften the stool by retaining water in the colon

Situation 4 – ENTEROSTOMAL THERAPY is now considered a specialty in nursing. You are participating in the OSTOMY CARE CLASS. 16. 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

17. When preparing to teach Fermin how to irrigate colostomy, you should plan to do the procedure: A. B. C. D. When Fermin would have normal bowel movement At least 2 hours before visiting hours Prior to breakfast and morning care After Fermin accepts alteration in body image

18. 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 only 500 ml of fluid has been instilled D. Clamps of the flow of fluid when felling uncomfortable 19. You are aware that teaching about colostomy care is understood when Fermin states, “I will contact my physician and report: A. B. C. D. If I have any difficulty inserting the irrigating tub into the stoma.” If I noticed a loss of sensation to touch in the stoma tissue.” The expulsion of flatus while the irrigating fluid is running out.” When mucus is passed from the stoma between the irrigations.”

20. 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 are 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 is less stool.” D. Everything that I ate before the operation, while avoiding foods that cause gas.” Situation 5 – Ensuring safety is one of your most important responsibilities. You will need to provide instructions and information to your clients to prevent complications. 21. Randy has chest tubes attached to a pleural drainage system. When caring for him you should: A. B. C. D. empty the drainage system at the end of the shift clamp the chest tube when suctioning palpate the surrounding areas for crepitus change the dressing daily using aseptic techniques

22. Fanny, came in from PACU after pelvic surgery. As Fanny’s nurse you know that the sign that would be indicative of a developing thrombophlebitis would be: A. B. C. D. a tender, painful area on the leg a pitting edema of the ankle a reddened area at the ankle pruritus on the calf and ankle

23. To prevent recurrent attacks on Terry who has acute glumerulonephritis, you should instruct her to: A. seek early treatment for respiratory infections B. take showers instead of tub bath C. continue to take the same restrictions on fluid intake D. avoid situations that involve physical activity 24. Herbert had a laryngectomy and he is now for discharge. He verbalized his

concern regarding his laryngectomy tube being dislodged. What should you teach him first? A. B. C. D. Recognize that prompt closure of the tracheal opening may occur Keep calm because there is no immediate emergency Reinsert another tubing immediately Notify the physician at once 25. When caring for Larry after an exploratory chest surgery and pneumonectomy, your priority would be to maintain: A. B. C. D. supplementary oxygen ventilation exchange chest tube drainage blood replacement Situation 6 – Infection can cause debilitating consequences when host resistance is compromised and virulence of microorganisms and environmental factors are favorable. Infection control is one important responsibility of the nurse to ensure quality of care. 26. Honrad, who has been complaining of anorexia and feeling tired, develops jaundice, after a workup he is diagnosed of having Hepatitis A. his wife asks you about gamma globulin for herself and her household help. Your most appropriate response would be: A. “Don’t worry your husband’s type of hepatitis is no longer communicable” B. “Gamma globulin provides passive immunity for hepatitis B” C. “You should contact your physician immediately about getting gammaglobulin.” D. “A vaccine has been developed for this type of hepatitis” 27. Voltaire develops a nosocomial respiratory tract infection. He ask you what that means? Your best response would be: A. “You acquired the infection after you have been admitted to the hospital.” B. “This is a highly contagious infection requiring complete isolation.” C. “The infection you had prior to hospitalization flared up.” D. “As a result of medical treatment, you have acquired a secondary infection.’ 28. As a nurse you know that one of the complications that you have to watch out for when caring for Omar who is receiving total parenteral nutrition is: A. B. C. D. stomatitis hepatitis dysrhythmia infection 29. A solution used to treat Pseudomonas wound infection is: A. Dakin’s solution

B. Half-strength hydrogen peroxide C. Acetic acid D. Betadine 30. Which of the following is the most reliable in diagnosing a wound infection? A. B. C. D. Culture and sensitivity Purulent drainage from a wound WBC count of 20,000/µL Gram stain testing Situation 7 – As a nurse you need to anticipate the occurrence of complications of stroke so that life threatening situations can be prevented. 31. Wendy is admitted to the hospital with signs and symptoms of stroke. Her Glasgow Coma Scale is 6 on admission. A central venous catheter was inserted an I.V. infusion was started. As a nurse assigned to Wendy what will be your priority goal? A. Prevent skin breakdown B. Preserve muscle function C. Promote urinary elimination D. Maintain a patent airway 32. Knowing that for a comatose patient hearing is the last sense to be lost, as Judy’s nurse, what should you do? A. B. C. D. Tell her family that probably she can’t hear them Talk loudly so that Wendy can hear you Tell her family who are in the room not to talk Speak softly then hold her hands gently 33. Which among the following interventions should you consider as the highest priority when caring for June who has hemiparesis secondary to stroke? A. B. C. D. Place June on an upright lateral position Perform range of motion exercises Apply antiembolic stockings Use hand rolls or pillows for support 34. Ivy, age 40, was admitted to the hospital with a severe headache, stiff neck and photophobia. She was diagnosed with a subarachnoid hemorrhage secondary to ruptured aneurysm. While waiting for surgery, you can provide a therapeutic environment by doing which of the following? A. B. C. D. honoring her request for a television placing her bed near the window dimming the light in her room allowing the family unrestricted visiting privileges

35. When performing a neurologic assessment on Walter, you find that his pupils are fixed and dilated. This indicated that he: A. B. C. D. probably has meningitis is going to be blind because of trauma is permanently paralyzed has received a significant brain injury Situation 8 – With the improvement in life expectancies and the emphasis in the quality of life it is important to provide quality care to our older patients. There are frequently encountered situations and issues relevant to the older patients. 36. Hypoxia may occur in the older patients because of which of the following physiologic changes associated with aging. A. B. C. D. Ineffective airway clearance Decreased alveolar surfaced area Decreased anterior-posterior chest diameter Hyperventilation 37. The older patient is at higher risk for incontinence because of: A. B. C. D. dilated urethra increased glomerular filtration rate diuretic use decreased bladder capacity 38. Merle, age 86, is complaining of dizziness when she stands up. This may indicate: A. B. C. D. dementia a visual problem functional decline drug toxicity 39. 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

40. The most dependable sign of infection in the older patient is: A. B. C. D. change in mental status fever pain decreased breath sounds with crackles

Situation 9 – A “disaster” is a large-scale emergency—even a small emergency left unmanaged may turn into a disaster. Disaster preparedness is crucial and is everybody’s business. There are agencies that are in charge of ensuring prompt response. Comprehensive Emergency Management (CEM) is an integrated approach to the management of emergency programs and activities for all four emergency phases (mitigation, preparedness, response, and recovery), for all types of emergencies and disasters (natural, man-made, and attack) and for all levels of government and the private sector. 41. Which of the four phases of emergency management is defined as “sustained action that reduces or eliminates long-term risk to people and property from natural hazards and their effects.”? A. B. C. D. Recovery Mitigation Response Preparedness 42. You are a community health nurse collaborating with the Red Cross and working with disaster relief following a typhoon which flooded and devastated the whole province. Finding safe housing for survivors, organizing support for the family, organizing counseling debriefing sessions and securing physical care are the services you are involved with. To which type of prevention are these activities included: A. B. C. D. Tertiary prevention Primary prevention Aggregate care prevention Secondary prevention

43. During the disaster you see a victim with a green tag, you know that the person: A. has injuries that are significant and require medical care but can wait hours with threat to life or limb B. has injuries that are life threatening but survival is good with minimal intervention C. indicates injuries that are extensive and chances of survival are unlikely even with definitive care D. has injuries that are minor and treatment can be delayed from hours to days 44. The term given to a category of triage that refers to life threatening or potentially life threatening injury or illness requiring immediate treatment: A. B. C. D. Immediate Emergent Non-acute Urgent

45. Which of the following terms refer to a process by which the individual receives education about recognition of stress reaction and management strategies for handling stress which may be instituted after a disaster? A. B. C. D. Clinical incident stress management Follow-up Debfriefing Defusion Situation 10 – As a member of the health and nursing team you have a crucial role to play in ensuring that all the members participate actively is the various tasks agreed upon. 46. While eating his meal, Matthew accidentally dislodges his IV lines and bleeds. Blood oozes on the surface of the over-bed table. It is most appropriate that you instruct the housekeeper to clean the table with: A. B. C. D. Acetone Alcohol Ammonia Bleach

47. You are a member of the infection control team of the hospital. Based on a feedback during the meeting of the committee there is an increased incidence of pseudomonas infection in the Burn Unit (3 out of 10 patients had positive blood and wound culture). What is your priority activity? A. Establish policies for surveillance and monitoring B. Do data gathering about the possible sources of infection (observation, chart review, interview). C. Assign point persons who can implement policies. D. Meet with the nursing group working in the burn unit and discuss problem with them. 48. Part of your responsibility as a member of the diabetes core group is to get referrals from the various wards regarding diabetic patients needing diabetes education. Prior to discharge today, 4 patients are referred to you. How would you start prioritizing your activities? A. Bring your diabetes teaching kit and start your session taking into consideration their distance from your office B. Contact the nurse in-charge and find out from her the reason for the referral C. Determine their learning needs then prioritize D. Involve the whole family in the teaching class 49. You have been designated as a member of the task force to plan activities for the Cancer Consciousness Week. Your committee has 4 months to plan and implement the plan. You are assigned to contact the various cancer support groups in your hospital. What will be your priority activity? A. Find out if there is a budget for this activity B. Clarify objectives of the activity with the task force before contacting the

support groups C. Determine the VIPs and Celebrities who will be invited D. Find out how many support groups there are in the hospital and get the contact number of their president 50. You are invited to participate in the medical mission activity of your alumni association. In the planning stage everybody is expected to identify what they can do during the medical mission and what resources are needed. You thought it is also your chance to share what you can do for others. What will be your most important role where you can demonstrate the impact of nursing in health? A. B. C. D. Conduct health education on healthy life style Be a triage nurse Take the initial history and document findings Act as a coordinator

Situation 11 – One of the realities that we are confronted with is our mortality. It is important for us nurses to be aware of how we view suffering, pain, illness, and even our death as well as its meaning. That way we can help our patients cope with death and dying. 51. Irma is terminally ill, she speaks to you in confidence. You now feel that Irma’s family could be helpful if they knew what Irma has told to you. What should you do first? A. B. C. D. Tell the physician who in turn could tell the family Obtain Irma’s permission to share the information in the family Tell Irma that she has to tell her family what she told you Make an appointment to discuss the situation with the family 52. Ruby who has been told she has terminal cancer, turns away and refuses to respond to you. You can best help her by: A. Coming back periodically and indicating your availability if she would like you to sit with her B. Insisting that Ruby should talk with you because it is not good to keep everything inside C. Leaving her alone because she is uncooperative and unpleasant to be with D. Encouraging her to be physically active as possible

53. Leo, who is terminally ill and recognizes that he is in the process of losing everything and everybody he loves, is depressed. Which of the following would best help him during his depression? A. B. C. D. Arrange for visitors who might cheer him Sit down and talk with him for a while Encourage him to look at the brighter side of things Sit silently with him 54. Which of the following statements would best indicate that Ruffy, who is dying, has accepted his impending death? A. B. C. D. “I’m ready to go.” “I have resigned myself to dying.” “What’s the use?” “I’m giving up”

55. Marla, 90 years old has planned ahead for her death-philosophically, socially, financially and emotionally. This is recognized as: A. B. C. D. Acceptance that death is inevitable Avoidance of the true situation Denial with planning for continued life Awareness that death will soon occur Situation 12 – Brain tumor, whether malignant or benign, has serious management implications. As a nurse, you should be able to understand the consequences of the disease and the treatment. 56. You are caring for Conrad who has a brained tumor and increased Intracranial Pressure (ICP). Which intervention should you include in your plan to reduce ICP? A. B. C. D. Administer bowel softener Position Conrad with his head turned toward the side of the tumor Provide sensory stimulation Encourage coughing and deep breathing 57. Keeping Conrad’s head and neck alignment results in: A. B. C. D. increased inthrathoracic pressure increased venous outflow decreased venous outflow increased intrabdominal pressure 58. Which of the following activities may increase intracranial pressure (ICP)?

A. B. C. D.

Raising the head of the bed Manual hyperventilation Use of osmotic diuretics Valsalva’s maneuver 59. After you asses Conrad, you suspected increased ICP. Your most appropriate respiratory goal is to:

A. B. C. D.

maintain partial pressure of arterial O2 (PaO2) above 80 mmHg lower arterial pH prevent respiratory alkalosis promote CO2 elimination

60. Conrad underwent craniotomy. As his nurse, you know that drainage on a craniotomy dressing must be measured and marked. Which findings should you report immediately to the surgeon? A. Foul-smelling drainage B. Yellowish drainage C. Greenish drainage D. Bloody drainage

Situation 13 – As a Nurse, you have specific responsibilities as professional. You have to demonstrate specific competencies. 61. The essential components of professional nursing practice are all the following EXCEPT: A. Culture B. Care C. Cure D. Coordination

62. You are assigned to care for four (4) patients. Which of the following patients should you give first priority? A. B. C. D. Grace, who is terminally ill with breast cancer. Emy, who was previously lucid but is now unarousable. Aris, who is newly admitted and is scheduled for an executive check-up. Claire, who has cholelithiasis and is for operation on call. 63. Brenda, the Nursing Supervisor of the intensive care unit (ICU) is not on duty when a staff nurse committed a serious medication error. Which statement accurately reflects the accountability of the nursing supervisor? A. Brenda should be informed when she goes back on duty B. Although Brenda is not on duty, the nursing supervisor on duty decides to call her if time permits C. The nursing supervisor on duty will notify Brenda at home D. Brenda is not duty therefore it is not necessary to inform her. 64. Which barrier should you avoid, to manage time wisely?

A. B. C. D.

Practical planning Procrastination Setting limits Realistic personal expectation

65. You are caring for Vincent who has just been transferred to the private room. He is anxious because he fears he won’t be monitored as closely as he was in the Coronary Care Unit. How can you allay his fear? A. B. C. D. Move his bed to a room far from nurse’s station to reduce Assign the same nurse to him when possible Allow Vincent uninterrupted period of time Limit Vincent’s visitors to coincide with CCU policies Situation 14 – As a nurse in the Oncology Unit, you have to be prepared to provide safe, efficient and effective care to your patients. 66. Which one of the following nursing interventions would be most helpful in preparing the patient for radiation therapy? A. B. C. D. Offer tranquilizers and antiemetics Instruct the patient of the possibility of radiation burn Emphasis on the therapeutic value of the treatment Map out the precise course of treatment 67. What side effects are most apt to occur the patient during radiation therapy to the pelvis? A. B. C. D. Urinary retention Abnormal vaginal or perineal discharge Paresthesia of the lower extremities Nausea and vomiting and diarrhea 68. Which of the following can be used on the irradiated skin during a course of radiation therapy? A. B. C. D. Adhesive tape Mineral oil Talcum powder Zinc oxide ointment 69. Earliest sign of skin reaction to radiation therapy is: A. B. C. D. desquamation erythema atrophy pigmentation

70. What is the purpose of wearing a film badge while caring for the patient who is radioactive? A. B. C. D. Identify the nurse who is assigned to care for such a patient Prevent radiation-induced sterility Protect the nurse from radiation effects Measure the amount of exposure to radiation Situation 15 – In a disaster there must be a chain of command in place that defined the roles of each member of the response team. Within the health care group there are pre-assigned roles based on education, experience and training on disaster. 71. As a nurse to which of the following groups are you best prepared to join? A. Treatment group B. Triage group C. Morgue management D. Transport group

72. There are important principles that should guide the triage team in disaster management that you have to know if you were to volunteer as part of the triage team. The following principles should be observed in disaster triage, EXCEPT: A. any disaster plan should have resources available to triage at each facility and at the disaster site if possible B. make the most efficient use of available resources C. training on the disaster is not important to the response in the event of a real disaster because each disaster is unique in itself D. do the greatest good for the greatest number of casualties 73. Which of the following categories of conditions should be considered first priority in a disaster? A. B. C. D. Intracranial pressure and mental status Lower gastrointestinal problems Respiratory infections Trauma 74. A guideline that is utilized in determining priorities is to asses the status of the following, EXCEPT: A. perfusion B. locomotion C. respiration D. mentation

75. The most important component of neurologic assessment is: A. pupil reactivity B. vital sign assessment

C. cranial nerve assessment D. level of consciousness/responsiveness Situation 16 – You are going to participate in a Cancer Consciousness Week. You are assigned to take charge of the women to make them aware of cervical cancer. You reviewed its manifestations and management, 76. The following are risk factors for cervical cancer EXCEPT: A. immunosuppressive therapy B. sex at an early age, multiple partners, exposure to socially transmitted disease, male partner’s sexual habits C. viral agents like the Human Papilloma Virus D. smoking 77. Late signs and symptoms of cervical cancer include the following EXCEPT: A. B. C. D. urinary/bowel changes pain in pelvis, leg or flank uterine bleeding lymph edema of lower extremities 78. When a panhysterectomy is performed due to cancer of the cervix, which of the following organs are removed? A. B. C. D. the uterus, cervix, and one ovary the uterus, cervix, and two-thirds of the vagina the uterus, cervix, tubes and ovaries the uterus and cervix 79. The primary modalities of treatment for Stage 1 and IIA cervical cancer include the following: A. B. C. D. surgery, radiation therapy and hormone therapy surgery radiation therapy surgery and radiation therapy

80. A common complication of hysterectomy is A. B. C. D. thrombophelbitis of the pelvic and thigh vessels diarrhea due to over stimulation atelectasis wound dehiscence

Situation 17 – The body has regulatory mechanism to maintain the needed electrolytes. However there are conditions/surgical interventions that could compromise life. You have to understand how management of

these conditions are done. 81. You are caring for Leda who is scheduled to undergo total thyroidectomy because of a diagnosis of thyroid cancer. Prior to total thyroidectomy, you should instruct Leda to: A. B. C. D. Perform range and motion exercise on the head and neck Apply gentle pressure against the incision when swallowing Cough and deep breath every 2 hours Support head with the hands when changing position

82. As Leda’s nurse, you plan to set up an emergency equipment at her beside following thyroidectomy. You should include: A. B. C. D. An airway and rebreathing tube A tracheostomy set and oxygen A crush cart with bed board Two ampules of sodium bicarbonate

83. Which of the following nursing interventions is appropriate after a total thyroidectomy? A. B. C. D. Place pillows under your patient’s shoulders. Raise the knee-gatch to 30 degrees Keep you patient in a high-fowler’s position. Support the patient’s head and neck with pillows and sandbags.

84. If there is an accidental injury to the parathyroid gland during a thyroidectomy which of the following might Leda develop postoperatively? A. Cardiac arrest B. Dyspnea C. Respiratory failure D. Tetany

85. After surgery Leda develops peripheral numbness, tingling and muscle twitching and spasm. What would you anticipate to administer? A. Magnesium sulfate B. Calcium gluconate C. Potassium iodide D. Potassium chloride

Situation 18 – NURSES are involved in maintaining a safe and healthy environment. This is part of quality care management. 86. The first step in decontamination is: A. to immediately apply a chemical decontamination foam to the area of contamination B. a through soap and water wash and rinse of the patient C. to immediately apply personal protective equipment

D. removal of the patients clothing and jewelry and then rinsing the patient with water 87. For a patient experiencing pruritus, you recommend which type of bath. A. water B. colloidal (oatmeal C. saline D. sodium bicarbonate

88. Induction of vomiting is indicated for the accidental poisoning patient who has ingested. A. rust remover B. gasoline C. toilet bowl cleaner D. aspirin

89. Which of the following term most precisely refer to an infection acquired in the hospital that was not present or incubating at the same time of hospital admission? A. B. C. D. Secondary blood stream infections Nosocomial infection Emerging infectious disease Primary blood stream infection

90. Which of the following guidelines is not appropriate to helping family members cope with sudden death? A. Obtain orders for sedation of family members B. Provide details of the factors attendant to the sudden death C. Show acceptance of the body by touching it and giving the family permission to touch D. Inform the family that the patient has passed on Situation 19 – As a nurse you are expected to participate in initiating or participating in the conduct of research studies to improve nursing practice. You have to be updated on the latest trends and issues affecting profession and the best practices arrived at by the profession. 91. You are interested to study the effects of meditation and relaxation on the pain experienced by cancer patients. What type of variable is pain? A. Dependent B. Correlational C. Independent D. Demographic

92. You would like to compare the support system of patients with chronic illness to those with acute illness. How will you best state your problem? A. A Descriptive Study To Compare The Support System Of Patients With Chronic Illness And Those With Acute Illness In Terms Of Demographic Data And Knowledge About Interventions. B. The Effect Of The Type Of Support System of Patients With Chronic Illness And Those With Acute Illness. C. A Comparative Analysis Of The Support System Of Patients

With Chronic Illness And Those With Acute Illness. D. A Study To Compare The Support System Of Patients With Chronic Illness And Those With Acute Illness. 93. You would like to compare the support system of patients with chronic illness to those with acute illness. What type of research it this? A. B. C. D. Correlational Descriptive Experimental Quasi-experimental

94. You are shown a Likert Scale that will be used in evaluating your performance in the clinical area. Which of the following questions will you not use in critiquing the Likert Scale? A. Are the techniques to complete and score the scale provided? B. Are the reliability and validity information on the scale described? C. If the Likert scale is to be used for a study, was the development process described? D. Is the instrument clearly described? 95. In any research study where individual persons are involved, it is important that an informed consent for the study is obtained. The following are essential information about the consent that you should disclose to the prospective subjects EXCEPT: A. B. C. D. Consent to incomplete disclosure Descriptions of benefits, risks and discomforts Explanation of procedure Assurance of anonymity and confidentiality

Situation 20 – Because severe burn can affect the person’s totality it is important that-you apply interventions focusing on the various dimensions of man. You also have to understand the rationale of the treatment. 96. What type of debridement involves proteolytic enzymes? A. Interventional B. Mechanical C. Surgical D. Chemical

97. Which topical antimicrobial is most frequently used in burn wound care? A. B. C. D. Neosporin Silver nitrate Silver sulfadiazine Sulfamylon

98. Hypertrophic burn scars are caused by: A. exaggerated contraction B. random layering of collagen

C. wound ischemia D. delayed epithelialization 99. The major disadvantage of whirlpool cleansing of burn wound is: A. B. C. D. patient hypothermia cross contamination of wound patient discomfort excessive manpower requirement

100. Oral analgesics are most frequently used to control burn injury pain: A. B. C. D. upon patient request during the emergent phase after hospital discharge during the acute phase *** END *** SUBMIT THIS TEST BOOKLET TOGETHER WITH THE ANSWER SHEET TO YOUR WATCHERS. BRINGING THE TEST BOOKLET OUT OF THE ROOM WILL BE A GROUND FOR CANCELLATION OF YOUR EXAMINATION. NURSING PRACTICE V- Care of Clients with physiologic and Psychosocial Alterations (Part C). SITUATIONAL Situation 1 – Jimmy developed this goal for hospitalization. “To get a handle on my nervousness.” The nurse is going to collaborate with him to reach his goal. Jimmy was admitted to the hospital because he called his therapist that he planned to asphyxiate himself with exhaust from his car but frightened instead. He realized he needed help. 1. The nurse recognized that Jimmy had conceptualized his problem and the next priority goal in the care plan is: A. B. C. D. help the client find meaning in his experience help the client to plan alternatives help the client cope with the present problem help the client to communicate

2. The nurse is guided that Jimmy is aware of his concerns of the “here and now” when he crossed out which item from this “list of what to know”. anxiety laden unconscious conflicts subjective idea of the range of mild to severe anxiety early signs of anxiety physiologic indices of anxiety

A. B. C. D.

3. While Jimmy was discussing the signs and symptoms of anxiety with his nurse, he recognized that complete disruption of the ability to perceive occurs in: A. B. C. D. panic state of anxiety severe anxiety moderate anxiety mild anxiety

4. Jimmy initiates independence and takes an active part in his self care with the following EXCEPT: A. B. C. D. agreeing to contact the staff when he is anxious becoming aware of the conscious feeling assessing need for medication and medicating himself writing out a list of behaviors that he identified as anxious

5. The nurse notes effectiveness of interventions in using subjective and objective data in the: A. B. C. D. initial plans or orders database problem list progress notes

Situation 2 – A research study was undertaken in order to identify and analyze a disabled boy’s coping reaction pattern during stress. 6. This study which is an in depth study of one boy is a: A. B. C. D. case study longitudinal study cross-sectional study evaluative study

7. The process recording was the principal tool for data collection. Which of the following is NOT a part of a process recording? A. B. C. D. Non verbal narrative account Analysis and interpretation Audio-visual recording Verbal narrative account

8. Which of these does NOT happen in a descriptive study? A. B. C. D. Exploration of relationship between two or more phenomena. Explanation of relationship between two or more phenomena. Investigation of a phenomenon in real life context. Manipulation of variable

9. The investigator also provided the nursing care of the subject. The investigator is referred to as a/an:

A. B. C. D.

Participant-observer Observer researcher Caregiver Advocate

10. To ensure reliability of the study, the investigator’s analysis and interpretations were: A. B. C. D. subjected to statistical treatment correlated with a list of coping behaviors subjected to an inter-observer agreement scored and compared standard criteria

Situation 3 – During the morning endorsement, the outgoing nurse informed the nursing staff that Regina, 35 years old, was given Flurazepam (Dalmane) 15mg at 10:00pm because she had trouble going to sleep. Before approaching Regina, the nurse read the observation of the night nurse. 11. Which of the following approaches of the nurse validates the data gathered? A. “I learned that you were up till ten last night, tell me what happened before you were finally able to sleep and how was your sleep?” B. “Hmm.. You look like you had a very sound sleep. That pill you were given last night is effective isn’t it?” C. “Regina, did you sleep well?” D. “Regina, how are you?” 12. Regina is a high school teacher. Which of these information LEAST communicate attention and care for her needs for information about her medicine? A. Guided by a medication teaching plan, go over with her the purpose, indications and special instructions, about the medication and provide her a checklist B. Provide a drug literature. C. Have an informal conversation about the medication and its effects D. Ask her what time she would like to watch the informative video about the medication. 13. The nurse engages Regina in the process of mutual inquiry to provide an opportunity for Regina to: A. B. C. D. face emerging problems realistically conceptualize her problem cope with her present problem perceive her participation in an experience

!4. Which of these responses indicate that Regina needs further discussion regarding special instructions? A. “I have to take this medicine judiciously” B. “I know I will stop taking the medicine when there is advice from the doctor for me to discontinue.” C. “I will inform you and the doctor any untoward reactions I have.” D. “I like taking this sleeping pill. It solves my problem of insomnia. I wish

I can take it for life.” 15. Regina commits to herself that she understood and will observe all the medicine precautions by: A. B. C. D. affixing her signature to the teaching plan that she has understood the nurse committing what she learned to her memory verbally agreeing with the nurse relying on her husband to remember the precautions

Situation 4 – The nurse-patient relationship is a modality through which the nurse meets the client’s needs. 16. The nurse’s most unique tool in working with the emotionally ill client is his/her A. B. C. D. theoretical knowledge personality make up emotional reactions communication skills

17. The psychiatric nurse who is alert to both the physical and emotional needs of clients is working from the philosophical framework that states: A. All behavior is meaningful, communicating a message or a need. B. Human beings are systems of interdependent and interrelated parts. C. Each individual has the potential for growth and change in the direction of positive mental health. D. There is a basic similarity among all human beings. 18. One way to increase objectivity in dealing with one’s fears and anxieties is through the process of: A. B. C. D. observation intervention validation collaboration

19. All of the following responses are non therapeutic. Which is the MOST direct violation of the concept, congruence of behavior? A. B. C. D. Responding in a punitive manner to the client. Rejecting the client as a unique human being Tolerating all behavior in the client. Communicating ambivalent messages to the client.

20. The mentally ill person responds positively to the nurse who is warm and caring. This is a demonstration of the nurse’s role as: A. B. C. D. counselor mother surrogate therapist socializing agent

Situation 5 – The nurse engages the client in a nurse-patient interaction. 21. The best time to inform the client about terminating the nurse-patient relationship is: A. B. C. D. when the client asks how long the relationship would be during the working phase towards the end of the relationship at the start of the relationship

22. The client says, “I want to tell you something but can you promise that you will keep this a secret?” A therapeutic response of the nurse is: A. “Yes, our interaction is confidential provided the information you tell me is not detrimental to your safety.” B. “Of course yes, this is just between you and me. Promise!” C. “Yes, it is my principle to uphold my client’s rights.” D. “Yes, you have the right to invoke confidentiality of our interaction.” 23. When the nurse respects the client’s self-disclosure, this is a gauge for the nurse’s: A. B. C. D. trustworthiness loyalty integrity professionalism

24. Rapport has been established in the nurse-client relationship. The client asks to visit the nurse after his discharge. The appropriate response of the nurse would be: A. “The best time to talk is during the nurse-client interaction time. I am committed to have this time available for us while you are at the hospital and ends after your discharge.” B. “Yes, If you keep it confidential, this is part of privileged communication.” C. “I am committed for your care.” D. “I am sorry, though I would want to, it is against hospital policy.” 25. The client has not been visited by relatives for months. He gives a telephone number and requests the nurse to call. An appropriate action of the nurse would be: A. B. C. D. Inform the attending physician about the request of the client. Assist the client to bring his concern to the attention of the social worker. “Here (gives her mobile phone). You may call this number now”. Ask the client what is the purpose of contacting his relatives.

Situation 6 – Camila, 25 years old, was reported to be gradually withdrawing and isolating herself from friends and family members. She became neglectful of her personal hygiene. She was observed to be talking irrelevantly and incoherently. She was diagnosed as schizophrenia disorder. 26. The past history of Camila would most probably reveal that her premorbid personality is: A. schizoid B. extrovert

C. ambivert D. cycloid 27. Camila refuses to relate with to others because she: A. B. C. D. is irritable feels superior of others anticipates rejection is depressed

28. Which of the following disturbances in interpersonal relationships MOST often predispose to the development of schizophrenia? A. B. C. D. Lack of participation in peer groups Faulty family atmosphere and interaction Extreme rebellion towards authority figures Solo parenting

29. Camila’s indifference toward the environment is a compensatory behavior to overcome: A. B. C. D. Guilt feelings Ambivalence Narcissistic behavior Insecurity feelings

30. Schizophrenia is a/an: A. B. C. D. anxiety disorder neurosis psychosis personality disorder

Situation 7 – Salome, 80 year old widow, has been observed to be irritable, demanding and speaking louder than usual. She would prefer to be alone and take her meals by herself, minimize receiving visitors at home and no longer bothers to answer telephone calls because of deterioration of hearing. She was brought by her daughter to the Geriatric clinic for assessment and treatment. 31. The nurse counsels Salome’s daughter that Salome’s becoming very loud and tendency to become aggressive is a/an: A. B. C. D. beginning indifference to the world around her attempt to maintain authoritative role overcompensation for hearing loss behavior indicative of unresolved repressed conflict of the past

32. A nursing diagnosis for Salome is: A. B. C. D. sensory deprivation social isolation cognitive impairment ego despair

33. The nurse will assist Salome and her daughter to plan a goal which is for Salome to: A. B. C. D. adjust to the loss of sensory and perceptual function participate in conversation and other social situations accept the steady loss of hearing that occurs with aging increase her self-esteem to maintain her authoritative role

34. The daughter understood, the following ways to assist Salome meet her needs and avoiding which of the following: A. B. C. D. Using short simple sentences Speaking distinctly and slowly Speaking at eye level and having the client’s attention Allowing her to take her meals alone

35. Salome was fitted a hearing aid. She understood the proper use and wear of this device when she says that the battery should be functional, the device is turned on and adjusted to a: A. B. C. D. therapeutic level comfortable level prescribed level audible level

Situation 8 – For more than a month now, Cecilia is persistently feeling restless, worried and feeling as if something dreadful is going to happen. She fears being alone in places and situations where she thinks that no one might come to rescue her just in case something happens to her. 36. Cecilia is demonstrating: A. B. C. D. acrophobia claustrophobia agoraphobia xenophobia

37. Cecilia’s problem is that she always sees and thinks negative things hence she is always fearful. Phobia is a symptom described as: A. B. C. D. organic psychosomatic psychotic neurotic

38. Cecilia has a lot of irrational thoughts: The goal of therapy is to modify her: A. B. C. D. communication cognition observation perception

39. Cognitive therapy is indicated for Cecilia when she is already able to handle anxiety reactions. Which of the following should the nurse implement?

A. B. C. D.

assist her in recognizing irrational beliefs and thoughts help find meaning in her behavior provide positive reinforcement for acceptable behavior Administer anxiolytic drug

40. After discharge, which of these behaviors indicate a positive result of being able to overcome her phobia? A. B. C. D. She reads a book in the public library She drives alone along the long expressway. She watches television with the family in the recreation room She joins an art therapy group

Situation 9 – It is the first day of clinical experience of nursing students at the Psychiatry Ward. During the orientation, the nurse emphasizes that the team members including nursing students are legally responsible to safeguard patient’s records from loss or destruction or from people not authorized to read it. 41. It is unethical to tell one’s friends and family members data about patients because doing so is a violation of patients’ rights to: A. B. C. D. Informed consent Confidentiality Least restrictive environment Civil liberty

42. The nurse must see to it that the written consent of mentally ill patients must be taken from: A. B. C. D. Doctor Social worker Parents or legal guardian Law enforcement authorities

43. In an extreme situation and when no other resident or intern is available, should a nurse receive telephone orders, the order has to be correctly written and signed by the physician within: A. B. C. D. 24 hours 36 hours 48 hours 12 hours

44. The following are SOAP (Subjective – Objective – Analysis – Plan) statements on a problem: Anxiety about diagnosis. What is the objective data? A. Relate patient’s feelings to physician; initiate and encourage her to verbalize her fears; give emotional support by spending more time with patient; continue to make necessary explanations regarding diagnostic tests. B. Has periods of crying; frequently verbalizes fear of what diagnostic tests will reveal C. Anxiety due to unknown

D. “I’m so worried about what else they’ll find wrong with me.” 45. Nursing care plans provide very meaningful data for the patient profile and initial plan because the focus is on the: A. Summary of chronological notations made by individual health team members B. Identification of patient’s responses to medical diagnoses and treatment C. Patient’s responses to health and illness as a total person in interaction with the environment D. Step by step procedures for the management of common problems Situation 10 – Marie is 5½ years old and described by the mother as bedwetting at night. 46. Which of the following is the MOST common physiological cause of night bed wetting? A. B. C. D. deep sleep factors abnormal bladder development infections familial and genetic factors

47. All of the following, EXCEPT one compromise the concepts of behavior therapy program. A. B. C. D. reward and punishment extinction learning placebo as a form of treatment

48. To help Marie who bed wets at night practice acceptable and appropriate behavior, it is important for the parents to be consistent with the following approaches EXCEPT: A. B. C. D. discipline with a kind attitude matter of fact in handling the behavior sympathize for the child be loving yet firm

49. A therapeutic verbal approach that communicates strong disapproval is: A. “You are supposed to get up and go in the toilet when you feel you have to go and did not. The next time you bed wet, I’ll tell your friends and hang your sheets out the window for them to see.” B. “You are supposed to get up and go in the toilet when you feel you have to go and did not. I expect you to from now on without fail.” C. “If you bed wet, you will change your bed linen and wash the sheets.” D. “If you don’t make an effort to control your bedwetting, I’d be upset and disappointed.” 50. During your conference, the parent inquires how to motivate Marie to be dry in the morning. Your response which is an immediate intervention would be: A. Give a star each time she wakes up dry and every set of five stars, give a prize. B. Tokens make her materialistic at an early age. Give praise and hugs occasionally. C. What does your child want that you can give every time he/she wakes up dry in the morning?

D. Promise him/her a long awaited vacation after school is over. Situation 11 – The nurse is often met with the following situations when clients become angry and hostile. 51. To maintain a therapeutic eye contact and body posture while interacting with angry and aggressive individual, the nurse should: A. B. C. D. keep an eye contact while staring at the client keep his/her hands behind his/her back or in one’s pockets fold his/her arms across his/her chest keep an “open” posture, e.g. Hands by sides but palms turned outwards

52. During the pre-interaction phase of the N-P relationship, the nurse recognizes this normal INITIAL reaction to an assaultive or potentially assaultive person. A. B. C. D. To remain and cope with the incident Display empathy towards the patient To call for help from other members of the team To stay and fight or run away

53. Which of the following is an accurate way of reporting and recording an incident? A. “When asked about his relationship with his father, client became anxious.” B. “When asked about his relationship with his father, client clenched his jaw/teeth, made a fist and turned away from the nurse.” C. “When asked about his relationship with his father, client was resistant to respond” D. “When asked about his relationship with his father, his anger was suppressed” 54. To encourage thought, which of the following approaches is NOT therapeutic? A. B. C. D. “Why do you feel angry?” “When do you usually feel angry?” “How do you usually express anger?” What situations provoke you to be angry?”

55. A patient grabs and about to throw it. The nurse best responds saying. A. B. C. D. “Stop! Put that chair down.” “Don’t be silly.” “Stop! The security will be here in a minute.” “Calm down.”

Situation 12 – Nursing care for the elderly 56. In planning care for a patient with Parkinson’s disease, which of these nursing diagnoses should have priority? A. B. C. D. potential for injury altered nutritional state ineffective coping altered mood state

57. A healthy adaptation to aging is primarily related to an individual’s… A. B. C. D. Number of accomplishments Ability to avoid interpersonal conflict Physical health throughout life Personality development in his life span

58. The frequent use of the older client’s name by the nurse is MOST effective in alleviating which of the following responses to old age? A. B. C. D. Loneliness Suspicion Grief Confusion

59. An elderly confused client gets out of bed at night to go to the bathroom and tries to go to another bed when she returns. The MOST appropriate action the nurse would take is to: A. B. C. D. Assign client to a single room Leave a light on all night Remind client to call the nurse when she wants to get up Put side rails on the bed

60. An elderly who has lots of regrets, unhappy and miserable is experiencing: A. B. C. D. Crisis Despair Loss Ambivalence

Situation 13 – Graciela 1½ year old is admitted to the hospital from the emergency room with a fracture of the left femur due to a fall down a flight of stairs. Graciela is placed on Bryant’s traction. 61. While on Bryant’s traction, which of these observations of Graciela and her traction apparatus would indicate a decrease in the effectiveness of her traction? A. Graciela’s buttocks are resting on the bed. B. The traction weights are hanging 10 inches above the floor. C. Graciela’s legs are suspended at a 90 degree angle to her trunk. D. The traction ropes move freely through the pulley. 62. The nurse notes that the fall might also cause a possible head injury. She will be observed for signs of increased intracranial pressure which include: A. B. C. D. Narrowing of the pulse pressure Vomiting Periorbital edema A positive Kernig’s sign

63. Graciela is assessed to have no head injury. The Bryant’s traction is removed. A plaster

of Paris hip spica is applied. Which of these finding is a concern of immediate attention that must be reported to the physician immediately? A. B. C. D. Graciela is scratching the cast over her abdomen. The toes of Graciela’s left foot blanch when the nurse applies pressure on them. Graciela’s cast is still damp. The nurse is unable to insert a finger under the edge of Graciela’s cast on her left foot.

64. Part of discharge plan is for the nurse to give instructions about the care of Graciela’s cast to the mother. Which of these statements indicate that the mother understood an important aspect of cast care? A. B. C. D. I will use white shoe polish to keep the cast neat. I will place plastic sheeting around the perineal area of the cast. I will use cool water to wash the cast. I will reinforce cracked areas on the cast with adhesive tape.

65. The nurse counsels Graciela’s mother ways to safeguard safety while providing opportunities for Graciela to develop a sense of: A. B. C. D. Trust Initiative Industry Autonomy

Situation 14 – Jolina is an 18 year old beginning college student. Her mother observed that she is having problems relating with her friends. She is undecided about her future. She has lost insight, lost interest in anything and complained of constant tiredness. 66. Jolina is put on antidepressant drugs. These drugs act on the brain chemistry, therefore they would be useful in which type of depression? A. B. C. D. exogenous depression neurotic depression endogenous depression psychotic depression

67. This is a tricyclic antidepressant drug: A. B. C. D. Venlafaxine (Effexor) Flouxetine (Prozac) Sertraline (Zoloft) Imipramine (Tofranil)

68. After one week of antidepressant medication, Jolina still manifests depression. The nurse evaluates this as: A. B. C. D. Unusual because action of antidepressant drug is immediate. Unexpected because therapeutic effectiveness takes within a few days. Expected because therapeutic effectiveness takes 2-4 weeks. Ineffective result because perhaps the drug’s dosage is inadequate.

69. Jolina continues to verbalize feeling sad and hopeless. She is not mixing well with other clients. One of the nurse’s important considerations for Jolina INITIALLY is: A. Formulate a structured schedule so she is able to channel her energies externally B. Let her alone until she feels like mingling with others. C. Encourage her to join socialization hour so she will start to relate with others. D. Encourage her to join group therapy with other patients. 70. During the predischarge conference, the nurse suggests vocational guidance because it should help Jolina to: A. B. C. D. Find a good job. Make some decisions about her future Realistically assess her assets and limitations Solve her own problems

Situation 15 – Group Approach in Nursing 71. Membership dropout generally occurs in group therapy after a member: A. B. C. D. Accomplishes his goal in joining the group Discovers that his feelings are shared by the group members Experiences feelings of frustration in the group Discusses personal concerns with group members

72. Which of the following questions illustrates the group role of encourager? A. B. C. D. What were you saying? Who wants to respond next? Where do you go from here? Why haven’t we heard from you?

73. The goal of remotivation therapy is to facilitate: A. B. C. D. Insight Productivity Socialization Intimacy

74. The treatment of the family as a unit is based on the belief that the family: A. is a social system and all the members are interrelated components of that system B. as a unit of society needs the opportunity to change its own destiny C. who has therapy together will tend to remain together D. is “contaminated” by the presence of deviant member and all members need treatment. 75. The working phase in a therapy group is usually characterized by which of the following? A. Caution

B. Cohesiveness C. Confusion D. Competition Situation 16 – The mental health – psychiatric nurse functions in a variety of setting with different types of clients. 76. Poverty as reflected in prevalence of communicable diseases, malnutrition and social ills such as street children, homeless and prostitution is a predisposing factor to mental illness. A community approach to cope with this problem is for the nurse to support: A. B. C. D. aggressive family planning methods provision of social welfare benefits for the poor social action free clinics and more hospitals

77. The MOST cost effective way to meet the mental health needs of the public is through programs with a priority goal of: A. B. C. D. treatment prevention rehabilitation research

78. Lorelie upon discharge was referred to a volunteer group where she has learned to read patterns, cut out fabric and use a sewing machine to make simple outfits that will help her earn in the future. What type of therapy is this? A. B. C. D. Recreational therapy Art therapy Vocational therapy Educational therapy

79. In a residential treatment home for adolescent girls, the clients were becoming increasingly tense and upset because of shortening of their recreation time. To deescalate possible anger and aggression among the clients it is BEST to play: A. B. C. D. religious music relaxation music dance music rock music

80. The parents of special children who are behaviorally disturbed need mental health education. Which of these topics would the school nurse consider as priority for their parent’s class? A. B. C. D. Drug education Child abuse Effective parenting Sex education

Situation 17 – Nurses in all practice areas are likely to come in contact with clients suffering from acute or chronic drug abuse.

81. The psychodynamic therapy of substance abuse is based upon the premise that drug abuse is: A. a common problem brought about by socioeconomic deprivation B. caused by multiplicity of factors C. predisposed by an inability to develop appropriate psychological resources to manage developmental stresses D. due to biochemical factors 82. Being in contact with reality and the environment is a function of the: A. B. C. D. conscience ego id super ego

83. Substance abuse is different from substance dependence in that, substance dependence: A. B. C. D. includes characteristics of adverse consequences and repeated use requires long term treatment in a hospital based program produces less severe symptoms than that of abuse includes characteristics of tolerance and withdrawal

84. During the detoxification stage, it is a priority for the nurse to: A. B. C. D. teach skills to recognize and respond to health threatening situations increase the client’s awareness of unsatisfactory protective behaviors implement behavior modification promote homeostasis and minimize the client’s withdrawal symptoms

85. Commonly known as “shabu” is: A. B. C. D. Cannabis Sativa Lysergic acid diethylamide Methylenedioxy methamphetamine Methamphetamine hydrochloride

Situation 18 – It is common that clients ask the nurse personal questions. 86. Anticipation of personal questions is given adequate attention during which phase of the nurse patient relationship? A. B. C. D. Orientation phase Working phase Pre-interaction phase Termination phase

87. If the client asks for the nurse’s telephone number, which of these responses is NOT appropriate? A. “It is confidential I just don’t give it to anyone.” B. “What would you do with my number if I give it to you?”

C. “If I say No to your request, what are your thoughts about it?” D. “Are you asking for an official number of the hospital/clinic for your reference?” 88. When the client asks about the family of the nurse, the MOST appropriate response is: A. B. C. D. Avoid the situation and redirect the client’s attention Give a brief and simple response and focus on the client. “Why don’t we talk about your family instead?” Introduce another topic like the client’s interests

89. When the nurse is asked a personal question, which of these reactions indicates a need for her to introspect? A. B. C. D. The client is simply curious. His/Her right to privacy is being intruded. The client knows no other way to begin a conversation. Some patients are like children in seeking recognition from the nurse.

90. It is 10 o’clock on your watch. The client asks, “What time is it?” The nurse’s appropriate is: A. B. C. D. “Are you getting bored?” “It is 10 o’clock.” “Why do you ask?” “Guess, what time is it?”

Situation 19 – Ricky is a 12 year old boy with Down’s syndrome. He stands 5’ ½” and weighs 100 lbs. he is slim and walks sluggishly with a limp. He wears a neck brace as a support for his neck. X-ray of cervical spine showed “subluxation of C1 in relation to C2 with cord compression”. He attends a school for a special education. 91. The classroom teacher consults the school nurse for guidance on how to take care of Ricky while inside of the classroom. The nurse considers as priority, Ricky’s: A. B. C. D. Physiological needs Need for self esteem Needs for safety and security Needs for belonging

92. Ricky’s mother visited the school nurse. She asked, “What should I do when Ricky fondles his genitalia?” An appropriate response of the nurse is for the mother to: A. B. C. D. Divert Ricky’s attention and engage him in satisfying activities Tell Ricky that it is wrong to keep fondling his genitalia Ignore Ricky’s behavior because he will outgrow it later Engage him in computer TV games that engage his hands

93. The nurse had one on one health education sessions with Ricky’s mother. The mother understood that for her son to learn to cope and be independent, she should constantly provide activities for Ricky to be able to:

A. B. C. D.

socialize with people eventually go to school alone select and prepare his own food do activities of daily living

94. All of the following activities are appropriate for Ricky EXCEPT: A. B. C. D. Working with clay Competitive sport Preparing and cooking simple menu Card and table games

95. Ricky’s IQ falls within the range of 50-55. he can be expected to: A. B. C. D. Profit from vocational training with moderate supervision Live successfully in the community Perform simple tasks in closely supervised settings Acquire academic skills of 6th grade level

Situation 20 – The abuse of dangerous drugs is a serious public health concern that nurses need to address. 96. The nurse should recognize that the unit primarily responsible for education and awareness of the members of the family on the ill effects of dangerous drugs is the: A. B. C. D. law enforcement agencies school church family

97. A drug dependent utilizes this defense mechanism and enables him to forget shame and pain. A. B. C. D. repression rationalization projection sublimation

98. This drug produces mirthfulness, fantasies, flight of ideas, loss of train of thought, distortion of size, distance and time, and “bloodshot eyes” due to dilated pupils. A. B. C. D. Opiates LSD Marijuana Heroin

99. The nurse evaluates that her health teaching to a group of high school boys is effective if these students recognize which of the following dangers of inhalant abuse. A. B. C. D. Sudden death from cardiac or respiratory depression Danger of acquiring hepatitis or AIDS Experience of “blackout” Psychological dependence after prolonged use

100. The mother of a drug dependent would never consider referring her son to a drug rehabilitation agency because she fears her son might just become worse while relating with other drug users. The mother’s behavior can be described as: A. B. C. D. Unhelpful Codependent Caretaking Supportive ***END***

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