SITUATION : Arthur, A registered nurse, witnessed an old woman hit by a motorcycle 6. As a nurse, you instructed Mr.

instructed Mr. Rojas how to use a cane. Mr. Rojas has a weakness
while crossing a train railway. The old woman fell at the railway. Arthur rushed at the on his right leg due to self immobilization and guarding. You plan to teach Mr. Rojas
scene. to hold the cane

1. As a registered nurse, Arthur knew that the first thing that he will do at the scene is A. On his left hand, because his right side is weak.
B. On his left hand, because of reciprocal motion.
A. Stay with the person, Encourage her to remain still and Immobilize the leg while While C. On his right hand, to support the right leg.
waiting for the ambulance. D. On his right hand, because only his right leg is weak.
B. Leave the person for a few moments to call for help.
C. Reduce the fracture manually.
D. Move the person to a safer place. 7. You also told Mr. Rojas to hold the cane
2. Arthur suspects a hip fracture when he noticed that the old woman’s leg is
A. 1 Inches in front of the foot.
A. A. Lengthened, Abducted and Internally Rotated. B. 3 Inches at the lateral side of the foot.
B. Shortened, Abducted and Externally Rotated. C. 6 Inches at the lateral side of the foot.
C. Shortened, Adducted and Internally Rotated. D. 12 Inches at the lateral side of the foot.
D. Shortened, Adducted and Externally Rotated. 8. Mr. Rojas was discharged and 6 months later, he came back to the emergency
3. The old woman complains of pain. John noticed that the knee is reddened, warm to room of the hospital because he suffered a mild stroke. The right side of the brain
touch and swollen. John interprets that this signs and symptoms are likely related to was affected. At the rehabilitative phase of your nursing care, you observe Mr. Rojas
use a cane and you intervene if you see him
A. Infection
B. Thrombophlebitis A. Moves the cane when the right leg is moved.
C. Inflammation B. Leans on the cane when the right leg swings through.
D. Degenerative disease C. keeps the cane 6 Inches out to the side of the right foot.
4. The old woman told John that she has osteoporosis; Arthur knew that all of the D. Holds the cane on the right side.
following factors would contribute to osteoporosis except SITUATION: Alfred, a 40 year old construction worker developed cough, night sweats
and fever. He was brought to the nursing unit for diagnostic studies. He told the nurse
A. Hypothyroidism he did not receive a BCG vaccine during childhood
B. End stage renal disease
C. Cushing’s Disease 9. The nurse performs a Mantoux Test. The nurse knows that Mantoux Test is also
D. Taking Furosemide and Phenytoin. known as
5. Martha, The old woman was now Immobilized and brought to the emergency room.
The X-ray shows a fractured femur and pelvis. The ER Nurse would carefully monitor A. PPD
Martha for which of the following sign and symptoms? B. PDP
C. PDD
A. Tachycardia and Hypotension D. DPP
B. Fever and Bradycardia 10. The nurse would inject the solution in what route?
C. Bradycardia and Hypertension
D. Fever and Hypertension A. IM
SITUATION: Mr. D. Rojas, An obese 35 year old MS Professor of OLFU Lagro is B. IV
admitted due to pain in his weight bearing joint. The diagnosis was Osteoarthritis. C. ID
D. SC
 11. The nurse notes that a positive result for Alfred is 18. According to the DOH, the most hazardous period for development of clinical
disease is during the first
A. 5 mm wheal
B. 5 mm Induration A. 6-12 months after
C. 10 mm Wheal B. 3-6 months after
D. 10 mm Induration C. 1-2 months after
12. The nurse told Alfred to come back after D. 2-4 weeks after
19. This is the name of the program of the DOH to control TB in the country
A. a week
B. 48 hours A. DOTS
C. 1 day B. National Tuberculosis Control Program
D. 4 days C. Short Coursed Chemotherapy
13. Mang Alfred returns after the Mantoux Test. The test result read POSITIVE. What D. Expanded Program for Immunization
should be the nurse’s next action? 20. Susceptibility for the disease [ TB ] is increased markedly in those with the
following condition except
A. Call the Physician
B. Notify the radiology dept. for CXR evaluation A. 23 Year old athlete with diabetes insipidus
C. Isolate the patient B. 23 Year old athlete taking long term Decadron therapy and anabolic steroids
D. Order for a sputum exam C. 23 Year old athlete taking illegal drugs and abusing substances
14. Why is Mantoux test not routinely done in the Philippines? D. Undernourished and Underweight individual who undergone gastrectomy
21. Direct sputum examination and Chest X ray of TB symptomatic is in what level of
A. It requires a highly skilled nurse to perform a Mantoux test prevention?
B. The sputum culture is the gold standard of PTB Diagnosis and it will definitively
determine the extent of the cavitary lesions A. Primary
C. Chest X Ray Can diagnose the specific microorganism responsible for the lesions B. Secondary
D. Almost all Filipinos will test positive for Mantoux Test C. Tertiary
15. Mang Alfred is now a new TB patient with an active disease. What is his category D. Quarterly
according to the DOH? SITUATION: Michiel, A male patient diagnosed with colon cancer was newly put in
colostomy.
A. I
B. II 22. Michiel shows the BEST adaptation with the new colostomy if he shows which of
C. III the following?
D. IV
16. How long is the duration of the maintenance phase of his treatment? A. Look at the ostomy site
B. Participate with the nurse in his daily ostomy care
A. 2 months C. Ask for leaflets and contact numbers of ostomy support groups
B. 3 months D. Talk about his ostomy openly to the nurse and friends
C. 4 months 23. The nurse plans to teach Michiel about colostomy irrigation. As the nurse prepares
D. 5 months the materials needed, which of the following item indicates that the nurse needs
17. Which of the following drugs is UNLIKELY given to Mang Alfred during the further instruction?
maintenance phase?
A. Plain NSS / Normal Saline
A. Rifampicin B. K-Y Jelly
B. Isoniazid C. Tap water
C. Ethambutol D. Irrigation sleeve
D. Pyridoxine
 24. The nurse should insert the colostomy tube for irrigation at approximately 31. The nurse knew that the normal color of Michiel’s stoma should be

A. 1-2 inches A. Brick Red

B. 3-4 inches B. Gray
C. 6-8 inches C. Blue
D. 12-18 inches D. Pale Pink
25. The maximum height of irrigation solution for colostomy is SITUATION: James, A 27 basketball player sustained inhalation burn that required
him to have tracheostomy due to massive upper airway edema.
A. 5 inches
B. 12 inches 32. Wilma, His sister and a nurse is suctioning the tracheostomy tube of James. Which
C. 18 inches of the following, if made by Wilma indicates that she is committing an error?
D. 24 inches
26. Which of the following behavior of the client indicates the best initial step in A. Hyperventilating James with 100% oxygen before and after suctioning
learning to care for his colostomy? B. Instilling 3 to 5 ml normal saline to loosen up secretion
C. Applying suction during catheter withdrawal
A. Ask to defer colostomy care to another individual D. Suction the client every hour
B. Promises he will begin to listen the next day 33. What size of suction catheter would Wilma use for James, who is 6 feet 5 inches
C. Agrees to look at the colostomy in height and weighing approximately 145 lbs?
D. States that colostomy care is the function of the nurse while he is in the hospital
27. While irrigating the client’s colostomy, Michiel suddenly complains of severe A. Fr. 5
cramping. Initially, the nurse would B. Fr. 10
C. Fr. 12
A. Stop the irrigation by clamping the tube D. Fr. 18
B. Slow down the irrigation 34. Wilma is using a portable suction unit at home, What is the amount of suction
C. Tell the client that cramping will subside and is normal required by James using this unit?
D. Notify the physician
28. The next day, the nurse will assess Michiel’s stoma. The nurse noticed that a A. 2-5 mmHg
prolapsed stoma is evident if she sees which of the following? B. 5-10 mmHg
C. 10-15 mmHg
A. A sunken and hidden stoma D. 20-25 mmHg
B. A dusky and bluish stoma 35. If a Wall unit is used, What should be the suctioning pressure required by James?
C. A narrow and flattened stoma
D. Protruding stoma with swollen appearance A. 50-95 mmHg
29. Michiel asked the nurse, what foods will help lessen the odor of his colostomy. B. 95-110 mmHg
The nurse best response would be C. 100-120 mmHg
D. 155-175 mmHg
A. Eat eggs 36. Wilma was shocked to see that the Tracheostomy was dislodged. Both the inner
B. Eat cucumbers and outer cannulas was removed and left hanging on James’ neck. What are the 2
C. Eat beet greens and parsley equipment’s at james’ bedside that could help Wilma deal with this situation?
D. Eat broccoli and spinach
30. The nurse will start to teach Michiel about the techniques for colostomy irrigation. A. New set of tracheostomy tubes and Oxygen tank
Which of the following should be included in the nurse’s teaching plan? B. Theophylline and Epinephrine
C. Obturator and Kelly clamp
A. Use 500 ml to 1,000 ml NSS D. Sterile saline dressing
B. Suspend the irrigant 45 cm above the stoma
C. Insert the cone 4 cm in the stoma
D. If cramping occurs, slow the irrigation
 37. Which of the following method if used by Wilma will best assure that the 43. The Nurse notices that Mr. Batumbakal cannot anymore determine RED from
tracheostomy ties are not too tightly placed? BLUE. The nurse knew that which part of the eye is affected by this change?

A. Wilma places 2 fingers between the tie and neck A. IRIS

B. The tracheotomy can be pulled slightly away from the neck B. PUPIL
C. James’ neck veins are not engorged C. RODS [RETINA]
D. Wilma measures the tie from the nose to the tip of the earlobe and to the xiphoid D. CONES [RETINA]
process. 44. Nurse Jet knows that Aqueous Humor is produce where?
38. Wilma knew that James have an adequate respiratory condition if she notices that
A. In the sub arachnoid space of the meninges
A. James’ respiratory rate is 18 B. In the Lateral ventricles
B. James’ Oxygen saturation is 91% C. In the Choroids
C. There are frank blood suction from the tube D. In the Ciliary Body
D. There are moderate amount of tracheobronchial secretions 45. Nurse Jet knows that the normal IOP is
39. Wilma knew that the maximum time when suctioning James is
A. 8-21 mmHg
A. 10 seconds B. 2-7 mmHg
B. 20 seconds C. 31-35 mmHg
C. 30 seconds D. 15-30 mmHg
D. 45 seconds 46. Nurse Jet wants to measure Mr. Batumbakal’s CN II Function. What test would
SITUATION : Juan Miguel Lopez Zobel Ayala de Batumbakal was diagnosed with Nurse Jet implement to measure CN II’s Acuity?
Acute Close Angle Glaucoma. He is being seen by Nurse Jet.
A. Slit lamp
40. What specific manifestation would nurse Jet see in Acute close angle glaucoma B. Snellen’s Chart
that she would not see in an open angle glaucoma? C. Wood’s light
D. Gonioscopy
A. Loss of peripheral vision 47. The Doctor orders pilocarpine. Nurse jet knows that the action of this drug is to
B. Irreversible vision loss
C. There is an increase in IOP A. Contract the Ciliary muscle
D. Pain B. Relax the Ciliary muscle
41. Nurse jet knew that Acute close angle glaucoma is caused by C. Dilate the pupils
D. Decrease production of Aqueous Humor
A. Sudden blockage of the anterior angle by the base of the iris 48. The doctor orders timolol [timoptic]. Nurse jet knows that the action of this drug
B. Obstruction in trabecular meshwork is
C. Gradual increase of IOP
D. An abrupt rise in IOP from 8 to 15 mmHg A. Reduce production of CSF
42. Nurse jet performed a TONOMETRY test to Mr. Batumbakal. What does this test B. Reduce production of Aquesous Humor
measures C. Constrict the pupil
D. Relaxes the Ciliary muscle
A. It measures the peripheral vision remaining on the client 49. When caring for Mr. Batumbakal, Jet teaches the client to avoid
B. Measures the Intra Ocular Pressure
C. Measures the Client’s Visual Acuity A. Watching large screen TVs
D. Determines the Tone of the eye in response to the sudden increase in IOP. B. Bending at the waist
C. Reading books
D. Going out in the sun
 50. Mr. Batumbakal has undergone eye angiography using an Intravenous dye and 55. After mastoidectomy, Nurse John should be aware that the cranial nerve that is
fluoroscopy. What activity is contraindicated immediately after procedure? usually damage after this procedure is

A. Reading newsprint A. CN I
B. Lying down B. CN II
C. Watching TV C. CN VII
D. Listening to the music D. CN VI
51. If Mr. Batumbakal is receiving pilocarpine, what drug should always be available in 56. The physician orders the following for the client with Menieres disease. Which of
any case systemic toxicity occurs? the following should the nurse question?

A. Atropine Sulfate A. Dipenhydramine [Benadryl]

B. Pindolol [Visken] B. Atropine sulfate
C. Naloxone Hydrochloride [Narcan] C. Out of bed activities and ambulation
D. Mesoridazine Besylate [Serentil] D. Diazepam [Valium]
SITUATION : Wide knowledge about the human ear, it’s parts and it’s functions will 57. Nurse Anna is giving dietary instruction to a client with Menieres disease. Which
help a nurse assess and analyze changes in the adult client’s health. statement if made by the client indicates that the teaching has been successful?

52. Nurse Anna is doing a caloric testing to his patient, Aida, a 55 year old university A. I will try to eat foods that are low in sodium and limit my fluid intake
professor who recently went into coma after being mauled by her disgruntled 3rd year B. I must drink atleast 3,000 ml of fluids per day
nursing students whom she gave a failing mark. After instilling a warm water in the C. I will try to follow a 50% carbohydrate, 30% fat and 20% protein diet
ear, Anna noticed a rotary nystagmus towards the irrigated ear. What does this D. I will not eat turnips, red meat and raddish
means? 58. Peachy was rushed by his father, Steven into the hospital admission. Peachy is
complaining of something buzzing into her ears. Nurse Joemar assessed peachy and
A. Indicates a CN VIII Dysfunction found out It was an insect. What should be the first thing that Nurse Joemar should
B. Abnormal try to remove the insect out from peachy’s ear?
C. Normal
D. Inconclusive A. Use a flashlight to coax the insect out of peachy’s ear
53. Ear drops are prescribed to an infant, The most appropriate method to administer B. Instill an antibiotic ear drops
the ear drops is C. Irrigate the ear
D. Pick out the insect using a sterile clean forceps
A. Pull the pinna up and back and direct the solution towards the eardrum 59. Following an ear surgery, which statement if heard by Nurse Oca from the patient
B. Pull the pinna down and back and direct the solution onto the wall of the canal indicates a correct understanding of the post operative instructions?
C. Pull the pinna down and back and direct the solution towards the eardrum
D. Pull the pinna up and back and direct the solution onto the wall of the canal A. Activities are resumed within 5 days
54. Nurse Jenny is developing a plan of care for a patient with Menieres disease. What B. I will make sure that I will clean my hair and face to prevent infection
is the priority nursing intervention in the plan of care for this particular patient? C. I will use straw for drinking
D. I should avoid air travel for a while
A. Air, Breathing, Circulation 60. Nurse Oca will do a caloric testing to a client who sustained a blunt injury in the
B. Love and Belongingness head. He instilled a cold water in the client’s right ear and he noticed that nystagmus
C. Food, Diet and Nutrition occurred towards the left ear. What does this finding indicates?
D. Safety
A. Indicating a Cranial Nerve VIII Dysfunction
B. The test should be repeated again because the result is vague
C. This is Grossly abnormal and should be reported to the neurosurgeon
D. This indicates an intact and working vestibular branch of CN VIII
 61. A client with Cataract is about to undergo surgery. Nurse Oca is preparing plan of 66. Postural Hypotension is
care. Which of the following nursing diagnosis is most appropriate to address the long
term need of this type of patient? A. A drop in systolic pressure less than 10 mmHg when patient changes position from
lying to sitting.
A. Anxiety R/T to the operation and its outcome B. A drop in systolic pressure greater than 10 mmHg when patient changes position from
B. Sensory perceptual alteration R/T Lens extraction and replacement lying to sitting
C. Knowledge deficit R/T the pre operative and post operative self care C. A drop in diastolic pressure less than 10 mmHg when patient changes position from
D. Body Image disturbance R/T the eye packing after surgery lying to sitting
62. Nurse Joseph is performing a WEBERS TEST. He placed the tuning fork in the D. A drop in diastolic pressure greater than 10 mmHg when patient changes position
patients forehead after tapping it onto his knee. The client states that the fork is from lying to sitting
louder in the LEFT EAR. Which of the following is a correct conclusion for nurse Josph 67. Which of the following measures will not help correct the patient’s condition
to make?
A. Offer large amount of oral fluid intake to replace fluid lost
A. He might have a sensory hearing loss in the left ear B. Give enteral or parenteral fluid
B. Conductive hearing loss is possible in the right ear C. Frequent oral care
C. He might have a sensory hearing loss in the right hear, and/or a conductive hearing D. Give small volumes of fluid at frequent interval
loss in the left ear. 68. After nursing intervention, you will expect the patient to have
D. He might have a conductive hearing loss in the right ear, and/or a sensory hearing
loss in the left ear. 1. Maintain body temperature at 36.5 C
63. Aling myrna has Menieres disease. What typical dietary prescription would nurse 2. Exhibit return of BP and Pulse to normal
Oca expect the doctor to prescribe? 3. Manifest normal skin turgor of skin and tongue
4. Drinks fluids as prescribed
A. A low sodium , high fluid intake A. 1,3
B. A high calorie, high protein dietary intake B. 2,4
C. low fat, low sodium and high calorie intake C. 1,3,4
D. low sodium and restricted fluid intake D. 2,3,4
SITUATION: A 65 year old woman was admitted for Parkinson’s Disease. The charge
nurse is going to make an initial assessment.
SITUATION : [ From DEC 1991 NLE ] A 45 year old male construction worker was
admitted to a tertiary hospital for incessant vomiting. Assessment disclosed: weak 69. Which of the following is a characteristic of a patient with advanced Parkinson’s
rapid pulse, acute weight loss of .5kg, furrows in his tongue, slow flattening of the disease?
skin was noted when the nurse released her pinch.
Temperature: 35.8 C , BUN Creatinine ratio : 10 : 1, He also complains for postural A. Disturbed vision
hypotension. There was no infection. B. Forgetfulness
C. Mask like facial expression
64. Which of the following is the appropriate nursing diagnosis? D. Muscle atrophy
70. The onset of Parkinson’s disease is between 50-60 years old. This disorder is
A. Fluid volume deficit R/T furrow tongue caused by
B. Fluid volume deficit R/T uncontrolled vomiting
C. Dehydration R/T subnormal body temperature A. Injurious chemical substances
D. Dehydration R/T incessant vomiting B. Hereditary factors
65. Approximately how much fluid is lost in acute weight loss of .5kg? C. Death of brain cells due to old age
D. Impairment of dopamine producing cells in the brain
A. 50 ml
B. 750 ml
C. 500 ml
D. 75 ml
 71. The patient was prescribed with levodopa. What is the action of this drug? 77. As the nurse talks to the daughter of Mr. Dela Isla, which of the following
statement of the daughter will require the nurse to give further teaching?
A. Increase dopamine availability
B. Activates dopaminergic receptors in the basal ganglia A. I know the hallucinations are parts of the disease
C. Decrease acetylcholine availability B. I told her she is wrong and I explained to her what is right
D. Release dopamine and other catecholamine from neurological storage sites C. I help her do some tasks he cannot do for himself
72. You are discussing with the dietician what food to avoid with patients taking D. Ill turn off the TV when we go to another room
levodopa? 78. Which of the following is most important discharge teaching for Mr. Dela Isla

A. Vitamin C rich food A. Emergency Numbers

B. Vitamin E rich food B. Drug Compliance
C. Thiamine rich food C. Relaxation technique
D. Vitamin B6 rich food D. Dietary prescription
73. One day, the patient complained of difficulty in walking. Your response would be SITUATION : Knowledge of the drug PROPANTHELINE BROMIDE [Probanthine] Is
necessary in treatment of various disorders.
A. You will need a cane for support
B. Walk erect with eyes on horizon 79. What is the action of this drug?
C. I’ll get you a wheelchair
D. Don’t force yourself to walk A. Increases glandular secretion for clients affected with cystic fibrosis
SITUATION: Mr. Dela Isla, a client with early Dementia exhibits thought process B. Dissolve blockage of the urinary tract due to obstruction of cystine stones
disturbances. C. Reduces secretion of the glandular organ of the body
D. Stimulate peristalsis for treatment of constipation and obstruction
74. The nurse will assess a loss of ability in which of the following areas? 80. What should the nurse caution the client when using this medication

A. Balance A. Avoid hazardous activities like driving, operating machineries etc.

B. Judgment B. Take the drug on empty stomach
C. Speech C. Take with a full glass of water in treatment of Ulcerative colitis
D. Endurance D. I must take double dose if I missed the previous dose
75. Mr. Dela Isla said he cannot comprehend what the nurse was saying. He suffers 81. Which of the following drugs are not compatible when taking Probanthine?
from:
A. Caffeine
A. Insomnia B. NSAID
B. Aphraxia C. Acetaminophen
C. Agnosia D. Alcohol
D. Aphasia 82. What should the nurse tell clients when taking Probanthine?
76. The nurse is aware that in communicating with an elderly client, the nurse will
A. Avoid hot weathers to prevent heat strokes
A. Lean and shout at the ear of the client B. Never swim on a chlorinated pool
B. Open mouth wide while talking to the client C. Make sure you limit your fluid intake to 1L a day
C. Use a low-pitched voice D. Avoid cold weathers to prevent hypothermia
D. Use a medium-pitched voice 83. Which of the following disease would Probanthine exert the much needed action
for control or treatment of the disorder?

A. Urinary retention
B. Peptic Ulcer Disease
C. Ulcerative Colitis
D. Glaucoma
 SITUATION : Mr. Franco, 70 years old, suddenly could not lift his spoons nor speak at 89. Which result of the lab test will be significant to the diagnosis?
breakfast. He was rushed to the hospital unconscious. His diagnosis was CVA.
A. RBC : 4.5 TO 5 Million / cu. mm.
84. Which of the following is the most important assessment during the acute stage of B. Hgb : 13 to 14 gm/dl.
an unconscious patient like Mr. Franco? C. Platelets : 250,000 to 500,000 cu.mm.
D. WBC : 12,000 to 13,000/cu.mm
A. Level of awareness and response to pain 90. Stat appendectomy was indicated. Pre op care would include all of the following
B. Papillary reflexes and response to sensory stimuli except?
C. Coherence and sense of hearing
D. Patency of airway and adequacy of respiration A. Consent signed by the father
85. Considering Mr. Franco’s conditions, which of the following is most important to B. Enema STAT
include in preparing Franco’s bedside equipment? C. Skin prep of the area including the pubis
D. Remove the jewelries
A. Hand bell and extra bed linen 91. Pre-anesthetic med of Demerol and atrophine sulfate were ordered to :
B. Sandbag and trochanter rolls
C. Footboard and splint A. Allay anxiety and apprehension
D. Suction machine and gloves B. Reduce pain
86. What is the rationale for giving Mr. Franco frequent mouth care? C. Prevent vomiting
D. Relax abdominal muscle
A. He will be thirsty considering that he is doesn’t drink enough fluids 92. Common anesthesia for appendectomy is
B. To remove dried blood when tongue is bitten during a seizure
C. The tactile stimulation during mouth care will hasten return to consciousness A. Spinal
D. Mouth breathing is used by comatose patient and it’ll cause oral mucosa dying and B. General
cracking. C. Caudal
87. One of the complications of prolonged bed rest is decubitus ulcer. Which of the D. Hypnosis
following can best prevent its occurrence? 93. Post op care for appendectomy include the following except

A. Massage reddened areas with lotion or oils A. Early ambulation

B. Turn frequently every 2 hours B. Diet as tolerated after fully conscious
C. Use special water mattress C. Nasogastric tube connect to suction
D. Keep skin clean and dry D. Deep breathing and leg exercise
88. If Mr. Franco’s Right side is weak, What should be the most accurate analysis by 94. Peritonitis may occur in ruptured appendix and may cause serious problems which
the nurse? are

A. Expressive aphasia is prominent on clients with right sided weakness 1. Hypovolemia, electrolyte imbalance
B. The affected lobe in the patient is the Right lobe 2. Elevated temperature, weakness and diaphoresis
C. The client will have problems in judging distance and proprioception 3. Nausea and vomiting, rigidity of the abdominal wall
D. Clients orientation to time and space will be much affected 4. Pallor and eventually shock
SITUATION : a 20 year old college student was rushed to the ER of PGH after he A. 1 and 2
fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation B. 2 and 3
of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. C. 1,2,3
Diagnosis is acute appendicitis. D. All of the above
 95. If after surgery the patient’s abdomen becomes distended and no bowel sounds
appreciated, what would be the most suspected complication?

A. Intussusception
B. Paralytic Ileus
C. Hemorrhage
D. Ruptured colon
96. NGT was connected to suction. In caring for the patient with NGT, the nurse must

A. Irrigate the tube with saline as ordered

B. Use sterile technique in irrigating the tube
C. advance the tube every hour to avoid kinks
D. Offer some ice chips to wet lips
97. When do you think the NGT tube be removed?

A. When patient requests for it

B. Abdomen is soft and patient asks for water
C. Abdomen is soft and flatus has been expelled
D. B and C only
Situation: Amanda is suffering from chronic arteriosclerosis Brain syndrome she fell
while getting out of the bed one morning and was brought to the hospital, and she
was diagnosed to have cerebrovascular thrombosis thus transferred to a nursing
home.

98. What do you call a STROKE that manifests a bizarre behavior?

A. Inorganic Stroke
B. Inorganic Psychoses
C. Organic Stroke
D. Organic Psychoses
99. The main difference between chronic and organic brain syndrome is that the
former

A. Occurs suddenly and reversible

B. Is progressive and reversible
C. tends to be progressive and irreversible
D. Occurs suddenly and irreversible
100. Which behavior results from organic psychoses?

A. Memory deficit
B. Disorientation
C. Impaired Judgement
D. Inappropriate affect
 Answers 48. B. Reduce production of Aquesous Humor
1. D. Move the person to a safer place. 49. B. Bending at the waist
2. D. Shortened, Adducted and Externally Rotated. 50. A. Reading newsprint
3. C. Inflammation 51. A. Atropine Sulfate
4. A. Hypothyroidism 52. C. Normal
5. A. Tachycardia and Hypotension 53. B. Pull the pinna down and back and direct the solution onto the wall of the canal
6. B. On his left hand, because of reciprocal motion. 54. D. Safety
7. c. 6 Inches at the lateral side of the foot. 55. C. CN VII
8. A. Moves the cane when the right leg is moved. 56. C. Out of bed activities and ambulation
9. A. PPD 57. A. I will try to eat foods that are low in sodium and limit my fluid intake
10. C. ID 58. A. Use a flashlight to coax the insect out of peachy’s ear
11. D. 10 mm Induration 59. D. I should avoid air travel for a while
12. B. 48 hours 60. D. This indicates an intact and working vestibular branch of CN VIII
13. A. Call the Physician 61. B. Sensory perceptual alteration R/T Lens extraction and replacement
14. D. Almost all Filipinos will test positive for Mantoux Test 62. C. He might have a sensory hearing loss in the right hear, and/or a conductive
15. A. I hearing loss in the left ear.
16. C. 4 months 63. D. low sodium and restricted fluid intake
17. C. Ethambutol 64. B. Fluid volume deficit R/T uncontrolled vomiting
18. A. 6-12 months after 65. C. 500 ml
19. B. National Tuberculosis Control Program 66. B. A drop in systolic pressure greater than 10 mmHg when patient changes position
20. A. 23 Year old athlete with diabetes insipidus from lying to sitting
21. B. Secondary 67. A. Offer large amount of oral fluid intake to replace fluid lost
22. B. Participate with the nurse in his daily ostomy care 68. D. 2,3,4
23. A. Plain NSS / Normal Saline 69. C. Mask like facial expression
24. B. 3-4 inches 70. D. Impairment of dopamine producing cells in the brain
25. C. 18 inches 71. A. Increase dopamine availability
26. C. Agrees to look at the colostomy 72. D. Vitamin B6 rich food
27. A. Stop the irrigation by clamping the tube 73. A. You will need a cane for support
28. D. Protruding stoma with swollen appearance 74. B. Judgment
29. C. Eat beet greens and parsley 75. D. Aphasia
30. B. Suspend the irrigant 45 cm above the stoma 76. D. Use a medium-pitched voice
31. A. Brick Red 77. B. I told her she is wrong and I explained to her what is right
32. D. Suction the client every hour 78. B. Drug Compliance
33. D. Fr. 18 79. C. Reduces secretion of the glandular organ of the body
34. C. 10-15 mmHg 80. A. Avoid hazardous activities like driving, operating machineries etc.
35. C. 100-120 mmHg 81. D. Alcohol
36. C. Obturator and Kelly clamp 82. A. Avoid hot weathers to prevent heat strokes
37. A. Wilma places 2 fingers between the tie and neck 83. B. Peptic Ulcer Disease
38. A. James’ respiratory rate is 18 84. D. Patency of airway and adequacy of respiration
39. A. 10 seconds 85. D. Suction machine and gloves
40. D. Pain 86. D. Mouth breathing is used by comatose patient and it’ll cause oral mucosa dying and
41. A. Sudden blockage of the anterior angle by the base of the iris cracking.
42. B. Measures the Intra Ocular Pressure 87. B. Turn frequently every 2 hours
43. D. CONES [RETINA] 88. A. Expressive aphasia is prominent on clients with right sided weakness
44. D. In the Ciliary Body 89. D. WBC : 12,000 to 13,000/cu.mm
45. A. 8-21 mmHg 90. B. Enema STAT
46. B. Snellen’s Chart 91. A. Allay anxiety and apprehension
47. A. Contract the Ciliary muscle 92. A. Spinal
93. B. Diet as tolerated after fully conscious
94. D. All of the above
95. B. Paralytic Ileus
96. A. Irrigate the tube with saline as ordered
97. C. Abdomen is soft and flatus has been expelled
98. D. Organic Psychoses
99. C. tends to be progressive and irreversible
100. B. Disorientation