1. Which of the following goals is correctly written?

A. Client will drink 200 ml of water per hour

B. Client will maintain client hydration
C. Client will restore fluid volume
D. Client will be able to drink 200 ml of water
2. In writing client goals, all of the following guidelines should be considered EXCEPT:
A. Ensure that the goals are compatible with therapies of other professionals
B. It must be realistic for clients limitation
C. Write client goals in terms of nurses response and activities
D. The goal must be derive from the nursing diagnosis
3. Which of the following nursing diagnosis should be given priority?
A. Risk for interrupted family process
B. Ineffective airway clearance
C. Self-care deficit
D. Disturbed sleeping pattern
4. All of the following describes Independent nursing interventions EXCEPT:
A. Activities such as physical care
B. Emotional assessment
C. Diagnostic test
D. Regulating IV fluids
5. The nurse selects the nursing diagnosis Risk for impaired skin integrity related to
immobility, dry skin, and surgical incision. Which of the following represents a properly
stated outcome?
A. Turn to bed every 2 hours
B. Report the importance of applying lotion to skin daily
C. Have intact skin during hospitalization
D. Use a pressure reducing mattress
6. 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. When doing
an initial assessment, the best way for you to identify the client’s priority problem is to:
A. Interview the client for chief complaints and other symptoms
B. Talk to the relatives to gather data about history of illness
C. Do auscultation to check for chest congestion
D. Do a physical examination while asking the client relevant questions
7. The basic difference between nursing diagnoses and collaborative problems is that:
 A. Nurses manage collaborative problems using physician-prescribed interventions.
B. Collaborative problems can be managed by independent nursing interventions.
C. Nursing diagnoses incorporate physician-prescribed interventions.
D. Nursing diagnoses incorporate physiologic complications that nurses monitor to
detect change in status.
8. 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. 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
9. You are doing bed bath to the client when suddenly, the nursing assistant rushed to the
room and tell you that the client from the other room was in Pain. The best intervention
in such case is:
A. Raise the side rails, cover the client and put the call bell within reach and then
attend to the client in pain to give the PRN medication
B. Tell the nursing assistant to give the pain medication to the client complaining of
pain
C. Tell the nursing assistant to go the client’s room and tell the client to wait
D. Finish the bed bath quickly then rush to the client in Pain
10. Which of the following is a form of primary prevention?
A. Regular Check ups
B. Regular Screening
C. Self-Medication
D. Immunization
11. The term psychomotor refers to physical actions that are controlled by the mind, and
not reflexive. Another term for this is:
A. Cognitive skills
B. Technical skills
C. Interpersonal skills
D. Affective skills
12. When initiating the implementation phase of the nursing process, the nurse performs
which of the following steps first? 243
A. Carrying out nursing interventions
B. Determining the need for assistance
C. Reassessing the client
13. Under what circumstances it is considered acceptable practice for the nurse to
document a nursing activity before it is carried out? 243
 A. When the activity is routine
B. When the activity occurs at regular interval
C. When the activity is to be carried out immediately
D. It is never acceptable
14. Which of the following is the primary purpose of the evaluating phase of the care
planning process to determine whether: 243
A. Desired outcomes have been met
B. Nursing activities were carried out
C. Nursing activities were effective
D. Clients condition have been changed
15. The traditional client record is a source oriented record. Its charting consists of written
notes that include routine care, normal findings, and client problems. An example of this
is:
A. Problem oriented record
B. Narrative charting
C. Progress notes
D. Database
16. The 4 components of POMR are:
A. Database, Progress notes, plan of care, narrative charting
B. Database, plan of care, problem list, narrative charting
C. Progress notes, narrative charting, data base, problem list
D. Progress notes, plan of care, database, problem list
17. A Progress Notes in the Problem Oriented Medical Record (POMR) is a chart entry made
by all health professionals involved in a client’s care. This type of format is frequently
used on this notes.
A. SOAP
B. SOAPIER
C. SOAPIE
D. All of the above
18. This type of charting is intended to make the client and client concerns and strengths
and focus of care. Three columns for recording are usually used:
A. Date and time, focus, progress notes
B. date and time, database, plan of care
C. date and time, focus, progress notes
D. progress notes, problem list, database
19. DAR means:
A. Date, action, results
B. Data, analysis, response
C. Data, action, response
D. Data, analysis, results
20. The infant of a substance-abusing mother is at risk for developing a sense of which of
the following?
A. Mistrust
B. Shame
C. Guilt
D. Inferiority
21. The mother of a 2-month-old is concerned that she may be spoiling her baby by picking
her up when she cries. Which of the following would be the nurse’s best response?
A. “ Let her cry for a while before picking her up, so you don’t spoil her”
B. “Babies need to be held and cuddled; you won’t spoil her this way”
C. “Crying at this age means the baby is hungry; give her a bottle”
D. “If you leave her alone she will learn how to cry herself to sleep”
22. If parents keep a toddler dependent in areas where he is capable of using skills, the
toddle will develop a sense of which of the following?
A. Mistrust
B. Shame
C. Guilt
D. Inferiority
23. After teaching a group of parents about accident prevention for school agers, which of
the following statements by the group would indicate the need for more teaching?
A. “School agers are more active and adventurous than are younger children.”
B. “School agers are more susceptible to home hazards than are younger children.”
C. “School agers are unable to understand potential dangers around them.”
D. “School agers are less subject to parental control than are younger children.”
24. The adolescent’s inability to develop a sense of who he is and what he can become
results in a sense of which of the following?
A. Shame
B. Guilt
C. Inferiority
D. Role diffusion
25. A flow sheet enables a nurse to record nursing data quickly and it provides easy to read
record. The TPR is written on :
A. Medication administration
B. Graphic record
C. Assessment record
26. In The most basic goal of health promotion is:
A. Absence of a disease
B. Wellness
C. No illness
D. Be healthy
27. Health promotion essentially involves nursing activities that:
A. Disseminate health knowledge, values and healthy lives
B. Encourage nurse community partnership in health
 C. Help people develop abilities to keep healthy
D. Enhance people’s quality of life
28. When a nurse conducts health promotion activity, an important aspect to consider is:
A. Giving anticipatory guidance
B. Coordinating public health education
C. Assisting in immunization
D. Case finding
29. To be able to modify the smoking behavior of a client, it is most important to collect
which of the following:
A. His health beliefs and practices
B. His family lifestyle
C. Coping ability of his family
D. Available health services in his community
30. Which of the following factors will most likely convince a client to quit smoking?
A. A motivation to quit smoking
B. Giving some incentives if he quits smoking
C. Knowledge on ill effects of smoking
D. Social support for the desired behavior
31. The primary purpose of health education is:
A. To assess peoples reaction to health services currently implemented
B. To inform the public of the available health programs and services
C. To provide information on health promotion
D. To facilitate change attitudes and behaviors towards health
32. Which of the following is true in health promotion?
A. Health behavior cannot be modified
B. The end product of learning is output
C. One’s response Is the key to behavior change
D. A persons behavior is not under conscious control.
33. Health promotion activities will likely be more effective when professional nurses:
A. Use health communication technology
B. Are models of health
C. Conduct health education programs
D. Know public views on health
34. Rehabilitation is what level of preventive measure?
A. First level
B. Second level
C. Third level
D. All of the above
35. Rehabilitation begins:
A. After the patient’s condition has stabilized
B. When the patient’s request for the service
 C. When the patient is admitted in the hospital
D. Upon discharge from the hospital
36. The ability to manage stress and to express emotions is under what component of
wellness?
A. Social
B. Emotional
C. Intellectual
D. Spiritual
37. Nurse’s definition of health largely determine the scope f nursing. In Adaptive model,
health is a creative process in where the aim of treatment is :
A. To meet self-actualization
B. To restore the ability of the person to adapt
C. To relieve from the signs and symptoms manifested by the patient
D. To be able to fulfill patients role even if they have illnesses.
38. According to Leavell and Clark, the agent-host environment model is also called the:
A. Ecologic model
B. Health grid
C. Eudemonistic model
D. Clinical model
39. When a person has the knowledge to implement a healthy lifestyle but is deprived of it
because of job demands, this person will fall under what category according to Dunn’s
High Level of Wellness?
A. Poor health in an unfavorable environment
B. Poor health in an unfavorable environment
C. High level wellness in a favorable environment
D. Emergent high level wellness in an unfavorable environment
40. Travis & Ryan believed:
A. It is possible to be physically ill and at the same time oriented towards illness
B. It is possible to be physically ill and at the same time oriented towards wellness
C. It is possible to be physically healthy and at the same time function from an illness
mentality
D. All of the above
41. The following are the internal variables affecting a person’s health
A. Innate temperament, emotional responses, standard of living
B. Mind body interactions, emotional responses, gender
C. Environment, standard of living, cultural beliefs
D. Lifestyle, psychological dimension, social supports
42. Hanz is able to maintain his ideal weight and avoid fatty foods. He exercises what kind of
control under the Health Locus of Control Model?
A. External
B. Appetite
 C. Internal
D. Weight
43. Perceived susceptibility reflects on what situation given?
A. When a person knows his prognosis of illness
B. When he knows he has a family history of Diabetes
C. When a person is living in a community surrounded by homosexuals and drug addict
D. When a person knows that AIDS is a very serious disease
44. Perceived threat reflects on what situation given?
A. When a person knows his prognosis of illness
B. When he knows he has a family history of Diabetes
C. When a person is living in a community surrounded by homosexuals and drug addict
D. When a person knows that AIDS is a very serious disease
45. Age could be a modifying factor to be able to perceive ones susceptibility to illness and
belongs to what variable?
A. Socio psychological variables
B. Demographic variables
C. Structural variables
D. External variables
46. When a nurse identifies non adherence, it is important to take the following steps
except:
A. Demonstrate caring
B. Provide knowledge, skills and information’s
C. Never give control to patients over their health
D. Leave a pamphlet for the client to read
47. It is described as an alteration in body function resulting in a reduction of one’s life span.
A. Etiology
B. Illness
C. Disease
D. Wellness
48. Exacerbation means:
A. Having sever symptoms on a short course duration
B. Slow onset of symptoms on a long course duration
C. When symptoms disappear
D. When symptoms reappear
49. A patient experiences pain on his chest area and is taken to the hospital immediately.
On what stage does the patient enters according to Suchman’s 5 stages of illness?
A. Stage 2
B. Stage 3
C. Stage 4
D. Stage 5
50. During this stage the client is expected to relinquish the dependent role mode and
resume former roles and responsibilities.
A. Stage 2
B. Stage 3
C. Stage 4
D. Stage 5
51. A person’s illness affects not only the person who is ill but also the family or significant
others. The kind of effect and its extend depend chiefly on the following except:
A. Members of the family
B. Seriousness of the illness
C. Cultural and social customs
D. Not making arrangements whenever possible to accommodate patient’s lifestyle.
52. Which of the following is an example of the emotional component of wellness?
A. The client chooses healthy foods
B. A new father decides to take parenting classes
C. A client expresses frustration towards his wife
D. A widow with no family decides to join basketball league
53. Which of the following is the best example of complete documentation?
A. “8:30 AM - Client received aspirin and oxycodone (Percodan; 1 tablet) PO”
B. “12:15 PM - I gave the client morphine 10 mg IM at 11:10 AM, but did not
document it then”
C. “2:45 PM - Acetylsalicylic acid (ASA) gr X given for temperature of 38.1° C”
D. “8:30 PM - Abdominal dressing change at 7:30 PM. No s/s of infection, and wound
edges approximating well
54. “Client is wheezing and experiencing some dyspnea on exertion.” This is an example of:
A. The “S” in SOAP documentation
B. FOCUS documentation
C. The “P” of PIE
D. The “R” in DAR documentation
55. The client draws back when the nurse reaches over the side rails to take his blood
pressure. To promote effective communication, the nurse should first:
A. Tell the client that the blood pressure can be taken at a later time
B. Rotate the nurses who are assigned to take the client’s blood pressure
C. Continue to perform the procedure quickly and quietly
D. Apologize for startling the client and explain the need for contact
56. Recording a nurse’s description of the teaching provided to the client on performance of
self-medication administration is found in a(n):
A. Kardex
B. Incident report
C. Nursing history form
D. Discharge summary form
57. The charge nurse is evaluating the documentation of the new staff nurse. On review of
the charting, the charge nurse notes that appropriate documentation is evident when
the new staff nurse:
A. Uses a pencil to make the entries
B. Uses correction fluid to correct written errors
C. identifies an error made by the attending physician
D. Dates and signs all of the entries made in the record
58. The nurse is establishing a helping relationship with the client. In addressing the client,
the nurse should:
A. Use the client’s first name.
B. Touch the client right away to establish contact.
C. Sit far enough away from the client.
D. Knock before entering the client’s room.
59. Which of the following chart entries are not acceptable?
A. Patient complained of chest pain
B. Patient ambulated to B/R
C. Vital signs 130/70; 84; 20
D. Pain relieved by Nitrogylcerine gr 1/150 sublingually
60. Which of the following indicates narrative charting?
A. Written descriptive nurse’s notes
B. Date recorded on nurse activity sheet
C. Use of checklist
D. Use of flowsheet
61. What are the three parts of the Nursing Diagnosis?
A. Medical Diagnosis, etiology, signs & symptoms
B. Problem, intervention, evaluation
C. Problem, etiology, signs and symptoms
D. Problem, etiology, goal
62. A nurse is caring for a client in a facility. Which intervention should the nurse perform to
measure the effectiveness of nursing care?
A. Document observable evidence
B. Reassess needs
C. Focus on actual problem
D. Set goals for client
63. When prioritizing nursing dx's, what should you keep in mind?
A. Rank nursing diagnosis
B. Focus on clients concerns
C. Actual nursing diagnosis may not be prioritized
D. Focus on psychosocial concerns of the client
64. A client with frequent chest pain that disappears after time. Assessment reveals non-
acute pain and the doctor suspects heartburn. Which question would the nurse ask to
validate this interpretation?
A. Do you see blood in your stool?
B. Do you have digestive problems?
C. When was your last menstrual period?
D. What immunizations did you have?
65. The primary purpose of the nursing care plan is:
A. Ensure consistency among staff
B. Substitute nursing care plan for policy and procedures
C. Organize the Laboratory works
D. Tell nurses what is to be done
66. A nurse is planning for discharge. What steps should he/she take?
A. Note unresolved problems in the nursing care plan
B. Set new goals after the old ones are met
C. Review if client has helped realize self- care goals
D. Change goals that were unmet
67. The nurse observes and monitors the client's v/s and listens carefully when interacting
with the client. The nurse also uses critical thinking skills to determine if her nursing
orders are effective. the nurse knows that performing these interventions will help in
which aspect of care?
A. Increase client interaction
B. Prepare a discharge plan
C. Collect data for the continuity of care
D. Analyzing client responses
68. The nurse in charge identifies a patient’s responses to actual or potential health
problems during which step of the nursing process?
A. Assessing
B. Diagnosing
C. Planning
D. Evaluating
69. A nurse is revising a client’s care plan. During which step of the nursing process does a
revision take place?
A. Assessment
B. Planning
C. Intervention
D. Evaluation
70. Which intervention should the nurse in charge try first for a client that exhibits sigs of
sleep disturbance?
 A. Administer sleeping medication as ordered?
B. Ask the client each morning to describe the quantity of sleep the night before
C. Teach the client relaxation techniques such as guided imagery
D. Provide client normal sleep aids such as pillows, back rubs
71. A nurse is assigned to care for postoperative male client who has DM. During the
assessment interview, the client reports he is impotent and says hes concerned about
the effect on his marriage. In planning the client’s care, the most appropriate
intervention would be to:
A. Encourage the client to ask questions about personal sexuality
B. Provide time for privacy
C. Suggest referral to a sex counselor or appropriate professional
D. Provide support for the spouse
72. Using Maslow’s Hierarchy of needs, a nurse assigns the highest priority to which client
need?
A. Elimination
B. Security
C. Safety
D. Belonging
73. A female client who receive a general anesthesia returns from surgery.
Postoperatively,.Which nursing diagnosis takes highest priority?
A. Acute pain related to surgery
B. Deficient Fluid volume related to fluid loss from surgery
C. Impaired physical mobility related to surgery
D. Risk for aspiration related to anesthesia
***general anesthesia may impaired gag and swallow reflex***
74. A male client is admitted to the hospital with blunt chest trauma after a motor vehicle
accident. The first nursing priority for this client would be to:
A. Assess the clients airway
B. Provide pain relief
C. Encourage deep breathing and coughing
D. Splint chest wall with a pillow
75. The nurse performs an assessment of a newly admitter patient. The nurse understands
that his admission assessment is conducted primarily to:
A. Diagnose the patient is at risk
B. Ensure the patient’s skin is intact
C. Establish a therapeutic relationship
D. Identify important data
76. The guidelines for writing an appropriate nursing diagnosis include all of the following
except:
A. State the diagnosis in terms of a problem, not a need
B. Use nursing terminology to describe the patient’s response
C. Use statements that assist in planning independent nursing interventions
D. Use medical terminology to describe the probable cause of the patients response
77. While the nurse is providing a patient personal hygiene, she observes that his skin is
excessively dry. During the procedure, he tells her that he is very thirsty. An appropriate
nursing diagnoss would be:
A. Potential for impaired skin integrity related to altered gland function
B. Potential for impaired skin integrity related to dehydration
C. Impaired skin integrity related to dehydration
D. Impaired skin integrity related to altered circulation
78. Which of the following is an appropriately written nursing diagnosis?
A. Pain related to insufficient use of medication
B. Pain related to difficulty ambulating
C. Anxiety related to cardiac monitor
D. Bedpan required frequently as a result of altered elimination pattern
79. Accountability is a critical aspect of nursing care. An example of accountability is
demonstrated by:
A. Selecting the medication schedule for the client
B. Implementing discharge teaching plans that meet individual needs
C. Evaluating the client's outcomes after implementation of care
D. Promoting participation of all staff members in unit meetings
80. The nurse is working with a client who is being prepared for a diagnostic test this
afternoon. The client tells the nurse she wants to have her hair shampooed. How would
the nurse prioritize this client need?
A. Immediate priority
B. High priority
C. Intermediate priority
D. Low priority
 Stage Basic Conflict
81. Infancy
82. Early Childhood
83. Late Childhood
84. School Age
85. Adolescence
86. Young Adulthood
87. Adulthood
88. Maturity

Stage Age Center of pleasure

89. 94. 99.
90. 95. 100.
91. 96. 101.
92 97. 102.
93 98. 103.