FUNDAMENTALS OF NURSING PRE BOARD SET E

SITUATION: A Nurse utilizes the nursing process in managing patient care. Knowledge of this
process is essential to deliver high quality care and to focus on the client’s response to their illness.

1. During the planning phase of the nursing process, which of the following is the product
developed?

A. Nursing care plan

B. Nursing diagnosis

C. Nursing history

D. Nursing notes

2. Objective data are also known as?

A. Covert data

B. Inferences

C. Overt data

D. Symptoms

3. Data or information obtained from the assessment of a patient is primarily used by nurse to:

A. Ascertain the patient’s response to health problems

B. Assist in constructing the taxonomy of nursing intervention

C. Determine the effectiveness of the doctor’s order

D. Identify the patient’s disease process

4. What is an example of a subjective data?

A. Color of wound drainage

B. Odor of breath

C. Respiration of 14 breaths/minute
D. The patient’s statement of “I feel sick to my stomach”

SITUATION : Correct application of the Nursing Process is vital in providing quality care. The nurse
must use her skills and knowledge in proper assessment, planning and evaluating to meet the
patient’s need and address the priority response of the client to his or her illness.

5. Which statement is a difference between comprehensive and focused assessment?

A. Comprehensive assessments can’t include any focus assessments

B. Focused assessments are more important than comprehensive assessments

C. Focused assessments are usually ongoing and concerning specific problems

D. Objective data are included only in comprehensive assessments

6. Two-year-old Ben’s mother states “Ben vomited 8 ounces of his formula this morning.” This
statement is an example of:

A. Objective data from a primary source

B. Objective data from a secondary source

C. Subjective data from a primary source

D. Subjective data from a secondary source

7. Which expected outcome is correctly written?

A. The patient will be less edematous in 24 hours

B. The patient will drink an adequate amount of fluid daily

C. The patient will identify 5 high-salt foods from prepared list by discharge

D. The patient will soon sleep well through the night

8. An expected outcome on a patient’s care plan reads: “Patient will state seven warning signs
of cancer by discharge.” When the nurse evaluates the patient progress, the patient is able to
state that a change in wart or mole, a sore that doesn’t heal and a change in bowel or bladder
habits are warning signals of cancer. Which of the following would be an appropriate
evaluative statement for the nurse to place on the patient’s nursing care plan?

A. Patient understands the warning signals of cancer

B. Goal met; Patient cited a change in wart of mole, sore that doesn’t heal and a change in bowel or
bladder habits as warning signals of cancer.

C. Goal not met

D. Goal partially met

9. A quality assurance nurse sends questionnaire to patients after discharge to determine their
level of satisfaction with the nurse care they received in the facility. What type of nursing audit
is this?

A. Concurrent

B. Outcome

C. Terminal

D. Retrospective

10. The nurse makes the following entry in the patient’s record: “Goal not met; patient refuses
to attend smoking cessation classes.” Because this goal hasn’t been met, the nurse should:

A. Develop a completely new nursing care plan

B. Assign the patient to a more experienced nurse

C. Critique the steps involved in the development of the goal

D. Transfer the patient to another facility

SITUATION : Health Care Delivery System affects the health status of every Filipino. As a nurse
knowledgeable of this system, she is expected to ensure quality of life.

11. When should rehabilitation commence?

A. The day before discharge

B. When the patient desires

C. Upon admission

D. 24 hours after discharge

12. What exemplified the preventive and promotive programs in the hospital?

A. Hospital as a center to prevent and control infection

B. Program for smokers

C. Program for alcoholics and drug addicts

D. Hospital Wellness Center

13. Which makes nursing dynamic?

A. Every patient is a unique physical, emotional, social and spiritual being

B. The patient participate in the overall nursing care plan

C. Nursing practice is expanding in the light of modern developments that takes place

D. The health status of the patient is constantly changing and the nurse must be cognizant and
responsive to these changes

14. Prevention is an important responsibility of the nurse in:

A. Hospitals

B. Community

C. Workplace

D. All of the above

15. This form of Health Insurance provides comprehensive prepaid health services to enrollees
for a fixed periodic payment.

A. Health Maintenance Organization

B. Medicare

C. Philippine Health Insurance Act

D. Hospital Maintenance Organization

SITUATION : Maslow’s hierarchy of needs is an integral component of prioritization. As a nurse,

you must know the client’s needs that request for an immediate action.

16. The client with history of pulmonary emboli is scheduled for insertion of an inferior vena
cava filter. The nurse checks on the client 1 hour after the physician has explained the
procedure and obtained consent from the client. The client is lying in bed, wringing the hands,
and says to the nurse, “I’m not sure about this. What if it doesn’t work, and I’m just as bad off
as before?” The nurse addresses which of the following primary concerns of the client?

A. Fear related to the potential risk and outcome of surgery

B. Anxiety related to the fear of death

C. Ineffective individual coping related to the therapeutic regimen

D. Knowledge deficit related to the surgical procedure

17. A nurse is formulating a plan of care for a client receiving enteral feedings. The nurse
identifies which nursing diagnosis as the highest priority for this client?

A. Altered nutrition, less than body requirements

B. High risk for aspiration

C. High risk for fluid volume deficit

D. Diarrhea

18. A home care nurse finds a client in the bedroom, unconscious, with pill bottle in hand. The
pill bottle contained the SSRI Sertraline (Zoloft). The nurse immediately assesses the client’s:

A. Blood pressure

B. Respirations

C. Pulse

D. Urine Output

19. A nurse is caring for a client admitted to the hospital for subclavian line placement. Which
psychosocial area of assessment should the nurse address with the client?

A. Strict restrictions of neck mobility

B. Loss of ability to ambulate as tolerated

C. Possible body image disturbance

D. Continuous pain related to ongoing placement of the subclavian line

20. A hospitalized client who has a living will is being fed through a nasogastric tube. During a
bolus feeding, the client vomits and begins choking. Which of the following actions is most
appropriate for the nurse to take?

A. Clear the client’s airway

B. Make the client comfortable

C. Start CPR

D. Stop feeding and remove the NG tube

SITUATION: Health Promotion is the priority nursing responsibility. The nurse should be able to
promote the client’s well being and identify ways on improving the client’s quality of life.

21. The nurse is caring for a 16 year old female client who isn’t sexually active. The client asks
if she needs a Papanicolaou test. The nurse should reply:

A. Yes, she should have a Pap test after the onset of menstruation

B. No, because she isn’t sexually active

C. Yes, because she’s 16 years old

D. No, because she is not yet 21 years old

22. The nurse is assessing a client who complains of abdominal pain, nausea and diarrhea.
When examining the client’s abdomen, which sequence should the nurse use?

A. Inspection, palpation, percussion, auscultation

B. Inspection, auscultation, percussion, palpation

C. Auscultation, inspection, percussion, palpation

D. Palpation, auscultation, percussion, inspection

23. The nurse is speaking to a group of women about early detection of breast cancer. The
average age of the women in the group is 45. Following the Philippine Cancer Society
guidelines, the nurse should recommend that the women:

A. Perform breast self examination annually

B. Have a mammogram annually

C. Have a hormonal receptor assay annually

D. Have a physician conduct a clinical examination every 2 years

24. The school nurse is planning a program for a group of teenagers on skin cancer prevention.
Which of the following instruction should the nurse emphasize in her talk?

A. Stay out of the sun between 1 p.m and 3 p.m

B. Tanning booth are a safe alternative for those who wish to tan

C. Sun exposure is safe, provided the client wears protective clothing

D. Examine skin once per month, looking for suspicious lesions or changes in moles

25. An employer establishes a physical exercise area in the workplace and encourages all
employees to use it. This is an example of which level of prevention?

A. Primary prevention

B. Secondary prevention

C. Tertiary prevention

D. Passive prevention

SITUATION : Basic nursing skills are essential for they are vital in many nursing procedures. Such
skills are needed in order to promote health, prevent illness, cure a disease and rehabilitate
infirmities.

26. A nurse has just been told by the physician that an order has been written to administer an
iron injection to a client. The nurse plans to give the medication in the:

A. Gluteal muscle using Z-Track technique

B. Deltoid muscle using an air lock

C. Subcutaneous tissue of the abdomen

D. Anterolateral thigh using 5/8-inch needle

27. A client has just been told by the physician that a cerebral angiogram will be obtained. The
nurse then collects data from the client about which of the following pieces of information?

A. Claustrophobia
B. Excessive weight

C. Allergy to eggs

D. Allergy to iodine or shellfish

28. A client has an order for a wound culture to be performed with the next wound irrigation
and dressing change. The nurse would plan to use which of the following solutions for
irrigation before this particular procedure?

A. Povidone-iodine (Betadine)

B. One-half-strength hydrogen peroxide

C. Normal saline

D. Acetic acid

29. Which of the following is the best indicator in determining that the client’s airway needs
suctioning?

A. Oxygen saturation measurement

B. Respiratory rate

C. Breath sounds

D. Arterial blood gas results

30. A nurse is planning to assist a diabetic client to perform self-monitoring of

blood glucose levels. The nurse should incorporate which of the following strategies to best help
the client obtain an adequate capillary sample?

A. Cleanse the hands beforehand using cool water

B. Let the arm hang dependently and milk the digit

C. Puncture the center of the finger pad

D. Puncture the finger as deeply as possible

SITUATION : Mastery of Intravenous therapy and all aspects that address the response of the client
to complication related to it will help the new nurse in providing quality care.
31. One hour after the IV was inserted, Nurse Net found out that the 1 liter of D5NSS was
empty. Patient was in severe respiratory distress with pinkish frothy sputum. The most
probable complication is:

A. Speed shock

B. Renal failure

C. Congestive heart failure

D. Pulmonary edema

32. When an IV of D5W is not infusing well on patient, it is best to first:

A. Pinch the rubber part to flush out clogged blood

B. Coil tube and squeeze hard

C. Lower IV to check for return flow

D. Restart the IV

33. The doctor ordered venoclysis of dextrose 5% in water one liter KVO for 24 hours as a
vehicle for IV medications. How many drops per minute should the fluid be regulated?

A. 20 drops per minute

B. 5 drops per minute

C. 10 drops per minute

D. 15 drops per minute

34. The nurse is administering I.V fluids to an infant. Infants receiving I.V Therapy are
particularly vulnerable to:

A. Hypotension

B. Fluid overload

C. Cardiac arrhythmias

D. Pulmonary emboli
35. A client with severe inflammatory bowel disease is receiving TPN. When administering
TPN, the nurse must take care to maintain the prescribed flow rate because giving TPN too
rapidly may cause:

A. Hyperglycemia

B. Air embolism

C. Constipation

D. Dumping syndrome

SITUATION : Teaching and learning is a nursing responsibility. The ability of a nurse to educate and
change the client’s behavior through health teaching is one important goal of nursing.

36. A client’s hypertension has been recently diagnosed. The nurse would plan to do which of
the following as the first step in teaching the client about the disorder?

A. Gather all available resource material

B. Plan for the evaluation of the session

C. Assess the client’s knowledge and needs

D. Decide on the teaching approach

37. A diabetic client who is performing self-monitoring of blood glucose at home asks a clinic
nurse why a glycosylated hemoglobin level needs to be measured. The nurse should plan to
incorporate which of the following into a response?

A. This laboratory test is done yearly to predict likelihood of long term complication

B. This laboratory test gives an indication of glycemic control over the last 3 months

C. It is done as a method of verifying the accuracy of the meter used at Home

D. It is done to predict risk of hypoglycemia with the current diet and medication regimen

38. In teaching the sister of a diabetic client about the proper use of a glucometer in
determining the blood sugar level of the client, The nurse is focusing in which domain of
learning according to bloom?

A. Cognitive

B. Affective
C. Psychomotor

D. Affiliative

39. Which of the following is the most important condition for diabetic client to learn how to
control their diet?

A. Use of pamphlets and effective teaching devices during health instruction

B. Motivation to be symptom free

C. Ability of the client to understand teaching instruction

D. Language and appropriateness of the instruction

40. When you prepare your teaching plan for a group of hypertensive clients, you first
formulate your learning objectives. Which of the following steps in the nursing process
corresponds to the writing of learning objectives?

A. Planning

B. Implementing

C. Evaluating

D. Assessing

SITUATION : Nursing is a science. It involves a wide spectrum of theoretical foundation applied in

different health care situation. The nurse must use these theories in order to deliver the most needed
quality care.

41. The theorist who believes that adaptation and manipulation of stressors are needed to foster
change is:

A. Betty Neuman

B. Dorothea Orem

C. Martha Rogers

D. Sister Callista Roy

42. The theorist whose theory can be defined as the development of a science of humankind,
incorporating the concepts of energy fields, openness, pattern and organization is:
A. Dorothy Johnson

B. Hildegard Peplau

C. Martha Rogers

D. Myra Levine

43. A theorist whose major theme is the idea of transcultural nursing and caring nursing is:

A. Dorothea Orem

B. Madeleine Leininger

C. Sister Callista Roy

D. Virginia Henderson

44. Florence Nightingale was born in

A. Italy, May 12, 1840

B. Italy, May 12, 1820

C. England, May 12, 1840

D. England, May 12, 1820

45. Smith conceptualizes this health model as a condition of actualization or realization of

person’s potential. Avers that the highest aspiration of people is fulfillment and complete
developmental actualization.

A. Clinical Model

B. Role performance Model

C. Adaptive Model

D. Eudaemonistic Model

SITUATION : Oxygen is the most important physiologic requirement of the body. Absence of this
vital element for over 6 minutes leads to irreversible brain damage. Measures that promotes
oxygenation is integral in successfully managing client’s response to illnesses.

46. The primary effect of oxygen therapy is to:

A. Increase oxygen in the tissues and cells

B. Increase oxygen carrying capacity of the blood

C. Increase respiratory rate

D. Increase oxygen pressure in the alveolar sac

47. A nurse suctions a client who has an endotracheal tube in place. Following the procedure,
which of the following would indicate to the nurse that the client is experiencing an adverse
effect of this procedure?

A. Hypertension

B. Cardiac Irregularities

C. A reddish coloration in the client’s face

D. Oxygen saturation level of 95%

48. The GAUGE size in ET tubes determines:

A. The external circumference of the tube

B. The internal diameter of the tube

C. The length of the tube

D. The tube’s volumetric capacity

49. The nurse is correct in performing suctioning when she applies the suction intermittently
during:

A. Insertion of the suction catheter

B. Withdrawing of the suction catheter

C. both insertion and withdrawing of the suction catheter

D. When the suction catheter tip reaches the bifurcation of the trachea

50. The purpose of the cuff in Tracheostomy tube is to:

A. Separate the upper and lower airway

B. Separate trachea from the esophagus

C. Separate the larynx from the nasopharynx

D. Secure the placement of the tube

SITUATION : To deliver a safe and quality care, Knowledge about wound care is necessary. The
nurse will have to deal with different types of wound during practice. It is of outmost important to
apply this knowledge to ensure optimum wound healing.

51. Based on the nurse’s knowledge of surgical wounds, simple surgical incisions heal by:

A. Primary intention

B. Secondary intention

C. Tertiary intention

D. Quarternary intention

52. The nurse documents that the wound edges are approximated. When the edges of an
incision are said to be approximated, this means edges are:

A. Brought together by sutures, tapes or staples

B. Eythematous and swollen

C. Gaping and draining

D. Necrotic and draining

53. Which vitamin is most essential for collagen synthesis?

A. Vitamin A

B. Vitamin B

C. Vitamin C

D. Vitamin D

54. When assessing the client’s wound for sign of infection, the nurse should look for the
presence of which of the following?

A. Granulation tissue

B. Pink tissue
C. Purulent drainage

D. Well approximated edges

55. The nurse is changing dressing and providing wound care. Which activity should she
perform first?

A. Assess the drainage in the dressing

B. Slowly remove the soiled dressing

C. Wash hands thoroughly

D. Put on latex gloves

SITUATION : Physical examination and health assessment are important in rendering care. The
nurse must use assessment knowledge in order to determine and prioritize client’s response to his or
her illness.

56. The component that should receive the highest priority before physical examination is the:

A. Psychological preparation of the client

B. Physical Preparation of the client

C. Preparation of the Environment

D. Preparation of the Equipments

57. When inspecting a client’s skin, the nurse finds a vesicle on the client’s arm. Which
description applies to a vesicle?

A. A flat, nonpalpable, and colored

B. Solid, elevated, and circumscribed

C. Circumscribed, elevated, and filled with serous fluid

D. Elevated, pus-filled, and circumscribed

58. When assessing a client with abdominal pain, the nurse should assess:

A. Any quadrant first

B. The symptomatic quadrant first

C. The symptomatic quadrant last

D. The sympomatic quadrant either second or third

59. To assess the client’s dorsalis pedis pulse, the nurse should palpate the:

A. Medial surface of the ankle

B. Lateral surface of the ankle

C. Ventral aspect of the top of the foot

D. Medial aspect of the dorsum of the foot

60. Which of the following assessment would be a priority for a 2 year old after bronchoscopy?

A. Cardiac rate

B. Respiratory quality

C. Sputum color

D. Pulse pressure changes

61. The nurse checks the client’s gag reflex. The recommended technique for testing the gag
reflex is to:

A. touch the back of the client’s throat with a tongue depressor

B. observe the client for evidence of spontaneous swallowing when the neck is stroked

C. place a few milliliters of water on the client’s tongue and note whether or not he swallows

D. observe the client’s response to the introduction of a catheter for endotracheal suctioning

62. The nurse is evaluating a client’s lung sounds. Which of the following breath sounds
indicate adequate ventilation when auscultated over the lung fields?

A. Vesicular

B. Bronchial

C. Bronchovesicular

D. Adventitious
63. The night nurse informs the primary nurse that a client receiving intermittent gavage
feedings is not tolerating them. The primary nurse should first:

A. Change the feeding schedule to omit nights

B. Request that the type of solution be changed

C. Observe the night nurse administering a feeding

D. Suggest that the prescribed antiemetic be given first

64. A client has a chest tubes attached to a pleural drainage system. When caring for this client,
the nurse should:

A. Palpate the surrounding are for crepitus

B. Clamp the chest tubes when suctioning the client

C. Change the dressing daily using aseptic technique

D. Empty drainage chamber at the end of the shift

65. The nurse, aware of a client’s 25 year history of excessive alcohol use, would expect the
physical assessment to reveal a:

A. Liver infection

B. Low blood ammonia

C. Small liver with a rough surface

D. High fever with a generalizedrash

SITUATION : Nursing is a profession. Miss Linda is a newly appointed nurse in a hospital in

Manila. Born May 1985, Her knowledge of nursing’s professional development is required in order
to project the profession in a way that it lifts the standards of nursing.

66. Mrs. Linda defined nursing as one of the following except:

A. Assisting individual, family and community in attaining health

B. Assisting basic health needs

C. Establishing nursing diagnosis and implementing nursing care

D. Diagnosing, treating, prescribing medication and doing minor surgery

67. Philippine Nurses Association (PNA) was established in:

1. 1922

2. 1926

3. With Mrs. Rosario Delgado as first president

4. With Mrs. Anastacia Tupas as first president

A. 1, 3

B. 1, 4

C. 2, 3

D. 2, 4

68. As a national nurses association, it is characterized as follows except:

A. Both a professional body and a labor union

B. Affiliated with the International Council Of Nurses

C. Advocating for improved work and life condition of Nurses

D. Accrediting body for continuing education program

69. CPE Units per year is needed for license renewal. The number of CPE units per year should
be:

A. 20 units

B. 30 units

C. 60 units

D. 100 units

70. As a nurse, R.A 1080 exempts her from:

A. Paying her professional tax

B. Examination for civil service eligibility

C. Qualifying for the CGFNS

D. Paying business permit

71. In resigning for her job as a staff nurse, she must give advance notice of:

A. 15 days

B. 30 days

C. 45 days

D. 60 days

72. Why is there an ethical dilemma?

A. Because the law do not clearly state what is right from what is wrong

B. Because morality is subjective and it differs from each individual

C. Because the patient’s right coincide with the nurse’s responsibility

D. Because the nurse lacks ethical knowledge to determine what action is correct and what action is
unethical

73. Who among the following can work as a practicing nurse in the Philippines without taking
the Licensure examination?

A. Internationally well known experts which services are for a fee

B. Those that are hired by local hospitals in the country

C. Expert nurse clinicians hired by prestigious hospitals

D. Those involved in medical mission who’s services are for free

74. The nurse is correct in determining that a License is:

A. A personal property

B. Can be revoked by the Board of Nursing

C. A Right

D. Can be revoked by the PNA

75. A License is renewed every:

A. 1 year
B. 2 years

C. 3 years

D. 4 years

76. Which of the following persons cannot have free access to a patient’s record?

A. The patient

B. The physical therapist

C. The pharmacist

D. The lawyer

77. Ms. Linda’s license will expire in 2007, She must renew her license when?

A. January 2007

B. December 2007

C. May 2007

D. May 2008

78. The practice of Nursing in the Philippines is regulated by:

A. RA 9163

B. RA 9173

C. RA 7164

D. RA 7146

79. This quality is being demonstrated by a Nurse who raise the side rails of a confuse and
disoriented patient?

A. Autonomy

B. Responsibility

C. Prudence

D. Resourcefulness
80. Nurse Joel and Ana is helping a 16 year old Nursing Student in a case filed against the
student. The case was frustrated homicide. Nurse Joel and Ana are aware of the different
circumstances of crimes. They are correct in identifying which of the following Circumstances
that will be best applied in this case?

A. Justifying

B. Aggravating

C. Mitigating

D. Exempting

SITUATION : This is the first day of Mark, R.N. to report as a staff nurse in a tertiary hospital. As a
morning duty nurse, she is about to chart her nursing care.

81. Which of the following is not an accepted medical abbreviation?

A. NPO

B. PRN

C. OD

D. NON

82. Communication is best undertaken if barriers are first removed. Considering this
statement, which of the following is considered as deterrent factor in communication?

A. Not universally accepted abbreviation

B. Wrong Grammar

C. Poor Penmanship

D. Old age of the client

83. 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

84. 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

85. Being a new staff nurse, Mark remembers that information needed for daily nursing care of
clients are readily available in which of the following?

A. Kardex

B. Order sheet

C. Admission notes

D. Nurses notes

SITUATION : Mr. Orlando is assigned to Mang Carlos, A 60 years old, newly diagnosed diabetes
patient. He is beginning to write objectives for his teaching plan.

86. Which of the following is written in behavioral term?

A. Mang Carlos will know about diabetes related foot care and the techniques and equipment
necessary to carry it out

B. Mang Carlos sister will be able to determine his insulin requirement based on blood glucose levels
obtained from glucometer in two days

C. Mang Carlos daugter should learn about diabetes milletus within the week

D. Mang Carlos wife needs to understand the side effects of insulin

87. Which of the following is the best rationale for written objectives?

A. Document the quality of care

B. Facilitate evaluation of the performance of the nurse

C. Ensure learning on the part of the nurse

D. Ensure communication among staff members

88. Mang Carlos has been terminally ill for 5 years. He asked his wife to decide for him when
he is no longer capable to do so. As a Nurse, You know that this is called:

A. Last will and testament

B. DNR

C. Living will

D. Durable Power of Attorney

89. Which of the following behavior of Mang Carlos least indicates readiness to learn?

A. Talking with the nurse in charge and doctor

B. Reading brochures and pamphlets about diabetes

C. Inquiring about date of discharge

D. Asking question about diabetes milletus

90. Which of the following behaviors best contribute to the learning of Mang Carlos regarding
his disease condition?

A. Drawing him into discussion about diabetes

B. Frequent use of technical terms

C. Loosely structured teaching session

D. Detailed lengthy explanation

SITUATION : Mrs. Purificacion is now the Chief nurse of a hospital in Manila. She is carefully
reviewing different management styles and theories that will best help her in running the nursing
services in the hospital.

91. Which leadership style best empower the staff towards excellence?

A. Autocratic

B. Situational

C. Democratic

D. Laissez Faire
92. As a Nurse Manager, DSJ enjoys his staff of talented and self motivated individuals. He
knew that the leadership style to suit the needs of this kind of people is called:

A. Autocratic

B. Participative

C. Democratic

D. Laissez Faire

93. A fire has broken in the unit of DSJ R.N. The best leadership style suited in cases of
emergencies like this is:

A. Autocratic

B. Participative

C. Democratic

D. Laissez Faire

94. Mrs. Purificacion is thinking of introducing the Primary Nursing Model Approach. You
understand that this nursing model is:

A. The nurse manager assigns tasks to the staff members

B. Critical paths are used in providng nursing care

C. A single registered nurse is responsible for planning and providing individualized nursing care

D. Nursing staff are led by an RN leader in providing care to a group of clients

95. Structure, Process and Outcome are components of which step of the management process?

A. Planning

B. Organizing

C. Directing

D. Controlling

SITUATION : Nursing research is the term used to describe the evidence used to support nursing
practice. Nursing, as an evidence based area of practice, has been developing since the time of
Florence Nightingale to the present day, where many nurses now work as researchers based in
universities as well as in the health care setting.

96. Mr. DSJ Plans to undertake a research of Community 1 and 2 on how they manage their
health using Primary health care after an organization and training seminars. This type of
research is:

A. Experimental

B. Historical

C. Descriptive

D. Basic

97. The independent variable is:

A. Primary Health Care

B. Community 1 and 2

C. Organization and training seminars

D. Management of their health

98. In this design, the variable that is being manipulated is

1. Independent

2. Organization and training seminars

3. Dependent

4. Management of Primary Health Care

A. 1,2

B. 1,4

C. 2,3

D. 3,4

99. In general, the research process follows the ff. ordered sequence:

1. Determination of design
2. Statement of the problem

3. Definition of variables

4. Collection and analysis of data

5. Review of related literature

A. 2,5,3,1,4

B. 3,5,4,1,2

C. 2,5,3,4,1

D. 2,5,1,3,4

100. Studies done in natural setting such as this one, posses difficulty of controlling which
variable?

A. Independent

B. Dependent

C. Extraneous

D. Organismic

Answers

Here are the answers for the exam. Unfortunately, rationales are not given. If you need clarifications
or disputes, please direct them to the comments section and we’ll be glad to give you an explanation.

1. A. Nursing care plan

2. C. Overt data

3. A. Ascertain the patient’s response to health problems

4. D. The patient’s statement of “I feel sick to my stomach”

5. C. Focused assessments are usually ongoing and concerning specific problems

6. B. Objective data from a secondary source

7. C. The patient will identify 5 high-salt foods from prepared list by discharge

8. D. Goal partially met

9. C. Terminal

10. C. Critique the steps involved in the development of the goal

11. C. Upon admission

12. D. Hospital Wellness Center

13. D. The health status of the patient is constantly changing and the nurse must be cognizant and
responsive to these changes

14. D. All of the above

15. A. Health Maintenance Organization

16. A. Fear related to the potential risk and outcome of surgery

17. B. High risk for aspiration

18. B. Respirations

19. C. Possible body image disturbance

20. A. Clear the client’s airway

21. B. No, because she isn’t sexually active

22. B. Inspection, auscultation, percussion, palpation

23. B. Have a mammogram annually

24. D. Examine skin once per month, looking for suspicious lesions or changes in moles

25. A. Primary prevention

26. A. Gluteal muscle using Z-Track technique

27. D. Allergy to iodine or shellfish

28. C. Normal saline

29. C. Breath sounds

30. D. Puncture the finger as deeply as possible

31. D. Pulmonary edema

32. C. Lower IV to check for return flow

33. C. 10 drops per minute

34. B. Fluid overload

35. A. Hyperglycemia

36. C. Assess the client’s knowledge and needs

37. B. This laboratory test gives an indication of glycemic control over the last 3 months

38. C. Psychomotor

39. B. Motivation to be symptom free

40. A. Planning

41. D. Sister Callista Roy

42. C. Martha Rogers

43. B. Madeleine Leininger

44. B. Italy, May 12, 1820

45. D. Eudaemonistic Model

46. A. Increase oxygen in the tissues and cells

47. B. Cardiac Irregularities

48. B. The internal diameter of the tube

49. B. Withdrawing of the suction catheter

50. A. Separate the upper and lower airway

51. A. Primary intention

52. A. Brought together by sutures, tapes or staples

53. C. Vitamin C

54. C. Purulent drainage

55. C. Wash hands thoroughly

56. A. Psychological preparation of the client

57. C. Circumscribed, elevated, and filled with serous fluid

58. C. The symptomatic quadrant last

59. D. Medial aspect of the dorsum of the foot

60. B. Respiratory quality

61. A. touch the back of the client’s throat with a tongue depressor

62. A. Vesicular

63. C. Observe the night nurse administering a feeding

64. A. Palpate the surrounding are for crepitus

65. C. Small liver with a rough surface

66. D. Diagnosing, treating, prescribing medication and doing minor surgery

67. A. 1,3

68. A. Both a professional body and a labor union

69. A. 20 units

70. B. Examination for civil service eligibility

71. B. 30 days

72. C. Because the patient’s right coincide with the nurse’s responsibility

73. D. Those involved in medical mission who’s services are for free

74. B. Can be revoked by the Board of Nursing

75. C. 3 years

76. D. The lawyer

77. C. May 2007

78. B. RA 9173

79. C. Prudence
80. C. Mitigating

81. D. NON

82. A. Not universally accepted abbreviation

83. C. Vital signs 130/70; 84; 20

84. A. Written descriptive nurse’s notes

85. A. Kardex

86. B. Mang Carlos sister will be able to determine his insulin requirement based on blood glucose
levels obtained from glucometer in two days

87. A. Document the quality of care

88. D. Durable Power of Attorney

89. C. Inquiring about date of discharge

90. C. Loosely structured teaching session

91. C. Democratic

92. D. Laissez Faire

93. A. Autocratic

94. C. A single registered nurse is responsible for planning and providing individualized nursing care

95. D. Controlling

96. A. Experimental

97. C. Organization and training seminars

98. A. 1,2

99. A. 2,5,3,1,4

100. C. Extraneous