Republic of the Philippines

N A V A L S T A T E U N I V ER S I T Y
College of Arts & Sciences
NURSING & HEALTH SCIENCES DEPARTMENT
Naval, Biliran

NCM 417: CARE OF CLIENTS WITH CELLULAR ABERRATION, in ACUTE BIOLOGIC CRISIS,
Including EMERGENCY AND DISASTER NURSING
FINAL EXAM

INSTRUCTION: Select the correct answer for each of the following questions. Mark only one answer for
each item by shading the corresponding letter of your choice on the answer sheet provided. STRICTLY
NO ERASURES ALLOWED. Use pencil #1 only.

SITUATION #1: Burns are injuries to tissue that result from heat, electricity, radiation, or chemicals.
Deep, extensive burns can cause serious complications, such as shock and severe infections.

1. The newly admitted client has burns on both legs. The burned areas appear white and leather-like. No
blisters or bleeding are present, and the client states that he or she has little pain. How should this injury
be categorized?
A. Superficial C. Partial-thickness deep
B. Partial-thickness superficial D. Full thickness

2. Which client factors should alert the nurse to potential increased complications with a burn injury?
A. The client is a 26-year-old male.
B. The client has had a burn injury in the past.
C. The burned areas include the hands and perineum.
D. The burn took place in an open field and ignited the client’s clothing.

3. The burned client is ordered to receive intravenous cimetidine, an H2 histamine blocking agent, during
the emergent phase. When the client’s family asks why this drug is being given, what is the nurse’s BEST
response?
A. “To increase the urine output and prevent kidney damage.”
B. “To stimulate intestinal movement and prevent abdominal bloating.”
C. “To decrease hydrochloric acid production in the stomach and prevent ulcers.”
D. “To inhibit loss of fluid from the circulatory system and prevent hypovolemic shock.”

4.The nurse conducts health teaching to the family of the burned patient to prevent the occurrence of
cross contamination. Which intervention is MOST important to include in the health teaching?
A. Handwashing on entering the client’s room
B. Encouraging the client to cough and deep breathe
C. Wear face mask on entering the client’s room
D. Changing linens everyday.

SITUATION #2:Nurse Amy is a nurse assigned in the poison control center of the hospital.

5. A patient arrives in the center a few hours after taking 20 to 30 tablets of acetaminophen. Which action
will the nurse plan to take?
A. Give heparin. C. Give N-acetylcysteine (Mucomyst).
B. Give protamine sulfate. D. Give vitamin K.

6. Gastric lavage and administration of activated charcoal are prescribed for an unconscious patient who
has been admitted to the hospital after ingesting 30 diazepam (Valium) tablets. Which action will the
nurse plan to take first?
A. Give activated charcoal. C. Assist with intubation.
B. Perform gastric lavage. D. Let the patient vomit.
7.A tearful parent brings a child to the hospital for taking unknown amount of children’s chewable
vitamins at an unknown time. The child is currently alert and asymptomatic. What information should be
immediately reported to the physician?
A. The ingested children’s chewable vitamins contain iron.
B. The child has been treated several times for ingestion of toxic substances.
C. The child has been treated several times for accidental injuries.
D. The child was nauseated and vomited once at home.

8. What is the method of choice for the removal of ingested poisons from the gastrointestinal tract?
A. Irrigation and gastric lavage C. Administration of osmotic diarrheal agents
B. Ingestion of syrup of ipecac D. Administration of activated charcoal

SITUATION #3:An emerging disease is one that has appeared in a population for the first time, or
that may have existed previously but is rapidly increasing in incidence or geographic range.

9.AB, 32 years old, has returned from Hong Kong and was admitted to a hospital with a tentative
diagnosis of SARS. AB is expected to have which of the following symptoms?
A. Fever, rapid progressive respiratory compromise
B. Fever and dyspnea
C. Fever and productive cough
D. Fever and cyanosis

10. The following countries where SARS originated include the following, except:
A. China C. Philippines
B. Canada D. Hongkong

11. What is the causative agent of SARS?

A. Corona virus C. Rhabdo virus
B. Retro virus D. Influenza virus

12. Which of the following is the MOST serious complication of SARS?

A. Pulmonary congestion C. Respiratory distress
B. Atelectasis D. Anaphylaxis

13. A person who harbors the microorganism but does not manifest the signs and symptoms of the
disease is called:
A. contact C. suspect
B. infected D. carrier

14.Nurse A administered the wrong antibiotic for victims of exposure to anthrax without clinical
manifestations of the disease. What legal action will the nurse be sued for?
A. Battery C. Malpractice
B. Tort D. Negligence

15.A national seminar on Emerging Illnesses was attended by Nurse A. Nurse A learned that the most
severe form of anthrax exposure is through:
A. skin contact. C. ingestion.
B. inhalation. D. open wound or sores.

16.Upon entering the room of the Anthrax exposed patient, Nurse A noticed some manifestations
commonly seen in Anthrax patients. Where will Nurse A record the new findings?
A. Write in the nurses’ notes at the end of the end
B. Write in the doctor’s order sheet
C. Write in the patient’s profile
D. Write in the patient’s discharge summary

17.Nurse A will conduct a study where the Anthrax infected patients are the respondents. The balance of
the research’s benefit versus its risk to the subject is called:
A. analysis C. percentile
B. risk-benefit ration D. maximum risk
18.A student nurse that had an exposure to anthrax asks Nurse A, “How long will I take the antibiotic?”
The nurse’s BEST response will be:
A. “I will refer you to the public health officer.”
B. “You will take the antibiotic for six months.”
C. “You’re taking antibiotic for your prophylactic. You will take it for six days prophylactic treatment.”
D. “It depends if you will develop signs and symptoms of the disease.”

19. When an unexpected death occurs in the ED, which of the following tasks is MOST appropriate to
delegate to the nursing assistant?
A. Escort the family to a place of privacy.
B. Go with the organ donor specialist to talk to the family.
C. Assist with postmortem care.
D. Assist the family to collect belongings.

SITUATION #4:The questions that follow introduce nurses to the role they play in emergency
preparedness and disaster management in local and international settings. Areas of focus include
the role in planning, partnerships, disaster response, and delivery of services.

20. In conducting a primary survey on a trauma patient, which of the following is considered one of the
priority elements of the primary survey?
A. Complete set of vital signs C. Brief neurologic assessment
B. Palpation and auscultation of the abdomen D. Initiation of pulse oximetry

21. A 56-year-old patient presents in triage with left-sided chest pain, diaphoresis, and dizziness. This
patient should be prioritized into which category?
A. Highly urgent C. Non-urgent
B. Urgent D. Emergent

22. You respond to a call for help from the ED waiting room. There is an elderly patient lying on the floor.
List the order for the actions that you must perform.
1. Perform the chin lift or jaw thrust maneuver.
2. Establish unresponsiveness.
3. Initiate cardiopulmonary resuscitation (CPR).
4. Call for help and activate the code team.
5. Instruct a nursing assistant to get the crash cart.

A. 1, 2, 3, 5, 4 C. 3, 1, 2, 5, 4
B. 2, 4, 1, 3, 5 D. 4, 3, 2, 5, 1

23. An experienced traveling nurse has been assigned to work in the ED; however, this is the nurse’s first
week on the job. Which area in the ED is the most appropriate assignment for her?
A. Trauma team C. Ambulatory or fast track clinic
B. Triage D. Pediatric medicine team

24.A teenager arrives by private car. He is alert and ambulatory, but his t-shirt and pants are covered
with blood. He and his hysterical friends are yelling and trying to explain that they were goofing around
and he got poked in the abdomen with a stick. Which of the following comments should be given first
consideration?
A. “There was a lot of blood and we used three bandages.”
B. “He pulled the stick out, just now, because it was hurting him.”
C. “The stick was really dirty and covered with mud.”
D. “He’s a diabetic, so he needs attention right away.”

25. The nurse manager decides to form a committee to address the issue of violence against ED
personnel. Which combination of employees is best suited to fulfill this assignment?
A. ED physicians and charge nurses.
B. Experienced RNs and experienced paramedics
C. RNs, LPNs, and nursing assistants
D. At least one representative from each group of ED personnel
26. A nursing student is studying about disasters and emergency preparedness. Which of the following
statements by the nursing student depicts a CORRECT understanding of the difference between a
disaster and an emergency?
A. “Disasters are man-made only.”
B. “An emergency is an unforeseen combination of circumstances calling for immediate action for a range
of victims.”
C. “Man-made disasters are intentional only.”
D. “Emergencies are caused by acts of nature or emerging diseases.”

27.A preceptor is teaching a graduate nurse the concepts of mitigation. Which of the following
statements, if made by the graduate nurse, would indicate an understanding of this concept?
A. “A key nursing activity related to mitigation is the active participation in learning about the major
aspects of disasters.”
B. “Response is having a comprehensive disaster plan in place that coordinates efforts.”
C. “Mitigation is the health care system’s ability to rapidly expand beyond normal services to meet the
increased demand for qualified personnel.”
D. “The key to effective disaster management is pre-disaster planning and response.”

28.A newly graduated nurse is learning about the nurse’s role in disaster relief as part of an orientation to
the hospital. Which of the following concepts is accurate?
A. Learning about the prevention and mitigation of disasters is nice to know, but not essential.
B. Nurses take a passive role in helping others to save lives and fulfill an important obligation.
C. Applying advanced skills can be very helpful until help arrives.
D. Nurses may have to assume expanded roles in making decisions for the most appropriate treatment of
casualties.

SITUATION #5: Triaging or classifying patients according to priority is one of the most important
skills an ED nurse should possess. It is used not only in hospital emergency rooms, but as well as on
battle fields and at disaster sites when limited medical resources must be allocated.

29. Which of the following conditions satisfies a “green” triage tag in an emergency triage scenario?
A. A broken thumb from falling debris
B. Burns over 98% of body from a chemical fire
C. A 3-inch laceration on the forearm from window glass in a building explosion
D. Tension pneumothorax

30.A four-tier triage system is used to test an organization’s disaster preparedness. A 22-year-old patient
with hemorrhagic shock from a punctured femoral artery presents to the triage nurse. What is the most
appropriate triage classification?
A. Emergent C. Delayed
B. Expectant D. Urgent

31.You are the charge nurse in an emergency department (ED) and must assign two staff members to
cover the triage area. Which team is appropriate for this assignment?
A. An advance practice nurse and an experienced LPN
B. An experienced LPN and an inexperienced RN
C. An experienced RN and an inexperienced RN
D. An experienced RN and a nursing assistant

32.In conducting a primary survey on a trauma patient, which of the following is considered one of the
priority elements of the primary survey?
A. Complete set of vital signs C. Brief neurologic assessment
B. Palpation and auscultation of the abdomen D. Initiation of pulse oximetry

33.You are working in the triage area of an ED, and four patients approach the triage desk at the same
time. List the order in which you will assess these patients.
A. An ambulatory, dazed 25-year-old male with a bandaged head wound
B. An irritable infant with a fever, petechiae, and nuchal rigidity
C. A 35-year-old jogger with a twisted ankle, having pedal pulse and no deformity
D. A 50-year-old female with moderate abdominal pain and occasional vomiting

A. ABDC C. CDBA
B. BADC D. CBAD
34.Nurse A is caring for a patient who is suspected to have sustained a spinal cord injury after a motor
crash incident. What BEST describes the overarching principles used to guide the care for this type of
condition?
A. Immobilize the cervical area to prevent further injury
B. Monitor the patient’s level of consciousness to prevent neurologic deterioration
C. Help the patient with activities of daily living and provide emotional and physical support to help them
adjust to their injury
D. Facilitate tissue perfusion to the spinal cord while maintaining airway and breathing

35.Nurse A observes that the patient with spinal cord injury has a blood pressure of 100/55mmHg and
pulse rate of 48bpm. These have both trended downwards from the baseline. What should the nurse
expect to be the next course of action ordered by the physician?
A. Assess the patient for decreased level of consciousness
B. Administer normal saline
C. Insert an NG tube
D. Connect and read an EKG

36.You are on a night duty in the ED. Martin, a prisoner, was rushed to the hospital who sustained an
abdominal gunshot wound. He is being guarded by policemen from the local police unit. You saw the
policemen trying to hit Martin. You asked why he was trying to hurt Martin. He denied the matter. Which
among the following activities will you do FIRST?
A. Write an incident report
B. Call security officer and report the incident
C. Call your nurse supervisor and report the incident
D. Call the physician on duty

37.A nurse employed in ED is assigned to assist with the triage of clients arriving to the ED for treatment
on the evening shift. The nurse would assign the highest priority to which of the following clients?
A. A client complaining of muscle aches, a headache, and malaise
B. A client who twisted her ankle when she fell while rollerblading
C. A client with a minor laceration on the index finger sustained while cutting an eggplant
D. A client with chest pain who states that he just ate pizza that was made with a very spicy sauce.

38.An unconscious client who is bleeding profusely is brought to the ED after a serious care accident.
Surgery is required immediately to save the client’s life. With regards to informed consent for the surgical
procedure, which of the following is the BEST action?
A.Call the nursing supervisor to initiate a court order for the surgical procedure.
B. Try calling the client’s spouse to obtain telephone consent before the surgical procedure.
C. Ask the friend who accompanied the client to the emergency department to sign the consent form.
D. Transport the client to the operating department immediately, as required by the health care provider
without obtaining an informed consent.

39. Research studies done in natural settings poses difficulty of controlling which variable?
A. Independent C. Extraneous
B. Dependent D. Organismic

SITUATION #6:Hospital Incident Command System (HICS) is an incident command system designed
for hospitals and intended for use in both emergency and non-emergency situations. It provides
hospitals of all sizes with tools needed to advance their emergency preparedness and response
capability.

40.The ED triage nurse is assessing four victims of an automobile accident. Which patient has the highest
priority for treatment?
A. A patient with face and head fractures. C. A patient with facial injuries.
B. A patient with a sucking chest wound. D. A patient with a broken left arm.
41. These four patients arrive in the ED after a motor vehicle crash. In which order should they be
assessed?
1. A 72-year-old with palpitations and chest pain
2. A 45-year-old complaining of 6/10 abdominal pain
3. A 22-year-old with multiple fractures of the face and jaw
4. A 30-year-old with a misaligned right leg with intact pulses

A. 1, 2, 3, 4 C. 3, 1, 2, 4
B. 4, 1, 3, 2 D. 2,3, 1, 4

42. The hospital has sounded the call for a disaster drill on the evening shift. Which of these clients would
the nurse put first on the list to be discharged in order to make a room available for a new admission?
A. A middle aged client with a history of being ventilator dependent for over 7 years and admitted with
bacterial pneumonia five days ago
B. A young adult with diabetes mellitus Type 2 for over 10 years and admitted with antibiotic induced
diarrhea 24 hours ago
C. An elderly client with a history of hypertension, hypercholesterolemia and lupus, and was admitted
with Stevens-Johnson syndrome that morning
D. An adolescent with a positive HIV test and admitted for acute cellulitis of the lower leg 48 hours ago

43. The client is brought to the ED after a serious accident. What would be the INITIAL nursing action of
the nurse to the client?
A. assess the level of consciousness and circulation
B. check respirations, circulation, neurological response
C. align the spine, check pupils, check for hemorrhage
D. check respiration, stabilize spine, check circulation

44.15. A 36-year-old patient with a history of seizures and medication compliance of phenytoin
(Dilantin) and carbamazepine (Tegretol) is brought to the ED by the MS personnel for repetitive seizure
activity that started 45 minutes prior to arrival. You anticipate that the physician will order which drug
for status epilepticus?
A. PO phenytoin and carbamazepine C. IV carbamazepam
B. IV lorazepam (Ativan) D. IV magnesium sulfate

45. You are preparing a child for IV conscious sedation prior to repair of a facial laceration. What
information should you immediately report to the physician?
A. The parent is unsure about the child’s tetanus immunization status.
B. The child is upset and pulls out the IV.
C. The parent declines the IV conscious sedation.
D. The parent wants information about the IV conscious sedation.

46.The nurse in the ED is very short staffed because two people did not show up for work. When asked
who among the four clients will be prioritized, the nurse answered:
A. “I will prioritize the client with acute abdominal pain and possible cholecystitis.”
B. “I will prioritize the client with nephritic syndrome.”
C. “I will prioritize the client with a head injury.”
D. “I will prioritize the confused client yelling because he is in soft restraints.”

47.The ED nurse is providing discharge teaching to the parents of a 2-year-old child who sustained burns.
The nurse evaluates that the parents have CORRECTLY understood the teaching when they state which of
the following?
A. “We will be sure not to leave hot liquids unattended.”
B. “I guess my child needs to understand what the word hot means.”
C. “We will be sure that our child stays in his room when we work in the kitchen.”
D. “We will install a safety gate as soon as we get home so that our child can’t get into the kitchen.”

48.What is the overarching nursing concern when caring for patients being treated with splints, casts,
and traction?
A. To assess for and prevent neurovascular complications or dysfunction
B. To ensure adequate nutrition during the healing process
C. To provide patient education for maintenance of splints, casts, or traction in the community
D. To treat acute pain
49.What nursing interventions demonstrates that the nurse understands the priority nursing diagnosis
when caring for patients being treated with splints, casts, or traction?
A. The nurse assesses extremity pulse, temperature, color, pain, and feeling every hour.
B. The nurse orders meals with adequate protein and calcium for the patient.
C. The nurse teaches the patient never to insert objects under a cast to scratch an itch.
D. The nurse administers oral painkillers as ordered.

50. You are a nurse in the ED. The personnel are very busy because of the influx of patients due to
vehicular accident. You were asked to check the narcotics cabinet. You found out that what is on the
record does not tally with the drugs used. Which among the following will you do first?
A. Write an incident report and refer the matter to the nursing director
B. Keep your findings to yourself
C. Report the matter to your supervisor
D. Find out from the endorsement any patient who might have been given narcotics

51.The emergency medical service (EMS) has transported a patient with severe chest pain. As the patient
is being transferred to the emergency stretcher, you note unresponsiveness, cessation of breathing, and
no palpable pulse. Which task is appropriate to delegate to the nursing assistant?
A. Chest compressions C. Assisting with oral intubation
B. Bag-valve mask ventilation D. Placing the defibrillator pads

52.The nurse has been assigned to these clients in the emergency room. Which client would the nurse go
check first?
A. Viral pneumonia with atelectasis
B. Spontaneous pneumothorax with a respiratory rate of 38
C. Tension pneumothorax with slight tracheal deviation to the right
D. Acute asthma with episodes of bronchospasm

53. An experienced nurse in the triage team who voluntarily trained a less experienced nurse with the
intention of enhancing the skills and knowledge and promoting professional advancement to the nurse is
called a:
A. mentor C. case manager
B. team leader D. change agent

54. A 15-year-old girl who is a victim of a vehicular accident needs an emergency surgery. The nurse
prepared the consent form and it should be signed by:
A. the physician C. the 15-year-old girl
B. the registered nurse caring for the client D. the mother of the girl

SITUATION #7:Hazardous waste poses substantial or potential threats to public health or the
environment.

55. A patient arrives in the emergency department after exposure to radioactive dust. Which action
should the nurse take first?
A. Let the patient take a shower. C. Place the patient in a closed room.
B. Let the patient change his clothes. D. Place the patient in a shower.

56. There has been a radioactive explosion nearby. The emergency room nurse must triage and manage
the decontamination of the clients systematically. Which of the following clients must be decontaminated
first?
A. A client with severe injuries C. A client with the least injuries
B. A client with minor injuries D. A client with the most injuries

57. A military nurse is working in Southern Mindanao. Because of the potential threat of hazardous gas,
which of the following should NOT be worn in a dangerous war zone?
A. Gas mask C. Sunglasses
B. Protective clothing D. Helmet
58.An emergency room nurse is at work when a major biologic terrorist attack occurs. In addition to
caring for injured clients, the nurse must control the crowd. Which of the following statements, if made
by the nurse, shows understanding of the concept of crowd control?
A. The job of crowd control is under the auspices of the nurses.
B. Even if the crowd control is maintained, chaos ensues.
C. The agency’s security personnel and/or the local police force must control these crowds
D. Nurses will need to enter areas that have not been secured yet in order to reach the clients.

59.A chemical exposure has just occurred at an airport. An off-duty nurse, knowledgeable about
biochemical agents, is giving directions to the travelers. Which direction should the nurse provide to the
travelers?
A. Hold their breath as much as possible. C. Lie down to stay under the exposure.
B. Stand up to avoid heavy exposure. D. Attempt to breathe through their clothing.

60.After the incident of chemical exposure, the patient suffered neurologic injuries. The patient felt
restless and was placed on restraint. When charting the procedure for applying restraints to the client,
the nurse would include:
A. condition of the extremity following application
B. what the client says about the restraint
C. physician’s orders regarding the restraint
D. procedure for applying the restraint

61. In general, the research process follows the following 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 C. 2, 5, 3, 4, 1
B. 3, 5, 4, 1, 2 D. 2, 5, 1, 3, 4

SITUATION #8:Bioterrorism is terrorism involving intentional release of biologic agents. These

agents are bacteria, viruses, or toxins and maybe in a naturally occurring or human-modified form.

62. When planning the response to the potential use of smallpox as an agent of terrorism, the emergency
department (ED) nurse-manager will plan to obtain sufficient quantities of:
A. vaccine C. antibiotics
B. IV fluids D. packed RBC

63. An emergency room nurse is working when there is a bioterrorism attack in the city. Which of the
following statements is CORRECT with regards to injuries or symptoms associated with a bioterrorism
attack?
A. The main purpose of biological weapon use is contained devastation.
B. It is not uncommon for the results of a biological attack to be made known several hours or days after
the attack.
C. Biological attacks are usually known right away.
D. Detection is easy as clients go to a number of different health care facilities.

64. What is the most likely source of exposure in a biologic weapon attack?
A. Absorption C. Inhalational
B. Adsorption D. Dermal

65. Which of the following potential bioterrorism agents has three routes of exposure to humans?
A. Smallpox C. Botulism
B. Anthrax D. Tularemia

66.An experienced nurse was invited to teach a class on biological warfare. Which information should the
nurse include in the presentation?
A. Contaminated water is the only source of transmission of biological agents.
B. Vaccines are available and being prepared to counteract biological agents.
C. Biological weapons are less of a threat than chemical agents.
D. Biological weapons are easily obtained and result in significant mortality.
67.The nurse was accused of killing the patient by causing a negligent act during a hospital emergency.
The one filing the criminal case against an accused party is said to be the:
A. Guilty C. Plaintiff
B. Accused D. Witness

68.The client has expired secondary to smallpox. Which information about funeral arrangements is most
important for the nurse to provide to the client’s family?
A. The client must be cremated. C. Bury the client within 24 hours.
B. Suggest an open casket funeral. D. Notify the public health department.

SITUATION #9: Blast injuries result from explosions that have the capability to cause multisystem,
life-threatening conditions.

69. The nurse is caring for a client with blast injury. Which of the following nursing assessment would be
most appropriate for this client?
A. Assess for vasovagal hypotension C. Assess for asphyxia
B. Assess the client for confusion D. Assess for hypervolemia

70.Five patients have been brought to the ED following an explosion that destroyed a chemical plant. All
of the patients show signs of secondary blast injuries, which include:
A. ruptured eardrums C. penetrating wounds
B. bloody sputum D. burns

71.An adult client was burned as a result of an explosion. The burn initially affected the client’s entire
face and the upper half of the anterior torso, and there were circumferential burns to the lower half of
both of the arms. The client’s clothes caught on fire, and the client ran, which caused subsequent burn
injuries of the posterior surface of the head and the upper half of the posterior torso. According to the
rule of nines, what is the extent of the client’s burn injury?
A. 16 % C. 36%
B. 26% D. 46%

72.A trauma nurse cared for a child with devastating injuries secondary to bomb explosion. She called in
sick for a couple of days and is now back working on the team. Which of the following behaviors would
indicate this nurse is coping well?
A. She is talking about taking the emergency nursing certification examination.
B. She keeps requesting to be assigned to the ambulatory area.
C. She is impatient and snaps at coworkers.
D. She is thinking about transferring out of the emergency department.

73.A new nurse asks the senior nurse, “After a bomb explosion, fragmentation injuries from the bomb or
objects in the environment are examples of which phase of injury?”
A. Primary C. Tertiary
B. Secondary D. Quartenary

74.The patient post blast injury suffered wounds in the body. The ED nurse conducted health teaching
about the importance of good hand hygiene in wound care. Hand hygiene is important because:
A. doctors don’t like dirty hands
B. clean hands smell nicer for the patient
C. it prevents the spread of infection
D. dressings don’t work if there is any dirt on the wound

75.The staff nurse working in the ED has been reprimanded for work that is done incorrectly. What is this
type of reinforcement?
A. Feedback C. Performance appraisal
B. Positive reinforcement D. Negative reinforcement

SITUATION #10: Metro Manila was struck by an 8.5 magnitude earthquake causing and resulting to
mass casualties and destruction to lives and properties.

76.The most common health problems in a natural disaster like earthquake or volcanic eruption would
be:
A. malaria. C. leptospirosis.
B. typhoid and cholera. D. pulmonary diseases.
77. The emergency nurse, who recently attended a seminar-workshop in advanced cardiac life support, is
caring David who is a 55 year old man exhibiting psychological disturbances. The nurse would color
tagged David with:
A. black. C. red.
B. green. D. yellow.

78. Those people who are trapped inside a crumbled building and who are less likely to survive are
triaged as:
A. priority 1. C. priority 3.
B. priority 2. D. priority 4.

79. According to studies, there is a direct relationship between time trapped and survival. If trapped
more than 2-6 hours, chance of survival is:
A. 80% C. <50%
B. 60% D. >80%

80. Following an earthquake, patients are triaged by emergency medical personnel and are transported
to the hospital. Which of these patients will the nurse need to assess first?
A. A patient with a red tag. C. A patient with a yellow tag.
B. A patient with a green tag. D. A patient with a black tag.

81.After the earthquake, some patients suffered brain injuries because of the fallen objects. Restless
patients were placed on restraint. When charting the procedure for applying restraints, the nurse would
document:
A. the condition of the extremity following application
B. what the client says about the restraint
C. physician’s orders regarding the restraint
D. the procedure for applying the restraint

82. In the work setting, what is your primary responsibility in preparing for disaster management that
includes natural disasters and bioterrorism?
A. Knowledge of the agency’s emergency response plan
B. Awareness of the signs and symptoms for potential agents of bioterrorism
C. Knowledge of how and what to report to the CDC
D. Ethical decision-making about exposing self to potentially lethal substances

SITUATION #11:The impact of natural disaster event goes far beyond physical damage. The
emotional toll can result in a wide range of intense, confusing, and sometimes frightening emotions.

83.Patient X, suffering from PTSD, will benefit from cognitive-behavioral therapy. Which intervention
would be typical of a nurse using cognitive-behavioral approach to a client suffering from stress
disorders?
A. Use of unconditional positive regard C. Analysis of free association
B. Classical conditioning D. Examination of negative thought patterns.

84. Which of the following therapies has been strongly advocated for the treatment of PTSD?
A. Electroconvulsive Therapy C. Hypnotherapy
B. Group Therapy D. Psychoanalysis

85.The nurse knows that in group therapy, the maximum number of members to include is:
A. 4 C. 10
B. 8 D. 16

86. The nursing management of anxiety related PTSD includes all of the following, except:
A. Encourage participation in recreation or sport activities
B. Reassure client safety while touching client
C. Speak in calm soothing voice
D. Remain with the client while fear level is high
87.When an unexpected death occurs in the ED, which of the following tasks is MOST appropriate to
delegate to the nursing assistant?
A. Escort the family to a place of privacy.
B. Go with the organ donor specialist to talk to the family.
C. Assist with postmortem care.
D. Assist the family to collect belongings.

88. Nurse DJ plans to undertake a research of those patients suffering from Post Traumatic Stress
Disorder (PTSD) on how they cope with their situation. This type of research is:
A. Experimental C. Descriptive
B. Historical D. Basic

89.Nurse DJ has documented an entry regarding client care in the client’s medical record. When checking
the entry, the nurse realizes that incorrect information was documented. How does the nurse correct this
error?
A. Erases the error and writes in the correct information.
B. Uses correction fluid to cover up the incorrect information and writes in the correct information.
C. Draws one line to cross out the incorrect information and then initials the change.
D. Covers up the incorrect information completely using a black pen and writes in the correct
information.

SITUATION #12: 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.

90.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 C. congestive heart failure
B. renal failure D. pulmonary edema

91. When an IV of D5W is not infusing well on the 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 of flow
D. restart the IV

92. The doctor ordered venoclysis of dextrose 5% in water one liter KVO for 24 hours as a vehicle for
medications. How many drops per minute should the fluid be regulated?
A. 20 drops per minute C. 10 drops per minute
B. 5 drops per minute D. 15 drops per minute

93. The nurse is administering IV fluids to an infant. Infants receiving IV therapy are particularly
vulnerable to:
A. hypotension C. cardiac arrhythmias
B. fluid overload D. pulmonary emboli

94. 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 C. constipation
B. air embolism D. dumping syndrome

95. A 12-year-old client is admitted to the hospital. The physician ordered Dilantin to the client. In
administering IV phenytoin (Dilantin) to a child, the nurse would be most CORRECT in mixing it with:
A. normal saline C. 5% dextrose in water
B. heparinized normal saline D. Lactated Ringer’s solution

96. The client is to receive an IV piggyback medication. When preparing the medication, the nurse should
be aware that it is very important:
A. use strict sterile technique
B. use exactly 100mL of fluid to mix the medication
C. change the needle just before adding the medication
D. rotate the bag after adding the medication
97. The physician orders a bolus of Lidocaine followed by a continuous Lidocaine infusion at a rate of
2mgm/minute. The IV solution contains 2 grams of Lidocaine in 500 cc’s of D5W. The infusion pump
delivers 60 microdrops/cc. What rate would deliver 4 mgm of Lidocaine/minute?
A. 20 microdrops/minute C. 40 microdrops/minute
B. 30 microdrops/minute D. 60 microdrops/minute

98.The nurse caring for a client receiving magnesium sulfate must closely observe for side effects
associated with drug therapy. The patient asked, “What is the expected side effect of the drug that I’m
taking?” The nurse is CORRECT when she answers:
A. “The expected side effect is decreased urinary output.”
B. “The expected side effect is hypersomnolence.”
C. “The expected side effect is absence of knee jerk reflex.”
D. “The expected side effect is decreased respiratory rate.”

99. RA 7164 is one of the laws affecting Intravenous Therapy Practice otherwise known as:
A. Special Training for Nurses on Intravenous Injection
B. Philippine Nursing Act of 2002
C. Generics Act of 1988
D. Sanitation Code of the Philippines

100.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

- God Bless! -

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