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Simon who came in with asthma. She has difficulty breathing and her respiratory rate is 40 per minute. Mr. Ibarra is asked to inject the client epinephrine 0.3mg subcutaneously 1. The indication for epinephrine injection for Mrs Simon is to: a. Reduce anaphylaxis b. Relieve hypersensitivity to allergen c. Relieve respirator distress due to bronchial spasm d. Restore client’s cardiac rhythm 2. When preparing the epinephrine injection from an ampule, the nurse initially: a. Taps the ampule at the top to allow fluid to flow to the base of the ampule b. Checks expiration date of the medication ampule c. Removes needle cap of syringe and pulls plunger to expel air d. Breaks the neck of the ampule with a gauze wrapped around it 3. Mrs. Simon is obese. When administering a subcutaneous injection to an obese patient, it is best for the nurse to: a Inject needle at a 15 degree angle' over the stretched skin of the client b. Pinch skin at the Injection site and use airlock technique c. Pull skin of patient down to administer the drug in a Z track d. Spread skin or pinch at the injection site and inject needle at a 45-90 degree angle 4. When preparing for a subcutaneous injection, the proper size of syringe and needle would be: a. Syringe 3-5ml and needle gauge 21 to 23 b. Tuberculin syringe 1 mi with needle gauge 26 or 27 c. Syringe 2ml and needle gauge 22 d. Syringe 1-3ml and needle gauge 25 to 27 5. The rationale for giving medications through the subcutaneous route is; a. There are many alternative sites for subcutaneous injection b. Absorption time of the medicine is slower c. There are less pain receptors in this area d. The medication can be injected while the client is in any position Situation 2 - The use of massage and meditation to help decrease stress and pain have been strongly recommended based on documented testimonials.
6. Martha wants to do a study on, this topic. "Effects of massage and meditation on stress and pain." The type of research that best suits this topic is: a. applied research b. qualitative research c. basic research d. quantitative research 7. The type of research design that does not manipulate independent variable is: a. experimental design b. quasi-experimental design c. non-experimental design d. quantitative design 8. This research topic has the potential to contribute to nursing because it seeks to: a. include new modalities of care b. resolve a clinical problem c. clarify an ambiguous modality of care d. enhance client care 9. Martha does review of related literature for the purpose of: a. determine statistical treatment of data research b. gathering data about what is already known or unknown c. to identify if problem can be replicated d. answering the research question 10. Client’s rights should be protected when doing research using human subjects. Martha identifies these rights as follows EXCEPT: a. right of self-determination b. right to compensation c. right of privacy d. right not to be harmed Situation 3 - Richard has a nursing diagnosis of ineffective airway clearance related to excessive secretions and is at risk for infection because of retained secretions. Part of Nurse Mario's nursing care plan is to loosen and remove excessive secretions in the airway, 11. Mario listens to Richard's bilateral sounds and finds that congestion is in the upper lobes of the lungs. The appropriate position to drain the anterior and posterior apical
segments of the lungs when Mario does percussion would be: a. Client lying on his back then flat on his abdomen on Trendelenburg position b. Client seated upright in bed or on a chair then leaning forward in sitting position then flat on his back and on his abdomen c. Client lying flat on his back and then flat on his abdomen d. Client lying on his right then left side on Trendelenburg position 12. When documenting outcome of Richard's treatment Mario should include the following in his recording EXCEPT: a. Color, amount and consistent of sputum b. Character of breath sounds and respirator/rate before and after procedure c. Amount of fluid intake of client before and after the procedure d. Significant changes in vital signs 13. When assessing Richard for chest percussion or chest vibration and postural drainage Mario would focus on the following EXCEPT: a. Amount of food and fluid taken during the last meal before treatment b. Respiratory rate, breath sounds and location of congestion c. Teaching the client's relatives to perform 'the procedure d. Doctor's order regarding position restriction and client's tolerance for lying flat 14. Mario prepares Richard for postural drainage and percussion. Which of the flowing is a special consideration when doing the procedure? a. Respiratory rate of 16 to 20 per minute b. Client can tolerate sitting and lying position c. Client has no signs of infection d. Time of fast food and fluid intake of the client 15. The purpose of chest percussion and vibration is to loosen secretions in the lungs. The difference between the procedure is; a. Percussion uses only one hand white vibration uses both hands b. Percussion delivers cushioned blows to the chest with cupped palms while gently shakes secretion loose on the exhalation cycle c. In both percussion and vibration the hands are on top of each other and hand action is in tune with client's breath rhythm d. Percussion slaps the chest to loosen secretions while vibration shakes the secretions along with the inhalation of air Situation 4 - A 61 year old man, Mr. Regalado, is admitted to the private ward for observation;
after complaints of severe chest pain. You are assigned to take care of the client. 16. When doing an initial assessment, the best way for you to identify the client’s priority problem is to: a. 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 white asking the client relevant questions 17. Upon establishing Mr. Regalado's nursing needs, the next nursing approach would be to: a. introduce the client to the ward staff to put the client and family at ease b. Give client and relatives a brief tour of the physical set up the unit c. Take his vital signs for a baseline assessment d. Establish priority needs and implement appropriate interventions 18. Mr. Regalado says he has "trouble going to sleep". In order to plan your nursing intervention you will. a. Observe his sleeping patterns in the next few days b. Ask him what he means by this statement c. Check his physical environment to decrease noise level d. Take his blood pressure before sleeping and upon waking up 19. Mr. Regalado's lower extremities are swollen and shiny. He has pitting pedal edema. When taking care of Mr. Regalado, which of the following intervention would be the most appropriate immediate nursing approach. a. Moisturize lower extremities to prevent skin irritation b. Measure fluid intake and output to decrease edema c. Elevate lower extremities for postural drainage d. Provide the client a list of food low in sodium 20. Mr. Regalado will be discharged from your unit within the hour. Nursing actions when preparing a client for discharge include all EXCEPT: a. Making a final physical assessment before client leaves the hospital b. Giving instructions about his medication regimen c. Walking the client to the hospital exit to ensure his safety d. Proper recording of pertinent data Situation 5 - Nancy, mother of 2 young kids. 36 years old, had a mammogram and was told that
Realizing that she feels angry about Nancy's condition. sweating and feelings of tension. The nurse's best response would be: a. the nurse can best assist Nancy by: a. doctor how you feel? Are you changing your mind) about surgery?" d. Giving her activities to divert her attention b. refusing to eat or talk to her family. 21. The nurse visits Nancy and prods her to eat her food. "Have you told your." c. Giving detailed explanations about the treatments she will undergo c. A religious person before. denial c. Ask the other nurses what they feel about the patient to find out if they share the same feelings 25. This causes her anxiety as shown by increase in her pulse and respiratory rate. bargaining b. Preparing her and her family in case surgery is not successful d. Advise the nurse to "be strong and learn to control her feelings" b. The best response of the head nurse would be: a.she has breast cysts and that she may need surgery. Reassure the nurse that the client has hope if she goes through all statements prescribed for her c. The nurse is a role model for the client and should be strong . "The doctor ordered full diet for you so that you will be strong for surgery. Considering her level of anxiety. This is a necessary part of the nurse -client relationship process b. Nancy replies "what's the use? My time is running out." 24. "I understand how you fee! but you have 1o try for your children's sake. She is easily provoked to tears and wants to be left alone. the nurse Seams that being self-aware is a conscious process that she should do in any situation like this because: a. Assign the nurse to another client to avoid sympathy for the client c. "You sound like you are giving up. The nurse understands that Nancy is grieving for her self and is in the stage of: a. Giving her clear but brief information at the level of her understanding 22. Nancy blames God for her situation. she now refuses to pray or go to church stating that God has abandoned her." b. The nurse feels sad about Nancy's illness and tells her head nurse during the end of shift endorsement that "it's unfair for Nancy to have cancer when she is still so young and with two kinds. anger d. acceptance 23.
26. wipe from anal area up towards the pubis d. 32 years old.C. loss of tone of the smooth muscles of the color d. decreased ability to absorb fluids in the lower intestines 28. instruct client to start wearing thin adult diapers c. no regular tine for defecation daily d. Seva asked for instructions for skin care for her mother who has urinary incontinence and is almost always in bed. asks you about possible problems regarding her elimination now that she is in the menopausal stage. Seva also tells the nurse that she is often constipated. Mrs. what physical changes predispose her to constipation? a. high fiber diet c. After urination. The nurse has to be therapeutic at all times and should not be affected Situation 6 – Mrs. ask the client to bring change of underwear "just in case" d. Using thick diapers to absorb urine well . Seva talks about rear of being incontinent due to a prior experience of dribbling urine when laughing or sneezing and when she has a full bladder. inhibition of the parasympathetic reflex b. tell client to drink less fluids to avoid accidents b.instruction would be to: a. Seva. Mrs. Instruction on health promotion regarding urinary elimination is important. If burning sensation is experienced while voiding. weakness of sphincter muscles of the anus c. The nurse understands that one of these factors contributes to constipation: a. prolonged use of laxatives 29. Which would you include? a. Hold urine. Because she is aging. How the nurse thinks and feels affect her actions towards her client and her work d. excessive exercise b. Your instruction would focus on prevention of skin irritation and breakdown by a. drink pineapple-juice c. Mrs. teach client pelvic exercise to strengthen perineal muscles 30. as long as she can before emptying the bladder to strengthen her sphincters muscles b. Your most appropriate . Jell client to empty the bladder at each voiding 27.
the distance from the tip of the nose to the middle of the cheek c. Airway.neck b. eight to ten inches 34.Mr. The nurse's knowledge and ability to identify and immediately intervene to meet these needs is important to save lives. Which of these clients has a problem with the transport of oxygen from the lungs to the tissues: a. You will nasopharyngeal suctioning Mr. Abad. You noted from the lab exams in the chart of Mr. Using gloves to prevent introduction of pathogens to the respiratory system c. Rotating catheter as it is inserted with gentle suction 35. Cyanosis b. Hypoxia c. rising and during of skin area that get wet with urine d. Sonny Boy with a fracture in the femur d. effectively and comfortably. the nurse can avoid trauma to the area by: a. Drying the skin with baby powder to prevent or mask the smell of ammonia c. 31. Myrna has difficulty breathing when on her back and must sit upright in bed to breath. Carol with a tumor in the brain b. While doing nasopharyngeal suctioning on . the distance from the tip of the nose to the tip of the ear lobe d. Applying no suction while inserting the catheter d. Your guide for the length of insertion of the tubing for an adult would be: a.Using Maslow's need theory. Brigette with diarrhea 32. Theresa with anemia c. Abad. Anemia 33. Making sure that linen are smooth and dry at all times Situation 7 . tip of the nose to the base of the . Hypoxemia d.b. Breathing and Circulation are the physiological needs vital to life. The nurse documents this condition as: . This condition is called: a. Apply suction for at least 20-30 seconds each time to ensure that all secretions are removed b. Santos that he has reduced oxygen in the blood. Thorough washing.
proper nutrition 39. When taking blood pressure reading the cuff should be: a. Tachypnea Situation 8 . tobacco hack b. asthma d. 36. These are the following except . In your health education class for clients with diabetes you teach. Chronic Obstructive Pulmonary Disease (COPD) in one of the leading causes of death worldwide and is a preventable disease.You are assigned to screen for hypertension: Your task is to take blood pressure readings and you are informed about avoiding the common mistakes in BP taking that lead to 'false or inaccurate blood pressure readings. Type II (NIDDM) is more common and is also preventable compared to Type I (IDDM) diabetes which is genetic in etiology c. them the areas. Type I (IDDM) and Type II (NDDM) Diabetes. for control . The primary cause of COPD is: a. thorough knowledge of foot care c. Apnea b. inflated to 30 mmHg above the estimated systolic BP based on palpation of radial or bronchial artery 37. Diabetes which include all EXCEPT: a. Lifestyle-related diseases in general share areas common risk factors. You teach your clients the difference between. regular physical activity b. deflated fully then immediately start second reading for same client b deflated quickly after inflating up to 180 mmHg c. Dyspnea d. cigarette smoking 38. prevention nutrition d. Orthopnea c. Which of the following is true? a. Type I (IDDM) is characterized by fasting hyperglycemia d. bronchitis c.a. both types diabetes mellitus clients are all prone to developing ketosis b. large enough to wrap around upper arm of the adult client 1 cm above brachial artery d. Type II (IDDM) is characterized by abnormal immune response 40.
Report the incident immediately to the local police authorities d.Nurse Rivera witnesses a vehicular accident near the hospital where she works.a. Assist in the police investigation since she is a witness c. Priority attention should be given to which of these clients? a. Andy whose left ankle swelled and has some abrasions 43. physical activity b. Linda who shows severe anxiety due to trauma of the accident b. Protect the wound from micro organisms in the air d. Bandage the wound and elevate the arm 44. After the treatment. Your responsibilities when the client is to be discharged include the following EXCEPT: . Her priority nursing action would be to: a. while assessing the extent of the wound the nurse observes that the wound is now starting to bleed profusely. of the accident 42. Control and. the client is sent home and asked to come back for follow-up care. Allow the pus to surface faster c. Nurse Rivera is assigned to attend to the client with . reduce bleeding of the wound d.lacerations on the arms. Reduce the need to change dressing frequently b. This intervention is done to: a. smoking c. Apply antiseptic to prevent infection b. 41. Noel who has lacerations on the arms with mild-bleeding c. Assess damage to property b. The most immediate nursing action would be to: a. Clean the wound vigorously of contaminants c. She decides to get involved and help the victims of the accident. is pate and with difficulty of breathing c. genetics d. In the emergency room. Promote hemostasis 45. Assess the extent of injuries incurred by the victims. Ryan who has chest injury. nutrition Situation 9 . The nurse applies pressure dressing on the bleeding site.
Instruct her to attend classes in nutrition to find food rich in complex carbohydrates to maintain daily high energy level d. She has lost weight during the past two weeks. gather data and make an assessment. As the clinic nurse. Start her off with a cleansing diet to free her body of toxins then change to a vegetarian. you are to assist the client fiil up forms. health needs and possible problems to develop a plan of care d. She confesses that she is in her 2nd month of pregnancy but she does not want to become fat that is why she limits her food intake. outpatient clinic for follow up care b. Geline tells you that she drinks 4-5 cups of black coffee and diet cola drinks. a new client. She also smokes up to a pack of cigarettes daily. the client experienced severe abdominal pain c. You will record this as follows: a. Understand her lifestyle. After drinking coffee. 46. she starts to moan and doubles up in pain. Client reported abdominal pain an hour after drinking black coffee for three weeks now 48. Instructing the client to see you after discharge for further assistance d. arrives for her doctor's appointment. Geline. Discuss with her the importance of eating a variety of food from the major food groups with plenty of fluids 49. Client complained of intermittent abdominal pain an hour after drinking coffee d. Encouraging the client to go to the.While working in the clinic. While interviewing Geline.a. Record pertinent information in the client chart for health team to read b Assist the client find solutions to her health concerns c. diet. low carbohydrate diet for her considering her favorite food c. you will: a. Accurate recording. You warn or caution her about which of the following? a. Plan a high protein. The nurse purpose of your initial nursing interview is to: a. of treatment done and instructions given to client c. in planning a healthy balanced diet with Geline. Caffeine products affect the central nervous system and may cause the mother to have a . Providing instructions regarding wound care Situation 10 . She tells you that this pain occurs about an hour after taking black coffee without breakfast for a few weeks now. Claims to have abdominal pains after intake of coffee unrelieved by analgesics b. 35 years old. Geline tells you that she drinks black coffee frequently within the day to "have energy and be wide awake" and she eats nothing for breakfast and eats strictly vegetable salads for lunch and dinner to lose weight. Make nursing diagnoses for identified health problems 47. diet and drink plenty of fluids b.
The following tasks can be safely delegated' by a nurse to a non-nurse health worker EXCEPT: . she is demonstrating: a. Malnutrition and its possible effects on growth and development problems in the unborn fetus c. Caffeine causes a stimulant effect on both the mother and the baby d. Your health education plan for Geline stresses proper diet for a pregnant woman and the prevention of non-communicable diseases that are influenced by her lifestyle these include of the following EXCEPT: a. Cardiovascular diseases b. 51. Osteoporosis Situation 11 . Autocratic leadership d.Management of nurse practitioners is done by qualified nursing leaders who have had clinical experience and management experience. Teaching patient do breathing and coughing exercises b. Studies show conclusively that caffeine causes mental retardation 50. Democratic leadership c. Performing nursing procedures for clients d. Cancer c. Managerial leadership 53. Delegation c. Responsibility b."nervous breakdown" b. Accountability d. Preparing for a surprise party for a client c. Authority 54. An example of a management function of a nurse is: a. Directing and evaluating the staff nurses 52. Your head nurse in the unit believes that the staff nurses are not capable of decision making so she makes the decisions for everyone without consulting anybody. Diabetes Mellitus d. When the head nurse in your ward plots and approves your work schedules and directs your work. This type of leadership is: a. Laissez faire leadership b.
severe headache. The nurse finds that the cuff is too narrow and this will cause the blood pressure reading to be: a. Autocracy Situation 12 – Mr. Dizon smokes and drinks coffee. Inconsistent b.Emergency Room for complaint of hypertension flushed face. 84 years old. Dizon. Responsibility b. and nausea. Dizon’s finger to: a. Measure the efficacy of the client’s anti hypertensive medications d. lower than what the reading should be 59. After a few hours in the Emergency Room. Take vital signs 55. Accountability c.a. A pulse oximeter is attached to Mr. Irrigation of a nasogastric tube d. 56. You are demonstrating: a. You are to measure the client’s initial blood pressure reading by doing all of the following EXCEPT: a. Authority d. Pump the cuff up to around 50 mmHg above the point where the pulse is obliterated d. Detect oxygen saturation of arterial blood before symptoms of hypoxemia develops 58. Check level of client’s tissue perfusion c. When taking the blood pressure of a client who recently smoked or drank coffee. Transfer a client from bed to chair b. You are doing the initial assessment of vital signs. Change IV infusions c. Listen to and identify the phases of Korotkoff’s sounds c. low systolic and high diastolic pressure c. Observe procedures for infection control 57. Take the blood pressure reading on both arms for comparison b. Determine if the client’s hemoglobin level is low and if he needs blood transfusion b. Dizon is admitted to the ward with an order of hourly monitoring of blood pressure. Through the client’s health history. how long should be the nurse wait before taking the client’s blood pressure for accurate . is brought to the . Mr. you gather that Mr. You made a mistake in giving the medicine to the wrong client You notify the client’s doctor and write an incident report. higher than what the reading should be d.
Act only when advised that the action is ethically sound b. Morality b. biology and the health professions is referred to as: a. Cover the fingertip sensor with a towel or bedsheet d. Your action will be to: a. nurses. Assume that ethical questions are the responsibility: of the health team d. Set and turn on the alarm of the oximeter b. To define the roles and functions of the health care giver. Not take sides remain neutral and fair c. 61. Be accountable for his or her own actions 64. Do nothing since there is no identified problem c. Religion c. The purpose of having nurses’ code of ethics is: a.govern right and proper conducts of a person regarding life. The principles that . You inform the patient about his rights which include the following EXCEPT: a. Identify nursing action recommended for specific healthcare situations c. Delineate the scope and areas of nursing practice b. While the client has the pulse oximeter on his fingertip. The most important nursing responsibility where ethical situations emerge in patient care is to: a. 30 minutes c.The nurse's understanding of ethico-legal responsibilities will guide his/her nursing practice. Bioethics 62.the area where the oximeter is. 15 minutes b. Values d. clients 63. 1 hour d.reading? a. expected of nurses d. you notice that the sunlight is shining on . 5 minutes 60. Change the location of the sensor every four hours Situation 13 . Right to expect reasonable continuity of care . To help the public understand professional conduct.
68. Have two nurses validate the phone order. family spokesperson. RO of the Nursing Intervention Classification d. You are taking care of critically ill client and the doctor in charge calls to order a DNR (do not resuscitate) for the client. It refers to the scope of nursing as defined in Republic Act 9173 c. The Standards of care includes the various steps of the nursing process and the standards of professional performance. Bioethics b. Right to obtain information about another patient d. Have the registered nurse. Patient satisfaction surveys provided b. Right to expect that the records about his care will be treated as confidential 65. nurse supervisor and doctor sign b. It is a license issued by the Professional Regulation Commission to protect the public from substandard nursing practice. As a staff nurse in that hospital you know that this entails quality assurance programs. Which of the following statements best describes what it is? a. c. both nurses sign the order and the doctor should sign his order within 24 hours. b. Justice c. family and doctor sign the order d. Right to consent to or decline to participate in research studies or experiments c. The nurse of the Standards of Nursing Practice is important in the hospital. Peer review clinical records of care of client c. a. Have 1 nurse take the order and sign it and have the doctor sign it within 24 hours . 67. Have the registered nurse. The principle states that a person has unconditional worth and has the capacity to determine his own destiny. Autonomy Situation 14 – Your director of nursing wants to improve the quality of health care offered in the hospital. 66. These are statements that describe the maximum or highest level of acceptable performance in nursing practice. Fidelity d. The following mechanisms can be utilized as part of the quality assessment program of your hospital EXCEPT: a.b. d. Which of the following is the appropriate action when getting DNR order over the phone? a.
limit intake of preserved or processed food 73. cooking demonstration and meal planning . sex and immediate concerns of the group. Mr. Bruno is: a. take baseline vital signs b. 1 tsp of salt/day but not patis or toyo 72. To ensure the client safety before starting blood transfusion the following are needed before the procedure can be done EXCEPT: a. use herbs and spices d. blood should be warmed to room temperature for 30 minutes before blood transfusion is administered c. Which of the following statements is NOT true? a. Part of standards of care has to do with the use of restraints. Bruno shows increased interest. harmful effect on drugs and alcohol intake c. Teaching strategies and approaches when giving nutrition education is influenced by age. 5 gms per day or 1 tsp of table salt/day c. 1 tsp of salt/day with iodine and sprinkle of MSG b. eat natural food with little or no salt added b. Your best response to Mr. 71. Bruno asks what the "normal" allowable salt intake is. Remove and reapply restraints every two hours c. Your instructions to reduce or limit salt intake include all the following EXCEPT: a. commercial preparation of dishes d. unit number and expiration date of blood d. diets limited in salt and fat b. have two nurses verify client identification. get a consent signed for blood transfusion 70. blood pressure and circulation every four hours d. Offer food and toileting every two hours Situation 15 – During the NUTRITION EDUCATION class discussion a 58 year old man. blood type. Check client’s pulse. 1 tbsp of salt/day with some patis and toyo d. limit use of table salt and use condiments instead c. Your presentation for a group of young mothers would be best if you focus on: a.69. Mr. Doctor’s order for restraints should be signed within 24 hours b.
focus on smoking cessation projects d. The role of the health worker in health education is to: a. Mr. Atienza is to receive 150mg/hour of D5W IV infusion for 12 hours for a total of 1800ml. early detection and prompt treatment 75. 76. use of alternative methods of healing b. How much fluid should he receive at 11am? a. The following important guidelines to observe EXCEPT: a. 36 years old is to be given 2700ml of D5RL to infuse for 18 hours starting at 8am. monitor clients with hypertension Situation 16 – You are assigned to take care of 10 patients during the morning shift. Apply to hairlines clean are of the skin not subject to much wrinkling b. Change application and site regularly to prevent irritation of the skin d. The endorsement includes the IV infusion and medications for these clients. He is also losing gastric fluid which must be replaced every two hours. Atienza has lost 250ml of gastric fluid. At what rate should the IV fluid be flowing hourly? a. You will be applying eye drops to Miss Romualdez. 400 ml/hour d. proficiency in doing breast self-examination d. watching out for warning signs of cancer c. 200 ml/hour 78. Patches may be applied to distal part of the extremities like forearm c. After checking all the necessary . 210 ml/hour c. 150 ml/hour d. Mr. You are to apply a transdermal patch of nitroglycerin to your client. educate as many people about warning signs of non-communicable diseases c. Wear gloves to avoid any medication of your hand 79. 275 ml/hour c. Between 8am to 10am. report incidence of non-communicable disease to community health center b. Cancer cure is dependent on a. 350 ml/hour b. 90 ml/hour 77.74. Felipe. Mr. 100 ml/hour b.
directly onto the cornea b. tell her to take the day off c. apply ointment from the inner canthus going outward of the affected eye c. ask about her family life 84. efficient management of human resources c. Connie. primary prevention 82. a. Mrs.information and cleaning the affected eyelid and eyelashes you administer the ophthalmic drops by instilling the eye drops. hold the tube above the conjunctival sac do not let tip touch the conjuctiva Situation 17 – The staff nurse supervisor request all the staff nurses to “brainstorm” and learn ways to instruct diabetic clients on self-administration of insulin. a. empathize with the nurse and listen to her b. is assigning the responsibility to the aide but not the accountability for those tasks c. The nurse supervisor should: a. discard the first bead of the eye ointment before application because the tube likely to expel more than desired amount of ointment d. When applying eye ointment. squeeze about 2 cm of ointment and gently close but not squeeze eye b. from the inner canthus going towards the side of the eye 80. She wants to ensure that there are nurses available daily to do health education classess. Process of formal negotiations of working conditions between a group of registered . delegates aspects of the clients care to the nurse-aide who is an unlicensed staff. into the outer third of the lower conjunctival sac d. 81. discuss how she is adjusting to her new job d. pressing on the lacrimal duct c. a nurse. does not have to supervise or evaluate the aide d. most know how to perform task delegated 83. the-new nurse. increasing human resources d. Guevarra. The plan of the nurse supervisor is an example of a. appears tired and sluggish and lacks the enthusiasms she give six weeks ago when she started the job. the following guidelines apply EXCEPT: a. in service education process b. makes the assignment to teach the staff member b. When Mrs. Guevarra.
The provision of health information in the rural areas nationwide through television and radio programs and video conferencing is referred to as: a. Nurse Beatrice is providing tertiary prevention to Mrs. When Danica states she need to improve her nutritional status this means: a.nurses and employer is: a. height and weight measurement smoking cessation classes and aerobics class services. Goals and intervention developed by nurse and client should be approved by the doctor c. a. Community health program b. Telehealth program c. Wellness program d. Goals and interventions to be followed by client are based on nurse's priorities b. An example of tertiary . advance training d. This is. A nearby community provides blood pressure screening. wellness center 88. interventions needed to meet client goals d. Client will decide the goals and interventions required to meet her goals 89.There are various developments in health education that the nurse should know about. strike 85. 86. This type of program is referred to as: a. Part of teaching client in health promotion is responsibility for one’s health. Red cross program 87. in-service education c. grievance b. Nurse will decide goals and. collective bargaining d. arbitration c. outreach program b. continuing education Situation 18 . You are attending a certification program on cardiopulmonary resuscitation (CPR) offered and required by the hospital employing you. De Villa. professional course towards credits b. barangay health center d. hospital extension program c.
Ostrea has a schedule for Pap Smear. "Why do you. B 7.Ronnie has a vehicular accident where he sustained injury to his left ankle. "Based on my assessment. D 5. Take him to the radiology. You establish rapport with him and to reduce his anxiety you initially a. primary prevention Situation: 19 . This is an example of: a. C 8. Do inspection and palpation to check extent of his injuries 92.provestion is: a. section for X-ray of affected extremity b. D 4. D 9. Talk to the physician for an order of Valium d.” The most appropriate nursing response would be: a. Identify yourself and state your purpose in being with the client c. C 2. "You seem to be concerned about being in a cast. you notice how anxious he looks. Poison. Identifying complication of diabetes d. B 6. Ronnie asks you "Do I have a fracture? I don't want to have a cast. control 90." d. Self-examination for breast cancer c. Mrs. sound so scared? It is just a cast and it's not painful" c. "You have to have an X-ray first to know if you have a fracture. there doesn’t seem to be a fracture. B 3. She has a strong family history of cervical cancer. tertiary prevention b. secondary prevention c. In the Emergency Room. health screening d." b. Marriage counseling b. B . 91." ANSWER KEY 1. While doing your assessment.
C 46. C 47. D 38. A 17. D 51. D 44. B 19. D . A 20. C 21. D 25. D 30. D 24. C 33. B 43. B 32. D 45. D 22. C 13. C 28. C 14. C 31. D 15. B 40. C 18. B 12. B 39. D 29. D 49.10. D 52. C 35. C 34. D 27. B 36. B 11. C 41. A 16. C 23. C 26. D 48. D 37. B 50. D 42. C 53.
B 86. C 84. D 67. . A 88. B 79. C 90. B 83. D 62. B 92. B 60. C 82. D 64. C 57. C 65. C 63. D 70. D 74. D 89. D 66. C 81. C 85. C COMMUNITY HEALTH NURSING AND CARE OF THE MOTHER AND CHILD Situation 1 . B 80.54. A 68. Here she handles a case of POSTPARTIAL MOTHER AND FAMILY focusing on HOME CARE. B 55.Nurse Minette is an independent Nurse Practitioner following-up referred clients in their respective homes. 78. B 91. D 58. B 72. B 73. D 75. C 59. B 76. C 61. D 69. B 87. C 71. B 56. C 77.
At 6-week postpartum visit what should this postpartial mother's fundic height be? a. Walk for at least half an hour daily to stimulate peristalsis c. No longer palpable on her abdomen d. Within 1 hour after discharge d. When is a first home-care visit typically made? a. Nurse Minette needs to schedule a first home visit to OB client Leah. Eat more frequent small meals instead of three large one daily b. Leah is developing constipation from being on bed rest. 1. She urges the baby to stay awake so that she can breast-feed him in her b.000 kcal/day Situation 2 . the professional growth and development of Nurses with specialties shall be addressed by a Specialty Certification Council. She says that she has not selected a name fir the baby as yet d.As the CPES is applicable for all professional nurse. so she is reluctant to increase her calorin intake for breast-feeding. She tells you she was in a lot of pain all during labor c. . 5CO kcal/day c. If you were Minette. Six fingerbreadths below the umbilicus c. Within 24 hours after discharge c. Inverted and palpable at the cervix b. 200 kcal/day d. Drink more milk.1. Drink eight full glasses of fluid such as water daily 3. which of the following actions. One centimeter above the symphysis pubis 5. What measures would you suggest she take to help prevent this? a. increased calcium intake prevents constipation d. This postpartal mother wants to loose the weight she gained in pregnancy. Within 1 week of discharge 2. 350 kcal/day b. Within 4 days after discharge b. The following questions apply to these special groups of nurses. would alert you that a new mother is entering a postpartial at taking-hold phase? a. She sleeps as if exhausted from the effort of labor 4. By how much should a lactating mother increase her caloric intake during the first 6 months after birth? a.
R. Quasi/Legislative Power d. b & c are strong justification b. Under the PRC-Board of Nursing Resolution promulgating the adoption of a Nursing Specialty-Certification Program and Council. R. 7610 b. R." This rule-making power is called: a. Which of the following is NOT a correct statement as regards Specialty Certification? a. 14 Series of the entitled: "Adoption of a Nursing Specialty Certification Program and Creation of Nursing Specialty Certification Council.A.industry and services imposed by the national laws of countries all over the world. Regulatory Power c. . By force of law. a & d are strong justification 9. The Board of Nursing shall oversee the administration of the NSCP through the various . 7164 7. Executive/Promulgation Power 8. a & c are strong justification d.A. therefore. Which of the following serves as the legal basis and statute authority for the Board of nursing to promulgate measures to effect the creation of a Specialty Certification Council and promulgate professional development programs for this group of nurseprofessionals? a. 9173 d. and (c) Awareness of this development should impel the nursing sector to prepare our people in the services sector to meet . R. a. 223 c. a & b are strong justification c.6. and (d) Current trends of specialization in nursing practice recognized by.A.the above challenges.A. the International Council of Nurses (ICN) of which the Philippines is a member for the benefit of the Filipino in terms of deepening and refining nursing practice and enhancing the quality of nursing care. there has emerged a new concept known as globalization which seeks to remove barriers in trade. the PRC-Board of Nursing released Resolution No. The Board of Nursing intended to create the Nursing Specialty Certification Program as a means of perpetuating the creation of an elite force of Filipino Nurse Professionals b. Quasi-Judicial Power b. which two (2) of the following serves as the strongest for its enforcement? (a) Advances made in science aid technology have provided the climate for specialization in almost all aspects of human endeavor and (b) As necessary consequence.
Nursing Specialty Boards which will eventually, be created c. The Board of Nursing at the time exercised their powers under R.A. 7164 in order to adopt the creation of the Nursing Specialty Certification /council and Program d. The Board of Nursing consulted nursing leaders of national nursing associations and other concerned nursing groups which later decided to ask a special group of nurses of .the program for nursing specialty certification 10. The NSCC was created for the purpose of implementing the Nursing Specialty policy under the direct supervision and stewardship of the Board of Nursing. Who shall comprise the NSCC? a. A Chairperson who is the current President of the APO a member from .the Academe, and the last member coming from the Regulatory Board b. The Chairperson and members of the Regulatory Board ipso facto acts as the CPE Council c. A Chairperson, chosen from among the Regulatory Board Members, a Vice Chairperson appointed by the BON at-large; two other members also chosen at-large; and one representing the consumer group d. A Chairperson who is the President of the Association from the Academe; a member from the Regulatory Board, and the last member coming from the APO Situation 3 - Nurse Anna is a new BSEN graduate and has just passed her Licensure Examination for Nurses in the Philippines. She has likewise been hired as a new Community Health Nurse in one of the Rural Health Units in their City, which of the following conditions may be acceptable TRUTHS applied to Community Health Nursing Practice. 11. Which of the following is the primary focus of community health nursing practice? a. Cure of illnesses b. Prevention of illness c. Rehabilitation back to health d. Promotion of health 12. In community health nursing, which of the following is our unit of service as nurses? a. The Community b. The Extended Members of every family c. The individual members of the Barangay d. The Family 13. A very important part of the Community Health Nursing Assessment Process includes a. the application of professional judgment in estimating importance of facts to family and community
b. evaluation structures arid qualifications of health center team c. coordination with other sectors in relation to health concerns d. carrying out nursing procedures as per plan of action 14. In community health nursing it is important to take into account the family health with an equally important need to perform ocular inspection of the areas activities which are powerful elements of: a. evaluation b. assessment c. implementation d. planning 15. The initial step in the PLANNING process in order to engage in any nursing project or parties at the community level involves: a. goal-setting b. monitoring c. evaluation of data d. provision of data Situation 4 - Please continue responding as a professional nurse in these other health situations through the following questions. 16. Transmission of HIV from an infected individual to another person occurs: a. Most frequency in nurses with needlesticks b. Only if there is a large viral load in the blood c. Most commonly as a result of sexual contact d. In all infants born to women with HIV infection 17. The medical record of a client reveals a condition in which the fetus cannot pass through the maternal pelvis. The nurse interprets this as: a. Contracted pelvis b. Maternal disproportion c. Cervical insufficiency d. Fetopelvic disproportion 18. The nurse would anticipate a cesarean birth for a client who has which infection present at the onset of labor? a. Herpes simplex virus b. Human papilloma virus
c. Hepatitis d. Toxoplasmosia 19. After a vaginal examination, the nurse»e determines that the client's fetus is in an occiput posterior position. The nurse would anticipate that the client will have: a. A precipitous birth b. Intense back pain c. Frequent leg cramps d. Nausea and vomiting 20. The rationales for using a prostaglandin gel for a client prior to the induction of labor is to: a. Soften and efface the cervix b. Numb cervical' pain receptors c. Prevent cervical lacerations d. Stimulate uterine contractions Situation 5 - Nurse Lorena is a Family Planning and Infertility Nurse Specialist and currently attends to FAMILY PANNING CLIENTS AND INFERTILE COUPLES. The following conditions pertain to meeting the nursing of this particular population group. 21. Dina, 17 years old, asks you how a tubal ligation prevents pregnancy. Which would be the best answer? a. Prostaglandins released from the cut fallopian tubes can kill sperm b. Sperm cannot enter the uterus, because the cervical entrance is blocked c. Sperm can no longer reach the ova, because the fallopian tubes are blocked d. The ovary no longer releases ova, as there is no where for them to go 22. The Dators are a couple undergoing testing for infertility. Infertility is said to exist when: a. a woman has no uterus b. a woman has no children c. a couple has been trying to conceive for 1 year d. a couple has wanted a child for 6 months 23. Another client names Lilia is diagnosed as having endometriosis. This condition interferes with the fertility because: a. endometrial implants can block the fallopian tubes b. the uterine cervix becomes inflamed and swollen
c. ovaries stop producing adequate estrogen d. pressure on the pituitary leads to decreased FSH levels 24. Lilia is scheduled to have a hysterosalpingogram. Which of the following, instructions would you give her regarding this procedure? a. She will not be able to conceive for 3 months after the procedure b. The sonogram of the uterus will reveal any tumors present c. Many women experience mild bleeding as an after effect d. She may feel some cramping when the dye is inserted 25. Lilia's cousin on the other hand, knowing nurse Lorena's specialization asks what artificial insemination by donor entails. Which would be your best answer if you were Nurse Lorena? a. Donor sperm are introduced vaginally into the uterus or cervix b. Donor sperm are injected intra-abdominally into each ovary c. Artificial sperm are injected vaginally to test tubal patency d. The husband's sperm is administered intravenously weekly Situation 6 - There are other important basic knowledge in the performance of our task as Community Health Nurse in relation to IMMUNIZATION these include: 26. The correct temperature to store vaccines in a refrigerator is: a. between -4 deg C and +8 deg C b. between 2 deg C and +8 deg C c. between -8 deg C and 0 deg C d. between -8 deg C and +8 deg C 27. Which of the following vaccines is not done by intramuscular (IM) injection? a. Measles vaccine b. DPT c. Hepa B vaccines d. DPT 28. This vaccine content is derived from RNA recombinants: a. Measles b. Tetanus toxoids c. Hepatitis B vaccines d. DPT
basic personal data. postpartum care. Hepatitis B d. DPT b. Nursing Kardex b. Measles c.. Tetanus toxoid 4 Situation 7 . What is this? a. instead this record of information on vital signs. 31.infant from neonatal tetanus and likewise provide 10 years protection for the mother? a. This does not replace the progress notes. types of information. care giving process. Medicine and Treatment Record . comprehensive descriptions of patient's health conditions and needs and at the same serve as evidences of every nurse's accountability in the.meeting needs for specifics. a.29. treatment. environmental history as well as physical assessment together with nursing diagnosis on admission. this is used whenever specific measurements or observations are needed to-be documented repeatedly. of . institution nonetheless they follow similar patterns of . What do you call this record? a. previous health history. health history of the family. emotional profile. Nursing Kardex b. BCG 30. This special form used when the patient is admitted to the unit. intake and output. Medicine and Treatment Record d. are sheets/forms which provide an efficient and time saving way to record information that must be obtained repeatedly at regular and/or short intervals. These. current illness. Which of the following dose of tetanus toxoid is given to the mother to protect her .time. etc. Tetanus toxoid 2 c. Discharge Summary d. Nursing records normally differ from institution to. Discharge Summary 32. Graphic Flow sheets c. The following pertalos to documentation/records management. postoperative care. and diabetic regimen. This is the vaccine needed before a child reaches one (1) year in order for him/her to qualify as a "fully immunized child".Records contain those. Nursing Health History and Assessment Worksheet c. Tetanus toxoid 1 d. the information in this records particularly his/her . Tetanus toxoid 3 b. The nurse completes.
This flip-over card is usually kept in a portable file at the Nurses Station.As Filipino Professional Nurses we must be knowledgeable. Which of the following is TRUE about the Code of Ethics of Filipino Nurses? a. about the Code of Ethics for Filipino Nurses and practice these by heart. Nursing Kardex 35. scheduled tests and procedures. What do you call this record? a. Nursing Kardex d. Discharge Summary b. The next questions pertain to this Code of Ethics. nursing orders. What record is this? a. Medicine and Treatment Record c. Nursing Health History and Assessment Worksheet d. Discharge Summary b. 36. directs of planning for discharge that starts soon after the' person is admitted to a healthcare institution. What do you call this? a. Medicine and Treatment Record d. It has 2parts: the activity and treatment section and a nursing care plan section. Code of Nurses was first formulated in 1982 published in the Proceedings of the Third Annual Convention of the PNA House of Delegates . primary medical diagnosis. Nursing Health History and Assessment Worksheet b. safety precautions in-patient care and factors related to daily living activities/ this record is used in the charge-of-shift reports or during the beside rounds or walking rounds. written nursing care plan. Most nurses regard this as conventional recording of the date. These records show all medications and treatment provided on a repeated basis. it is accepted that collaboration or multidisciplinary involvement (of all members of the health team) in discharge results in comprehensive care. Discharge Summary c. The Philippine Nurses Association for being the accredited professional organization was given the privilege to formulate a Code of Ethics which the Board of Nurses promulgated b.33. Nursing Kardex c. time and mode by which the patient leaves a healthcare unit but this record includes importantly. current orders of the physician to be carried out by the nurse. This carries information about basic demographic data. Medicine and Treatment Record 34. Nursing Health History and Assessment Worksheet Situation 8 .
Nursing Specialty Certification Council c. Mr. Santos. regardless of creed and gender b. what is regarded as the hallmark of nursing responsibility and accountability? a. The present code utilized the Code of Good Governance for the Professions in the Philippines d. may be revoked or suspended for violations of any provisions of the Code of Ethics 37. Mr. Which condition would make her more prone than . Association of Deans of Philippine Colleges of Nursing d. Santos knows a primary duty of an advocate is to: a. works in a nursing home. maintain the patient's right to privacy Situation 9 . Bernadette is a 22-year old woman. Based on the Code of Ethics for Filipino Nurses. act as the patient's legal representative b. The following conditions apply. Nurse Reviewers and/or nurse review center managers who pays a considerable amount of cash for reviewees who would memorize items from the Licensure exams and submit these to them after the examination 39. R. Professional Regulation Commission b. A nurse endorsing a person running for congress d. Human rights of clients.Nurse Joanna works as an OB-Gyne Nurse and attends to several HIGH-RISK PREGNANCIES: Particularly women with preexisting of Newly Acquired illness. Philippine Nurse Association 40.N. A nurse declining commission sent by a doctor for her referral c. A nurse withholding harmful information to the family members of a patient b. safeguard the well being of every patient d. Accurate documentation of actions and outcomes 38. The privilege of being a registered professional nurses c. A nurse should be cognizant that professional programs for specialty certification by the Board of Nursing are accredited through the a. and he knows that one of his duties is to be an advocate for his patients. complete all nursing responsibilities on time c.c. Which of the following nurses behavior is regarded as a violation of the Code of Ethics of Filipino Nurses? a. being a fundamental right of every individual d. 41. Health. Certificate of Registration of registered nurses.
The cousin of Bernadette with sickle-cell anemia alerted Joanna that she may need further instruction on prenatal care. Increased bleeding can occur from uterine pressure on leg veins c. Newborns develop withdrawal headaches from salicylates d. Josie brought her 3-rnonths old child to your clinic because of cough and colds. Aspirin can lead to deep vein thrombosis following birth b. Some infants will be born with allergic symptoms to heparin b. I am careful to drink at least eight glasses of fluid everyday d. Lacerations can provoke allergic responses because of gonadothropic hormone b. Her husband plays gold 6 days a week b. She was over 35 when she became pregnant c. What should Joanna educate her about in regard to this? a. so these will not heal until after birth Situation 10 . Newborns develop a red rash from salicylate toxicity c.others to developing a Candida infection during pregnancy? a. Bernadette develops a deep-vein thrombosis following an auto accident and is prescribed heparin sub-Q. Salicyates can lead to increased maternal bleeding at childbirth 45. your encounter these cases pertaining to the CARE OF CHILDREN WITH PULMONARY AFFECTIONS. Bernadette received a laceration on her leg from her automotive accident. I take an iron pull every day to help grown new red blood cells c. She has developed gestational diabetes 42. A woman is less able to keep the laceration clean because o f her fatigue d. Bernadette routinely takes acetylsalicylic acid (aspirin) for arthritis. . Heparin does not cross the placenta and so does not affect a fetus 43. 46.Still in your self-managed Child Health Nursing Clinic. Why are lacerations of lower extremities potentially more serious in pregnant women than others? a. 1 understand why folic acid is important for red cell formation 44. I've stopped jogging so I don't risk becoming dehydrated b. Heparin can cause darkened skin in newborns d. Which statement signifies this fact? a. Healing is limited during pregnancy. Her infant will be born with scattered petechiae on his trunk c. Why should she limit or discontinue this toward the end of pregnancy? a. She usually drinks tomato juice for breakfast d.
Taking of the temperature of the sick child c. a mother with a 2 year old daughter asks. Refer to the doctor d. Teach the mother how to count her child's bearing 47.Which of the following is your primary action? a. Stopped bleeding c. Giving of antibiotics b. Assess the patient using the chart on management of children with cough c. "at what are can I be able to take . the following cases pertain to ASSESSMENT AND CARE OP THE NEWBORN AT RISK conditions. Seek assistance and mobilize the BHWs to have a meeting with mothers 50. 51. Give contrimoxazole tablet or syrup b. Wheezing b. Provision of Careful Assessment d. Make home visits to sick children c. Theresa. Which of the following is the principal focus on the CARI program of the Department of Health? a. Difficulty to awaken 48. Weighing of the sick child 49. Fast breathing d. Teach other community health workers how to assess patients Situation 11 . Enhancement of health team capabilities b. Teach mothers how to detect signs and where to refer c. You were able to identify factors that lead to respiratory problems in the community where your health facility serves.You are working as a Pediatric Nurse in your own Child Health Nursing Clinic. Mortality reduction through early detection d. In responding to the care concerns of children with severe disease. Refer cases to hospitals d. Teach mothers how to recognize early signs and symptoms of pneumonia b. referral to the hospital of the essence especially if the child manifests which of the following? a. Which of the following is the most important responsibility of a nurse in the prevention of necessary deaths from pneumonia and other severe diseases? a. Your primary role therefore in order to reduce morbidity due to pneumonia is to: a.
They do not have as many fat stores as other infant’s b. Penicillin G 54. when a boy has a possible inguinal hernia c. when a child has symptoms of epiglottitis d. Baby John was given a drug at birth to reverse the effects of a narcotic given to his mother in' labor. They are preterm so are born relatively small in size 55. Sodium Chloride d. Their skin is more susceptible to conduction of cold d.the blood pressure of my daughter as a routine procedure since hypertension is common in the family?" Your answer to this is: a. Morphine Sulfate c. They are more active than usual so throw off covers c. When she's 6 years old? 52. You typically gag children to inspect the back of their throat. Gentle exercise to stop muscle breakdown d. Administration of a cardiovascular stimulant c. When is it important NOT to solicit a gag reflex? a. Baby John develops hyperbilirubinemia. As early as 1 year old c. At 2 years you may b. When she's 3. he has: .You are the nurse in the Out-Patient-Department and during your shift you encountered multiple children's condition. when children are under 5 years of age 53. when a girl has a geographic tongue b. Naloxone (Narcan) b. Keeping infants in a warm arid dark environment b. 56. What is a method used to treat hyperbilirubinemia in a newborn? a. What drug is commonly used for this? a. Why are small-for-gestational-age newborns at risks for difficulty maintaining body temperature? a.years old d. The following questions apply. Early feeding to speed passage of meconium Situation 12 . You assessed a child with visible severe wasting.
moderate anemia/normal weight b. A child who has some palmar pallor can be classified as: a. 61. Nette explains this because the fundus is: a.Nette. LBM c. There is no contraindication to immunization if the child is well enough to go home and a child should be immunized in the health center before referrals are both correct d. A child with visible severe wasting or severe palmar pallor may be classified as: a. A child should be immunized in the center before referral 59. At the level the umbilicus. do not give BOG if the child has known hepatitis . . do not give BCG if the child has known AIDS 58. She is unsure of the date of her last menstrual period. severe malnutrition/anemia c. Medina. not very low eight to anemia Situation 13 . do not give OPT to a child who has recurrent convulsion or active neurologic disease d. c. not very tow weight no anemia d. anemia/very low weight 60. severe malnutrition/anemia c. anemia/very low weight d.a. a primigravida. The obstetrician told mat she appears to be 20 weeks pregnant. and the fetal heart can be heard with a fetoscope . A child with diarrhea who is due for OPV should receive the OPV and make extra dose on the next visit b. marasmus 57. a nurse palpates the abdomen of Mrs. do not give DPT2 or DPT3 to a child who has convulsions within 3 days of DPT1 b. edema b. Which of the following statements about immunization is NOT true: a. moderate malnutrition/anemia b. Leopold's Maneuver is done. kwashiorkor d. There is no contraindication to immunization if the child is well enough to go home c. Which of the following conditions is NOT true about contraindication to immunization? a.
The hands of the nurse should be cold so that abdominal muscles would contract and tighten c. 66. fundic ht. The nurse assesses the woman at 20 weeks gestation3 and expects the woman to report: a. Fundic ht 2 fingers below xyphoid process. 28 cm. Spotting related to fetal implantation b. she experienced fatigue and drowsiness. 18 cm. her EDO is June 11. engaged Situation 14: . FH-midway between the umbilicus and symphysis pubis c. Symptoms of diabetes as human placental lactogen is released c.Please continue responding as a professional nurse in varied health situations through the following questions. Cervix open. and fetal heart cannot be heard d. 2 fingers below xyphoid process. Nausea and vomiting related HCG production 65. d. floating . Medina comes to you for check-up on June 2. is just over the symphysis. the fetus utilizes her glucose stores and leaves her with a Sow blood glucose d. Phenobarbital b. what do you expect during assessment? a. Be certain that your hands are warm (by washing them in warm water first if necessary) d. uneffaced. engaged b. Nifedipine . The woman empties her bladder before palpation 63. Feeling fetal kicks d. In doing Leopold's maneuver palpation which among the following is NOT considered a good preparation? a. she is expressing pressure c. In her pregnancy. If Mrs. and the baby is just about to move c. This probably occurs because: a. of the rapid growth of the fetus 64. Which of the following medications would the nurse expect the physician to order for recurrent convulsive seizures of a 10-year old child brought to your clinic? a. of high blood pressure b. Fundic height at least at the level of the xyphoid process. The woman should lie in a supine position wither knees flexed slightly b. and fetal heart can be heard with a Doppler 62.b. Cervix close.
Placenta previa c. The Community/Public Health Bag is: a. Unsuccessful artificial insemination procedure b. a requirement for home visits b.One important toot a community health nurse uses in the conduct of his/her activities is the CHN Bag. Which of the following BEST DESCRIBES the use of this vital facility for our practice? 71. Demonstrate how to assess her blood glucose b. Pregnancy fosters the development of carbohydrate cravings d. Hyperemesis gravidarum d. Therapeutic or spontaneous abortion d. Glucose levels decrease to accommodate fetal growth b. Blood transfusion after hemorrhage c. which of the following would be important for the nurse to do? a. There is progressive resistance to the effects of insulin 69. Butorphanol d. Which of the following conditions would cause an insulin-dependent diabetic client the most difficulty during her pregnancy? a. When providing prenatal education to a pregnant woman with asthma. Head injury from a car accident 68.c. Diazepam 67. Rh incompatibility b. Abruption placentae Situation 15 . Ensure she seeks treatment for any acute exacerbation d. Hypoinsulinemia develops early in the first trimester c. RhoGAM is given to Rh-negative women to prevent maternal sensitization from occurring. Explain that she should avoid steroids during her pregnancy 70. Rh-negative women would also receive this medication after which of the following? a. Which of the following would the nurse include when describing the pathophysiologv of gestational diabetes? a. an essential and indispensable equipment of the community health nurse . The nurse is aware that in addition to pregnancy. Teach correct administration of subcutaneous bronchodilators c.
protection of the CHN bag b. Arrangement of the bag's contents must be convenient to the nurse b. . arrangement of the contents of the CHM bag c.As a Community Health Nurse relating with people in different communities. What is the rationale in the use of bag technique during home visit? a. cleaning of the CHN bag d. This is an important procedure of the nurse during home visits? a. The following statements can correctly be made about Organization and management? A. Which among the following is important in the use of the bag technique during home visit? a. It helps render effective nursing care to clients or other members of the family b. It saves time and effort of the nurse in the performance of nursing procedures c. and in the implementation of health programs and projects you experience vividly as well the varying forms of leadership and management from the Barangay Level to the Local Government/Municipal City Level.c. proper handwashing 75. contains basic medications and articles used by the community health nurse d. which side of the paper lining of the CHN bag is considered clean to make a non-contaminated work area? a. Minimize if not totally prevent the spread of infection 74. 76. In consideration of the steps in applying the bag technique. Values make people persons: values give vitality. The bag should contain all necessary supplies and equipment ready for use c. It should minimize or prevent the spread of infection from individuals to families d. The outer surface c. Be sure to thoroughly clean your bag especially when exposed to communicable disease cases d. An organization (or company) is people. The lower lip b. a tool used by the Community health nurse is rendering effective nursing procedure during a home visit 72. It should not overshadow concerns for the patient 73. The upper lip d. The inside surface Situation 16 .
organizational goals b. the Nursing sector is no except. traditions and human relations. National goals. B and D only c. national goals 78. Organizational goats. organizational goals. Management by Filipino values advocates the consideration of the Filipino goals trilogy according to the Filipino priority-values which are: a. B. commitments and employee objective/satisfaction 79. national goals. organizational objectives and employee satisfaction c. management needs to examine Filipino values and discover its positive potentials and harness them to achieve: a. family goals d. Management effectiveness can be measured in terms of accomplishment of the purpose of the organization while management efficiency is measured in terms of the satisfaction of individual motives D. Considers the achievement and advancement of the organization she/he represents as well as his people B. The following statements can correctly be made about an effective and efficient community or even agency managerial-leader. and C only 77. and objectives C. values. Considers the recognition of individual efforts toward the realization of organizational goals as well as the welfare of his people C. Management principles are universal therefore one need not be concerned about people. a. organizational goals. family goals c. culture.ants. so the company becomes. A. As the people of an organization value. A. goals.meaning and direction to a company. Management is the process by which administration achieves its mission. commitments and organizational objectives d. Employee objectives/satisfaction. B. Employee satisfaction b. A. A and D only d. Considers the welfare of the organization above all other consideration by higher administration D. Family goals. Family goals. Organizational commits . B and C only b. Since the advocacy for the utilization of Filipino value-system in management has been encouraged. Organizational objectives. Considers its own recognition by higher administration for purposes of promotion and prestige a. Only C and D are correct . national goals.
Only A and B are correct 80. resource management skills a. A and D are correct b. Whether management at the community or agency level.You are actively practicing nurse who just finished your Graduate Studies. C and D are correct c.g.b. "I signed the papers for that research study because the doctor was so insistent and I want: him to continue taking . understanding the human expertise) a. Naturalistic inquiry c. Which type of research Inquiry investigates the issue of human complexity (e. Which of the following studies is based on quantitative research? a. A study exploring factors influencing weight control behavior c. Logical position b. Which of the following studies is based on qualitative research? a. You earned the value of Research and would like to utilize the knowledge and skills gained in the application of research to Nursing service. Technical skills. A study measuring the effects of sleep deprivation on wound healing d. budget and accounting skills. Quantitative Research 82. during and after a bone marrow aspiration 83. these are: A. A study examining the bereavement process in spouses of clients with terminal cancer b. human relation/behavioral skills. A study measuring differences in blood pressure before during and after a procedure 84. The following questions apply to research. Manipulative skills. Human relation skills. C and D are correct Situation 17 . A is correct d. A. and D are correct d. skills in fund-raising D. Conceptual skills. technical skills. 81. A study examining client's feelings before. A study examining oxygen levels after endotracheal suctioning d. there are 3 essential types of skills managers must have. technical skills. and technical skills C. C. A study examining clients reactions to stress after open heart surgery b. and cognitive skills B. loss/gain in clients with cancer c. B. A study measuring nutrition and weight. Positivism d. B is correct c. An 85 year old client in a nursing home tells a nurse.
They remind him that some activities are private d. How many does a typical 3-year-old ask in a day's time? a. Ronnie asks constant questions.Nurse Michelle works with a Family Nursing Team in Calbayog Province specifically handling a UNICEF Project for Children. a paradigm b. Right of self determination b." best defines: a. Ronnie's parents want to know how to react to him when he begins to masturbate while watching television. Ask him to get his crib ready for the new baby 88. to CARE OP THE FAMILIES PRESCHOOLERS. Right to privacy and confidentiality c. Right to full disclosure d. Tell him he will have to share with the new baby d. a conceptual framework Situation 18 . 86. What would you suggest? a. Ronnie will need to change to a new bed because his baby sister will need Ronnie's old crib.care of me. 1. Right not to be harmed 85. What measure would you suggest that his parents take to help decrease sibling rivalry between Ronnie and his new sister? a. They refuse to allow him to watch television b. Less than 50 c. 300-400 87. Explain that new sisters grow up to become best friends c. They schedule a health check-up for sex-related disease c.200 or more b. They give him "timeout" when this begins . 100-200 d. a theory d. "A supposition or system of ideas that is proposed to explain a given phenomenon. The following conditions pertain. a concept c." Which client right is being violated? a. Move him to the new bed before the baby arrives b.
Two. acute ear infection d. Check for tender swellings. ear pain 92. About 12 words b. check for malnutrition 93. An ear discharge that has been present for more than 14 days can be classified as: a. 91. What are two of the most common types of accidents among infants? a.Among common conditions found in children especially among poor communities are ear infection/problems. You reviewed infant safety procedures with Bryan's mother. Check for ear pain d. acute ear infection . chronic ear infection b. if discharge is present for how long? d. Go to the next question. A child with ear problem should be assessed for the following EXCEPT: a is there any fever? b. The following questions apply. mastoditis c. How many words does a typical 12-month-old infant use? a.89. If the child does not have ear problem. Drowning and homicide Situation 19 . mastoditis b. what should you as the nurse do? a. Falls and auto accidents c. Aspiration and falls b. Poisoning and burns d. As a nurse. using IMCI. complicated ear infection 94. An ear discharge that has been present for jess than 14 days can be classified as: a. plus "mama" and "dada" 90. Twenty or more words c. Check for ear discharge b. behind the ear c. About 50 words d. ear discharge c. chronic ear infection c.
no dehydration b. If the child has severe classification because of ear problem. persistent diarrhea 99. drinking eagerly. If the child has sunken eyes. severe dehydration 97. severe persistent diarrhea b.d. row in the IMCI Chart. know when to return to the health center d. The child with no dehydration needs home treatment Which of the following is not included the rules for home treatment in this case: a. dysentery c. A child who has had diarrhea for 14 days but has no sign of dehydration is classified as: a. instruct mother when to return immediately b. the classification would be: a. refer urgently c. dry the ear by wicking Situation 20 . dysentery d. moderate dehydration c. 96. what would be the best thing that you as the nurse can do? a. give an antibiotic for 5 days d. continue feeding the child b.If a child with diarrhea registers one sign in the pink row and one in the yellow. thirsty and skin pinch goes back slowly. no dehydration d. We can classify the patient as: a. give oresol every 4 hours c. some dehydration d. severe dehydration . some dehydration c. moderate dehydration b. complicated ear infection 95. severe dysentery b. give the child extra fluids 98.
A 28. D 31. D 18. D 9. C 22. His eyes are sunken the nurse offers fluid to Carlo and he drinks eagerly. How will you classify Carlo’s illness? a. A 19. it goes back slowly. A 2. C 25. C 17. A 26. B 33. B 3. B 15. he is irritable. no dehydration c. A 4. A 10. Carlo has had diarrhea for 5 days. A 14. B 20. B 11. D 13. D . A 24. severe dehydration b. B 27. moderate dehydration ANSWER KEY: 1. When the nurse pinched the abdomen. B 30. C 23. D 12. C 29. There is no blood in the stool. C 8. some dehydration d. D 7.100. C 5. B 32. A 16. B 6. D 21.
B 60. D 35.34. A 39. A 36. A 50. A 67. C 49. B 76. B 63. D 74. A 66. D 48. B 47. C 68. C 71. C 51. A 73. D 77. B 72. D 45. D 64. C 41. C 52. D . D 75. A 55. B 44. 61. D 56. D 57. B 40. C 38. A 54. C 65. B 46. D 69. B 58. D 43. C 37. A 62. C 70. C 53. D 42. A 59.
remove the burning clothes d. D 97. D 99. A 91. D 87. Once the flames are extinguished. The most effective way to extinguish the flames with as little further damage as possible is to: a. B 94. B 98. C 81. slap the flames with his hands c. give him sips of water c. B 96. D 93. it is most important to: a. B 82. C 100. C 86. C 89.78. calculate the extent of his burns d. pour cold liquid over the flames 2. C CARE OF CLIENTS WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS Situation 1 . A 90. C 95. assess the Sergio's breathing . While Sergio was lighting a barbecue grill with a lighter fluid. You have important responsibilities as a nurse. A 88. D 79. A 92. 1. C 83. cover Sergio with a warm blanket b. A 85. D 80.Because of the serious consequences of severe burns management requires a multi disciplinary approach. his shirt burst into flames. A 84. log roll on the grass/ground b.
Situation 2 . who sustained deep partial thickness and full thickness burns of the face. He denied the matter. Hypervolemia c. You recognize that this most likely indicates that Teddy is developing: a. Cerebral hypoxia b. You have to be prepared to handle situations with ethico-legal and moral implications. Epidermis and dermis are both damaged d. You have 10 patients assigned to you. Call security officer and report the incident c. you should assess Sergio for a. Call the physician on duty 7. Your most accurate response would be: a. Sergio sustained superficial partial thickness bums on his trunk. hyperkalemia and hypernatremia 5. hypokalemia and hypernatremia b. Write an incident report b. Call your nurse supervisor and report the incident : d. You are on morning duty in the medical ward. Metabolic acidosis d. Dermis is partially damaged c. hypokalemia and hyponatremia c. 6. His wife asks what that means. Sergio is brought to the Emergency Room after the barbecue grill accident.3. During the first 24 hours after thermal injury. Renal failure . You are on night duty in the surgical ward. He is being guarded by policemen from the local police unit. You saw the policeman trying to hit Martin. One of our patients Martin is prisoner who sustained an abdominal gunshot wound. Structures beneath the skin are damaged b. Epidermis is damaged 4. you found out that one of your patients was not in bed. begins to exhibit extreme restlessness. right upper extremities ad right lower extremities. hyperkalemia and hyponatremia d. You asked why he was trying to hurt Martin. Teddy. Which among the following activities will you do first? a. The patient next to him informed you that he went home without notifying the . During your endorsement rounds. Based on the assessment of the physician. whole anterior chest and both upper extremities two days ago. During your rounds you heard a commotion.You are now working as a staff nurse in a general hospital.
55 years old. Report the incident to your supervisor 8. Find out from the endorsement any patient who might have been given narcotics 9. Go to see Fiolo and assess for airway patency and breathing problems 10. Bring the crush cart to the room d. Which among the following will you do first? a. Which among the following will you do first? a. Call security to report the incident c. Larry. You are assigned in the Cancer institute to care of patients with this type of cancer.Colorectal cancer can affect old and younger people. Barium enema b. Keep your findings to yourself c. Which among the following will you do first? a. Report the matter to your supervisor d. Wait for 2 hours before reporting d. Report the matter to your head nurse Situation 3 . Call for the Code c. After taking the history and vital signs the physician does which test as a screening test for colorectal cancer. You are on duty in the medical ward. Make and incident report b. You are admitting Jorge to the ward and you found out that he is positive for HIV. Start basic life support measures b. is admitted to the CI. a. You are on duty in the medical ward. Write an incident report and refer the matter to the nursing director b. Which among the following will you do first? a. You found out that what is on record does not tally with the drugs used. Surgical procedures and other modes of treatment are done to ensure quality of life. Take note of it and plan to endorse this to next shift b. You were asked to check the narcotics cabinet. The mother of your patient who is also a nurse came running to the nurse station and informed you that Fiolo went into cardiopulmonary arrest. who is suspected of having colorectal cancer. 11. Write an incident report d.nurses. Annual digital rectal examination . Carcinoembryonig antigen c. Keep this matter to your self c.
ENTEROSTOMAL THERAPY is now considered especially in nursing. high fat. blood in the stools. anorexia. proctosigmoidbscopy c.d. anemia. Symptoms associated with cancer of the colon include: a. and pencil-shaped. stools d. you should plan to do the procedure: . 16. soften the stool by retaining water in the colon Situation 4 . stool hematologic test d. ascites and mucus in the stool b. and increased peristalsis 15. promote rest of the bowel by minimizing peristalsis b. The abdominal incision is close and contamination is no longer a danger d. abdominal computed tomography (CT) test 13. The stool starts to become formed. hematemesis. Proctosigmoidoscopy 12. about the 3rd postoperative day c. constipation. You plan to teach Fermin how to irrigate the colostomy when: a. heartburn and eructation c. around the 7th postoperative day 17. Larry will require which diagnostic study? a. Fermin can lie on the side comfortably. smoking d. genetic factors-familial adenomatous polyposis 14. The perineal wound heals and Fermin can sit comfortably on the commode b. inflammatory bowels b. The following are risk factors for colorectal cancer. EXCEPT: a. When preparing to teach Fermin how to irrigate his colostomy. diarrhea. high fiver diet c. Larry may be given sulfasuxidine and neomycin primarily to: a. carcinoembryonic antigen b. You are participating in the OSTOMY CARE CLASS. To confirm his impression of colorectal cancer. reduce the bacterial content of the colon c. Several days prior to bowel surgery. empty the bowel of solid waste d.
When Fermin would have normal bowel movement b. Bland food so that my intestines do not become irritate.a." c. clamp the chest tube when auctioning c. change the dressing daily using aseptic techniques 22. At least 2 hours before visiting hours c." Situation 5 . Soft foods that are easily digested and absorbed by my large intestine. Clamps off the flow of fluid when feeling uncomfortable 19. 21. Discontinues the insertion of fluid after only 500 ml of fluid had been insertion d. When mucus is passed from the stoma between irrigation. When caring for him you should: a.” b. The expulsion of flatus while the irrigating fluid is running out. "It is important that I eat: a. "I will contact my physician and report: a." d. Fanny came in from PACU after pelvic surgery. If I have any difficulty inserting the irrigating tub into the stoma.Ensuring safety is one of your most important responsibilities. When observing a rectum demonstration of colostomy irrigation. If I notice a loss of sensation to touch in the stoma tissue. As Fanny's nurse you know that the sign that would be indicative of a developing thrombophlebitis would be: . You are aware that teaching about colostomy care is understood when Fermin states. Fermin that dietary instruction for him is effective when he states. empty the drainage system at the end of the shift b. Lubricates the tip of the catheter prior to inserting into the stoma b." b. You will need to provide instructions and information to your clients to prevent complications. You would know after teaching. Hands the irrigating bag on the bathroom door doth hook during fluid insertion c. Food low in fiber so that there is less stool. Prior to breakfast and morning care d." c." 20. palpate the surrounding areas for crepitus d. Everything that I ate before the operation. Randy has chest tubes attached to a pleural drainage system. while avoiding foods that cause gas. you know that more teaching is required if Fermin: a." d. After Fermin accepts alteration in body image 18.
Re verbalized his concern regarding his laryngectomy tube being dislodged. Reinsert another tubing immediately d. After a workup he is diagnosed of having Hepatitis A. Recognize that prompt closure of the tracheal opening may occur b. His wife asks you about gamma globulin for herself and her household help. who has been complaining of anorexia and feeling tired. Herbert has a laryngectomy and he is now for discharge. Honrad. Notify the physician at once 25. Infection control is one important responsibility of the nurse to ensure quality of care. you should instruct her to: a.Infection can cause debilitating consequences when host resistance is compromised and virulence of microorganisms and environmental factors are favorable. a tender. develops jaundice. chest tube drainage d. To prevent recurrent attacks on Terry who has acute glumerulonephritis. ventilation exchange c. painful area on the leg b. pruritus on the calf and ankle 23. Your most appropriate response would be: a. a pitting edema of the ankle c." d.a. seek early treatment for respiratory infections b. supplementary oxygen b. a reddened area at the ankle d. 26. your priority would be to maintain: a. What should you teach him first? a. "A vaccine has been developed for this type of hepatitis" 27. avoid situations that involve physical activity 24. He asks you what that means. continue to take the same restrictions on fluid intake d. Keep calm because there is no immediate emergency c. "Don't worry your husband's type of hepatitis is no longer communicable" b. blood replacement Situation 6 . When caring for Larry after an exploratory chest surgery and pneumonectomy. take showers instead of tub bath c. Voltaire develops a nosocomial respiratory tract infection. "Gamma globulin provides passive immunity for Hepatitis B" c. "You should contact your physician immediately about getting gamma globulin. .
A central venous catheter was inserted and an I. Which of the following is most reliable in diagnosing a wound infection? a. Knowing that for a comatose patient hearing is the best last sense to be lost. "As a result of medical treatment.As a nurse you need to anticipate the occurrence of complications of stroke so that life threatening situations can be prevented. WBC count of 20.a. you have acquired a secondary infection. As a nurse you know that one of the complications that you have to watch out for when caring for Omar who is receiving total parenteral nutrition is: a. As a nurse assigned to Wendy what will he your priority goal? a. "You acquired the infection after you have been admitted to the hospital." d. Maintain a patent airway 32. Preserve muscle function c." c. 31. Wendy is admitted to the hospital with signs and symptoms of stroke.000/pL d. Purulent drainage from a wound c. hepatitis c. "This is a highly contagious infection requiring complete isolation. as Judy's nurse. Betadine 30. Half-strength hydrogen peroxide b. Culture and sensitivity b. Prevent skin breakdown b. what should you do? a. Acetic acid d. Promote urinary elimination d." b. infusion was started. Her Glasgow Coma Scale is 6 on admission. infection 29. Gram stain testing Situation 7 . "The infection you had prior to hospitalization flared up. Dakin's solution b.V. stomatitis b. dysrhythmia d.'' 28. Tell her family that probably she can't hear them . A solution used to treat Pseudomonas would infection is: a.
Decreased anterior-posterior chest diameter d. has received a significant brain injury Situation 8 . you find that his pupils are fixed and dilated. Which among the following interventions should you consider as the highest priority when caring for June who has hemiparersis secondary to stroke? a. Speak softly then hold her hands gently 33. Talk loudly so that Wendy can hear you c. Tell her family who are in the room not to talk d. She was diagnosed with a subarachnoid hemorrhage secondary to ruptured aneurysm. stiff neck and photophobia.b. is permanently paralyzed d. While waiting for surgery. Perform range of motion exercises c. probably has meningitis b. When performing a neurological assessment on Walter. you can provide a therapeutic by doing which of the following? a. This indicated that he: a. Place June on an upright lateral position b. Decreased alveolar surface area c. patients. Hypoxia may occur in the older patients because of which of the following physiologic changer associated with aging. is going to be blind because of trauma c. dimming the light in her room d. honoring her request for a television b. Use hand rolls or pillows for support 34. The older patient is at higher risk for in inconvenience because of: . age 40. 36. allowing the family unrestricted visiting privileges 35. placing her bed near the window c. a Ineffective airway clearance b. Ivy. Hyperventilation 37. was admitted to the hospital with a severe headache. Apply antiembolic stocking d.With the improvement in life expectancies and the emphasis in the quality of life it is important to provide quality care to our older patients. There are frequently encountered situations and issues relevant to the older.
functional decline d. The most dependable sign of infection in the older patient is: a. decreased bladder capacity 38. chest pain radiating to the left arm d. acute confusion 40. Cardiac ischemia in an older patient usually produces: a. Recovery b.a. There are agencies that are in charge of ensuring prompt response. Very high creatinine kinase level c. 41. and attack) and for all levels of government and the private sector. response.A "disaster" is a large-scale emergency—even a small emergency left unmanaged may turn into a disaster. a visual problem c. is complaining of dizziness when she stands up. pain d. Mitigation c. fever c. diuretic use d. age 86. and recovery). Preparedness 42. change in mental status pain b. Response d. dilated urethra b. This may indicate: a. Comprehensive Emergency Management (CEM) is an integrated approach to the management of emergency program and activities for all four emergency phases (mitigation. drug toxicity 39. dementia b. preparedness. You are a community health nurse collaborating with the Red Cross and working with . Disaster preparedness is crucial and is everybody's business. Merle. man-made. decreased breath sound with crackles Situation 9 . Which of the four phases of emergency management is defined as "sustained action that reduces or eliminates long-term risk to people and properly from natural hazards and the effect"? a. for all type of emergencies and disasters (natural. ST-T wave changes b. increased glomerular filtration rate c.
Acetone . The term given to a category of triage that refers to life threatening or potentially life threatening injury or illness requiring immediate treatment: a. organizing support for the family. a. To which type of prevention are these activities included.disaster relief following a typhoon which flooded and devastated the whole province. Matthew accidentally dislodges his IV line and bleeds. Blood oozes on the surface of the over-bed table. Tertiary prevention b. During the disaster you see a victim with a green tag. It is most appropriate that you instruct the housekeeper to clean the table with: a. indicates injuries that are extensive and chances of survival are unlikely even with definitive care d. organizing counseling debriefing sessions and securing physical care are the services you are involved with. While eating his meal. Secondary prevention 43. has injuries that are significant and require medical care but can wait hours will threat to life or limb b. Finding safe housing for survivors. Critical incident stress management b. has injuries that are life threatening but survival is good with minimal intervention c. you know that the person: a. Which of the following terms refer to a process by which the individual receives education about recognition of stress reactions and management strategies for handling stress which may be instituted after a disaster? a. Non-acute d. Emergent c. Follow-up c. Immediate b. Urgent 45. Defriefing d.As a member of the health and nursing team you have a crucial role to play in ensuring that all the members participate actively is the various tasks agreed upon. Primary prevention c. Aggregate care prevention d. Defusion Situation 10 . has injuries that are minor and treatment can be delayed from hours to days 44. 46.
Find out how many support groups there are in the hospital and get the contact number of their president 50. Meet with the nursing group working in the burn unit and discuss problem with them feel 48. Ammonia d. chart review. What will be your most important role where you can demonstrate the impact of nursing health? a. Clarify objectives of the activity with the task force before contacting the support groups c. Part of your responsibility as a member of the diabetes core group is to get referrals from the various wards regarding diabetic patients needing diabetes education. Determine their learning needs then prioritize d. You are assigned to contact the various cancer support groups in your hospital.b. What is your priority activity? a. involve the whole family in the teaching class 49. Determine the VIPs and Celebrities who will be invited d. Your committee has 4 months to plan and implement the plan. Conduct health education on healthy lifestyle . You are a member of the infection control team. What will be your priority activity? a. You are invited to participate in the medical mission activity of your alumni association. Based on a feedback during the meeting of the committee there is an increased incidence of pseudomonas infection in the Burn Unit (3 out of 10 patients had positive blood and wound culture). In the planning stage everybody is expected to identify what they can do during the medical mission and what resources are needed. Bring your diabetes teaching kit and start your session taking into consideration their distance from your office b. of the hospital. Bleach 47. Do data gathering about the possible sources of infection (observation. Assign point persons who can implement policies d. Contact the nurse-in-charge and find out from her the reason for the referral c. Find out if there is a budget for this activity b. You though it is also your chance to share what you can do for others. How would you start prioritizing your activities? a. interview) c. Establish policies for surveillance and monitoring b. You have been designated as a member of the task force to plan activities for the Cancer Consciousness Week. Alcohol c. Prior to discharge today 4 patients are referred to you.
Tell Irma that she has to tell her family what she told you d. and even our death as well as its meaning. You now feel that Irma's family could be helpful if they knew what Irma has told you. Ruby who has been told she has terminal cancer turns away aha refuses to respond to you. "I have resigned myself to dying" c. Irma is terminally ill she speaks to you in confidence. Which of the following statements would best indicate that Ruffy. financially and emotionally. Take the initial history and document findings d. Encouraging her to be physically active as possible 53. Sit down and talk with him for a while c. pain. Encourage him to look at the brighter side of things d. Be a triage nurse c. Insisting that Ruby should talk with you because it is not good to Keep everything inside c. Obtain Irma's permission to share the information with the family c." b. Leo who is terminally ill and recognizes that he is in the process of losing. What should you do first? a. Make an appointment to discuss the situation with the family 52.One of the realities that we are confronted with is'6w mortality. Leaving her atone because she is uncooperative and unpleasant to be with d. Coming back periodically and indicating your availability if she would like you to sit with her b. Arrange for visitors who might cheer him b. illness. That way we can help our patients cope with death and dying. 90 years old has planned ahead for her-death-philosophically. everything and everybody he loves. who is dying has accepted this impending death? a. Sit silently with him 54. "What's the use"? d: "I'm giving up" 55. 51. socially. You can best help her by: a. is depressed.b. Maria. Act as a coordinator Situation 11 . This is recognized as: . Tell the physician who in turn could tell the family b. It is important for us nurses to be aware of how we view suffering. Which of the following would best help him during depression? a. "I'm ready to do.
Foul-smelling drainage b. Acceptance that death is inevitable b Avoidance of the true sedation c. you know that drainage on a craniotomy dressing must be measured and marked. Valsava's maneuver 59. Which of the following activities may increase intracranial pressure (ICP)? a. You are caring for Conrad who has a brain tumor and increased intracranial Pressure (ICP). whether malignant or benign. lower arterial pH c.a. you suspected increased ICP! Your most appropriate respiratory goal is to: a. Raising the head of the bed b. Use of osmotic Diuretics d. promote CO2 elimination 60. maintain partial pressure of arterial 02 (PaO2) above 80 mmHg b. Which intervention should you include in your plan to reduce ICP? a. Conrad underwent craniotomy. increased intra abdominal pressure 58. increased intrathoracic pressure b. 56. Provide sensory stimulation d. increased venous outflow c. Administer bowel! Softener b. decreased venous outflow d. Encourage coughing and deep breathing 57. Denial with planning for continued life d. As his nurse. Awareness that death will soon occur Situation 12 . Keeping Conrad's head and neck in alignment results in: a. Manual hyperventilation c.Brain tumor. After you assessed Conrad. has serious management implications nurse. yellowish drainage . Which findings should you report immediately to the surgeon? a. you should be able to understand the consequences of the disease and the treatment. prevent respiratory alkalosis d. Position Conrad with his head turned toward the side of the tumor c.
Realistic personal expectation 65. You have to demonstrate specific competencies. Care c. who is newly admitted and is scheduled for an executive check-up d. Emy. He is anxious because he fears he won't be monitored as closely as he was in the Coronary Care Unit. the nursing supervisor on duty decides to call her if time permits c. who is terminally ill with breast cancer b. Claire. Greenish drainage d. You are caring for Vincent who has just been transferred to the private room. Cure d. Bloody drainage Situation 13 -As a Nurse. 61. Brenda should be informed when she goes back on duty b. Aris. Which of the following patients should you give first priority? a. Setting limits d. you have specific responsibilities as professional. to manage your time wisely? a. Which statement accurately reflects the accountability of the nursing supervisor? a. The essential components of professional nursing practice are all the following EXCEPT: a. The nursing supervisor on duty will notify Brenda at home d. Culture b. Brenda is not duty therefore it is not necessary to inform her 64. Practical planning b. How can you allay his fear? a. who was previously lucid but is now unarousable c.c. the Nursing Supervisor of the intensive care unit (ICU) is not on duty when a staff nurse committed a serious medication error. Brenda. Procrastination c. Which barrier should you avoid. who has cholelithiasis and is for operation on call 63. Grace. Although Brenda is not on duty. You are assigned to care for four (4) patients. Move his bed to a room far from nurse's station to reduce . Coordination 62.
Abnormal vaginal or perineal discharge c. 66. Prevent radiation-induced sterility c. Map out the precise course of treatment 67. Adhesive tape b. Earliest sign of skin reaction to radiation therapy is: a. Urinary retention b. atrophy d. Zinc oxide ointment 69.b.As a nurse in the Oncology Unit. Allow Vincent uninterrupted period of time d. Paresthesia of the lower extremities d. Identify the nurse who is assigned to care for such a patient b. Assign the same nurse to him when possible c. erythema c. Instruct the patient of the possibility of radiation burn c. Emphasis on the therapeutic value of the treatment d. Protect the nurse from radiation effects . you have to be prepared to provide efficient and effective care to your patients. Nausea and vomiting and diarrhea 68. Talcum powder d. What is the purpose of wearing a film badge while caring for the patient who is radioactive? a. Which of the following can be used on the irradiated skin during a course of radiation therapy? a. What side effects are most apt to occur to patient during radiation therapy to the pelvis? a. desquamation b. Offer tranquilizers and antiemetics b. Limit Vincent's visitors to coincide with CCU policies Situation 14 . pigmentation 70. Which one of the following nursing interventions would be most helpful in preparing the patient for radiation therapy? a. Mineral oil c.
make the most efficient use of available resources c. Respiratory infection d. EXCEPT: a. Lower gastrointestinal problems c. 71. vital sign assessment . do the greatest good for the greatest number of casualties 73. Within the health care group there are pre-assigned roles based on education.In a disaster there must be a chain of command in place that defines the roles of each member of the response team. The following principles should be observed in disaster triage. Triage group c.d. respiration d. Which of the following categories of conditions should be considered first priority in a disaster? a. EXCEPT? a. Measure the amount of exposure to radiation Situation 15 . Intracranial pressure and mental status b. experience and training on disaster. Transport group 72. training on disaster is not important to the response in the event of a real disaster because each disaster is unique in itself d. Trauma 74. As a nurse to which of the following groups are you best prepared to join? a. Treatment group b. mentation 75. Morgue management d. A guideline that is utilize d in determining priorities is to assess the status of the following. There are important principles that should guide the triage team in disaster management that you have to know if you were to volunteer as part of the triage team. The most important component of neurologic assessment is: a. pupil reactivity b. perfusion b. locomotion c. any disaster plan should have resource available to triage at each facility and at the disaster site if possible b.
and two-thirds of the vagina c. leg of flank c. and one ovary b. tubes and ovaries d. the uterus. the uterus. which of the following organs are moved? a. Late signs and symptoms of cervical cancer include the following EXCEPT: a. 76. viral agents like the Human Papilloma Virus d. exposure to socially transmitted diseases. cervix. A common complication of hysterectomy is: a. cervix. surgery c. surgery and radiation therapy 80. uterine bleeding d. You are assigned to take charge of the women to make them aware of cervical cancer. sex at an early age. When a panhysterectomy is performed due to cancer of the cervix. urinary/bowel changes b. thrombophlebitis of the pelvic and thigh vessels b. diarrhea due to over stimulating c. The primary modalities of treatment for Stage 1 and IIA cervical cancer include the following: a. lymph edema of lower extremities 78. level of consciousness/responsiveness Situation 16 . You reviewed its manifestations and management. surgery. smoking 77.c. male partner's sexual habits c. multiple partners.You are going to participate in a Cancer Consciousness Week. atelectasis d. wound dehiscence . immunisuppressive therapy b. cervix. radiation therapy d. pain in pelvis. radiation therapy and hormone therapy b. the uterus and cervix 79. cranial nerve assessment d. the uterus. The following are risk factors for cervical Cancer EXCEPT: a.
You have to understand how management of these conditions are done. You should include: a An airway and rebreathing tube b. If there is an accidental injury to the parathyroid gland during a thyroidectomy which of the following might Leda develops postoperative? a. Potassium chloride . Tetany 85. 81. Prior to total thyroidectomy. Respiratory failure d. Calcium gluconate c. you should instruct Leda to: a. Perform range and motion exercises on the head and neck b.with bed board d.Situation 17 . As Leda's nurse. A tracheostomy set and oxygen c. A crush cart . What would you anticipate to administer? a. Magnesium sulfate b. Support the patient's head and neck with pillows and sandbags 84. tingling and muscle twitching and spasm.The body has regulatory mechanism to maintain the needed electrolytes. Two ampules of sodium bicarbonate 83. Support head with the hands when changing position 82. Raise the knee-gatch to 30 degrees c. Cardiac arrest b. Place pillows under your patient's shoulders b. You are caring for Leda who is scheduled to undergo total thyroidectomy because of a diagnosis of thyroid cancer. Which of the following nursing interventions is appropriate after a total thyroidectomy? a. Dyspnea c. Apply gentle pressure against the incision when swallowing c. However there are conditions/surgical interventions that could compromise life. Cough and deep breath every 2 hours d. After surgery Leda develops peripheral numbness. Potassium iodine d. Keep your patient in a high-fowler's position d. you plan to set up an emergency equipment at her beside following thyroidectomy.
Inform the family that the patient has passed on Situation 19 . removal of the patients clothing and jewelry and then rinsing the patient with water 87. aspirin 89. Induction of vomiting is indicated for the accidental poisoning patient who has ingested. Obtain orders for sedation of family members b. colloidal (oatmeal) c. to immediately apply personal protective equipment d. Which of the following term most precisely refer to an infection acquired in the hospital that was not present or incubating at the time of hospital admission? a. rust remover b. Secondary bloodstream infection b. 86. Provide details of the factors attendant to the sudden death c. Emerging infectious disease d. Primary bloodstream infection 90. For a patient experiencing pruritus. to immediately apply a chemical decontamination foam to the area of contamination b. gasoline c. a. toilet bowl cleaner d. This is part of quality care management. Nosocomial infection c. saline d. a thorough soap and water was and rinse of the patient c. You have to be updated on the latest .As a nurse you are expected to participate in initiating or participating in the conduct of research studies to improve nursing practice. The first step in decontamination is: a. sodium bicarbonate 88.NURSES are involved in maintaining a safe and health environment. you recommend which type of bath: a. Show acceptance of the body by touching it and giving the family permission to touch d. Which of the following guidelines is not appropriate to helping family members cope with sudden death? a.Situation 18 . Water b.
was the development process described? d. Descriptive c. What type of variable is pain? a. The following are essential information about the consent that you should disclose to the prospective subjects EXCEPT: a. What type of research it this? a. system of patients with chronic illness to those with acute illness. Independent d. A comparative analysis of the support: system of patients with chronic illness and those with acute illness d. Which of the following questions will you not use in critiquing the Likert Scale? a. Quasi-experimental 94. Is the instrument clearly described? 95. The effect of the Type of Support system of patients with chronic illness and those with acute illness c. Dependant b. A descriptive study to compare the support system of patients with chronic illness and those with acute illness in terms of demographic data and knowledge about interventions b. In any research study where individual persons are involves. Demographic 92. Experimental d. You would like to compare the support system of patients with chronic illness to those with acute illness. Correlational c.trends and issues affecting profession and the best practices arrived at by the profession 91. Correlational b. it is important that an informed consent for the Study is obtained. Consent to incomplete disclosure . You are shown a Likert Scale that will be used in evaluating your performance in the clinical area. How will you best state your problem? a. You would like to compare the support. A study to compare the support system of patients with chronic illness and those with acute illness 93. Are the reliability and validity information on the scale described? c. You are interested to study the effects of meditation and relaxation on the pain experienced by cancer patients. Are the techniques to complete and score the scale provided? b. If the Likert Scale is to be used for a study.
Explanation of procedure d. Silver nitrate c. Silver sulfadiazine d. Interventional b. Oral analgecis are most frequently used to control burn injury pain: a. cross contamination of wound c. Mechanical c. Neosporin b. Which topical antimicrobial is most frequently used in burn wound care? a. Hypertrophic burns scars are caused by: a. The major disadvantage of whirlpool cleansing of burn wounds is: a. 96. excessive manpower requirement 100. Surgical d Chemical 97. wound ischemia d. You also have to understand the rationale of the treatment. risks and discomforts c. patient hypothermia b.b. patient discomfort d. delayed epithelialization 99. exaggerated contraction b. Assurance of anonymity and confidentiality. What type of debribement involves proteolytic enzymes? a. during the cute phase . during the emergent phase c. Situation 20 . Sulfamylon 98. random layering of collagen c. after hospital discharge d.Because severe burn can affect the person's totality it is important that you apply interventions focusing on the various dimensions of man. Description of benefits. upon patient request b.
C 35. B 34. D 6. A 28 D 29. C 15. C 18. D 38. A 24. C 40. B 5. B 8. A 2. D 3. D 10. C 22. A 7. A 23. D 31. A 26. C 41. D 36. D 25. C . B 37. D 27. C 17. A 20. B 16. B 12. B 42. B 13. B 14. D 4. C 19. B 39.ANSWER KEY: 1. C 30. D 33. A 9. D 32. A 11. C 21.
C 73. D 54. D 44. A 61. C 71. D 56. A 77. D 76. B 50. A 68. B 59. B 70. B 72. A 81. A 55. B 83. C 67. C 79. A 46.43. B 65. A 64. A 53. B 78. C 49. C 84. B 66. A 51. C . B 63. D 80. D 60. D 69. D 47. B 75. C 82. B 86. A 62. D 74. A 48. A 57. D 45. C 52. B 58. D 85.
Circulating nurse 3. Laboratory department c. Surgery schedules are communicated to the OR usually a day prior to the procedure by the nurse of the floor or ward where the patient is confined. Surgeon c. When there is a need for sterile supply which is not in the sterile field. A 94. Rehabilitation department b. Radiology department . B 90. C Situation 1 . White the surgeon performs the surgical procedure. A 91. A 95.87.Concerted work efforts among members of the surgical team is essential to the success of the surgical procedure. Anesthesiologist d. C 93. For orthopedic cases. D 97. The OR team performs distinct roles for one surgical procedure to be accomplished within a prescribed time frame and deliver a standard patient outcome. what department is usually informed to be present in the OR? a. B 88. blood loss? a. who monitors the status of the client like urine output. Anesthesiologist c. Surgeon d. Maintenance department d. A 96. B 98. A 99. Circulating nurse b. who hands out these items by opening its outer cover? a. A 100. A 92. Scrub nurse b. The sterile nurse or sterile personnel touch only sterile supplies and instruments. 1. Nursing aide 2. D 89.
M. When the client asks for the next dose b. Left foot is cold to touch and pedal pulse is absent c. Social Service Section d.You are assigned in the Orthopedic Ward where clients are complaining of pain in varying degrees upon movement of body parts. The client reports independence from watchers . Laboratory technicial 5. Security Division b. BP 114/78.M. Minimally invasive surgery is very much into technology. pulse of 82 beats/minute 7. 6. At 11pm d. The client can distract himself during pain episodes d. Information technician b. You injected Demerol at 5 pm. Which of the following behaviors-indicate appropriate adaptation? a. Aside from the usual surgical team who else to be present when a client undergoes laparoscopic surgery? a. The next dose of Demerol 50 mg I. Troy is a one day post open reduction and internal fixation (ORIF) of the left hip and is in pain. Chaplaincy c. You continuously evaluate the client's adaptation to pain. There is an order of Demerol 50 mg I. At 12pm 8. The client reports pain reduction and decreased activity b. Dressing is intact but partially soiled b. The client denies existence of pain c. Electrician d. prompt replacement of compatible blood is crucial. is given: a. Which of the following observation would prompt you to call the doctor? a. When the patient is in severe pain c. What department needs to be alerted to coordinate closely with the patient's family for immediate blood component therapy? a. now and every 6 hours p r n. Pathology department Situation 2 . Left leg in limited functional anatomic position d. In massive blood loss.4. Biomedical technician c.
incomplete. The hospital director c. 11. When the medical record is inaccurate. Instruct client to observe strict bed rest b. when you need-the medical record of a discharged patient for research. Assess respiratory rate carefully Situation 3 . Doctor in charge b. Metro Manila Development Authority (MMDA) c. When the record is voluminous b. Depart of Health (DOH) 13. When can the medical record become the doctor's/nurse worst enemy? a. an epidural catheter for Fentanyl epidural analgesia is given. Department of Interior and Local Government (DILG) b. Promote client's sense of control and participation in pain control by listening to his concerns 10. There might be other factors such as cultural or psychological that influence pain. In some hip surgeries. Pain in Ortho cases may not be mainly due to the surgery. Establish trusting relationship by giving his medication on time c. Explain all the possible interventions that may cause the client to worry. When it is missing d. When a medical record is subpoenaed in court c. What is your nursing priority care in such a case? a. Check for epidural catheter drainage c. Records Management Archives Office (RMAO) d.9. How can you alter these factors as the nurse? a. Disposal of medical records in government hospitals/institutions must be done in close coordination with what agency? a. The patient's medical record can work as a double-edged swords. Stay with the client during pain episodes d. Medical records section . you will request permission through: a.Records are vital tools in any institution and should be properly maintained for specific use and time. Administer analgesia through epidural catheter as prescribed d. In the hospital. b. The nursing Service d. and inadequate 12.
OR nurses should be aware that maintaining the client's safety is the overall goal of nursing care during the intraoperative phase. Your hospital is considered tertiary b.. strap made of strong non-abrasive material are fastened securely around the joints of the . You know that your institution is covered by this policy it. Your hospital is in Metro Manila c. In between cases c. When are these. The OR nurse should be well versed with all these to safeguard the safety and quality to patient delivery outcome.. the surgeon and anestheriologist are in tandem c. a. from whom do you request the old chart? a. Surgeries like I and D (incision and drainage) and debribement are relatively short procedures but considered ‘dirty cases’. Check for jewelry. there are safety protocols that should be followed. disposal. Medical records section 15. 16. It obtained permit to operate from DOH d. Records Management and Archives Offices of the DOH is responsible for implementing its policies on record. Last case b. Verify patient identification and informed consent c. Previous doctor's clinic c. the surgeon greets his client before induction of anesthesia b. According to availability of anesthesiologist d. manicure and dentures 17. Department where the patient was previously admitted d. Since you will need the previous chart. Which of the following should be given highest priority when receiving patient in the OR? a. According to the surgeon's preference 18.In the OR. you make certain that throughout the procedure. As the circulating nurse. You readmitted a client who was in another department a month ago. Central supply section b. procedures best scheduled? a. Assess level of consciousness b. a. Assess vital signs d. Your hospital is Philhealth accredited Situation 4 .14. gown.
If hair at the operative site is not shaved. Pulled c. Obtain consent form 23. Clipped .Nurses hold a variety of roles when providing care to a perioperative patient. postoperative respiratory function Situation 5 . Send the client to ORD with the family c. Assess the readiness of the client prior to surgery b. Some different habits and hobbies affect postoperative respiratory function. Ensure that the airway is adequate c. nurse to do skin prep for patients undergoing surgery. Evaluate the type of anesthesia appropriate for the surgical client 22. Draped b. client is monitored throughout the surgery by the assistant anesthesiologist 19. Which of the following role would be the responsibility of the scrub nurse? a. Put side rails up and ask client not to get out of bed b. how can you best meet the safety need of the client after administering preoperative narcotic? a. Used during the surgical procedure d. check patient's d. As a perioperative nurse. Another nursing check that should not be missed before the induction of general anesthesia is: a. check for presence dentures c. perioperative anxiety and stress b. you will anticipate increased risk for: a. delayed wound healing d. Account for the number of sponges. supplies. delayed coagulation time c. check baseline vital signs 20. 21. needles. what should be done to make suturing easy and lessen chance of incision infection? a. check for presence underwear b. Allow client to get up to go to the comfort room d. If your client smokes 3 packs of cigarettes a day for the part 10 years. It is the responsibility of the pre-op.knees and ankles and around the 2 hands around an arm board d.
Request the client to expose the incision wound Situation 6 . comes to the ER with acute asthmatic attack. Which of She following nursing actions should be initiated first? a. It is also the nurse's function to determine when infection is developing in the surgical incision. Promote emotional support b. The perioperative nurse should observe for what signs of impending infection? a. Blood clots and scar tissue are visible 25. Localized heat and redness b.Carlo. The health instruction will include the following EXCEPT: a. 16 years old. Aminophylline was ordered for acute asthmatic attack. Administer oxygen at 6L/min c. Avoid emotional stress and extreme temperature b.d. Get patient's consent c. Suppress cough 28. Promote expectoration c. Administer bronchodilator by nebulizer 27. You will give health instructions to Carlo. RR is 46/min and he appears to be in acute respiratory distress. Shampooed 24. The mother asked the nurse. Separation of the incision d. Which of the following nursing intervention is done when examining the incision wound and changing the dressing? a. dust seafood d. Practice respiratory isolation . Serosanguinous exudates and skin blanching c. a case of bronchial asthma. Relax smooth muscles of the bronchial airway b. 26. Observe the dressing and type and odor of drainage if any b. Suction the client every 30 min d. Avoid pollens. Prevent thickening of secretions d. Avoid pollution like smoking c. Wash hands d. what its indication the nurse will say is: a.
Push on abdomen during exhalation d. implement a regular inventory of supplies and equipment c. The asthmatic client asked you what breathing technique he can best practice when asthmatic attack starts. Mark the operative site if possible b. respiratory acidosis c. As a nurse you are always alerted to monitor status asthmaticus who will likely and initially manifest symptoms of: a. 31. What will be the best position? a. Sit-up with shoulders back c. Lean forward 30-40 degrees with each exhalation 30. Conduct pre-procedure verification process c. infusion pump before use d. Sit in high-Fowler's position with extended legs b. Allow the technician to set the. respiratory alkalosis d. and similar devices/machines. metabolic alkalosis b. As a staff.Joint Commission on Accreditation of Hospital Organization (JCAHP) patient safety goals and requirements include the care and efficient use of technology in the OR arid elsewhere in the healthcare facility. metabolic acidosis Situation 7 . Take a video of the entire intra-operative procedure . wrong person. how can you improve the safety of using infusion pumps? a. Implement a regular maintenance and testing of alarm systems 32. how can you improve the effectiveness of clinical alarm systems? a. Verify the flow rate against your computation 33. As the head nurse in the OR. and wrong procedures/surgery includes the following EXCEPT: a. sphymomanometer. JCAHOs universal protocol for surgical and invasive procedures to prevent wrong site. Check the functionality of the pump before use b. limit suppliers to a few so that quality is maintained b. Select your brand of infusion pump like you do with your cellphone C. Over dosage of medication or anesthetic can happen even with the aid of technology like infusion pump.29. Adherence to manufacturer's recommendation d.
circulating nurse. 37. we should limit the number of people in the room for infection control. Assess potential risk of fail associated with the patient's the following EXCEPT: medication regimen b. Nurse anesthetist. identify the client by his/her wrist tag and verify with family members b. nurse assistant. While team effort is needed in the OR for efficient and quality patient care delivery. scrub nurse. and what is your preferred time and type of surgery? c. what important information do you need to ask the surgeon? a. assistant surgeon. and instrument technician c. Who comprise this team? a. scrub nurse. Conduct time out immediately before starting the procedure 34. Instrument technician and circulating nurse b. identify client by his/her wrist tag and call his/her by name c. As a nurse you know you can improve on accuracy of patient's identification by 2 patient identifiers. If you are the nurse in charge for scheduling surgical cases. anesthesiologist. call the patient by his/her name and bed number Situation 8 . Surgeon. Surgeon. radiologist. internist. Scrub and circulating nurses 38. Scrub nurse and nurse anesthetist d. scrub nurse. In the OR.Team efforts is best demonstrated in the OR 36. Assess and periodically reassess individual client's risk for falling 35. Surgeon. assistants.d. anesthesiologist c. Who are your anesthesiologist. and assistant d. call the client by his/her case and bed number d. you can implement the following EXCEPT: a. orderly b. Who is your anesthesiologist. Allow client to walk with relative to the OF? d. EXCEPT: a. anesthesiologist. pathologist . the nursing tandem for every surgery is: a. You identified a potential risk of pre and post operative clients. Who is your internist b. Take action to address any identified risks through Incident Report (IR) c. Who is your assistant and anesthesiologist. To reduce the risk of patient harm resulting from fall.
Anaesthesiologist 40. Electricity b. which of the following condition is NOT expected? a. Skin care around the stoma is critical. Clean the area daily with soap and water before applying bag d. Communication Situation 9 . intern. scrub nurse 39.It can be temporary or permanent. Restrict exercise to walking only 43. Eat fruits and vegetables in all three meals c. Orderly/clerk b. Which of the following is not indicated as a skin care barriers? a. Irrigate after lunch everyday b. increased weight b. Apply liberal amount of mineral oil to the area b. anesthesiologist. Liquid stool d. 41. who coordinates the activities outside. Surgeon. Leg work d. assistant surgeon. When surgery is on-going. Nurse supervisor c. including the family? a. After ileostomy. What health instruction will enhance regulation of a colostomy (defecation) of clients? a.Colostomy is a surgically created anus. Irritation of skin around the stoma c. Inadequate supply c. Eat balanced meals at regular intervals d. Use karaya paste and rings around the stoma c. The following are appropriate nursing interventions during colostomy irrigation EXCEPT: . depending on the disease condition.d. Apply talcum powder twice a day 42. Establishment of regular bowel movement 44. Circulating nurse d. The breakdown in teamwork is often times a failure in: a.
Sensation of taste b. you are aware that sampling is an essential element of the research process.a. Convenience c. Insert 2-4 inches of an adequately lubricated catheter to the stoma c. Sensation of smell d. 46. Representativeness 48. Been selected based on set criteria d. Randomization b. Control group b. Increase the irrigating solution flow rate when abdominal cramps is felt b. Study subjects c. Appropriate number d. Purposive b. Position client in semi-Fowler d. Hand the solution 18 inches above the stoma 45. Universe 47. Appropriate location c. What is the most important characteristics of a sample? a. Which of the following sampling methods allows the use of any group of research subject? a. Sensation of pressure c. Snow-bail . Random sampling ensures that each subject has: a.As a beginner in research. General population d. Characteristics that match other samples 49. Been selected systematically b. What sensation is used as a gauge so that patients with ileostomy can determine how often their pouch should be drained? a. Urge to defecate Situation 10 . An equal change of selection c. What does a sample group represent? a.
invisible suture . What should be the appropriate method for you to use in this care? a. Skin 53. Absorbent dressing d. Before closing the subcutaneous layer b. Staple b. 51. A traumatic needle c. Another alternative "suture" for skin closure is the use of _______________: a. needles also vary in shape and uses. Fascia b. Reverse cutting needle d. When is the first sponge/instrument count reported? a. If you are the scrub nurse for a patient who is prone to keloid formation and has a low threshold of pain. Quota 50. Systematic sampling Situation 11 -After an abdominal surgery. Muscle c. Cluster sampling b. Round needle b.d. Peritoneum d. What major supportive layer of the abdominal wall must be sutured with long tensile strength such as cotton or nylon or silk suture? a. what needle would you prepare? a. the circulating and scrub nurses have critical responsibility about sponge and Instrument count. Like sutures. Before the fascia is sutured 52. You decided to include 5 barangays in your municipality and chose a sampling method that would get representative samples from each barangay. Stratifies sampling d. Random sampling c. Tapered needle 54. Before dosing the skin d. Before peritoneum is closed c. Therapeutic glue c.
Use of labels and signs 59. Text messaging and e-mail 58. what is one of the best way to reconcile medications across the continuum of care? a. However. What role do you play. counts should be documented. your primary focus in the workplace is the client's safety.55. Using standardized list of abbreviations. To whom does the scrub nurse report any discrepancy of country so that immediate 'and appropriate action in instituted? a. personal safety is also a concern. Like any nursing interventions. You can communicate hazards to your co-workers through the use of the following EXCEPT: a. Circulating nurse Situation 12 . Use of reminders of what to do b. Educator c. Patient's advocate b. Endorse the routine and 'stat' medications every shift . Patient's Liaison d. Communication a complete list of the patient's medication to the next provider of service c. As a nurse. when you hold all clients’ information entrusted to you in the strictest confidence? a.As a nurse. Surgeon c. One-on-one oral endorsement d. and symbols c. Posting IR in the bulletin board d. acronyms. you should be aware and prepared of the different roles you play. Or nurse supervisor d. As a nurse. Anesthesiologist b. 56. As a nurse. Posters c. Endorse on a case-to-case basis b. Patient's arbiter 57. Endorse in writing d. Formal training b. you can help improve the effectiveness of communication among healthcare givers a.
Instruct client to go to sleep and relax b. Advising the client. that which can contribute to the client's wellbeing c. Skill of surgical team and lesser manipulation b. Endorsement thru trimedia to advertise your favorite disinfectant solution 61. Appropriate preparation For the scheduled procedure c. Offer hot and clear soup d. Call surgeon stat 62. Medicate client as prescribed b. more importantly RR . The client complained of abdominal and pain. Advice the client to close the lips and avoid deep breathing and talking c.60. Use of modem technology in closing the wound d. As a nurse. A one-day postoperative abdominal surgery client has been complaining of severe throbbing abdominal pain described as 9 in a 1-10 pain rating. Monitor VS. Provide information to clients about a variety of services that can help alleviate the client's pain and other conditions b. Pentoxicodone 5 mg IV every 8 hours was prescribed for post abdominal pain. Health education among clients and significant others regarding the use of chemical disinfectant d. you protect yourself and co-workers from misinformation and misrepresentations through the following EXCEPT: a. Explain the proper use of PCA to alleviate anxiety c. Your nursing intervention that can alleviate pain is: a. Turn to sides frequently and avoid too much talking 64. Avoid overdosing to prevent dependence/tolerance d. Proper positioning and draping of clients . Surgical pain might be minimized by which nursing action in the OR: a. by virtue of your expertise. Which will be your priority nursing action? a. What nursing intervention would you take? a. Encourage client to do imagery c. Encourage deep breathing and turning d. Your assessment reveals bowel sounds on all quadrants and the dressing is dry and intact. Check abdominal dressing for possible swelling b. 63.
and comfortable environment d. quiet. Your independent nursing care for hypothyroidism includes: a. encourage to drink 6-8 glasses of water 67. Break in aseptic technique d. Hyperglycemia b. hypoglycemia 70. you know that the most common type of goiter is related to a deficiency .You were on duty at the medical ward when Zeny came in for admission for tiredness. Lidocaine c. Forceful traction during surgery b. Your appropriate nursing diagnosis for Zeny who is suffering from hypothyroidism would probably include which of the following? a. hyperthermia d. Levothyroxine b. Activity intolerance related to tiredness associated with disorder b. Lipitor d. Imbalance nutrition related to hypermetabolism d. providing a cool. constipation. a. Prolonged surgery c. One very common cause of postoperative pain is: a. As a nurse. Risk to injury related to incomplete eyelid closure c. Levophed 68. administer sedative round the clock b. and weight gain. the doctor's diagnosis was hypothyroidism. cold intolerance. administer thyroid hormone replacement c. Inadequate anesthetic Situation 14 . 66. Deficient fluid volume related to diarrhea 69. hypothermia c.65. Upon examination. you should anticipate to administer which of the following medications to Zeny who is diagnosed to be suffering from hypothyroidism? a. As the nurse. Myxedema coma is a life threatening complication of long standing and untreated hypothyroidism with one of the following characteristics.
EXCEPT: a. iron d. Apply pressure over the puncture site as soon as the needle is withdrawn 74. sitting on the edge of the bed with her feet supported and arms and head on a padded overhead table 73. lying on the unaffected side with the bed elevated 30-40 degrees c. During thoracentesis. Place flat in bed b. Pichay is admitted to your ward. Ensure that informed consent has been signed c.Mrs. Ascertain if chest x-rays and other tests have been prescribed and completed 72. Mrs. To prevent leakage of fluid in the thoracic cavity. Which of the following nursing responsibility is essential in Mrs. how wilt you position the client after thoracentesis? a. which of the following nursing intervention will be most crucial? a. Chest x-ray was ordered after thoracentesis. On bed rest 75. Pichay who will undergo thoracentesis? a. lying prone with the head of the bed lowered 15-30 degrees d. Maintain strict aseptic technique c. Determine if client has allergic reaction to local anesthesia d. Advice patient to sit perfectly still during needle insertion until it has been withdrawn from the chest d. When you client asks what is the reason ." 71. iodine Situation 15 . Turn on the unaffected side c.a. Turn on the affected side d. Support. The MD ordered "Prepared for thoracentesis this pm to remove excess air from the pleural cavity. Place patient in a quiet and cool room b. straddling a chair with arms and head resting on the back of the chair b. thyrotropin c. thyroxine b. Pichay who is for thoracentesis is assisted by the nurse to any of the following positions. and reassure client during the procedure b.
use of a variety of equipment/devices to enhance quality patient care delivery. Kyle. to rule out any possible perforation c. Macroset c. Kyle's room is fully mechanized. Provide a glass of fruit every meal b. Provide a writing pad to record his intake 79. What IV administration set will you prepare? a. will have a liberal oral fluid intake? a. Gown b. 76. Blood transfusion set b. You will do which of the following: a. to rule out any foreign: body Situation 16 . who is febrile. to rule out pneumothorax b. What will you do to ensure that Kyle. who is febrile. Microset 77. you are aware that we are helped by the . you will explain: a. Kyle is diagnosed to have measles. Gloves 78. Face mask d. Regulate his IV to 30 drops per minute c. What do you teach the watcher and Kyle to alert the nurse for help? . to decongest d. Test the call system d. What will your protective personal attire include? a. 5. You are initiate an IV line to your patient. you went to ensure Kyle's safety in 'bed. Put the side rails up c. Eyewear c. Before bedtime. Put the lights on b. Volumetric chamber d. Lock the doors 80.In the hospital.for another chest x-ray. Provide a calibrated pitcher of drinking water and juice at the bedside and monitor intake and output d.
Mothers of children undergoing tonsillectomy and adenoidectomy usually ask what food prepared and give their children after surgery. hot soup when awake c. endotracheal tube perforation c. You as the nurse will say: a. balanced diet when fully awake b. epiglottis 84. How to lock side rails b. Call system d. spinal anesthesia b. Supine with neck hyperextended and supported with pillow b. has 'kissing tonsils' and is scheduled for tonsillectomy and adenoidectomy or T and A. The PACU nurse will maintain postoperative T and A client in what position? a. offer soft foods for a week to minimize discomfort while swallowing . offer osteorized feeding b. His mother asked you if Tony will be put to sleep. anesthesiologist’s preference c. Tony is to be discharged in the afternoon of the same day after tonsillectomy and adenoidectomy. hemorrhage b.Tony. esopharyngeal edema d. You are the nurse of Tony who will undergo T and A in the morning. Reverse trendelenburg with extended neck 85. Remote control Situation 17 . Semi-Fowler's with neck flexed d. Prone with the head on pillow and tuned to the side c. 11 years old. You as the RN will make sure that the family knows to: a. Your teaching will focus on: a. local anesthesia d. Number of the telephone operator c. 81. soft diet when fully awake 83. ice cream when fully awake d. The RR nurse should monitor for the most common postoperative complication of: a.a. general anesthesia 82.
initial hemodialysis shall be done for 30 minutes only so as not to rapidly remove the waste from the blood than from the brain d. As the nurse you will collect a. Which of the following action would be of highest priority with regards to the external shunt? a.Rudy was diagnosed to have chronic renal failure. Bananas. Encourage client to include raw cucumbers. A renal failure patient was ordered for creatinine clearance. 48 jour urine specimen b. Diet therapy for Rudy. is tow-protein. Instruct the client not to exercise the arm with the shunt c. Avoid taking BP or blood sample from the arm with shunt b.c. poultry and lean meat b. Rudy undergoes hemodialysis for the first time and was scared of disequilibrium syndrome. and other processed food d. Checking bowel movement c. cabbage. who has acute renal failure. He asked you how this can be prevented. offer clear liquid for 3 days to prevent irritation Situation 18 . and tomatoes c. low potassium and sodium. Monitoring and recording I and O b. maintain aseptic technique throughout the hemodialysis 89. maintain a conducive comfortable and cool environment b. carrot. Allowing the client cheese. Obtaining vital signs d. Recommend protein of high biologic value like eggs. Heparinize the shunt daily d. first morning urine . cantaloupe. supplement his diet with vitamin C rich juices to enhance heating d. Monitoring diet 90. 86. orange and other fresh fruits can be included in the diet 88. You are assisted by a nursing aide with the care of the client with renal failure. Hemodialysis is ordered that an A-V shunt was surgically created. The nutrition instruction should include: a. maintain fluid and electrolyte balance c. Change dressing of the shunt daily 87. Which delegated function to the aide would you particularly check? a. canned foods. Your response is: a.
Nephrolithiasis c. Fe should excrete the contrast medium. She was advised to undergo IVP by her physician. Ureterolithiasis . The IVP reveals that Fe has small renal calculus that can be passed out spontaneously. Colelithiasis b. Post IVP. The presence of calculi in the urinary tract is called: a. Bed rest 95. assure the client that x-ray procedure like IVP is only done by experts 92. assure the client that contrast medium will be given orally d. Balanced diet b. Fe was so anxious about the procedure and particularly expressed her low pain threshold. you instructed her to force fluids and do which of the following? a. barium enema c. You instructed the family to include more vegetables in the diet and a. To increase the chance of passing the stones. Increase fluid intake d. Monitor intake and output 93.Fe is experiencing left sharp pain and occasional hematuria. increase fluid intake b. cleansing enema d. 91.c. assure the client that the pain is associated with the warm sensation during the administration of the Hypaque by IV b. Ambulance more c. Nursing health instruction will include: a. What will the nurse monitor and instruct the client and significant others. Strain all urine d. random urine specimen Situation 19 . post IVP? a. Report signs and symptoms for delayed allergic reactions b. assure the client that the procedure painless c. Observe NPO for 6 hours c. 24 hour urine specimen d. gastric lavage 94.
it should be understood that our body normally releases insulin according to our blood glucose level. Yes. No. After a good night's rest . Always flush with NSS after IV administration b. Urolithiasis Situation 20 . How will you administer drugs such as insulin. what solution should you prepare in anticipation of the doctors order? a. Will you follow the order? a. nitroglycerine hydralazine to promote better therapeutic drug effects? a. because insulin is chemically stable with TPN and can enhance blood glucose level c. 96. No. After excitement b. Incorporate to the IV solution d. Yes. When is insulin and glucose level highest? a. To prevent temporary excess of insulin transient hyperinsulin reaction. However. Administering drugs with more diluents c. Improving on preparation techniques d. Isotonic solution c. Inject the drugs as close to the IV injection site c. Administer by fast drip b.At the medical-surgical ward. In insulin administration. Hypertonic solution d. because insulin will induce hyperglycemia in patients with TPN b.d. the MD's order read. like blood transfusion. Any IV solution available to KVO b. there should be no drug incorporation. Referring to manufacturer's guidelines 100. Use volumetric chamber 98. How can nurse prevent drug interaction including absorption? a. because it was ordered by the MD 97. the nurse must also be concerned about drug interactions. Hypotonic solution 99. incorporate insulin to present TPN. because insulin is not compatible with TPN d. One patient has a 'runaway' IV of 50% dextrose. You have a client with TPN. The RN should also know that some drugs have increased absorption when infused in PVC container. You know that in TPN.
A 18.C 68.B 2.A 12.C 10.C 9.C 24.A 19.C 65.D 64.B 20.A .B 22.C 62.A 26.D 14.A 74.B 25.C 58.A 51.B 69.C 71.D 81.B 80.C 41.D 53.C 84.B 36.A 72.D 55.C 33.D 21.B 38.D 13.D 54.A 5.B 32.c.D 11.B 6.D 90.D 15.C 85.C 83.A 7.A 67.C 29.C 23.A 37.A 57.D 40.A 77.A 34.C 75.B 35.B 4.C 31.C 73.B 66.D 61.B 88.A 16.D 78.B 86.A 82.D 17.B 63.A 91.C 89.D 59. After an exercise d.C 27.B 8.A 76.B 56.D 60.C 28.D 79.A 3.B 30.D 87.D 52. After ingestion of food 1.C 39.C 70.
A 94.A 43.B 99.D .B 49.A 92.A 44.D 97.B 95.C 96.A 100.D 93.B 48.B 98.B 45.D 46.42.A 50.B 47.