Nurse's Guide to Loss, Grief and End-of-Life Care

ASSESSMENT EXAMINATION – NLE ENHANCEMENT PROGRAM
SITUATION 1 - Loss and grief affect not only the clients and
their families but also the nurse who care for them.
LOSS = absence of something/someone important/valuable

GRIEF = emotional response to a loss
MOURNING = outward expression of grief
BEREAVEMENT = process / stages of grieving
Kuhbler-Ross Stages of Grieving (DABDA)
Denial = non-acceptance of the reality of a loss

Anger = strong emotion and an expression of frustration
projected to others or to self
Bargaining = negotiation/ asking for more opportunities
(TIME) to accomplish something
Depression = lowest point of grieving
Acceptance = final stage
1
ASSESSMENT EXAMINATION
(background)
1. A 55-year-old client is terminally ill with advance cancer
of the ovary. To assist and comfort her, the nurse should
FIRST: (stem = actual query)
a. attend to her physical needs. (PRIORITIZATION)

b. provide support to the client. ONLY TELLING NOT SHOWING
c. assess continuously the client’s condition.
d. assess client’s understanding of impending death.
NOTE:
“Do not just TELL me what to do. SHOW me what to do!”
NOTE:
If TWO OPTIONS are essentially the same, NONE of them is
the correct answer.
2
2. Upon learning about her condition, the client says to the

nurse, “Why me? I did not do anything wrong.” What response
of the nurse is most appropriate? (LOOKING FOR SOMETHING
POSITIVE/ CORRECT RESPONSE)
a. “You will be fine.” FALSE REASSURANCE
b. “Death is a normal part of life.” STEREOTYPE COMMENTS
c. “This must be very difficult for you.” (acknowledging
what the patient is going through)
d. “Everyone has to die sooner or later.” STEREOTYPE
COMMENTS
THERACOM QUESTION
= very popular in the NLE
= TIP: PLAY THE SCENE IN YOUR HEAD!
3
3. The client is in severe pain and manifests signs of

impending death. The husband asks the nurse if his wife is
going to die soon. Which of the following is the most
appropriate response of the nurse? (LOOKING FOR THE BEST
RESPONSE)
a. “The signs do not predict time of death.” (DOES NOT
RESPOND WELL TO THE HUSBAND’S QUESTION)
b. “You are concerned that your wife will die?”
(acknowledging what the HUSBAND is going through)
c. “Death is inevitable.” STEREOTYPE COMMENTS
d. “Are you worried that your wife will die?” CLOSE-ENDED
QUESTION
THERACOM QUESTION
4
4. The client has just died with her family around her. What
appropriate nursing action should the nurse make? (LOOKING
FOR A CORRECT & BEST ACTION)
a. Allow the family time to be with the dead client.
b. Allow the family to grieve. ONLY TELLING
c. Give the client’s belongings to her family. NOT THE
PRIORITY
d. Reassure family that body will be taken care of. NOT
THE PRIORITY
NOTE:
“Do not just TELL me what to do. SHOW me what to do!”
5
5. The body is being prepared for transfer to the mortuary.

Which is the most appropriate action of the nurse? (LOOKING
FOR A CORRECT ACTION)
a. Remove all contraptions.
b. Record the time of death. NOT A PRIORITY
c. Secure all belongings in a plastic bag. NOT PREPARING
THE BODY
d. Bathe the body and place identification tags.
NOTE: Be careful with ABSOLUTE words. Encircle them!

a. ALL
b. NEVER
c. ANY
d. ONLY
6
SITUATION 2 - An understanding of the infectious process and

appropriate methods to protect health workers and clients
from disease is important. The following questions pertain
to preventing transmission of infection.
CHAIN OF INFECTION
1. Causative agent = microorganism
2. Reservoir = breeding place of the microorganism
3. Portal of exit
4. Mode of transmission = airborne, direct or indirect
5. Portal of entry
6. Susceptible host
MAIN PRINCIPLE: Break the chain of infection in its earliest

stages as much as possible!
7
6. The nurse is explaining standard protection to the client.

This includes which of the following actions?
a. Wearing protective equipment when doing any nursing
procedures.
b. Hand washing using soap and hot water.
c. Recapping of used needles with both hands.
d. Using clean gloves to handle contaminated items, blood
and excretions.
STANDARD PRECAUTION = used for all types of patient

Four basic elements:
1. Handwashing
2. Use of personal protective equipment
3. Safe handling of needles and other sharp instruments
4. Coughing and sneezing etiquette
8
7. The nurse is changing the wound dressing of the client.

The MOST appropriate action of the nurse would be to:
a. remove old dressing with sterile gloves. CLEAN GLOVES
ONLY
b. wear sterile gloves while in contact with the area. TO
PREVENT CROSS CONTAMINATION
c. open the sterile dressings with sterile gloves. NO
GLOVES REQUIRED
d. pour solution out of container with sterile gloves. NO
GLOVES REQUIRED
OBJECT IS CONTAMINATED = CLEAN GLOVES

OBJECT IS STERILE = STERILE GLOVES
9
8. The client has an order for contact precautions. The nurse

is to give her a bath. The precautionary measure that the
nurse observes is to use:
a. face mask and gloves
b. sterile gloves and cap (OR)
c. gloves and gowns
d. cap and face mask (OR)
CORRECT ORDER OF DONNING (WEARING) PPE: Gow-Ma-Gog-Glov

CORRECT ORDER OF DOFFING (REMOVING) PPE: Glo-Gog-Gow-Ma
10
9. The clinical instructor in the Surgical Unit is teaching

the nursing students about the prevention of spread of
diseases in the care environment. Which of the following
is the MOST important practical way to prevent the spread
of diseases?
a. Consistently washing hands
b. Isolating infected clients
c. Wearing gloves whenever giving care
d. Wearing cap and gown
11
10. The nurse is to perform a sterile procedure while

assisting in a minor surgery. Which of the following
actions of the nurse maintains sterile technique?
a. Keeping the sterile field within view.
b. Handing medicine over the sterile field.
c. Talking to other personnel over the sterile field.
d. Using sterile gloves in opening sterile packages.
12
SITUATION 3 – Nurse Frankie and Nurse Diana engaged in

conducting a nursing research project on “Common Errors
Regarding Standards of Nursing Documentation in the
Obstetrics Ward of a University Hospital.”
11. Among the options below, the most fitting major purpose
of Nurse Frankie’s and Nurse Diana’s study is to:
a. improve the clarity of patient data documentation.
b. duplicate the study in other maternity hospitals.
c. reduce, if not eliminate, errors in documentation.
d. protect members of the hospital from any lawsuits.
“Common Errors Regarding Standards of Nursing

Documentation in the Obstetrics Ward of a University
Hospital.”
13
12. Which of the following could be the BEST method to

gather the research data needed to achieve the major goal
of this study? (MOST PROBABLE DESIGN: QUANTITATIVE)
a. Nursing Audit
b. Focus group discussion QUALITATIVE
c. Phenomenological QUALITATIVE
d. Survey
“Common Errors Regarding Standards of Nursing Documentation

in the Obstetrics Ward of a University Hospital.”
14
13. What term is used to describe the arrangement of

statistical data exhibiting the number of times the values
of a variable occur?
a. Frequency distribution
b. Frequency (the number of times the values of a variable
occur)
c. Skewness (CHARACTERISTIC OF THE TRENDS OF THE VALUES
OF THE VARIABLES)
d. Mean (SHOULD BE MODE)
15
14. In statistics, what is the definition of percentage?

a. It is the whole population included in the study.
(PORTION OF THE POPULATION ONLY)
b. It is a value on a scale of 100. (INCOMPLETE
DEFINITION)
c. It is a share of profits. (DEFINITION OF PERCENTAGE
BUSINESS ECONOMICS)
d. It is a part of a whole expressed in hundredths.
16
“Common Errors Regarding Standards of Nursing Documentation

in the Obstetrics Ward of a University Hospital.”
15. Based on Nurse Frankie’s and Nurse Diana’s study

findings, recommendations should be directly addressed to
who of the following?
I. Nursing Educators
II. Staff Nurses
III. Nursing Administrators
IV. Nursing Aides
a. All except IV
b. All except III
c. All except II
d. All except I
17
SITUATION 4 - Promotion of safe motherhood in varied

clinical settings is consistent with safety and quality
concerns of every nurse in the care of women during normal
pregnancy. The following questions apply.
16. Nurse Jojie is taking care of a pregnant client, whose

last menstrual period was June 22, 2014. Using the
Naegele’s Rule the estimated date of birth would be:
a. March 15, 2014
b. April 29, 2015
c. March 29, 2015
d. April 14, 2014
EDC / EDD = Expected date of confinement / delivery

NAEGELE’S RULE
1. Get the FIRST DAY of the LMP. 06 22 2014
2. Subtract 3 from the months. -3
3. Add 7 to the days +7
4. Add 1 to the year +1
18
17. Nurse Jojie attends to another pregnant client who has

two children. Her history reveals that her first pregnancy
ended in a stillbirth at 32 weeks gestation, her second
pregnancy with the birth of her daughter, at 35 weeks, and
her third pregnancy with the birth of her son at 41 weeks.
Using the GP TPALM format. Nurse Jojie would record the
woman’s obstetrical history as:
a. G3P3 (T1P1A1L3MO)
b. G4P3 (T1P2L2MO)
c. G4P4 (T2P1AOL1 MO)
d. G3P3 (T1P2AOL1MO)
GRAVIDA = # of pregnancies
PARA = # of deliveries beyond age of viability (20 weeks)
TERM = # of deliveries beyond 37 weeks
PRETERM = # of deliveries beyond 20 weeks but before 38
ABORTA = # of miscarriages before 20 weeks
LIVE BIRTHS = # of children born alive
MULTIPLE BIRTHS = # of twins, triplets, etc.
19
18. A twenty-year-old client visits Nurse Jojie at her

nursing prenatal clinic because she is pregnant. She tells
Nurse Jojie that she missed one menstrual period
(amenorrhea) and that she experienced nausea and vomiting
(morning sickness), urinary frequency and fatigue. Based
on her assessment, Nurse Jojie suspects that her client
has what kind of signs of pregnancy?
a. Presumptive
b. Predictive
c. Probable
d. Positive
PRESUMPTIVE = first perceived and reported by the woman

PROBABLE = first perceived and identifies by the examiner
POSITIVE = confirmatory or diagnostic of pregnancy
20
19. While doing Leopold’s maneuver on a client, Nurse Jojie

notes the presence of a firm round prominence over the
pubic symphysis (FETAL HEAD), a smooth convex structure
down her right side (FETAL BACK), an irregular lump down
her left side and soft roundness in the fundus. Nurse Jojie
should conclude that the fetal position is:
a. Left occiput anterior
b. Left occiput posterior
c. Right shoulder anterior
d. Right occiput anterior
21
20. When performing Leopold’s maneuver to a primigravida,

Nurse Jojie is aware that to make her client more
comfortable during the procedure, she should prepare the
client by asking her to:
a. empty her bladder prior to the procedure.
b. lie on her left side during the procedure
c. avoid eating immediately before examination.
d. hyperventilate for a short time.
22
SITUATION 5 - Teaching clients about healthy food intake for

health promotion and disease prevention is an important
function of the nurse. Nutritional deficiency is preventable
if individuals and families have adequate knowledge about
normal nutrition.
MACRONUTRIENTS
= primary purpose: to supply energy
= three groups
1. CARBOHYDRATES (CHO) (1 g = 4 kcal)
2. PROTEIN (CHON) (1 g = 4 kcal)
3. FATS (CARBON CHAINS) (1 g = 9 kcal)
MICRONUTRIENTS
= primary purpose: aid in metabolism and specific bodily
functions
= two groups
1. VITAMINS = fat soluble and water soluble
2. MINERALS
23
21. The nurse is teaching a family to take food with high

protein content. She discovers that the family’s
consideration is the high cost. Which of the following
affordable high protein food should the nurse recommended?
a. Peas and beans
b. Beef steak & vegetables
c. Fried rice and dried fish
d. Spaghetti and bread
24
22. During the follow-up visit, the client asks the nurse
foods that are complete in protein. Which of the following
should the nurse recommend?
a. Oatmeal with raisins
b. Toast with peanut butter
c. Eggs
d. Lentil soup (VEGETABLE SOUP)
COMPLETE IN PROTEIN = ANIMAL SOURCES
25
23. A mother asks that nurse what finger food is safe for
her toddler. Knowing that children can easily choke on
food, the nurse should advice the mother to feed the
toddler which of the following foods?
a. Popcorn
b. Grilled hotdogs
c. Cereals
d. Salted nuts
26
24. A client diagnosed with peptic ulcer asks you what food
is best to add to his diet so as not to exacerbate his
symptoms. Which of the following is the MOST appropriate
food for the client?
a. Citrus fruit juices (CITRIC ACID)
b. Cafe latte and similar drinks (CAFFEINE)
c. Green vegetable dishes
d. Frequent intake of milk (LACTIC ACID)
PEPTIC ULCER DISEASE

= erosion of the mucosal lining of the stomach or small
intestine (duodenum)
= risk factors:
1. Highly acidic diet 6. High level stress
2. Caffeine 7. Type O blood
3. Spicy food 8. Type A personality
4. Alcohol
5. Nicotine (smoking)
27
25. When teaching your clients about nutrition, you include

the following food as rich sources of good cholesterol,
EXCEPT: (LOOKING FOR NEGATIVE)
a. Fish
b. Beef
c. Soya
d. Olive oil
NOTE: ALWAYS ENCIRCLE THE WORD EXCEPT.
28
SITUATION 6 – A 37-year-old client is brought to the

Emergency Room for passing fresh blood upon defecation. The
client is actively bleeding and his blood pressure drops to
80/50. Fluids and blood transfusion of packed RBC are
ordered immediately.
BLOOD TRANSFUSION
= administration of blood and blood products
= two methods: autologous and homologous/allogenic
= requires formal consent
= religions prohibited:
1. Jehovah’s witness
2. Christian scientists
= cross matching is required
1. Universal donor = Type O negative
2. Universal recipient = Type AB positive
29
26. This is the first time that the client will have blood
transfusion. He and his family are very worried about the
procedure. Your MOST appropriate nursing intervention
would be to:
a. talk to the client and family and inquire what their
fears are about blood transfusion.
b. reassure the client and family that blood transfusion
is a simple low risk procedure.
c. tell the client that he will be closely observed for
the first hour so he will be safe.
d. request the doctor to explain to the client why blood
transfusion is necessary.
30
27. The nurse prepares the following equipment for blood

transfusion EXCEPT: (looking for negative)
a. 0.9% normal saline solution (FLUSHING/PRIMING IV
TUBING)
b. IV infusion set with gauge with 22 needle (16 to 18)
c. Blood product properly typed and cross matched
d. Y type filter transfusion set
31
28. The nurse understands that normal saline solution is

used to initiate the intravenous infusion rather than
dextrose solution before blood transfusion to:
a. avoid cardiac overload.
b. maintain adequate hemoglobin content.
c. prevent increasing the blood sugar of the client.
d. avoid hemolysis and clumping of red cells.
32
29. The nurse stays and observes closely the client after
the start of the blood transfusion for possible transfusion
reaction which includes the following EXCEPT: (LOOKING FOR
NEGATIVE)
a. hypovolemic reaction (OVERLOAD)
b. febrile reaction
c. transfusion reaction
d. allergic reaction
33
30. After starting blood transfusion, the nurse should make

sure that the blood is transfused to the patient within
how many hours from the time it started?
a. 12 hours
b. 10 hours
c. 8 hours
d. 4 hours
34
SITUATION 7 - Nurse Gazini was talking about HIV-AIDS to a

group of senior high school students. Here are some
questions which were asked by them during the open forum.
31. One student asks, “What are some of the general

symptoms during PRIMARY HIV infection (FLU-LIKE
SYMPTOMS)?” The nurse enumerated the following. Which among
these are CORRECT?
I. Fatigue
II. Headache
III. Fever
IV. Sore throat
V. Cough
VI. Dyspnea
a. I. II, V ,VI c. I, II, III, IV
b. I, II, IV, V d. II, III, IV, VI
SCREENING TEST: ELISA CONFIRMATORY TEST FOR AIDS

CONFIRMATORY TEST: WESTERN BLOT CD4 COUNT < 200
35
32. A female student queries, “When can AIDS be manifested?”

The nurse’s CORRECT answer was “It can be as early as:
a. 1 year or as late as 2 years
b. 2 years or as late as 10 years
c. 1 year
d. 6 months
STAGES OF HIV INFECTION
A = Acute HIV infection → 2 years

B = Latent / Asymptomatic HIV → from 2 years to 10 years
C = End stage HIV (AIDS)
36
33. Nurse Gazini also asked the participants if they

understood the transmission of HIV based from her lecture?
Which participant response indicates a need for further
teaching? (LOOKING FOR NEGATIVE/INCORRECT)
a. Needlestick
b. Dry kissing
c. Unprotected sex
d. Vertical transmission
37
34. On the question as to which of the following are the

effects of AIDS on pregnancy, one teenager cited a wrong
answer which was _________________.
a. mild weight loss
b. prematurity
c. repeated abortion
d. infertility
38
35. HIV transmission from mother to infant occur at post-

natal period during _____________.
a. bathing
b. washing of vagina
c. bottle feeding
d. breastfeeding
39
SITUATION 8 – Noncommunicable diseases, or NCDs, are by far

the leading cause of death in the world, representing 63%
of all annual deaths. Noncommunicable diseases (NCDs) kill
more than 36 million people each year. Some 80% of all NCD
deaths occur in low- and middle-income countries like the
Philippines.
36. Four of these identified chronic diseases referred to

by the World Health Organization (WHO):
I. Acute coronary syndrome IV. Osteoporosis
II. Cancer V. Diabetes Mellitus
III. Dementia VI. COPD
a. I, II, III and IV c. II, III, IV and V

b. I, II, V and VI d. II, IV, V and VI
40
37. Based on their 2015 estimates, the WHO identifies that

the leading cause of death from chronic diseases worldwide
is _____________________.
a. tuberculosis.
b. diabetes mellitus.
c. cardiovascular diseases
d. psoriasis
41
38. In the Philippines, this disease is ranked by the

Department of Health as the NUMBER ONE cause of mortality
among Filipinos in the year 2009.
a. Heart disease
b. Malignant neoplasm
c. Cerebrovascular accident
d. COPD
42
39. When studying chronic diseases, the multifactorial

etiology of illness is considered. What does this imply?
a. Single organism that causes the disease, such as
cholera, must be studied in more detail.
b. Focus should be on the factors or combination and
levels of factors contributing to disease.
c. The rise in infectious and communicable disease must be
the main focus.
d. Genetics and molecular structure of disease in
paramount.
Leading risk factors for chronic non communicable diseases:

1. Sedentary lifestyle
2. High fat diet
3. High level of stress
4. Obesity
5. Smoking & alcoholism
43
40. Determinants of health (factors that influence the

health status of people in a community) to address the
development of cancer in a community include:
I. Proximity of the community to chemical plants that emit
poisonous gases.
II. High percentage of tobacco use among the residents.
III. Prevailing diet high in processed food and fat
IV. Availability of health facilities.
V. Mean age of women population.
a. III, IV and V
b. I, II and III
c. I, III and IV
d. II, IV and V
44
SITUATION 9 - The nurse is responsible for administering

medication to some clients.
41. A client with congestive heart failure is taking

hydrochlorothiazide (POTASSIUM WASTING DIURETIC) once a
day. While the client is taking the medication, the nurse
should encourage the client to eat which of the following
fruits?
a. Banana
b. Papaya
c. Orange
d. Apple
45
42. The nurse is administering a bronchodilator (widens the

airway) to a client with severe upper respiratory tract
infection. The client is manifesting the desired effect of
the bronchodilator when the nurse assesses which of the
following:
a. effortless respiration.
b. increased respiratory rate. (normal RR)
c. blowing sounds heard over the bronchi. (hyperresonance =
a sign of COPD)
d. liquefied thick secretions. (desired effect of
mucolytics)
46
43. The nurse routinely administers antibiotics to clients

with infectious diseases. Of the following, which is the
most important nursing action when administering
antibiotics?
a. Administer the antibiotic in between meals.
b. Assess for toxicity.
c. Monitor intake and output.
d. Encourage foods high in Vitamin K.
47
44. A client for surgery has been taking long-term

prescribed corticosteroids. The drug is withdrawn slowly
in preparation for surgery. He asks the nurse why there is
a need to withdraw the drug. The nurse addressing the
question appropriately when she says:
a. “The drug has to be withdrawn slowly because abrupt
withdrawal may cause shock.”
e. “This preparation prevents drug interaction.”
b. “Withdrawing the drug is necessary to prevent bleeding
during surgery.”
c. “Withdrawing the drug limits allergic responses.”
Long term corticosteroids → suppresses natural production of

steroids → abruptly withdrawn → steroid levels go down →
sodium goes down as well → fluid levels go down → hypovolemia
→ SHOCK
48
45. When teaching a patient about the proper storage of

medications, what information does the nurse include?
a. Keep medications in their original containers.
b. Store medications in a bathroom cabinet as a reminder to
take the medication.
c. Keep medications in a brightly lit area to better read
labels.
d. Avoid storing medications in cool, dark locations.
49
SITUATION 10 - Epidemiology is more than “the study of.”

As a discipline within public health, epidemiology
provides data for directing public health action. The
discipline did not blossom until the end of the Second
World War. The contributions of some of these early and
more recent thinkers are described below.
50
46. After 1854, John Snow earned the title “the father of
field epidemiology.” Who is John Snow?
a. a London haberdasher who was the first to quantify
patterns of birth, death, and disease occurrence JOHN
GRAUNT
b. a British statistician who developed many of the basic
practices used today in vital statistics and disease
classification WILLIAM FARR
c. an English anesthesiologist who conducted studies of
cholera outbreaks to discover the cause and prevention of
the disease
d. a Greek philosopher suggested that environmental and
host factors such as behaviors might influence the
development of disease HIPPOCRATES
51
47. Historically, many scientists have contributed to the

method used in epidemiology. Robert Koch, a private
practice physician and district medical officer from
Germany, discovered in 1882 which highly contagious disease
now responsible for “Koch’s disease?”
a. Smallpox (biological agent used for terrorism)
b. Tuberculosis
c. Cholera (El Tor)
d. Scurvy
52
48. During the evolution of epidemiology, various

scientists also correlated diseases to an array of factors.
James Lind (RESPONSIBLE FOR DISCOVERING CURE FOR
SCURVY)(1716–1794) observed the effect of time, place,
weather, and diet on the spread of disease. Lind noticed
that while on long ocean voyages, sailors would become sick
and malnourished. What did he discover as the best
treatment for the sailors?
a. Voracious intake of lemons and oranges
b. Garlic, mustard seed, and horseradish
c. Spoonfuls of vinegar and apple cider
d. Boiled biscuit with sugar, barley and raisins
53
49. This scientist identified the importance of washing

hands to prevent the spread of disease in the pursuit of
the Viennese (Vienna = Austria) Maternity Hospital to
decrease the rates of “childbed fever” among postpartum
mothers.
a. Bernardino Ramazzini (Italian)
b. Mary Mallon (American)
c. Ignaz Semmelweis
d. Florence Nightingale (Italian)
54
50. Among all her contributions in epidemiology, what was

Florence Nightingale’s (ENVIRONMENTAL NURSING THEORY) most
important contribution?
a. The advocacy for an innate empathy among patients,
especially for the sick and wounded
b. The harmful effects of the physical aspects of work
c. The idea that some diseases, especially chronic
diseases, can have a multifactorial etiology
d. The correlation of cleanliness in the environment and
personal hygiene in the improvement of health
55
SITUATION 11 - Pain is a complex, multidimensional

experience that can cause suffering and decreased quality
of life. Pain is one of the major reasons that people seek
health care. To effectively assess and manage patients
with pain, the nurse needs to understand the physiologic
and psychosocial dimensions of pain.
51. Pain has been defined as “whatever the person

experiencing the pain says it is, existing whenever the
patient says it does (MCCAFFERY GUIDELINE).” This
definition is problematic for the nurse when caring for
which type of patient?
a. A patient placed on a ventilator (CAN STILL
COMMUNICATE)
b. A patient with a history of opioid addiction
c. A patient with decreased cognitive function
d. A patient with pain resulting from severe trauma
56
52. Which of the following should nurse least expect to

find in a client responding to acute pain?
a. Muscle spasms
b. Decreased tidal volume
c. Increased urine output (URINARY RETENTION)
d. Poor concentration
ACUTE PAIN CHRONIC PAIN

Short term Long term
Abrupt onset Gradual onset
Stimulates the SNS Stimulates the PNS
Increased level of VS Stable VS
57
53. What part of your patient’s body is expected to be

painful if your patient has lumbago?
a. Lower back
b. Inner ear
c. Vagina
d. Left calf
58
54. A patient with trigeminal neuralgia (tic doloreaux =

CNV) has moderate to severe burning and shooting pain. In
helping the patient to manage the pain, the nurse
recognizes what about this type of pain?
a. Treatment includes the use of adjuvant analgesics
b. Will be chronic in nature and require long-term
treatment
c. Responds to small to moderate around-the-clock doses
of oral opioids
d. Can be well controlled with salicylates or
nonsteroidal anti-inflammatory drugs (NSAIDs)
NEUROPATHIC PAIN = pain is attributed to nerve problem
59
55. A patient is receiving a patient-controlled analgesia

(PCA) (OPIOIDS) after surgery to repair a hip fracture.
She is sleeping soundly but awakens when the nurse speaks
to her in a normal tone of voice. Her respirations are 8
breaths/min. The most appropriate nursing action in this
situation is to:
a. Stop the PCA infusion.
b. Obtain an oxygen saturation level.
c. Continue to closely monitor the patient.
d. Administer naloxone and contact the physician.
60
SITUATION 12 - A pregnant patient has been diagnosed as

having appendicitis and needs surgery.
56. When should the surgery be performed?

a. Third trimester
b. Second trimester
c. Immediately (CAN BE AN EMERGENCY)
d. After delivery (CAN CAUSE RUPTURE OF THE APPENDIX)
61
57. You enter the OR at the beginning of the shift and

notices a spot of blood on the wall. When should the blood
be removed?
a. At the end of the first case
b. At the moment it is noticed (PREVENTS CROSS
CONTAMINATION)
c. During opening of the sterile field
d. Leave it for the circulator to notice
62
58. The nurse has just passed a new #10 blade to the surgeon
to make the first incision on the skin. The surgeon has
requested a #10 blade again. What should the nurse do?
a. Pass the same #10 blade. (CONTAMINATED ALREADY)
b. Change the blade to a new blade and pass.
c. Give the surgeon a new #15 blade.
d. Tell the surgeon that you are unsure of what to do.
63
59. The surgeon asks the nurse for a monofilament suture.

The nurse should prepare and give:
a. Monocryl
b. Ethibond
c. Silk
d. Vicryl
64
60. What solution should the scrub nurse use to clean

instruments at the point of use?
a. Saline (for flesh and body cavity)
b. Sterile water
c. Cidex (post-op)
d. Sodium hypochlorite (bleach/chlorox)
65
SITUATION 13 - You are a nurse who has just been hired to

provide health care in a small barangay by doing home
visits. Before you begin seeing your clients, you realize
that it would be helpful for you to become familiar with
the neighborhood and resources in the community where your
clients live.
61. Building a trusting relationship with the family client

is the cornerstone of successful home visits. This
transpires during the initiation phase. The following are
your activities during this phase, EXCEPT:
a. Clarify source of referral for visit.
b. Clarify purpose for home visit.
c. Share information on purpose of home visit.
d. Implement nursing process. (In-home phase)
66
62. A nurse must be flexible and anticipate that families

may or may not be able to control interruptions during the
visit. What should you do if upon arrival to the home your
target family is singing karaoke?
a. Tell the head of the family that you will just come
back some other time.
b. Observe the family while they are having fun and wait
patiently for them to finish.
c. Ask a member of the family if they can take a short
break around 15 minutes.
d. Visit another family for the meantime.
67
63. Upon entering the household during the in-home phase,

you encountered an old man who the mother calls an
“albularyo.” You saw the old man putting a rose petal over
the forehead and oil over the chest of one of the mother’s
children who has been coughing for two weeks now. How
should you respond to this situation?
a. Remove the oil and the rose petal right away.
b. Check what type of oil the old man applied.
c. Observe and assess the patient right after the ritual.
(with respect to cultural beliefs)
d. Interview the albularyo during the ritual.
68
64. You are assessing the vital signs of the family

members. In assessing the femoral pulse, which site should
you locate?
a. Medial surface of the ankle (dorsalis pedis)
b. Over bones of the foot between big & second toes
(pedal)
c. Alongside the inguinal ligament.
d. Behind the knee. (popliteal)
69
65. One of the family members appears to be slightly

hypothermic. The best initial response by the nurse is to
give:
a. soup.
b. coffee. (caffeine)
c. cocoa. (caffeine)
d. brandy
70
SITUATION 14 - You have been assigned to be the primary

nurse for Martha, an 18-year-old, who has come to the clinic
to confirm pregnancy. She tells you that she knows she is
pregnant because she has already missed three periods, she
has been having morning sickness and a home pregnancy test
that she did last week was positive. Martha states that she
has had very little contact with the health care system, and
the only reason she came today is because her boyfriend
insisted that she “make sure” she is really pregnant.
66. Martha tells you, “If I'm going to have all of these
discomforts, I'm not sure I want to be pregnant!” The nurse
interprets the client's statement as an indication of which
of the following?
a. Fear of pregnancy outcome.
b. Rejection of the pregnancy.
c. Normal ambivalence.
d. Inability to care for newborn
71
67. At 7 weeks’ gestation, Martha complains that she is

sick every morning with nausea and vomiting and adds that
she does not think she can tolerate it throughout her
pregnancy. The nurse assures her that this is a common
occurrence in early pregnancy and will probably disappear
by the end of the:
a. fifth month.
b. third month.
c. fourth month.
d. second month.
MORNING SICKNESS
= due to the rising levels of HCG
= onset: first trimester
= management
1. Eat dry crackers upon arising.
2. Provide adequate rest.
3. Avoid noxious stimuli
4. Drink fluids in between meals
72
68. A pregnant woman tells a nurse in the prenatal clinic

that she knows that folic acid is very important during
pregnancy and she is taking a prescribed supplement. She
asks the nurse what foods contain folic acid (folate) so
she can add them to her diet in its natural form. Which
foods should the nurse recommend? Select all that apply.
1) Beef and fish 4) Black and pinto beans
2) Milk and cheese 5) Enriched bread and pasta
3) Chicken and turkey
a. 4 & 5 only c. 1, 2, & 3 only

b. 1, 2, 3, 4 & 5 d. 3 & 4 only
73
69. After preliminary tests were done, Martha has been

prescribed to undergo clinical pelvimetry (visualization
and measurement of the pelvic inlet). The value of this
procedure rests in its ability to:
a. predict successful vaginal birth.
b. identify the characteristics of the woman’s pelvis.
c. determine if she will have a breech presentation.
d. predict an occiput posterior position
74
70. You are also caring for a mother and her newborn infant.
Using the data below, which nursing intervention is
required?
a. Neonatal blood transfusion

b. Maternal rubella vaccination (normal = 1:8)
c. Maternal RhoGAM injection both are negative
d. Neonatal 50% glucose infusion neonatal glucose is
normal
75
SITUATION 15 – Milestones in growth and development

dramatically transpire as the child undergoes the process.
It is the crucial task of the nurse to monitor the child in
all these phases.
71. While taking the history of 6-month old Alexandria, you

learn that she is not sleeping through the night and will
not fall back to sleep without the parents rocking or
feeding her. This is an example of:
a. Somnambulism (sleepwalking)
b. Pavor nocturnus (night terrors)
c. Learned behavior
d. Delayed sleep phase
76
72. The parents of Jona are about to enroll her in school.

Which of the following scenarios is suggestive that Doris
may not be ready to enter first grade if she is unable to:
a. recognize six colors & remember one’s phone number.
b. accurately use pronouns.
c. empathize with others.
d. count to five and draw a person with three parts.
77
73. The mother of 5-year-old Bryan is concerned that her

son often cheats when playing board games with his older
sister. What is the most appropriate response to Bryan’s
behavior?
a. Encourage the parent to use 5-minute time-outs when
cheating occurs.
b. Explain that Bryan is developmentally unable to
comprehend rigid rules.
c. Make sure that Bryan understands the rules before
starting to play the game.
d. Explain to Bryan that cheating is like lying and is
not acceptable behavior.
78
74. You would expect Edmar, a school-age child to:

a. Grow 1.5 inches per year
b. Grow 0.5 inch per year
c. Gain about 6 pounds per year
d. Gain about 3 pounds per year
79
75. Adolescents like Andrea who engage in risky behavior,

such as having pre-marital sex, are displaying:
a. A type of egocentrism (TODDLER)
b. A need for independence (TODDLER)
c. Role experimentation
d. Low self-esteem
80
SITUATION 16 - In a private postpartum room, a nurse was

taking care of a sleeping patient who just gave birth to a
bouncing baby boy. While inside the room, the husband
angrily entered the room with a knife attempting to stab
the patient after learning that he was not the real father
of the baby. In the process of taking the knife and
protecting the patient, the nurse accidentally stabbed the
husband and killed him. Devastated, the patient
immediately called the police.
76. Unless proven innocent, the nurse in this situation is

considered a/an:
a. principal to the crime.
b. accomplice to the crime.
c. accessory to the crime.
d. a witness to the crime.
81
77. Upon the arrest of the nurse, the police reads the
Miranda rights of an accused which includes the:
a. rights to remain silent and avail legal
representation.
b. rights to freedom of speech and appeal.
c. rights to due process and a fair trial.
d. rights to remain calm and steady.
82
78. The patient plans to file a case of murder against the

nurse. The law that establishes a time frame within which
legal action must be initiated is known as:
a. The discovery rule
b. The proof of liability
c. The statute of limitations
d. The claims made period
83
79. The nurse who stabbed the patient’s husband pleads not
guilty regarding the accusation of murder and insisted that
he was just trying to protect the patient. This alibi can
be accepted as which type of circumstance?
a. Justifying (self defense)
b. Mitigating (sufficient provocation, irresistible
force)
c. Exempting (insanity, imbecility, minority)
d. Aggravating (political ascendancy, made against
gender, done during time of disaster)
84
80. During the legal proceeding, the defense attorney

describes mentioned the legal principle damnum absque
injuria. The defense attorney is defining a legal principle
that says:
a. the thing speaks for itself. (RES IPSA LOQUITUR)
b. although there is physical injury, there is no
liability.
c. there is an exception to the rule. (EPIKIA)
d. the superior is responsible for the subordinate.
(RESPONDEAT SUPERIOR)
85
SITUATION 17 - A 21-year-old college student was admitted

at 12 noon because of a generalized abdominal pain which
became localized after midnight on the right lower
quadrant accompanied by nausea and vomiting. In the
Emergency Department, the diagnosis of acute appendicitis
was confirmed. The patient was scheduled for Appendectomy.
81. The development of appendicitis usually follows a

pattern that correlates with the clinical signs. The
admitting nurse understands that the appendix initially
becomes distended with fluid secreted by its mucosa
following:
a. obstruction of the appendiceal lumen. (FECALITH)
b. fibrotic changes in inner walls of the appendix.
c. impairment of blood supply of the appendix.
d. proliferation of microorganisms inside the appendix.
86
82. On palpation of the McBurney’s point (RLQ), which of

the following observation would support the physician’s
diagnosis?
a. Pain aggravated by coughing (SIGN OF PERICARDITIS)
b. Rigid “board-like” abdomen (SIGN OF PERITONITIS)
c. Pain increased with internal rotation of the right
hip
d. Relief of pain with direct palpation and pain on
release of pressure (REBOUND TENDERNESS)
87
83. Preoperative nursing care plan includes “potential

complication related to ruptured appendix” as one the
nursing diagnosis. Which of the following is the nurse
expected to report immediately as a possible sign of a
ruptured appendix?
a. Severe nausea and vomiting
b. Sudden increase in the body temperature
c. Unbearable excruciating localized pain
d. Pain subsides
88
84. To prevent perforation of the inflamed appendix, which

of the following will the nurse consider as an effective
intervention?
a. Keep on NPO. (EATING → INCREASES PERISTALSIS → WAVES
THAT CAN HIT & RUPTURE APPENDIX)
b. Maintain on a complete bed rest.
c. Apply hot compress to abdomen.
d. Monitor progress of pain. (IT WILL NOT PREVENT)
89
85. Postoperative medical diagnosis of the client is

“Perforated appendix”. Client has a nasogastric tube
connected to continuous drainage. Which of the following
is the purpose of this intervention?
a. Relieve pain due to abdominal distention
b. Intestinal decompression(INTESTINAL LAVAGE TO PREVENT
ABDOMINAL DISTENTION)
c. Medium to cleanse the upper GI tract
d. Drain out blood
90
SITUATION 18 - You started to chart for the shift when you

discovered that there was an error in medication. The
following questions apply.
86. You have just administered a per orem medication which

should be taken sublingually. Which of the following
actions should you do FIRST?
a. Induce the client to vomit.
b. Monitor the client closely.
c. Notify the attending physician of the incident.
d. Chart the medication.
91
87. Fortunately your client did not manifest any untoward

reaction. Even so you still have to accomplish a/an:
a. justification letter.
b. explanation that the client did not react.
c. incident report. OR UNUSUAL OCCURRENCE REPORT
d. affidavit.
92
88. In the patient’s chart, the following should be

documented, EXCEPT: (LOOKING FOR NEGATIVE)
a. the fact that you wrote an incident report.
b. time the incident happened.
c. the physician who examined the client.
d. the client’s response
93
89. The incident report should not be viewed as an

acceptance of negligence because it offers the following
advantages. Identify all the benefits derived from an
incident report.
1) For potential liability claims
2) Identify risks areas
3) Find ways to prevent similar incident in the future
4) Rich source for research
a. 1, 2 and 3 c. 1, 3, 4
b. 2, 3 and 4 d. All of the above
94
90. An incident report is best written when all facts are

still fresh in the mind of the nurse. It should include
all of the following, EXCEPT:
a. How the patient responded
b. Draw your conclusion
c. What you saw
d. How you intervened
95
SITUATION 19 – The nurse is caring for a geriatric patient

in a local clinic in the suburbs. Whenever the nurse calls
the patient from afar, the patient would not respond and
just be found staring blankly at the wall. But once the
nurse gets near to the patient and pats his back, the
patient responds appropriately.
91. What would be most likely the case of this patient?

a. Active hallucinations and delusions
b. Display of senility
c. Depression
d. Signs of age-related hearing loss
96
92. The nurse refers the patient to the physician for

conclusive tests. Which hearing examination will the nurse
expect the physician to prescribe to estimate the amount
of hearing loss the patient has?
a. Audiometry test
b. Rinne test TESTS FOR CONDUCTIVE & SENSORINEURAL
HEARING LOSS
c. Weber test TESTS FOR CONDUCTIVE & SENSORINEURAL
HEARING LOSS
d. Whisper test TEST FOR CHECKING NEAR DISTANCE HEARING
LOSS
97
93. The nurse is assisting the patient who has recently

received a hearing aid. Which would the nurse include in
the teaching?
a. “This device will amplify background noise so you can
hear more clearly.”
b. “This occludes the ear to increase the transport of
sound to nerve endings.”
c. “A hearing aid is used to amplify musical sounds.”
d. “The hearing aid improves your ability to hear.”
98
94. The client with a hearing aid does not seem to be able
to hear the nurse. The nurse should do which of the
following first?
a. Contact the client's audiologist.
b. Cleanse the hearing aid ear mold in normal saline.
c. Irrigate the ear canal.
d. Check the hearing aid's placement.
99
95. The best method to remove cerumen from a client's ear

involves:
a. Inserting cotton buds into external canal.
b. Irrigating the ear gently.
c. Using aural suction.
d. Using a cerumen curette.
100
SITUATION 20 - It was Valentine’s day when Hannah was

rushed to the Emergency Room after she was discovered to
have taken a bottle of sleeping pills. She revealed to the
physician that she tried to “end it all” after she was
allegedly raped by one of her classmates and was
continuously bullied in school.
96. Hannah is admitted to the psychiatric hospital after

assessment revealed that she had many self-inflicted
nonlethal injuries over the last month. Which level of
suicidal behavior is reflective of the Hannah’s behavior?
a. Threats
b. Gestures (NOT INJURIOUS)
c. Attempts (LETHAL ACTIVITIES)
d. Ideations (NO ACTIONS)
101
97. Myths surround suicide but among these statements,

which should the nurse take as a reality?
a. All suicide behaviors should be taken seriously.
b. Only psychotic persons try to kill themselves.
c. Suicide risk is over when improvement follows the crisis.
d. Suicide attempts are manipulative ploys.
102
98. Hannah is on antidepressant treatment and was placed

on the “Suicide Watch” list. The nurse must be alert that
among depressed patients, suicide is likely to be committed
when:
a. there is a traumatic experience.
b. antidepressant medication begins to raise mood.
c. depression is at its peak.
d. the patient is depressed anytime.
103
99. Which of these should be taken out of Hannah’s room?

a. Throw Pillow
b. String Bracelet
c. Coke in can
d. Book
104
100. Hannah tells a nurse, “I want to die.” Which is the

nurse’s most therapeutic response?
a. “You would rather not live.” (RESTATING = clarifies
the statement of the patient)
b. “You are not alone in feeling this way.”
c. “When was the last time you felt this way?”
d. “Do you believe that there is life after death?”
END OF EXAMINATION
_________________________________
PROCTOR’S NAME & SIGNATURE
105

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Nurse's Guide to Loss, Grief and End-of-Life Care

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ASSESSMENT EXAMINATION – NLE ENHANCEMENT PROGRAM

LOSS = absence of something/someone important/valuable

Kuhbler-Ross Stages of Grieving (DABDA)

Denial = non-acceptance of the reality of a loss

a. attend to her physical needs. (PRIORITIZATION)

2. Upon learning about her condition, the client says to the

3. The client is in severe pain and manifests signs of

5. The body is being prepared for transfer to the mortuary.

NOTE: Be careful with ABSOLUTE words. Encircle them!

SITUATION 2 - An understanding of the infectious process and

MAIN PRINCIPLE: Break the chain of infection in its earliest

6. The nurse is explaining standard protection to the client.

STANDARD PRECAUTION = used for all types of patient

7. The nurse is changing the wound dressing of the client.

OBJECT IS CONTAMINATED = CLEAN GLOVES

8. The client has an order for contact precautions. The nurse

CORRECT ORDER OF DONNING (WEARING) PPE: Gow-Ma-Gog-Glov

9. The clinical instructor in the Surgical Unit is teaching

10. The nurse is to perform a sterile procedure while

SITUATION 3 – Nurse Frankie and Nurse Diana engaged in

“Common Errors Regarding Standards of Nursing

12. Which of the following could be the BEST method to

“Common Errors Regarding Standards of Nursing Documentation

13. What term is used to describe the arrangement of

14. In statistics, what is the definition of percentage?

“Common Errors Regarding Standards of Nursing Documentation

15. Based on Nurse Frankie’s and Nurse Diana’s study

SITUATION 4 - Promotion of safe motherhood in varied

16. Nurse Jojie is taking care of a pregnant client, whose

EDC / EDD = Expected date of confinement / delivery

17. Nurse Jojie attends to another pregnant client who has

18. A twenty-year-old client visits Nurse Jojie at her

PRESUMPTIVE = first perceived and reported by the woman

19. While doing Leopold’s maneuver on a client, Nurse Jojie

20. When performing Leopold’s maneuver to a primigravida,

SITUATION 5 - Teaching clients about healthy food intake for

21. The nurse is teaching a family to take food with high

COMPLETE IN PROTEIN = ANIMAL SOURCES

PEPTIC ULCER DISEASE

25. When teaching your clients about nutrition, you include

NOTE: ALWAYS ENCIRCLE THE WORD EXCEPT.

SITUATION 6 – A 37-year-old client is brought to the

27. The nurse prepares the following equipment for blood

28. The nurse understands that normal saline solution is

30. After starting blood transfusion, the nurse should make

SITUATION 7 - Nurse Gazini was talking about HIV-AIDS to a

31. One student asks, “What are some of the general

SCREENING TEST: ELISA CONFIRMATORY TEST FOR AIDS

32. A female student queries, “When can AIDS be manifested?”

STAGES OF HIV INFECTION

A = Acute HIV infection → 2 years

33. Nurse Gazini also asked the participants if they

34. On the question as to which of the following are the

35. HIV transmission from mother to infant occur at post-

SITUATION 8 – Noncommunicable diseases, or NCDs, are by far

36. Four of these identified chronic diseases referred to

a. I, II, III and IV c. II, III, IV and V

37. Based on their 2015 estimates, the WHO identifies that

38. In the Philippines, this disease is ranked by the

39. When studying chronic diseases, the multifactorial

Leading risk factors for chronic non communicable diseases:

40. Determinants of health (factors that influence the

SITUATION 9 - The nurse is responsible for administering