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NP3 Nursing Board Exam June 2007 Answer Key 'Nursing Care of Client with Physiological and Psychosocial

Alteration'

100 nursing board exam test questions of June 2007 Nurse Licensure Examination (NLE) Nursing Practice III Nursing Care of Client with Physiological and Psychosocial Alteration Medical and Surgical Nursing / Psychology PART 1 Board Exam test questions 1 - 50

NURSING PRACTICE III Care of Clients with Physiologic and Psychosocial Alterations (Part A) SITUATIONAL Situation 1 Concerted work efforts among members of the surgical team is essential to the success of the surgical procedure. 1. The sterile nurse or sterile personnel touch only sterile supplies and instruments. When there is a need for sterile supply which is not in the sterile field, who hands out these items by opening its outer cover? A. B. C. D. Circulating Nurse Anaesthesiologist Surgeon Nursing Aide 2. The OR team performs distinct roles for one surgical procedure to be accomplished within a prescribed time frame and deliver a standard patient outcome. While the surgeon performs the surgical procedure, who monitors the status of the client like urine output, blood loss? A. B. C. D. Scrub Nurse Surgeon Anesthesiologist Circulating Nurse 3. 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. For orthopedic cases, what department is usually informed to be present in the OR? A. B. C. D. Rehabilitation department Laboratory department Maintenance department Radiology department 4. Minimally invasive surgery is very much into technology. Aside from the usual surgical team, who else has to be present when a client undergoes laparoscopic surgery? A. B. C. D. Information technician Biomedical technician Electrician Laboratory technician

5. In massive blood loss, prompt replacement of compatible blood is crucial. What department needs to be alerted to coordinate closely with the patients family for immediate blood component therapy? A. B. C. D. Security Division Chaiplaincy Social Service Section Pathology department

Situation 2 You are assigned in the Orthopedic Ward where clients are complaining of pain in varying degrees upon movement of body parts. 6. Troy is a one day post open reduction and internal fixation (ORIF) of the left hip and is in pain. Which of the following observation would prompt you to call the doctor? A. B. C. D. Dressing is intact but partially soiled Left foot is cold to touch and pedal pulse is absent Left leg in limited functional anatomic position BP 114/78, pulse of 82 beats/minute 7. There is an order of Demerol 50 mg I.M. now and every 6 hours p r n. You injected Demerol at 5 pm. The next dose of Demerol 50 mg I.M. is given: A. B. C. D. When the client asks for the next dose When the patient is in severe pain At 11 pm At 12 pm 8. You continuously evaluate the clients adaptation to pain. Which of the following behaviors indicate appropriate adaptation? A. B. C. D. The client reports pain reduction and decreased activity The client denies existence of pain The client can distract himself during pain episodes The client reports independence from watchers 9. Pain in ortho cases may not be mainly due to the surgery. There might be other factors such as cultural or psychological that influence pain. How can you alter these factors as the nurse? A. B. C. D. Explain all the possible interventions that may cause the client to worry Establish trusting relationship by giving his medication on time Stay with the client during pain episodes Promote clients sense of control and participation in control by listening to his concerns 10. In some hip surgeries, an epidural catheter for Fentanyl epidural analgesia is given. What is your nursing priority care in such a case? A. B. Instruct client to observe strict bed rest Check for epidural catheter drainage

C. D.

Administer analgesia through epidural catheter as prescribed Assess respiratory rate carefully Situation 3 Records are vital tools in any institution and should be properly maintained for specific use and time. 11. The patients medical record can work as a double edged sword. When can the medical record become the doctors/nurses worst enemy?

A. B. C. D.

When the record is voluminous When a medical record is subpoenaed in court When it is missing When the medical record is inaccurate, incomplete, and inadequate 12. Disposal of medical records in government hospitals/institutions must be done in close coordination with what agency?

A. B. C. D.

Department of Interior and Local Government (DILG) Metro Manila Development Authority (MMDA) Records Management Archives Office (RMAO) Department of Health (DOH) 13. In the hospital, when you need the medical record of a discharged patient for research you will request permission through:

A. B. C. D.

Doctor in charge The hospital director The nursing service Medical records section 14. You readmitted a client who was in another department a month ago. Since you will need the previous chart, from whom do you request the old chart?

A. B. C. D.

Central supply section Previous doctors clinic Department where the patient was previously admitted Medical records section 15. Records Management and Archives Office of the DOH is responsible for implementing its policies on record disposal. You know that your institution is covered by this policy if:

A. B. C. D.

Your hospital is considered tertiary Your hospital is in Metro Manila It obtained permit to operate from DOH Your hospital is PhilHealth accredited Situation 4 In the OR, there are safety protocols that should be followed. The OR nurse should be well versed with all these to safeguard the safety and quality of patient delivery outcome. 16. Which of the following should be given highest priority when receiving patient in the OR?

A. B. C. D.

Assess level of consciousness Verify patient identification and informed consent Assess vital signs Check for jewelry, gown, manicure, and dentures 17. Surgeries like I and D (incision and drainage) and debridement are relatively short procedures but considered dirty cases. When are these procedures best scheduled?

A. B. C. D.

Last case In between cases According to availability of anaesthesiologist According to the surgeons preference 18. OR nurses should be aware that maintaining the clients safety is the overall goal of nursing care during the intraoperative phase. As the circulating nurse, you make certain that throughout the procedure

A. B. C.

the surgeon greets his client before induction of anesthesia the surgeon and anesthesiologist are in tandem strap made of strong non-abrasive materials are fastened securely around the joints of the knees and ankles and around the 2 hands around an arm board. D. Client is monitored throughout the surgery by the assistant anesthesiologist 19. Another nursing check that should not be missed before the induction of general anesthesia is: A. B. C. D. check for presence underwear check for presence dentures check patients ID check baseline vital signs 20. Some lifetime habits and hobbies affect postoperative respiratory function. If your client smokes 3 packs of cigarettes a day for the past 10 years, you will anticipate increased risk for: A. B. C. D. perioperative anxiety and stress delayed coagulation time delayed wound healing postoperative respiratory function Situation 5 Nurses hold a variety of roles when providing care to a perioperative patient. 21. Which of the following role would be the responsibility of the scrub nurse? A. B. C. Assess the readiness of the client prior to surgery Ensure that the airway is adequate Account for the number of sponges, needles, supplies, used during the surgical procedure. D. Evaluate the type of anesthesia appropriate for the surgical client 22. As a perioperative nurse, how can you best meet the safety need of the client after administering preoperative narcotic?

A. B. C. D.

Put side rails up and ask the client not to get out of bed Send the client to OR with the family Allow client to get up to go to the comfort room Obtain consent form 23. It is the responsibility of the pre-op nurse to do skin prep for patients undergoing surgery. If hair at the operative site is not shaved, what should be done to make suturing easy and lessen chance of incision infection?

A. B. C. D.

Draped Pulled Clipped Shampooed 24. It is also the nurses function to determine when infection is developing in the surgical incision. The perioperative nurse should observe for what signs of impending infection?

A. B. C. D.

Localized heat and redness Serosanguinous exudates and skin blanching Separation of the incision Blood clots and scar tissue are visible 25. Which of the following nursing interventions is done when examining the incision wound and changing the dressing?

A. B. C. D.

Observe the dressing and type and odor of drainage if any Get patients consent Wash hands Request the client to expose the incision wound Situation 6 Carlo, 16 years old, comes to the ER with acute asthmatic attack. RR is 46/min and he appears to be in acute respiratory distress. 26. Which of the following nursing actions should be initiated first?

A. B. C. D.

Promote emotional support Administer oxygen at 6L/min Suction the client every 30 min Administer bronchodilator by nebulizer 27. Aminophylline was ordered for acute asthmatic attack. The mother asked the nurse, what is its indication, the nurse will say:

A. B. C. D.

Relax smooth muscles of the bronchial airway Promote expectoration Prevent thickening of secretions Suppress cough 28. You will give health instructions to Carlo, a case of bronchial asthma. The health instruction will include the following, EXCEPT:

A. B.

Avoid emotional stress and extreme temperature Avoid pollution like smoking

C. D.

Avoid pollens, dust, seafood Practice respiratory isolation 29. The asthmatic client asked you what breathing techniques he can best practice when asthmatic attack starts. What will be the best position?

A. B. C. D.

Sit in high-Fowlers position with extended legs Sit-up with shoulders back Push on abdomen during exhalation Lean forward 30-40 degrees with each exhalation 30. As a nurse, you are always alerted to monitor status asthmaticus who will likely and initially manifest symptoms of:

A. B. C. D.

metabolic alkalosis respiratory acidosis respiratory alkalosis metabolic acidosis Situation 7 Joint Commission on Accreditation of Hospital Organization (JCAHO) patient safety goals and requirements include the care and efficient use of technology in the OR and elsewhere in the healthcare facility. 31. As the head nurse in the OR, how can you improve the effectiveness of clinical alarm systems?

A. B. C. D.

Limit suppliers to a few so that quality is maintained Implement a regular inventory of supplies and equipment Adherence to manufacturers recommendation Implement a regular maintenance and testing of alarm systems 32. Overdosage of medication or anesthetic can happen even with the aid of technology like infusion pumps, sphygmomanometer and similar devices/machines. As a staff, how can you improve the safety of using infusion pumps?

A. B. C. D.

Check the functionality of the pump before use Select your brand of infusion pump like you do with your cellphone Allow the technician to set the infusion pump before use Verify the flow rate against your computation 33. JCAHOs universal protocol for surgical and invasive procedures to prevent wrong site, wrong person, and wrong procedure/surgery includes the following, EXCEPT:

A. B. C. D.

Mark the operative site if possible Conduct pre-procedure verification process Take a video of the entire intra-operative procedure Conduct time out immediately before starting the procedure 34. You identified a potential risk of pre-and postoperative clients. To reduce the risk of patient harm resulting from fall, you can implement the following, EXCEPT:

A. B.

Assess potential risk of fall associated with the patients medication regimen Take action to address any identified risks through Incident Report (IR)

C. D.

Allow client to walk with relative to the OR Assess and periodically reassess individual clients risk for falling 35. As a nurse, you know you can improve on accuracy of patients identification by 2 patient identifiers, EXCEPT:

A. B. C. D.

identify the client by his/her wrist tag and verify with family members identify client by his/her wrist tag and call his/her by name call the client by his/her case and bed number call the patient by his/her name and bed number Situation 8 Team efforts is best demonstrated in the OR. 36. If you are the nurse in charge for scheduling surgical cases, what important information do you need to ask the surgeon?

A. B.

Who is your internist Who is your assistant and anesthesiologist, and what is your preferred time and type of surgery? C. Who are your anesthesiologist, internist, and assistant D. Who is your anesthesiologist 37. In the OR, the nursing tandem for every surgery is: A. B. C. D. Instrument technician and circulating nurse Nurse anesthetist, nurse assistant, and instrument technician Scrub nurse and nurse anesthetist Scrub and circulating nurses 38. While team effort is needed in the OR for efficient and quality patient care delivery, we should limit the number of people in the room for infection control. Who comprise this team? A. B. C. D. Surgeon, anesthesiologist, scrub nurse, radiologist, orderly Surgeon, assistants, scrub nurse, circulating nurse, anesthesiologist Surgeon, assistant surgeon, anesthesiologist, scrub nurse, pathologist Surgeon, assistant surgeon, anesthesiologist, intern, scrub nurse 39. When surgery is on-going, who coordinates the activities outside, including the family? A. B. C. D. Orderly/clerk Nurse Supervisor Circulating Nurse Anesthesiologist 40. The breakdown in teamwork is often times a failure in: A. B. C. D. Electricity Inadequate supply Leg work Communication

Situation 9 Colostomy is a surgically created anus. It can be temporary or permanent, depending on the disease condition. 41. Skin care around the stoma is critical. Which of the following is not indicated as a skin care barriers? A. B. C. D. Apply liberal amount of mineral oil to the area Use karaya paste and rings around the stoma Clean the area daily with soap and water before applying bag Apply talcum powder twice a day 42. What health instruction will enhance regulation of a colostomy (defecation) of clients? A. B. C. D. Irrigate after lunch everyday Eat fruits and vegetables in all three meals Eat balanced meals at regular intervals Restrict exercise to walking only 43. After ileostomy, which of the following condition is NOT expected? A. B. C. D. Increased weight Irritation of skin around the stoma Liquid stool Establishment of regular bowel movement 44. The following are appropriate nursing interventions during colostomy irrigation, EXCEPT: A. B. C. D. Increase the irrigating solution flow rate when abdominal cramps is felt Insert 2-4 inches of an adequately lubricated catheter to the stoma Position client in semi-Fowler Hang the solution 18 inches above the stoma 45. What sensation is used as a gauge so that patients with ileostomy can determine how often their pouch should be drained? A. B. C. D. Sensation of taste Sensation of pressure Sensation of smell Urge to defecate Situation 10 As a beginner in research, you are aware that sampling is an essential elements of the research process. 46. What does a sample group represent? A. B. C. D. Control group Study subjects General population Universe 47. What is the most important characteristic of a sample?

A. B. C. D.

Randomization Appropriate location Appropriate number Representativeness 48. Random sampling ensures that each subject has:

A. B. C. D.

Been selected systematically An equal chance of selection Been selected based on set criteria Characteristics that match other samples 49. Which of the following methods allows the use of any group of research subject?

A. B. C. D.

Purposive Convenience Snow-ball Quota 50. You decided to include 5 barangays in your municipality and chose a sampling method that would get representative samples from each barangay. What should be the appropriate method ofor you to use in this care?

A. B. C. D.

Cluster sampling Random sampling Stratified sampling Systematic sampling


NP3 Nursing Board Exam June 2007 Answer Key 'Nursing Care of Client with Physiological and Psychosocial Alteration'

100 Nursing Board Exam test questions of June 2007 Nurse Licensure Examination (NLE) Nursing Practice III Nursing Care of Client with Physiological and Psychosocial Alteration Medical and Surgical Nursing / Psychology PART 1 Board Exam test questions 51 - 100 Situation 11 After an abdominal surgery, the circulating and scrub nurses have critical responsibility about sponge and instrument count. 51. When is the first sponge/instrument count reported? A. Before closing the subcutaneous layer B. Before peritoneum is closed C. Before closing the skin D. Before the fascia is sutured 52. What major supportive layer of the abdominal wall must be sutured with long tensile strength such as cotton or nylon or silk suture? A. Fascia B. Muscle C. Peritoneum D. Skin

53. Like sutures, needles also vary in shape and uses. If you are the scrub nurse for a patient who is prone to keloid formation and has low threshold of pain, what needle would you prepare? A. Round needle B. Atraumatic needle C. Reverse cutting needle D. Tapered needle 54. Another alternative suture for skin closure is the use of ____________ A. Staple B. Therapeutic glue C. Absorbent dressing D. Invisible suture 55. Like any nursing interventions, counts should be documented. To whom does the scrub nurse report any discrepancy of counts so that immediate and appropriate action is instituted? A. Anesthesiologist B. Surgeon C. OR nurse supervisor D. Circulating nurse

Situation 12 As a nurse, you should be aware and prepared of the different roles you play. 56. What role do you play when you hold all clients information entrusted to you in the strictest confidence? A. Patients advocate B. Educator C. Patients Liaison D. Patients arbiter 57. As a nurse, you can help improve the effectiveness of communication among healthcare givers by: A. Use of reminders of what to do B. Using standardized list of abbreviations, acronyms, and symbols C. One-on-one oral endorsement D. Text messaging and e-mail 58. As a nurse, your primary focus in the workplace is the clients safety. However, personal safety is also a concern. You can communicate hazards to your co-workers through the use of the following EXCEPT: A. Formal training B. Posters C. Posting IR in the bulletin board D. Use of labels and signs 59. As a nurse, what is one of the best way to reconcile medications across the continuum of care? A. Endorse on a case-to-case basis B. Communicate a complete list of the patients medication to the next provider of service C. Endorse in writing

D. Endorse the routine and stat medications every shift 60. As a nurse, you protect yourself and co-workers from misinformation and misrepresentations through the following EXCEPT: A. Provide information to clients about a variety of services that can help alleviate the clients pain and other conditions B. Advising the client, by virtue of your expertise, that which can contribute to the clients well-being C. Health education among clients and significant others regarding the use of chemical disinfectant D. Endorsement thru trimedia to advertise your favorite disinfectant solution Situation 13 You are assigned at the surgical ward and clients have been complaining of post pain at varying degrees. Pain as you know, is very subjective. 61. A one-day postoperative abdominal surgery client has been complaining of severe throbbing abdominal pain described as 9 in a 1-10 pain rating. Your assessment revelas bowel sounds on all quadrants and the dressing is dry and intact. What nursing intervention would you take A. Medicate client as prescribed B. Encourage client to do imagery C. Encourage deep breathing and turning D. Call surgeon stat 62. Pentoxidone 5 mg IV every 8 hours was prescribed for post abdominal pain. Which will be your priority nursing action? A. Check abdominal dressing for possible swelling B. Explain the proper use of PCA to alleviate anxiety C. Avoid overdosing to prevent dependence/tolerance D. Monitor VS, more importantly RR 63. The client complained of abdominal distention and pain. Your nursing intervention that can alleviate pain is: A. Instruct client to go to sleep and relax B. Advice the client to close the lips and avoid deep breathing and talking C. Offer hot and clear soup D. Turn to sides frequently and avoid too much talking 64. Surgical pain might be minimized by which nursing action in the O.R. A. Skill of surgical team and lesser manipulation B. Appropriate preparation for the scheduled procedure C. Use of modern technology in closing the wound D. Proper positioning and draping of clients 65. One very common cause of postoperative pain is: A. Forceful traction during surgery B. Prolonged surgery C. Break in aseptic technique D. Inadequate anesthetic

Situation 14 You were on duty at the medical ward when Zeny came in for admission for tiredness, cold intolerance, constipation, and weight gain. Upon examination, the doctors diagnosis was hypothyroidism. 66. Your independent nursing care for hypothyroidism includes: A. administer sedative round the clock B. administer thyroid hormone replacement C. providing a cool, quiet, and comfortable environment D. encourage to drink 6-8 glasses of water 67. As the nurse, you should anticipate to administer which of the following medications to Zeny who is diagnosed to be suffering from hypothyroidism? A. Levothyroxine B. Lidocaine C. Lipitor D. Levophed 68. Your appropriate nursing diagnosis for Zeny who is suffering from hypothyroidism would probably include which of the following? A. Activity intolerance related to tiredness associated with disorder B. Risk to injury related to incomplete eyelid closure C. Imbalance nutrition to hypermetabolism D. Deficient fluid volume related to diarrhea 69. Myxedema coma is a life threatening complication of long standing and untreated hypothyroidism with one of the following characteristics. A. Hyperglycemia B. Hypothermia C. Hyperthermia D. Hypoglycemia 70. As a nurse, you know that the most common type of goiter is related to a deficiency of: A. thyroxine B. thyrotropin C. iron D. iodine Situation 15 Mrs. Pichay is admitted to your ward. The MD ordered Prepare for thoracentesis this pm to remove excess air from the pleural cavity. 71. Which of the following nursing responsibilities is essential in Mrs. Pichay who will undergo thoracentesis? A. Support and reassure client during the procedure B. Ensure that informed consent has been signed C. Determine if client has allergic reaction to local anesthesia D. Ascertain if chest x-rays and other tests have been prescribed and completed 72. Mrs. Pichay who is for thoracentesis is assigned by the nurse to which of the following positions? A. Trendelenburg position B. Supine position

C. Dorsal Recumbent position D. Orthopneic position 73. During thoracentesis, which of the following nursing intervention will be most crucial? A. Place patient in a quiet and cool room B. Maintain strict aseptic technique C. Advice patient to sit perfectly still during needle insertion until it has been withdrawn from the chest D. Apply pressure over the puncture site as soon as the needle is withdrawn 74. To prevent leakage of fluid in the thoracic cavity, how will you position the client after thoracentesis? A. Place flat in bed B. Turn on the unaffected side C. Turn on the affected side D. On bed rest 75. Chest x-ray was ordered after thoracentesis. When your client asks what is the reason for another chest x-ray, you will explain: A. to rule out pneumothorax B. to rule out any possible perforation C. to decongest D. to rule out any foreign body Situation 16 In the hospital, you are aware that we are helped by the use of a variety of equipment / devices to enhance quality patient care delivery. 76. You are to initiate an IV line to your patient, Kyle, 5, who is febrile. What IV administration set will you prepare? A. Blood transfusion set B. Macroset C. Volumetric chamber D. Microset 77. Kyle is diagnosed to have measles. What will your protective personal attire include? A. Gown B. Eyewear C. Face mask D. Gloves 78. What will you do to ensure that Kyle, who is febrile, will have a liberal oral fluid intake? A. Provide a glass of fruit juice every meal B. Regulate his IV to 30 drops per minute C. Provide a calibrated pitcher of drinking water and juice at the bedside and monitor intake and output D. Provide a writing pad to record his intake 79. Before bedtime, you went to ensure Kyles safety in bed. You will do which of the following: A. Put the lights on B. Put the side rails up C. Test the call system

D. Lock the doors 80. Kyles room is fully mechanized. What do you teach the watcher and Kyle to alert the nurses for help? A. How to lock side rails B. Number of the telephone operator C. Call system D. Remote control Situation 17 Tony, 11 years old, has kissing tonsils and is scheduled for tonsillectomy and adenoidectomy or T and A. 81. You are the nurse of Tony who will undergo T and A in the morning. His mother asked you if Tony will be put to sleep. Your teaching will focus on: A. spinal anesthesia B. anesthesiologists preference C. local anesthesia D. general anesthesia 82. Mothers of children undergoing tonsillectomy and adenoidectomy usually ask what food to prepare and give their children after surgery. You as the nurse will say: A. balanced diet when fully awake B. hot soup when awake C. ice cream when fully awake D. soft diet when fully awake 83. The RR nurse should monitor for the most common postoperative complication of: A. hemorrhage B. endotracheal tube perforation C. osopharyngeal edema D. epiglottis 84. The PACU nurse will maintain postoperative T and A client in what position? A. Supine with neck hyperextended and supported with pillow B. Prone with the head on pillow and turned to the side C. Semi-fowlers with neck flexed D. Reverse trendelenburg with extended neck 85. Tony is to be discharged in the afternoon of the same day after tonsillectomy and adenoidectomy. You as the RN will make sure that the family knows to: A. offer osterized feeding B. offer soft foods for a week to minimize discomfort while swallowing C. supplement his diet with Vitamin C rich juices to enhance healing D. offer clear liquid for 3 days to prevent irritation Situation 18 Rudy was diagnosed to have chronic renal failure. Hemodialysis is ordered so that an A-V shunt was surgically created. 86. Which of the following action would be of highest priority with regards to the external shunt? A. Avoid taking BP or blood sample from the arm with the shunt B. Instruct the client not to exercise the arm with the shunt

C. Heparinize the shunt daily D. Change dressing of the shunt daily 87. Diet therapy for Rudy, who has acute renal failure is low-protein, low potassium and low sodium. The nutrition instructions should include: A. Recommend protein of high biologic value like eggs, poultry and lean meats B. Encourage client to include raw cucumbers, carrot, cabbage, and tomatoes C. Allowing the client cheese, canned foods and other processed food D. Bananas, cantaloupe, orange and other fresh fruits can be included in the diet 88. Rudy undergoes hemodialysis for the first time and was scared of disequilibrium syndrome. He asked you how this can be prevented. Your response is: A. maintain a conducive comfortable and cool environment B. maintain fluid and electrolyte balance C. initial hemodialysis shall be done 30 minutes only so as not to rapidly remove the waste from the blood than from the brain D. maintain aseptic technique throughout the hemodialysis 89. You are assisted by a nursing aide with the care of the client with renal failure. Which delegated function to the aide would you particularly check? A. Monitoring and recording I and O B. Checking bowel movement C. Obtaining vital signs D. Monitoring diet 90. A renal failure patient was ordered for creatinine clearance. As the nurse you will collect A. 48 hour urine specimen B. first morning urine C. 24 hour urine specimen D. random urine specimen Situation 19 Fe is experiencing left sharp pain and occasional hematuria. She was advised to undergo IVP by her physician. 91. Fe was so anxious about the procedure and particularly expressed her low pain threshold. Nursing health instruction will include: A. assure the client that the pain is associated with the warm sensation during the administration of the Hypaque by IV B. assure the client that the procedure painless C. assure the client that contrast medium will be given orally D. assure the client that x-ray procedure like IVP is only done by experts 92. What will the nurse monitor and instruct the client and significant others post IVP? A. Report signs and symptoms for delayed allergic reaction B. Observe NPO for 6 hours C. Increased fluid intake D. Monitor intake and output 93. Post IVP, Fe should excrete the contrast medium. You instructed the family to include more vegetables in the diet and:

A. increase fluid intake B. barium enema C. cleansing enema D. gastric lavage 94. The IVP reveals that Fe has small renal calculus that can be passed out spontaneously. To increase the chance of passing the stones, you instructed her to force fluids and do which of the following? A. Balanced diet B. Ambulate more C. Strain all urine D. Bed rest 95. The presence of calculi in the urinary tract is called A. Colelithiasis B. Nephrolithiasis C. Ureterolithiasis D. Urolithiasis Situation 20 At the medical-surgical ward, the nurse must also be concerned about drug interactions. 96. You have a client with TPN. You know that in TPN like blood transfusion, these should be no drug incorporation. However the MDs order read; incorporate insulin to present TPN. Will you follow the order? A. No, because insulin will induce hyperglycemia in patients with TPN B. Yes, because insulin is chemically stable with TPN and can enhance blood glucose level C. No, because insulin is not compatible with TPN D. Yes, because it was ordered by the MD 97. The RN should also know that some drugs have increased adsorption when infused in the PVC container. How will you administer drugs such as insulin, nitroglycerine hydralazine to promote better therapeutic drug effects? A. Administer by fast drip B. Inject the drugs as close to the IV injection site C. Incorporate to the IV solutions D. Use volumetric chamber 98. One patient had a runaway IV of 50% dextrose. To prevent temporary excess of insulin or transient hyperinsulin reaction what solution you prepare in anticipation of the doctors order? A. Any IV solution available to KVO B. Isotonic solution C. Hypertonic solution D. Hypotonic solution 99. How can nurses prevent drug interaction including adsorption? A. Always flush with NSS after IV administration B. Administering drugs with more diluents C. Improving on preparation techniques D. Referring to manufacturers guidelines

100. In insulin administration, it should be understood that our body normally releases insulin according to our blood glucose level. When is insulin and glucose level highest? A. After excitement B. After a good nights rest C. After an exercise D. After ingestion of food

NURSING PRACTICE IV SET B NURSING PRACTICE IV Care of Clients with Physiologic and Psychosocial Alterations (Part B) MULTIPLE CHOICE Situation 1 Because of the serious consequences of severe burns, management requires a multidisciplinary approach. You have important responsibilities as a nurse. 1. While Sergio was lighting a barbecue grill with a lighter fluid, his shirt burns into flames. The most effective way to extinguish the flames with as little further damage as possible is to: A. log roll on the grass/ground B. slap the flames with his hands C. remove the burning clothes D. pour cold liquid over the flames 2. Once the flames are extinguished, it is most important to: A. cover Sergio with a warm blanket B. give him sips of water C. calculate the extent of his burns D. assess the Sergios breathing 3. Sergio is brought to Emergency Room after the barbecue grill accident. Based on the assessment of the physician, Sergio sustained superficial partial thickness burns on his trunk, right upper extremities and right lower extremities. His wife asks what that means? Your most accurate response would be: A. Structures beneath the skin are damage B. Dermis is partially damaged C. Epidermis and dermis are both damaged D. Epidermis is damaged 4. During the first 24 hours after the thermal injury, you should asses Sergio for: A. hypokalemia and hypernatremia B. hypokalemia and hyponatremia C. hyperkalemia and hyponatremia D. hyperkalemia and hypernatremia 5. Teddy, who sustained deep partial thickness and full thickness burns of the face, whole anterior chest and both upper extremities two days ago begins to exhibit extreme restlessness. You recognize that this most likely indicates that Teddy is developing: A. Cerebral hypoxia B. Hypervolemia

C. metabolic acidosis D. Renal failure Situation 2 You are now working as a staff nurse in a general hospital. You have to be prepared to handle situations with ethico-legal and moral implifications. 6. You are in night duty in surgical ward. One of your patients Martin is a prisoner who sustained an abdominal gunshot wound. He is being guarded by policeman from the local police unit. During your rounds you heard a commotion. You saw the policeman trying to hit Martin. You asked why he was trying to hit Martin. He denied the matter. Which among the following activities will you do first? A. Write an accident report B. Call security officer and report the incident C. Call your nurse supervisor and report the incident D. Call the physician on duty 7. You are on morning duty in the medical ward. You have 10 patients assigned to you. During your endorsement rounds, you found out that one of your patients was not in bed. The patient next to him informed you that he went home without notifying the nurses. Which among the following will you do first? A. Make an incident report B. Call security to report the incident C. Wait for 2 hours before reporting D. Report the incident to your supervisor 8. You are on duty in the medical ward. You were asked to check the narcotics cabinet. You found out that what is on record does not tally with the drugs used. Which among the following will you do first? A. Write an incident report and refer the matter to the nursing director B. Keep your findings to yourself C. Report the matter to your supervisor D. Find out from the endorsement any patient who might have been given narcotics 9. You are on duty in the medical ward. The mother of your patient who is also a nurse, came running to the nurses station and informed you that Fiolo went into cardiopulmonary arrest. A. Start basic life support measures B. Call for the Code C. Bring the crush cart to the room D. Go to see Fiolo and assess for airway patency and breathing problems 10. You are admitting Jorge to the ward and you found out that he is positive for HIV. Which among the following will you do first? A. Take note of it and plan to endorse this to next shift B. Keep this matter to yourself C. Write an incident report D. Report the matter to your head nurse Situation 3 - Colorectal cancer can affect old and younger people. Surgical procedures and other modes of treatment are done to ensure quality of life. You are assigned in the cancer institute to care of patients with this type of cancer.

11. Larry, 55 years old, who is suspected of having colorectal cancer, is admitted to the CI. After taking the history and vital signs the physician does which test as a screening test for colorectal cancer. A. Barium enema B. Carcinoembryonic antigen C. Annual digital rectal examination D. Proctosigmoidoscopy 12. To confirm his impression of colorectal cancer, Larry will require which diagnostic study? A. Carcinoembryonic antigen B. Proctosigmoidoscopy C. Stool hematologic test D. Abdominal computed tomography (CT) test 13. The following are risk factors for colorectal cancer, EXCEPT: A. Inflammatory bowels B. High fat, high fiber diet C. Smoking D. Genetic factors-familial adenomatous polyposis 14. Symptoms associated with cancer of the colon include: A. constipation, ascites and mucus in the stool B. diarrhea, heart burn and eructation C. blood in the stools, anemia, and pencil shaped stools D. anorexia, hematemesis, and increased peristalasis 15. Several days prior to bowel surgery, Larry may be given sulfasuxidine and neomycin primarily to: A. promote rest of the bowel by minimizing peristalsis B. reduce the bacterial content of the colon C. empty the bowel of solid waste D. soften the stool by retaining water in the colon Situation 4 ENTEROSTOMAL THERAPY is now considered a specialty in nursing. You are participating in the OSTOMY CARE CLASS. 16. You plan to teach Fermin how to irrigate the colostomy when: A. The perineal wound heals And Fermin can sit comfortably on the commode B. Fermin can lie on the side comfortably, about the 3rd postoperative day C. The abdominal incision is closed and contamination is no longer a danger D. The stools starts to become formed, around the 7th postoperative day 17. When preparing to teach Fermin how to irrigate colostomy, you should plan to do the procedure: A. When Fermin would have normal bowel movement B. At least 2 hours before visiting hours C. Prior to breakfast and morning care D. After Fermin accepts alteration in body image 18. When observing a return demonstration of a colostomy irrigation, you know that more teaching is required if Fermin: A. Lubricates the tip of the catheter prior to inserting into the stoma

B. Hangs the irrigating bag on the bathroom door cloth hook during fluid insertion C. Discontinues the insertion of fluid after only 500 ml of fluid has been instilled D. Clamps of the flow of fluid when felling uncomfortable 19. You are aware that teaching about colostomy care is understood when Fermin states, I will contact my physician and report: A. If I have any difficulty inserting the irrigating tub into the stoma. B. If I noticed a loss of sensation to touch in the stoma tissue. C. The expulsion of flatus while the irrigating fluid is running out. D. When mucus is passed from the stoma between the irrigations. 20. You would know after teaching Fermin that dietary instruction for him is effective when he states, It is important that I eat: A. Soft food that are easily digested and absorbed by my large intestines. B. Bland food so that my intestines do not become irritated. C. Food low in fiber so that there is less stool. D. Everything that I ate before the operation, while avoiding foods that cause gas. Situation 5 Ensuring safety is one of your most important responsibilities. You will need to provide instructions and information to your clients to prevent complications. 21. Randy has chest tubes attached to a pleural drainage system. When caring for him you should: A. empty the drainage system at the end of the shift B. clamp the chest tube when suctioning C. palpate the surrounding areas for crepitus D. change the dressing daily using aseptic techniques 22. Fanny, came in from PACU after pelvic surgery. As Fannys nurse you know that the sign that would be indicative of a developing thrombophlebitis would be: A. a tender, painful area on the leg B. a pitting edema of the ankle C. a reddened area at the ankle D. pruritus on the calf and ankle 23. To prevent recurrent attacks on Terry who has acute glumerulonephritis, you should instruct her to: A. seek early treatment for respiratory infections B. take showers instead of tub bath C. continue to take the same restrictions on fluid intake D. avoid situations that involve physical activity 24. Herbert had a laryngectomy and he is now for discharge. He verbalized his concern regarding his laryngectomy tube being dislodged. What should you teach him first? A. Recognize that prompt closure of the tracheal opening may occur B. Keep calm because there is no immediate emergency C. Reinsert another tubing immediately D. Notify the physician at once

25. When caring for Larry after an exploratory chest surgery and pneumonectomy, yourpriority would be to maintain: A. supplementary oxygen B. ventilation exchange C. chest tube drainage D. blood replacement Situation 6 Infection can cause debilitating consequences when host resistance is compromised and virulence of microorganisms and environmental factors are favorable. Infection control is one important responsibility of the nurse to ensure quality of care. 26. Honrad, who has been complaining of anorexia and feeling tired, develops jaundice, after a workup he is diagnosed of having Hepatitis A. his wife asks you about gamma globulin for herself and her household help. Your most appropriate response would be: A. Dont worry your husbands type of hepatitis is no longer communicable B. Gamma globulin provides passive immunity for hepatitis B C. You should contact your physician immediately about getting gammaglobulin. D. A vaccine has been developed for this type of hepatitis 27. Voltaire develops a nosocomial respiratory tract infection. He ask you what that means? Your best response would be: A. You acquired the infection after you have been admitted to the hospital. B. This is a highly contagious infection requiring complete isolation. C. The infection you had prior to hospitalization flared up. D. As a result of medical treatment, you have acquired a secondary infection. 28. 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. stomatitis B. hepatitis C. dysrhythmia D. infection 29. A solution used to treat Pseudomonas wound infection is: A. Dakins solution B. Half-strength hydrogen peroxide C. Acetic acid D. Betadine 30. Which of the following is the most reliable in diagnosing a wound infection? A. Culture and sensitivity B. Purulent drainage from a wound C. WBC count of 20,000/L D. Gram stain testing Situation 7 As a nurse you need to anticipate the occurrence of complications of stroke so that life threatening situations can be prevented.

31. Wendy is admitted to the hospital with signs and symptoms of stroke. Her Glasgow Coma Scale is 6 on admission. A central venous catheter was inserted an I.V. infusion was started. As a nurse assigned to Wendy what will be your priority goal? A. Prevent skin breakdown B. Preserve muscle function C. Promote urinary elimination D. Maintain a patent airway 32. Knowing that for a comatose patient hearing is the last sense to be lost, as Judys nurse, what should you do? A. Tell her family that probably she cant hear them B. Talk loudly so that Wendy can hear you C. Tell her family who are in the room not to talk D. Speak softly then hold her hands gently 33. Which among the following interventions should you consider as the highest priority when caring for June who has hemiparesis secondary to stroke? A. Place June on an upright lateral position B. Perform range of motion exercises C. Apply antiembolic stockings D. Use hand rolls or pillows for support 34. Ivy, age 40, was admitted to the hospital with a severe headache, stiff neck and photophobia. She was diagnosed with a subarachnoid hemorrhage secondary to ruptured aneurysm. While waiting for surgery, you can provide a therapeutic environment by doing which of the following? A. honoring her request for a television B. placing her bed near the window C. dimming the light in her room D. allowing the family unrestricted visiting privileges 35. When performing a neurologic assessment on Walter, you find that his pupils are fixed and dilated. This indicated that he: A. probably has meningitis B. is going to be blind because of trauma C. is permanently paralyzed D. has received a significant brain injury Situation 8 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 patients. 36. Hypoxia may occur in the older patients because of which of the following physiologic changes associated with aging. A. Ineffective airway clearance B. Decreased alveolar surfaced area C. Decreased anterior-posterior chest diameter D. Hyperventilation 37. The older patient is at higher risk for incontinence because of: A. dilated urethra

B. increased glomerular filtration rate C. diuretic use D. decreased bladder capacity 38. Merle, age 86, is complaining of dizziness when she stands up. This may indicate: A. dementia B. a visual problem C. functional decline D. drug toxicity 39. Cardiac ischemia in an older patient usually produces: A. ST-T wave changes B. Very high creatinine kinase level C. Chest pain radiating to the left arm D. Acute confusion 40. The most dependable sign of infection in the older patient is: A. change in mental status B. fever C. pain D. decreased breath sounds with crackles Situation 9 A disaster is a large-scale emergencyeven a small emergency left unmanaged may turn into a disaster. Disaster preparedness is crucial and is everybodys business. There are agencies that are in charge of ensuring prompt response. Comprehensive Emergency Management (CEM) is an integrated approach to the management of emergency programs and activities for all four emergency phases (mitigation, preparedness, response, and recovery), for all types of emergencies and disasters (natural, man-made, and attack) and for all levels of government and the private sector. 41. Which of the four phases of emergency management is defined as sustained action that reduces or eliminates long-term risk to people and property from natural hazards and their effects.? A. Recovery B. Mitigation C. Response D. Preparedness 42. You are a community health nurse collaborating with the Red Cross and working with disaster relief following a typhoon which flooded and devastated the whole province. Finding safe housing for survivors, organizing support for the family, organizing counseling debriefing sessions and securing physical care are the services you are involved with. To which type of prevention are these activities included: A. Tertiary prevention B. Primary prevention C. Aggregate care prevention D. Secondary prevention 43. During the disaster you see a victim with a green tag, you know that the

person: A. has injuries that are significant and require medical care but can wait hours with threat to life or limb B. has injuries that are life threatening but survival is good with minimal intervention C. indicates injuries that are extensive and chances of survival are unlikely even with definitive care D. has injuries that are minor and treatment can be delayed from hours to days 44. The term given to a category of triage that refers to life threatening or potentially life threatening injury or illness requiring immediate treatment: A. Immediate B. Emergent C. Non-acute D. Urgent 45. Which of the following terms refer to a process by which the individual receives education about recognition of stress reaction and management strategies for handling stress which may be instituted after a disaster? A. Clinical incident stress management B. Follow-up C. Debfriefing D. Defusion Situation 10 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. 46. While eating his meal, Matthew accidentally dislodges his IV lines and bleeds. Blood oozes on the surface of the over-bed table. It is most appropriate that you instruct the housekeeper to clean the table with: A. Acetone B. Alcohol C. Ammonia D. Bleach 47. You are a member of the infection control team of the hospital. 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). What is your priority activity? A. Establish policies for surveillance and monitoring B. Do data gathering about the possible sources of infection (observation, chart review, interview). C. Assign point persons who can implement policies. D. Meet with the nursing group working in the burn unit and discuss problem with them. 48. 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. Prior to discharge today, 4 patients are referred to you. How would you start prioritizing your activities? A. Bring your diabetes teaching kit and start your session taking into consideration their distance from your office. B. Contact the nurse in-charge and find out from her the reason for the referral C. Determine their learning needs then prioritize

D. Involve the whole family in the teaching class 49. You have been designated as a member of the task force to plan activities for the Cancer Consciousness Week. Your committee has 4 months to plan and implement the plan. You are assigned to contact the various cancer support groups in your hospital. What will be your priority activity? A. Find out if there is a budget for this activity B. Clarify objectives of the activity with the task force before contacting the support groups C. Determine the VIPs and Celebrities who will be invited D. Find out how many support groups there are in the hospital and get the contact number of their president 50. You are invited to participate in the medical mission activity of your alumni association. In the planning stage everybody is expected to identify what they can do during the medical mission and what resources are needed. You thought it is also your chance to share what you can do for others. What will be your most important role where you can demonstrate the impact of nursing in health? A. Conduct health education on healthy life style B. Be a triage nurse C. Take the initial history and document findings D. Act as a coordinator Situation 11 One of the realities that we are confronted with is our mortality. It is important for us nurses to be aware of how we view suffering, pain, illness, and even our death as well as its meaning. That way we can help our patients cope with death and dying. 51. Irma is terminally ill, she speaks to you in confidence. You now feel that Irmas family could be helpful if they knew what Irma has told to you. What should you do first? A. Tell the physician who in turn could tell the family B. Obtain Irmas permission to share the information in the family C. Tell Irma that she has to tell her family what she told you D. Make an appointment to discuss the situation with the family 52. Ruby who has been told she has terminal cancer, turns away and refuses to respond to you. You can best help her by: A. Coming back periodically and indicating your availability if she would like you to sit with her B. Insisting that Ruby should talk with you because it is not good to keep everything inside C. Leaving her alone because she is uncooperative and unpleasant to be with D. Encouraging her to be physically active as possible 53. Leo, who is terminally ill and recognizes that he is in the process of losing everything and everybody he loves, is depressed. Which of the following would best help him during his depression? A. Arrange for visitors who might cheer him B. Sit down and talk with him for a while C. Encourage him to look at the brighter side of things D. Sit silently with him 54. Which of the following statements would best indicate that Ruffy, who is dying, has accepted his impending death? A. Im ready to go. B. I have resigned myself to dying.

C. Whats the use? D. Im giving up 55. Marla, 90 years old has planned ahead for her death-philosophically, socially, financially and emotionally. This is recognized as: A. Acceptance that death is inevitable B. Avoidance of the true situation C. Denial with planning for continued life D. Awareness that death will soon occur Situation 12 Brain tumor, whether malignant or benign, has serious management implications. As a nurse, you should be able to understand the consequences of the disease and the treatment. 56. You are caring for Conrad who has a brained tumor and increased Intracranial Pressure (ICP). Which intervention should you include in your plan to reduce ICP? A. Administer bowel softener B. Position Conrad with his head turned toward the side of the tumor C. Provide sensory stimulation D. Encourage coughing and deep breathing 57. Keeping Conrads head and neck alignment results in: A. increased inthrathoracic pressure B. increased venous outflow C. decreased venous outflow D. increased intrabdominal pressure 58. Which of the following activities may increase intracranial pressure (ICP)? A. Raising the head of the bed B. Manual hyperventilation C. Use of osmotic diuretics D. Valsalvas maneuver 59. After you asses Conrad, you suspected increased ICP. Your most appropriate respiratory goal is to: A. maintain partial pressure of arterial O2 (PaO2) above 80 mmHg B. lower arterial pH C. prevent respiratory alkalosis D. promote CO2 elimination 60. Conrad underwent craniotomy. As his nurse, you know that drainage on a craniotomy dressing must be measured and marked. Which findings should you report immediately to the surgeon? A. Foul-smelling drainage B. Yellowish drainage C. Greenish drainage D. Bloody drainage Situation 13 As a Nurse, you have specific responsibilities as professional. You have to demonstrate specific competencies. 61. The essential components of professional nursing practice are all the following EXCEPT: A. Culture B. Care C. Cure

D. Coordination 62. You are assigned to care for four (4) patients. Which of the following patients should you give first priority? A. Grace, who is terminally ill with breast cancer. B. Emy, who was previously lucid but is now unarousable. C. Aris, who is newly admitted and is scheduled for an executive check-up. D. Claire, who has cholelithiasis and is for operation on call. 63. Brenda, the Nursing Supervisor of the intensive care unit (ICU) is not on duty when a staff nurse committed a serious medication error. Which statement accurately reflects the accountability of the nursing supervisor? A. Brenda should be informed when she goes back on duty B. Although Brenda is not on duty, the nursing supervisor on duty decides to call her if time permits C. The nursing supervisor on duty will notify Brenda at home D. Brenda is not duty therefore it is not necessary to inform her. 64. Which barrier should you avoid, to manage time wisely? A. Practical planning B. Procrastination C. Setting limits D. Realistic personal expectation 65. You are caring for Vincent who has just been transferred to the private room. He is anxious because he fears he wont be monitored as closely as he was in the Coronary Care Unit. How can you allay his fear? A. Move his bed to a room far from nurses station to reduce B. Assign the same nurse to him when possible C. Allow Vincent uninterrupted period of time D. Limit Vincents visitors to coincide with CCU policies Situation 14 As a nurse in the Oncology Unit, you have to be prepared to provide safe, efficient and effective care to your patients. 66. Which one of the following nursing interventions would be most helpful in preparing the patient for radiation therapy? A. Offer tranquilizers and antiemetics B. Instruct the patient of the possibility of radiation burn C. Emphasis on the therapeutic value of the treatment D. Map out the precise course of treatment 67. What side effects are most apt to occur the patient during radiation therapy to the pelvis? A. Urinary retention B. Abnormal vaginal or perineal discharge C. Paresthesia of the lower extremities D. Nausea and vomiting and diarrhea 68. Which of the following can be used on the irradiated skin during a course of radiation therapy? A. Adhesive tape B. Mineral oil C. Talcum powder D. Zinc oxide ointment

69. Earliest sign of skin reaction to radiation therapy is: A. desquamation B. erythema C. atrophy D. pigmentation 70. What is the purpose of wearing a film badge while caring for the patient who is radioactive? A. Identify the nurse who is assigned to care for such a patient B. Prevent radiation-induced sterility C. Protect the nurse from radiation effects D. Measure the amount of exposure to radiation Situation 15 In a disaster there must be a chain of command in place that defined the roles of each member of the response team. Within the health care group there are preassigned roles based on education, experience and training on disaster. 71. As a nurse to which of the following groups are you best prepared to join? A. Treatment group B. Triage group C. Morgue management D. Transport group 72. 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 following principles should be observed in disaster triage, EXCEPT: A. any disaster plan should have resources available to triage at each facility and at the disaster site if possible B. make the most efficient use of available resources C. training on the disaster is not important to the response in the event of a real disaster because each disaster is unique in itself D. do the greatest good for the greatest number of casualties 73. Which of the following categories of conditions should be considered first priority in a disaster? A. Intracranial pressure and mental status B. Lower gastrointestinal problems C. Respiratory infections D. Trauma 74. A guideline that is utilized in determining priorities is to asses the status of the following, EXCEPT: A. perfusion B. locomotion C. respiration D. mentation 75. The most important component of neurologic assessment is: A. pupil reactivity B. vital sign assessment C. cranial nerve assessment D. level of consciousness/responsiveness Situation 16 You are going to participate in a Cancer Consciousness Week. You are assigned to take charge of the women to make them aware of cervical cancer. You reviewed its manifestations and

management, 76. The following are risk factors for cervical cancer EXCEPT: A. immunosuppressive therapy B. sex at an early age, multiple partners, exposure to socially transmitted disease, male partners sexual habits C. viral agents like the Human Papilloma Virus D. smoking 77. Late signs and symptoms of cervical cancer include the following EXCEPT: A. urinary/bowel changes B. pain in pelvis, leg or flank C. uterine bleeding D. lymph edema of lower extremities 78. When a panhysterectomy is performed due to cancer of the cervix, which of the following organs are removed? A. the uterus, cervix, and one ovary B. the uterus, cervix, and two-thirds of the vagina C. the uterus, cervix, tubes and ovaries D. the uterus and cervix 79. The primary modalities of treatment for Stage 1 and IIA cervical cancer include the following: A. surgery, radiation therapy and hormone therapy B. surgery C. radiation therapy D. surgery and radiation therapy 80. A common complication of hysterectomy is A. thrombophelbitis of the pelvic and thigh vessels B. diarrhea due to over stimulation C. atelectasis D. wound dehiscence Situation 17 The body has regulatory mechanism to maintain the needed electrolytes. However there are conditions/surgical interventions that could compromise life. You have to understand how management of these conditions are done. 81. You are caring for Leda who is scheduled to undergo total thyroidectomy because of a diagnosis of thyroid cancer. Prior to total thyroidectomy, you should instruct Leda to: A. Perform range and motion exercise on the head and neck B. Apply gentle pressure against the incision when swallowing C. Cough and deep breath every 2 hours D. Support head with the hands when changing position 82. As Ledas nurse, you plan to set up an emergency equipment at her beside following thyroidectomy. You should include: A. An airway and rebreathing tube B. A tracheostomy set and oxygen C. A crush cart with bed board D. Two ampules of sodium bicarbonate 83. Which of the following nursing interventions is appropriate after a total thyroidectomy? A. Place pillows under your patients shoulders. B. Raise the knee-gatch to 30 degrees

C. Keep you patient in a high-fowlers position. D. Support the patients head and neck with pillows and sandbags. 84. If there is an accidental injury to the parathyroid gland during a thyroidectomy which of the following might Leda develop postoperatively? A. Cardiac arrest C. Respiratory failure B. Dyspnea D. Tetany 85. After surgery Leda develops peripheral numbness, tingling and muscle twitching and spasm. What would you anticipate to administer? A. Magnesium sulfate B. Calcium gluconate C. Potassium iodide D. Potassium chloride Situation 18 NURSES are involved in maintaining a safe and healthy environment. This is part of quality care management. 86. The first step in decontamination is: A. to immediately apply a chemical decontamination foam to the area of contamination B. a through soap and water wash and rinse of the patient C. to immediately apply personal protective equipment D. removal of the patients clothing and jewelry and then rinsing the patient with water 87. For a patient experiencing pruritus, you recommend which type of bath. A. water B. colloidal (oatmeal C. saline D. sodium bicarbonate 88. Induction of vomiting is indicated for the accidental poisoning patient who has ingested. A. rust remover B. gasoline C. toilet bowl cleaner D. aspirin 89. Which of the following term most precisely refer to an infection acquired in the hospital that was not present or incubating at the same time of hospital admission? A. Secondary blood stream infections B. Nosocomial infection C. Emerging infectious disease D. Primary blood stream infection 90. Which of the following guidelines is not appropriate to helping family members cope with sudden death? A. Obtain orders for sedation of family members B. Provide details of the factors attendant to the sudden death C. Show acceptance of the body by touching it and giving the family permission to touch D. Inform the family that the patient has passed on Situation 19 As a nurse you are expected to participate in initiating or participating in the conduct of research studies to improve nursing practice. You have to be updated on the latest trends and issues affecting profession and the best practices arrived at by the profession.

91. You are interested to study the effects of meditation and relaxation on the pain experienced by cancer patients. What type of variable is pain? A. Dependent C. Independent B. Correlational D. Demographic 92. You would like to compare the support system of patients with chronic illness to those with acute illness. How will you best state your problem? A. 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. The Effect Of The Type Of Support System of Patients With Chronic Illness And Those With Acute Illness. C. A Comparative Analysis Of The Support System Of Patients With Chronic Illness And Those With Acute Illness. D. A Study To Compare The Support System Of Patients With Chronic Illness And Those With Acute Illness. 93. You would like to compare the support system of patients with chronic illness to those with acute illness. What type of research it this? A. Correlational B. Descriptive C. Experimental D. Quasi-experimental 94. You are shown a Likert Scale that will be used in evaluating your performance in the clinical area. Which of the following questions will you not use in critiquing the Likert Scale? A. Are the techniques to complete and score the scale provided? B. Are the reliability and validity information on the scale described? C. If the Likert scale is to be used for a study, was the development process described? D. Is the instrument clearly described? 95. In any research study where individual persons are involved, it is important that an informed consent for the study is obtained. The following are essential information about the consent that you should disclose to the prospective subjects EXCEPT: A. Consent to incomplete disclosure B. Descriptions of benefits, risks and discomforts C. Explanation of procedure D. Assurance of anonymity and confidentiality Situation 20 Because severe burn can affect the persons totality it is important that-you apply interventions focusing on the various dimensions of man. You also have to understand the rationale of the treatment. 96. What type of debridement involves proteolytic enzymes? A. Interventional B. Mechanical C. Surgical D. Chemical 97. Which topical antimicrobial is most frequently used in burn wound care? A. Neosporin B. Silver nitrate C. Silver sulfadiazine

D. Sulfamylon 98. Hypertrophic burn scars are caused by: A. exaggerated contraction B. random layering of collagen C. wound ischemia D. delayed epithelialization 99. The major disadvantage of whirlpool cleansing of burn wound is: A. patient hypothermia B. cross contamination of wound C. patient discomfort D. excessive manpower requirement 100. Oral analgesics are most frequently used to control burn injury pain: A. upon patient request B. during the emergent phase C. after hospital discharge D. during the acute phase

Situation Ensuring safety is one of your most important responsibilities. You will need to provide instructions and information to your clients to prevent complications.

1. Randy has chest tubes attached to a pleural drainage system. When caring for him you should: A. empty the drainage system at the end of the shift B. clamp the chest tube when suctioning C. palpate the surrounding areas for crepitus D. change the dressing daily using aseptic techniques 2. Fanny, came in from PACU after pelvic surgery. As Fannys nurse you know that the sign that would be indicative of a developing thrombophlebitis would be: A. a tender, painful area on the leg B. a pitting edema of the ankle C. a reddened area at the ankle D. pruritus on the calf and ankle 3. To prevent recurrent attacks on Terry who has acute glumerulonephritis, you should instruct her to: A. seek early treatment for respiratory infections B. take showers instead of tub bath C. continue to take the same restrictions on fluid intake D. avoid situations that involve physical activity 4. Herbert had a laryngectomy and he is now for discharge. He verbalized his concern regarding his laryngectomy tube being dislodged. What should you teach him first? A. Recognize that prompt closure of the tracheal opening may occur B. Keep calm because there is no immediate emergency C. Reinsert another tubing immediately D. Notify the physician at once 5. When caring for Larry after an exploratory chest surgery and pneumonectomy, yourpriority would be to maintain: A. supplementary oxygen B. ventilation exchange C. chest tube drainage D. blood replacement

Situation As a nurse you need to anticipate the occurrence of complications of stroke so that life threatening situations can be prevented. 6. Wendy is admitted to the hospital with signs and symptoms of stroke. Her Glasgow Coma Scale is 6 on admission. A central venous catheter was inserted an I.V. infusion was started. As a nurse assigned to Wendy what will be your priority goal? A. Prevent skin breakdown B. Preserve muscle function C. Promote urinary elimination D. Maintain a patent airway 7. Knowing that for a comatose patient hearing is the last sense to be lost, as Judys nurse, what should you do? A. Tell her family that probably she cant hear them B. Talk loudly so that Wendy can hear you C. Tell her family who are in the room not to talk D. Speak softly then hold her hands gently 8. Which among the following interventions should you consider as the highest priority when caring for June who has hemiparesis secondary to stroke? A. Place June on an upright lateral position B. Perform range of motion exercises C. Apply antiembolic stockings D. Use hand rolls or pillows for support 9. Ivy, age 40, was admitted to the hospital with a severe headache, stiff neck and photophobia. She was diagnosed with a subarachnoid hemorrhage secondary to ruptured aneurysm. While waiting for surgery, you can provide a therapeutic environment by doing which of the following? A. honoring her request for a television B. placing her bed near the window C. dimming the light in her room D. allowing the family unrestricted visiting privileges 10. When performing a neurologic assessment on Walter, you find that his pupils are fixed and dilated. This indicated that he: A. probably has meningitis B. is going to be blind because of trauma C. is permanently paralyzed D. has received a significant brain injury Situation 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 patients. 11. During a meal a client with hepatitis B dislodge her IV line and bleeds on the surface of the over-the-bed table. It would be most appropriate for the nurse to instruct a housekeeper to clean the table with: A. Alcohol B. Acetone C. Ammonia D. Bleach 12. Nino is being treated with radiation therapy. What would be included in the plan of care to minimize skin damage from the radiation therapy? A. Cover the areas with thick clothing materials B. Apply a heating pad to the site C. Wash skin with water after the therapy D. Avoid applying creams and powders to the area 13. You are assigned to the following patients. Which of the following patients is most at risk for metabolic alkalosis? A. Grace, 30 years old post surgical patient who has continuous nasogastric suction B. Rachel, 55 year old who has just experienced a stroke C. Helen, 70 year old with altered level of consciousness who is unable to access water freely.

D. Mary Jane a 2 year old infant receiving isotonic sodium chloride IV solution 14. Studies have shown that the highest incidence of Hodgkins disease is common among young adults. Juana, 20 years old approaches you and tells you I am worried about the mass on my neck. What should you do as a nurse? A. Tell her there is nothing to worry if it does not bother her B. Palpate Juanas neck and explain the possible cause C. Tell her Hodgkins disease is common among young adults like her D. Tell her to see a doctor 15. As a nurse, you accidentally administer 40mg of Propanolol (Inderal) to a client instead of 10mg although the client exhibits no adverse reactions to the larger dose, you should: A. Complete an incident report B. Call the hospital attorney C. Inform the clients family D. Do nothing because the clients condition is stable Situation Radiation therapy is another modality of cancer management. With emphasis on multidisciplinary management you have important responsibilities as a nurse 16. Albert is receiving external radiation therapy and he complains of fatigue and malaise. Which of the following nursing interventions would be most helpful for Albert? A. Tell him that sometimes these feelings can be psychogenic B. Refer him to the physician C. Reassures him that these feelings are normal D. Help him plan his activities 17. Immediately following the radiation teletherapy, Albert is: A. Considered radioactive fro 24hours B. Given a complete bath C. Placed on isolation for 6 hours D. Free from Radiation 18. Albert is admitted with a radiation induced thrombocytopenia. As a nurse you should observe the following symptoms: A. Petechiae, ecchymosis, epistaxis B. Weakness, easy fatigability, pallor C. Headache, dizziness, blurred vision D. Severe sore throat, bacteremia, hepatomegaly 19. What nursing diagnosis should be the highest priority? A. Knowledge deficit regarding thrombocytopenia precautions B. Activity intolerance C. Impaired tissue integrity D. Ineffective tissue perfusion, peripheral, cerebral, cardiovascular, gastrointestinal, renal 20. What intervention should you include in your care plan? A. Inspect his skin for petechiae, bruising, GI bleeding regularly B. Place Albert on strict isolation precaution C. Provide rest in between activities D. Administer antipyretics if his temperature exceeds 38 C Situation - You are assigned to take care of four patients with different conditions. 21. KJ, who is to have a kidney transplant asks you how long will he take azathioprime (Imuran), cyclosporine and prednisone? You recognized that KJ understood the teaching when he states, I must take these medications: A. until the anastomosis heals B. during the preoperative period C. until the supply is over D. for the rest of my life 22. After the kidney transplant, you must observe KJ for signs of rejection which includes:

A. fever and weight gain B. hematuria and seizure C. polyuria and jaundice D. moon face and muscle atrophy 23. FB, 28 years old with chronic renal disease plans to receive a kidney transplant. Recently, FB was told by his physician that he was a poor candidate for transplant because of his hypertension and diabetes mellitus. Now, FB tells you I want to go off dialysis, Id rather not live than to be in this treatment the rest of my life. How would you respond to him? A. leave the room and allow him to collect his thoughts B. tell FB that We all have days when we dont feel like going on C. tell FB that Treatments are only three times a week, you can live with that D. take a sit next to him and sit quietly 24. DS signed a consent form for participation in a clinical trial for implantable cardioverter defibrillators. Which statement by DS indicates the need for further teaching before true informed consent can be obtained? A. a wire from the generator will be attached to my heart B. the physician will make a small incision in my chest wall and place the generator there C. I wonder if there is another way to protect these bad rhythms D. this implanted defibrillator will protect me from those bad rhythms my heart goes into 25. KP is participating in a cardiac study in which his physician is directly involved. Which statement by KP indicates a lack of understanding about his rights as a research study participant? A. My confidentiality will not be compromised in this study B. I understand the risk associated in this study C. I can withdraw from the study anytime D. Ill have to find a new physician if I dont complete this study Situation - Foot care among patients with peripheral vascular problems is very important. 26. When teaching a client with peripheral vascular disease about foot care, you should include which instructions: A. avoid wearing canvas shoes B. avoid using a nail clipper to cut toe nails C. avoid use of cornstarch on the foot D. avoid wearing cotton socks 27. FT, who has no known history of peripheral vascular disease, comes to the emergency room complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses, paresthesia and a mottled, cyanotic, cold, cadaverous left calf. While the physician determines the appropriate management, you should: A. shave the affected leg in anticipation of surgery B. place a healing pad around the calf C. keep the affected leg level or slightly dependent D. elevate the affected calf as high as possible 28. Peripheral neuropathies primarily affect: A. sensory functions B. vascular functions C. optic functions D. motor functions 29. Peripheral neuropathy can BEST be controlled by: A. good glucose control B. steroid therapy C. vitamin supplement D. nothing, there is no slowing the process 30. In addition to clients with diabetes mellitus you must be aware that acute hypoglycemia can also develop in a client with: A. hypertension B. hyperthyroidism C. liver disease D. diabetes insipidus

Situation - The physician has ordered 3 units of whole blood to be transfused to WQ following a repair of a dissecting aneurysm of the aorta. 31. You are preparing the first unit of whole blood for transfusion. From the time you obtain it from the blood bank, how long should you infuse it? A. 6 hours B. 1 hour C. 4 hours D. 2 hours 32. What should you do FIRST before you administer blood transfusion? A. verify client identity and blood product, serial number, blood type, cross matching results, expiration date B. verify client identity and blood product serial number, blood type, cross matching results, expiration date with another nurse C. check IV site and use appropriate BT set and needle D. verify physicians order 33. As WQs nurse, what will you do AFTER the transfusion has started? A. add the total amount of blood to be transfused to the intake and output B. discontinue the primary IV of Dextrose 5% Water C. check the vital signs every 15 minutes D. stay with WQ for 15 minutes to note for any possible BT reactions 34. WQ is undergoing blood transfusions of the first unit. The EARLIEST signs of transfusion reactions are: A. oliguria and jaundice B. urticaria and wheezing C. hypertension and flushing D. headache, chills, fever 35. In case WQ will experience an acute hemolytic reaction, what will be your PRIORITY intervention? A. immediately stop the blood transfusion, infuse Dextrose 5% in Water and call the physician B. stop the blood transfusion and monitor the patient closely C. immediately stop the BT, infuse NSS, call the physician, notify the blood bank D. immediately stop the BT, notify the blood bank and administer antihistamines Situation - The kidneys have very important excretory, metabolic, erythropoietic functions. Any disruptions in the kidneys functions can cause disease. As a nurse it is important that you understand the rationale behind the treatment regimen used. 36. PL, who is in acute renal failure, is admitted to the Nephrology Unit. The period of oliguria usually lasts for about 10 days. Which assessment parameter for kidney function will you use during the oliguric phase? A. urine output directly related to the amount of IV fluid infused B. urine output is less than 400 ml/24 hours C. urine output of 30-60 ml/hour D. no urine output, kidneys in a state of suspension 37. During the shock phase, what is the effect of the rennin-aldosterone-angiotensin system on renal function? A. increased urine output, increased absorption of sodium and water B. decreased urine output, decreased absorption of sodium and water C. increased urine output, decreased absorption of sodium and water D. decreased urine output, increased absorption of sodium and water 38. As you are caring for PL who has acute renal failure, one of the collaborative interventions you are expected to do is to start hypertonic glucose with insulin infusion and sodium bicarbonate to treat: A. hyperkalemia B. hypercalcemia C. hypokalemia D. hypernatremia

39. BN, 40 year old with chronic renal failure. An arteriovenous fistula was created for hemodialysis in his left arm. What diet instructions will you need to reinforce prior to his discharge? A. drink plenty of water B. restrict your salt intake C. monitor your fruit intake and eat plenty of bananas D. be sure to eat meat every meal 40. BN, is also advised not to use salt substitute in the diet because: A. salt substitute contain potassium which must be limited to prevent arrhythmias B. limiting salt substitutes in the diet prevents a buildup of waste products in the blood C. fluid retention is enhanced when salt substitutes are included in the diet D. a substance in the salt substitute interferes with fluid transfer across the capillary membrane Situation 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 patients. 41. Hypoxia may occur in the older patients because of which of the following physiologic changes associated with aging. A. Ineffective airway clearance B. Decreased alveolar surfaced area C. Decreased anterior-posterior chest diameter D. Hyperventilation 42. The older patient is at higher risk for incontinence because of: A. dilated urethra B. increased glomerular filtration rate C. diuretic use D. decreased bladder capacity 43. Merle, age 86, is complaining of dizziness when she stands up. This may indicate: A. dementia B. a visual problem C. functional decline D. drug toxicity 44. Cardiac ischemia in an older patient usually produces: A. ST-T wave changes B. Very high creatinine kinase level C. Chest pain radiating to the left arm D. Acute confusion 45. The most dependable sign of infection in the older patient is: A. change in mental status B. fever C. pain D. decreased breath sounds with crackles Situation A disaster is a large-scale emergencyeven a small emergency left unmanaged may turn into a disaster. Disaster preparedness is crucial and is everybodys business. There are agencies that are in charge of ensuring prompt response. Comprehensive Emergency Management (CEM) is an integrated approach to the management of emergency programs and activities for all four emergency phases (mitigation, preparedness, response, and recovery), for all types of emergencies and disasters (natural, man-made, and attack) and for all levels of government and the private sector. 46. Which of the four phases of emergency management is defined as sustained action that reduces or eliminates long-term risk to people and property from natural hazards and their effects.? A. Recovery B. Mitigation C. Response D. Preparedness

47. You are a community health nurse collaborating with the Red Cross and working with disaster relief following a typhoon which flooded and devastated the whole province. Finding safe housing for survivors, organizing support for the family, organizing counseling debriefing sessions and securing physical care are the services you are involved with. To which type of prevention are these activities included: A. Tertiary prevention B. Primary prevention C. Aggregate care prevention D. Secondary prevention 48. During the disaster you see a victim with a green tag, you know that the person: A. has injuries that are significant and require medical care but can wait hours with threat to life or limb B. has injuries that are life threatening but survival is good with minimal intervention C. indicates injuries that are extensive and chances of survival are unlikely even with definitive care D. has injuries that are minor and treatment can be delayed from hours to Days 49. The term given to a category of triage that refers to life threatening or potentially life threatening injury or illness requiring immediate treatment: A. Immediate B. Emergent C. Non-acute D. Urgent 50. Which of the following terms refer to a process by which the individual receives education about recognition of stress reaction and management strategies for handling stress which may be instituted after a disaster? A. Clinical incident stress management B. Follow-up C. Debfriefing D. Defusion Situation 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. 51. While eating his meal, Matthew accidentally dislodges his IV lines and bleeds. Blood oozes on the surface of the over-bed table. It is most appropriate that you instruct the housekeeper to clean the table with: A. Acetone B. Alcohol C. Ammonia D. Bleach 52. You are a member of the infection control team of the hospital. 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). What is your priority activity? A. Establish policies for surveillance and monitoring B. Do data gathering about the possible sources of infection (observation, chart review, interview). C. Assign point persons who can implement policies. D. Meet with the nursing group working in the burn unit and discuss problem with them. 53. Part of your responsibility as a member of the diabetes core group is to getreferrals from the various wards regarding diabetic patients needing diabetes education. Prior to discharge today, 4 patients are referred to you. How would you start prioritizing your activities? A. Bring your diabetes teaching kit and start your session taking into consideration their distance from your office B. Contact the nurse in-charge and find out from her the reason for the referral C. Determine their learning needs then prioritize D. Involve the whole family in the teaching class

54. You have been designated as a member of the task force to plan activities for the Cancer Consciousness Week. Your committee has 4 months to plan and implement the plan. You are assigned to contact the various cancer support groups in your hospital. What will be your priority activity? A. Find out if there is a budget for this activity B. Clarify objectives of the activity with the task force before contacting the support groups C. Determine the VIPs and Celebrities who will be invited D. Find out how many support groups there are in the hospital and get the contact number of their president 55. You are invited to participate in the medical mission activity of your alumni association. In the planning stage everybody is expected to identify what they can do during the medical mission and what resources are needed. You thought it is also your chance to share what you can do for others. What will be your most important role where you can demonstrate the impact of nursing in health? A. Conduct health education on healthy life style B. Be a triage nurse C. Take the initial history and document findings D. Act as a coordinator Situation One of the realities that we are confronted with is our mortality. It is important for us nurses to be aware of how we view suffering, pain, illness, and even our death as well as its meaning. That way we can help our patients cope with death and dying. 56. Irma is terminally ill, she speaks to you in confidence. You now feel that Irmas family could be helpful if they knew what Irma has told to you. What should you do first? A. Tell the physician who in turn could tell the family B. Obtain Irmas permission to share the information in the family C. Tell Irma that she has to tell her family what she told you D. Make an appointment to discuss the situation with the family 57. Ruby who has been told she has terminal cancer, turns away and refuses to respond to you. You can best help her by: A. Coming back periodically and indicating your availability if she would like you to sit with her B. Insisting that Ruby should talk with you because it is not good to keep everything inside C. Leaving her alone because she is uncooperative and unpleasant to be with D. Encouraging her to be physically active as possible 58. Leo, who is terminally ill and recognizes that he is in the process of losing everything and everybody he loves, is depressed. Which of the following would best help him during his depression? A. Arrange for visitors who might cheer him B. Sit down and talk with him for a while C. Encourage him to look at the brighter side of things D. Sit silently with him 59. Which of the following statements would best indicate that Ruffy, who is dying, has accepted his impending death? A. Im ready to go. B. I have resigned myself to dying. C. Whats the use? D. Im giving up 60. Marla, 90 years old has planned ahead for her death-philosophically, socially, financially and emotionally. This is recognized as: A. Acceptance that death is inevitable B. Avoidance of the true situation C. Denial with planning for continued life D. Awareness that death will soon occur

Situation Andrea is admitted to the ER following an assault where she was hit on the face and head. She was brought to the ER by a police woman. Emergency measures were stated. 61. As Andreas nurse, what will be your priority interventions? A. Insert and intravenous catheter B. Insert an oral or nasopharyngeal airway C. Obtain arterial blood gases D. Give 100% oxygen 62. Andreas arterial blood gases respiratory acidosis. This most likely related to: A. Partially obstructed airway B. Ineffective breathing pattern C. Head injury D. Pain 63. Andrea loses consciousness. You should prepare for which of the following FIRST? A. Placement of nasogastric tube B. Placement of a second IV line C. Endotracheal intubation or surgical airway placement D. CT scan of head 64. Andreas physician gives an order of Mannitol 0.25 g/kg IV bolus for increased ICP. This is given to: A. Promote cerebral-tissue fluid movement B. Promote renal perfusion C. Correct acid-base imbalances D. Enhance renal-excretion of drugs 65. As Andreas nurse your goal is to prevent increased Intracranial Pressure (ICP). Which of the following independent nursing interventions is NOT suited for her? A. Do oropharyngeal suction every 15 minutes to prevent pulmonary aspiration? B. Keep ahead of bed 30-35 degrees elevated C. Maintain Andreas head in straight alignment and prevent hip flexion D. Prevent constipation and increases in intra-abdominal pressure 66. Andreas respiration is described as waxing and waning. You know that this rhythm of respiration is defined as: A. Biots B. Kussmauls C. Cheyne Stokes D. Eupnca 67. What do you call the triad of sign and symptoms seen in a client with increasing ICP? A. Virchows Triad B. The Chinese triad C. Cuschings Triad D. Charcots Triad 68. Which of the following is true with the Cushings Triad seen in head injuries? A. Narrowing of Pulse Pressure, Cheyne strokes respiration, Tachycardia B. Widening Pulse pressure, Irregular respiration, Bradycardia C. Hypertension, Kussmauls respiration, Tachycardia D. Hypotension, Irregular respiration, Bradycardia 69. In a client with a Cheyne stokes respiration, which of the following is the most appropriate nursing diagnosis? A. Ineffective airway clearance B. Ineffective breathing pattern C. Impaired gas exchange D. Activity Intolerance 70. You know the apnea is seen in clients with cheyne stoke respiration, APNEA is defined as: A. Inability to breath in a supine position so the patient sits up in bed to breathe. B. The patient is dead, the breathing stops C. There is an absence of breathing for a period of time usually 15 seconds or more

D. A period of hypercapnea and hypoxia due to cessation of respiratory effort inspite of normal respiratory functioning Situation - Specific surgical interventions may be done when lung cancer is detected early. You have important perioperative responsibilities in caring for patients with lung cancer. 71. Horace underwent lobectomy. Which of following is the purpose of Horaces closed chest drainage post lobectomy: a. expansion of the remaining lung b. facilitation of coughing c. prevention of mediastinal shift d. promotion of wound healing 72. Which of the following observations indicates that the closed chest drainage system is functioning properly? A. absence of bubbling in the suction-control bottle B. the fluctuating movement of fluid in the long tube of the water-seal bottle during inspiration C. intermittent bubbling through the long tube of the suction control bottle. D. less than 25 ml drainage in the drainage bottle 73. Following lobectomy, you can BEST help Horace to reduce pain during the deep breathing and coughing exercises by: A. placing the patient on his/her operative side during exercises B. splinting the patients chest with both hands during the exercises C. administering the prescribed analgesic immediately prior to exercises D. providing rest for 6 hours before exercises 74. Peter underwent pneumonectomy. During the immediate post operative period, deep tracheal suction should be done with extreme caution because: A. Peter will not be able to tolerate coughing B. the tracheobronchial trees are dry C. the remaining normal lung needs minimal stimulation D. the bronchial suture line maybe traumatized 75. On which of the following positions should you place Peter who just underwent pneumonectomy? A. Prone position B. On his abdomen or on the side opposite the surgery C. On his back or on the side of surgery D. Any position is acceptable Situation Mang Felix, a 79 year old man who is brought to the Surgical Unit from PACU after a transurethral resection. You are assigned to receive him. You noted that he has a 3-way indwelling catheter for continuous fast dip bladder irrigation which is connected to a straight drainage. 76. Immediately after surgery, what would you expect his urine to be? A. Light yellow B. Amber C. Bright red D. Pinkish to red 77. The purpose of the continuous bladders irrigation is to: A. Allow continuous monitoring of the fluid output status B. Provide continuous flushing of clots and debris from the bladder C. Allow for proper exchange of electrolytes D. Ensure accurate monitoring of intake and output 78. Mang Felix informs you that he feels some discomfort on the hypogastric area and he has to void. What will be your most appropriate action? A. Remove his catheter then allow him to void his own B. Irrigate his catheter C. Tell him Go ahead and void. You have an indwelling catheter D. Assess color and rate of outflow, if there is a change refer to urologist for possible irrigation

79. You decided to check on Mang Felixs IV fluid infusion. You noted in flow rate, pallor and coldness around the insertion site. What is your assessment finding? A. Phlebitis B. Infiltration to subcutaneous tissue C. Pyrogenic reaction D. Air embolism 80. Knowing that proper documentation of assessment findings and interventions share important responsibilities of the nurse during first post operative days, which of the following is the LEAST relevant to document in the case of Mang Felix? A. Chest pain and vital signs B. Intravenous infusion rate C. Amount, color and consistency of bladder irrigation drainage D. Activities of daily living started Situation Many hospitals from bioethical review committees to ensure quality of life of patients. You are invited by the nursing service departments to participate in their bioethical review committee. You are expected to know the purpose and apply bioethical principles. 81. Which of the following is the purpose of the ethical review committee? A. Promote implementation of general standards B. Enhance health care providers liability C. Increase individuals responsibility D. Decrease Public security of health care providers action 82. Daria who is admitted to the hospital with autoimmune thrombocytopenia and a platelet count of 20,000/ml develops epistaxis and melena. Treatment with corticosteroid and immunoglobulin has not been successful. Her physician recommend splenectomy. Daria states I dont need surgery. This will go away on its own. A. Beneficence B. Justice C. Autonomy D. Advocacy 83. Zorayda is terminally ill and is experiencing sever pain. She has bone and liver metastasis. She has been on morphine for several months now. Zorayda is aware that they are having financial problems. She decides to sign DNR form,. What ethical principle did Zorayda and her family utilize as basis for their decision to sign a DNR. A. Justice B. Autonomy C. Advocacy D. Beneficence 84. Tricia, a staff nurse working in a cancer unit, is considered a role model not only by her colleagues but also by her patients. She goes out of her way to help other. She is very active in their professional organization and he practices what she teaches. What ethical principles is she practicing? A. Beneficence B. Justice C. Autonomy D. Advocacy 85. You are commuting to work riding the LRT. An older person collapsed and nobody seems to notice her. The security guard tried to make ker sit down but she remained unconscious. You saw what happened and you decided to help. With help, you brought the patient to the nearest hospital. You learned later that woman was diabetic. She was on her way To the diabetes clinic to have fasting blood sugar tested. She developed hypoglycemia. You were able to save a life. You felt good. What principle was applied? A. Advocacy B. Beneficence C. Justice D. Autonomy

Situation Ensuring safety before, during, and after a diagnostic procedure is an important responsibility of the nurse 86. To help Fernan better tolerate the bronchoscopy, you should instruct him to practice which of the following prior to the procedure? A. Clenching his fist every 2 minutes B. Breathing in and out through the nose with his mouth open C. Tensing the shoulder muscles while lying on his back D. Holding his breath periodically for 30 seconds 87. Following bronchoscopy, which of the following complains to Fernan should be noted as possible complication: A. Nausea and vomiting B. Shortness of breath and laryngeal stridor C. Blood tinged sputum and coughing D. Sore throat and hoarseness 88. Immediately after bronchoscopy, you instructed Fernan to: A. Exercise the neck muscles B. Breathe deeply C. Retrain from coughing and talking D. Clear his throat 89. Thoracentesis may be performed for cytologic study of pleural fluid. As a nurse your most important function during procedure is to: A. Keep the sterile equipment from contamination B. Assist the physician C. open and close the three-way stopcock D. Observe the patients vital signs 90. Right after thoracentesis, which of the following is most appropriate intervention? A. Instruct the patient not to cough or deep breathe for two hours B. Observe for symptoms of tightness of chest or bleeding C. Place an ice pack to the puncture site D. Remove the dressing to check for bleeding Situation Brain tumor, whether malignant or benign, has serious management implications. As a nurse, you should be able to understand the consequences of the disease and the treatment. 91. You are caring for Conrad who has a brained tumor and increased Intracranial Pressure (ICP). Which intervention should you include in your plan to reduce ICP? A. Administer bowel softener B. Position Conrad with his head turned toward the side of the tumor C. Provide sensory stimulation D. Encourage coughing and deep breathing 92. Keeping Conrads head and neck alignment results in: A. increased inthrathoracic pressure B. increased venous outflow C. decreased venous outflow D. increased intrabdominal pressure 93. Which of the following activities may increase intracranial pressure (ICP)? A. Raising the head of the bed B. Manual hyperventilation C. Use of osmotic diuretics D. Valsalvas maneuver 94. After you asses Conrad, you suspected increased ICP. Your most appropriaterespiratory goal is to: A. maintain partial pressure of arterial O2 (PaO2) above 80 mmHg B. lower arterial pH

C. prevent respiratory alkalosis D. promote CO2 elimination 95. Conrad underwent craniotomy. As his nurse, you know that drainage on a craniotomy dressing must be measured and marked. Which findings should you report immediately to the surgeon? A. Foul-smelling drainage B. Yellowish drainage C. Greenish drainage D. Bloody drainage Situation As a nurse you are expected to be competent in utilizing the nursing process in the care of your clients. 96. Getty is receiving chemotherapy for cancer. You review Gettys laboratory report and note that he has anemia. To which nursing diagnosis should you give the highest priority? A. Activity intolerance B. Impaired oral mucous membrane C. Impaired tissue perfusion, cerebral, cardiovascular, gastrointestinal D. Impaired tissue integrity 97. An immediate objective for nursing care of an overweight mildly hypertensive client with ureteral colic and hematuria is to decrease: A. Hypertension B. Pain C. Hematuria D. Weight 98. A difficult problem to deal with when caring for a patient with a partial thickness burns sustained 3 days ago is: A. Alteration in body image B. Maintenance of sterility C. Frequent dressing change D. Severe pain 99. Which outcome criterion would be appropriate for a client with a nursing diagnosis of effective airway clearance? A. Continued use of oxygen when necessary B. Breath sound clear on auscultation C. Respiratory rate of 24/min D. Presence of congestion 100. Which assessment would be most supportive of the nursing diagnosis, impaired skin integrity related to purulent drainage? A. Heart rate of 88 beats/min B. Dry and intact wound dressing C. Oral temperature D. Wound healing by first intention