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Nurse Licensure Examination Dec 2006
Nurse Licensure Examination Dec 2006
. Martin, 71 years old was suddenly rushed to the hospital because of severe chest pain. On admission, he was diagnosed to have acute myocardial infarction and was placed in the ICU. 1. While in the ICU, he executes the document tat list the medical treatment he chooses to refuse in case his condition becomes severe to a point that he will be unable to make decisions for himself. This document is: A. living will C. last will and testament B. informed consent D. power of attorney 2. After one day, the patients condition worsened and feeling hopeless. He requested the nurse to remove the oxygen. The nurse should: A. follow the patient because it is his right to die gracefully B. follow the patient as it is his right to determine the medical regimen he needs C. refuse the patient and encourage him to verbalize hid feelings D. refuse the patient since euthanasia is not accepted in the Philippines 3. Euthanasia is an ethical dilemma which confronts nurses in the ICU because: A. the choices involved do not appear to be clearly right or wrong B. a clients legal right co-exist with the nurses professional obligation C. decisions has to be made based on societal norms. D. decisions has to be mad quickly, often under stressful conditions 4. A nurse who supports a patient and familys need to make decisions that is right for them is practicing which of the following ethical principles? A. Autonomy B. confidentiality C. privacy D. truthfulness 5. Mr. Martin felt better after 5 days but recognizing the severity of his illness, he executes a document authorizing the wife to transact any form of business in his behalf in addition to all decisions relative to his confinement his document is referred to as: A. power of attorney C. informed consent B. living will D. medical records Situation 2: Miss Castro was recently appointed chief nurse of a 50-bed government hospital in Valenzuela. On her first day of duty, she tried to remember the elements of administration she learned from her basic nursing education. 6. One of the first things Ms. Castro did was to engage her until in objective writing, formulating goals and philosophy of nursing service. Which activities are MOST appropriately described to which elements of administration? A. planning B. controlling C. directing d. organizing 7. In recognizing the Department of Nursing, she comes up with the organizational structure defining the role and function of the different nursing positions and line-up the position with qualified people. This is included in which element of administration: A. monitoring B. evaluation C. organizing d. planning
8. After one month, she and her management committee assess the regulatory measures taken and correct whatever discrepancies are found. This is part of which element of administration: A. monitoring B. organizing C. evaluation d. planning 9. Revaluation and administrative process is BEST described as: A. a continuing process of seeing that performance meets goals and targets B. obtaining commitment of members to do better C. informing personnel how well and how much improvement has been made D. follow-up of activities that have been studied 10. In all of the various administrative functions, which of the following management skill is demanded efficiently and effectively of Ms. Castro? 1. Decision making skills 3. Auditing skills 2. Forecasting skills 4. Communications skills A. 2 & 3 B. 1 & 4 C. 1 & 2 D. 2 & 4 Situation 3: Meldy. 40 years old. is waiting for her doctors appointment at the clinic where you work. 11. You are to interview her as an initial nursing action so that you can. A. Document important data in her client records for health team to read. B. Gather data about her lifestyle, health needs , lifestyle, health needs and problems to develop plan of care C. provide solutions to her immediate health concern D. identify the most appropriate nurse diagnosis for her heath problem 12. During the interview, Meldy experiences a sharp abdominal pain on the right side of her abdomen. She further tells you that an hour ago, she ate fatty food and this had happened many times before. You will record this as: A. Client complains of intermittent abdominal pain an hour alter eating fatty foods B. After eating fatty food the client experienced severe abdominal pain C. Client claims to have sharp abdominal pains after eating fatty food unrelieved by pain medication D. Client reported sharp abdominal pain on the right upper quadrant of abdomen an hour after ingestion of fatty foods. 13. Meldy tells you that she has been on a high protein / high fat / low carbohydrate diet order to lose weight and that she has successfully lost 8 lbs during the past two weeks. In planning a healthy balanced diet for her, you will: A. Encourage her to eat well-balanced diet with a variety of food from the major food groups and take plenty of fluids. B. Ask her to shift to a macrobiotic diet rich in complex carbohydrates. C. Encourage her to cleanse her body toxins by changing a vegetarian diet with regular exercise. D. Encourage her to eat a high carbohydrate, low protein diet and low fat diet. 14. You learn that Meldy drinks 5-8 cups o coffee a day plus cola drinks. Because she is in her pre-menopausal years, the nurse instructs her to decrease consumption of coffee and cola preparation because: A. these products increase calcium loss from the bones B. These products have stimulant effect n the body C. these products encourage increase in sugar consumption D. these products are addicting 15. Health education plan for Meldy stresses prevention of NCD or Non-communicable diseases that are influenced by lifestyle. These include the following EXCEPT: A. Cancer B. DM C. Osteoporosis D. Cardiovascular diseases
Situation 4: Changes in technology, the nations economy and the increasing number of population have brought about changes in the Health Care System. 16. At present, government hospitals are expected to offer comprehensive health services to include illness prevention and health promotion. In which of the following unit of services are these services integrated? A. Wellness center B. Rehabilitation Center C. Intensive Care unit D. newborn screening unit 17. Which of the following is the MOST recent government initiative to help subsidize the cost of health services for both the employed and the unemployed? A. National Health Insurance Act C. Medicare Act B. Workers Compensation Act D. Magna Carta for Public Health Workers 18. The top ten morbidity cases in the Phil. Include TB, diarrhea among children to name a few. Many of these conditions are preventable and have implications are preventable and have implications in the development of which nursing competencies? A. Execution of nsg. procedure and technique B. Therapeutic use of self C. Administration of treatment and medication D. Health education 19. The cost of hospitalization is getting more expensive and unaffordable to many of our people. These facts will MOST LIKELY bring about development in which of the following? A. acute services C. home care services B. managed care services D. advance practice nursing 20. Which of the following latest trend has expanded health services based on prepaid fees with emphasis on health promotion and illness prevention? A. Government Insurance Plan C. Health Maintenance Organization B. Preferred Provider Organization D. Private Insurance Plan Situation 5: It is Safety Awareness Week in the Community and the nurse checks on the presence of hazards at home. The nurse plan is to have the residents themselves identify the physical hazards in their own homes. 21. Which of the following is NOT a physical hazard in the home? A. unstable and slippery stairway B. large windows that allow good ventilation C. obstacle people cam trip over like door mats, rugs, electric cords D. inadequate lighting in and out of the house 22. Risk factors exist for each of the different developmental levels. From infancy to preschool age, the most common cause of death is injury rather than disease. To protect children from harm, that parents should be aware that MOST injuries for this age group are due to: A. Accidents at home caused by the swallowed poisonous materials, small objects, exploring electrical sockets B. Accidents from self inflicted wounds C. accidents from sports related activities at school or the neighborhood D. accidents in the Playground Park, school and presence of strangers who may abduct of molest the child. 23. To promote safety at home, the nurse identifies ways and means of child proofing the house. Which of the following is NOT safe? A. apply child proof caps and medicine bottles and chemicals
B. covering electrical outlets, tying up long and loose electrical and telephone cords, securing cabinets or doors within reach o the child C. giving colorful grocery bags to play with or to store toys and materials D. removing objects that the child could easily dismantle and swallow like small parts of a mechanical toy, buttons, materials inside, stuffed animals, liquid chemicals. 24. The nurse knows that a persons hygienic practices are influenced family customs and traditions. Which of the following is NOT part of Basic Hygienic Practices? A. bathing practices, frequency and time, care of eyes, ear and nose B. oral hygiene practices such as brushing and flossing teeth, gum care C. care of skin with lesions, cuts with infection D. hair and skin such as washing hair and face, feet, hand and nail care 25. Falls are the common home accident among elderly and these are due to physical limitations imposed by aging and some hazards in the home setting. The nurse reduces the risk of falling through the following EXCEPT: A. rearranging furniture frequently B. having the bed or mattress close to the floor C. providing a nonskid and well fitted shoes or slippers D. having a call bell within the persons reach and answering call bells immediately Situation 6: Eileen, 45 years old is admitted to the hospital with a diagnosis of renal calculi. She is experiencing severe flank pain, nauseated and with a temperature of 39 0C. 26. Given the above assessment data, the most immediate goal of the nurse would be which of the following? A. Prevent urinary complication C. Alleviate pain B. maintains fluid and electrolytes D. Alleviating nausea 27. After IVP a renal stone was confirmed, a left nephrectomy was done. Her post operative order includes daily urine specimen to be sent to the laboratory . Eileen has a foley catheter attached to a urinary drainage system. How will you collect the urine specimen? A. remove urine from drainage tube with sterile needle and syringe and empty urine from the syringe into the specimen container B. empty a sample urine from the collecting bag into the specimen container C. disconnect the drainage tube from the indwelling catheter and allow urine to flow from catheter into the specimen container. D. disconnect the drainage the from the collecting bag and allow the urine to flow from the catheter into the specimen container. 28. Where would the nurse tape Eileens indwelling catheter in order to reduce urethral irritation? A. to the patients inner thigh C. to the patient B. to the patients lower thigh D. to the patient lower abdomen 29. Which of the following menu is appropriate for one with low sodium diet? A. instant noodles, fresh fruits and ice tea B. ham and cheese sandwich, fresh fruits and vegetables C. white chicken sandwich, vegetable salad and tea D. canned soup, potato salad, and diet soda 30. Howe will you prevent ascending infection to Eileen who has an indwelling catheter? A. see to it that the drainage tubing touches the level of the urine B. change he catheter every eight hours C. see to it that the drainage tubing does not touch the level of the urine
D. clean catheter may be used since urethral meatus is not a sterile area Situation 7: Miss Tingson is assigned to Mang Carlos, a 60 year old newly diagnosed diabetic patient. She is beginning to write objectives of her teaching plan. 31. Which of the following objectives is written in behavioral terms? A. Mang Carlos will know about diabetes related to foot care and the techniques and equipments necessary to carry it out B. Mang Carlos daughter should learn about DM within the week C. Mang Carlos wife needs to understand the side effects of insulin D. Mang Carlos sister will be able to determine in two days his insulin requirement based on blood glucose levels obtained from glucometer 32. Which of the following is the BEST rationale for written objectives? A. ensure communication among staff members B. facilitate evaluation of the nurses performance C. ensure learning on the part of the nurse D. document the quality of care 33. Which of the following behavior BEST contribute to the learning of Mang Carlos regarding his disease condition? A. frequent use of technical terms for familiarization B. drawing him into discussion about diabetes C. detailed lengthy explanation about his condition D. loosely structured teaching session 34. Miss T should encourage exercise in the management of diabetes, because it: A. decrease total triglyceride levels C. lowers blood glucose B. improves insulin utilization D. accomplishes all of the above 35. The chief life-threatening hazard for surgical patient w/ uncontrolled diabetes is: A. dehydration B. hypertension C. hypoglycemia D. glucosuria Situation 8: Caring for the perioperative patient. 36. An appendectomy during a hysterectomy would be classified as: A. Major, emergency, diagnosis C. Minor, elective, ablative B. major, urgent, palliative D. minor, urgent, reconstructive 37. An informed consent is required for: A. closed reduction of a fracture C. irrigation of the external ear canal B. insertion of intravenous catheter D. urethral catheterization 38. The circulating nurses responsibilities, in contrast to the scrub nurses responsibilities, include: A. assisting the surgeon C. setting up the sterile tables B. monitoring aseptic practices D. all of the above functions 39. The primary nursing goal in the immediate postoperative period is maintenance of pulmonary function and prevention of: A. Laryngospasm C. hypoxemia and hypercapnea B. hyperventilation D. pulmonary edema ad embolism
40. Unless contraindicated, any unconscious patient should be positioned: A. flat on his of her back, without elevation of the head, to facilitate frequent turning and minimize pulmonary complications B. in semi-fowlers position, to promote respiratory function and reduce the incidence of orthostatic hypotension when the patient can eventually stand. c. in fowlers position, which most closely stimulates a sitting position, thus facilitating reparatory as well as gastrointestinal functioning. D. on his or her side without a pillow at the patients back and his or her chin ext ended to minimize the danger of aspirations Situation 9: To prevent further injury to patients with problems of immobility / mobility, the nurse should observe certain principles of body mechanics for herself and her patients. 41. Which of the following are appropriate goals for client with positioning and mobility needs? A. developing of contractures C. sensory alterations B. proper body alignment D. decrease in activity tolerance 42. Which for the following would MOST likely cause injury to the nurse when moving the patient from bed to the wheelchair? A. bending at the knees C. using body weight to assist with the movement B. standing with feet together D. standing with feet apart 43. Which of the following is the CORRECT guideline when positioning patients? A. put pillows above a joint to immobilize it B. position of the joint should be slightly extended C. joints of patient to be supported with pillow D. patients position should be changed at least three or four times a day 44. Which of the following can be used by clients with problem of immobility to enable them raise their body from bed to wheelchair or perform some bed exercises? A. sandbag B. side-rail C. trochanter roll D. trapeze bar 45. The importance of forcing fluids with an immobilized patient is to: A. prevent pneumonia C. prevent skin breakdown B. prevent urinary stasis D. maintain peristalsis 46. Which of the following is the least nursing activity in performing assessment of the patient? A. laboratory test C. Health history B. physical examination D. systemic review 47. One of the responsibilities of Mr. Lata, RN, an industrial nurse, is to conduct physical head-to-toe assessment of a newly hired factory worker. As part of the assessment, he took the vital signs. Which of the four assessment techniques did he utilize? 1. auscultation 2. percussion 3. palpation 4. inspection A. 1,2 & 3 B. 3 &4 C. 1 & 2 D. 1,3 & 4 48. Which of the following are the purpose of performing a physical assessment? 1. gather baseline data about the clients health 2. confirm and identify nursing diagnosis 3. evaluate physiological outcome of care 4. make clinical judgment of patients diagnosis
A. 1,2 & 4
B. 2, 3 & 4
C. 1, 3 & 4
D. 1,2 & 3
C. plans and coordinate the patient care assigned to her from admission to discharge D. coordinates the care given to a group of patients by support staff 57. Primary nursing is MOST advantageous and satisfying to the patient and nurse because of which of the following principles? A. autonomy and authority for planning care are best delegated to a nurse B. accountability is clearest since our nurse is responsible for the overall plan and implementation of care C. the holistic approach provides fro a therapeutic relationship continuity of care and efficient nursing care D. continuity of patients care promotes efficient nursing care. 58. Which is the role of the associate nurse in primary nursing? A. over-all manager of the unit B. responsible for the over-all care of the patient during off days of primary nurse C. patient advocate in the health care team D. coordinator of comprehensive, holistic patient care 59. In primary nursing, the nurse is responsible for which of the following group of patient? A. the whole ward B. small group of patient like 3-5 patients C. big group of patients like 10-15 patients D. the whole unit 60. In primary nursing who among the following is needed to her leadership and quality control in the ward? A. the chief nurse C. the nurse supervisor B. the head nurse D. the service director Situation 13: Your nursing unit plans to conduct a study on the use of structured preoperative preparation in lessening the demand for post-operative pain medications. 61. Which of the following research activities should you initially do? A. find out from interview how many patients are willing to participate B. get the permission from the hospital director C. review literature on the topic D. prepare the tool for collecting data 62. Which of the following statements do NOT contribute to the researchabilty of your proposed problem? A. potential use of findings C. well-defined problem statement B. readability of findings D. measurability of variables 63. A study /research table should NOT contain which of the following ? A. categories of data collected C. specific title of table B. relevant rows and columns D. names and sample of the selected 64. Which of the following actions will facilitate analysis of research data? A. consult a physician C. consult a complete expert B. consult an adviser D. categorize data collected 65. The research methodology that is appropriate for the above problem would be: A. descriptive B. normative C. experimental D. quasi experimental Situation 14: The nurse meets a new client, Mr. Principe, 50 years old. During the initial interview, the nurse begins to feel irritated towards the client. Shortly after, he becomes uncomfortable and politely leaves the room.
49. Which of the following should be given the HIGHEST PRIORITY before physical examination is done to a patient? A. preparation of the equipment C. preparation of the environment B. psychological preparation of the client D. physical preparation of the client 50. During the assessment phase of the nursing process, the nurse is concerned with: A. interpreting data B. designing nursing strategies C. establishing a data base D. comparing client responses with the anticipated outcome Situation 11: The nurse is responsible to accurately records and reports patients progress. She is able to communicate to the other member of the team by documenting the nursing care plan and the appropriate nursing intervention. 51. A main function of the patients records is to: A. prepare the nurse for the shift worked B. serve as a record of financial charges C. serve as a vehicle for communication D. ensure that the message is received 52. When the nurse writes in the chart and discovers an error has been made, which is the BEST approach? A. erase the erroneous material B. carefully ink out the erroneous material C. place as asterisk next to the statement, then footnote it D. draw a straight line through the error and initial it. 53. Which of the following persons cannot have the access to the patient record? A. physical therapist C. the patient B. lawyer of the family D. speech therapist 54. POMR charting is different from traditional method because of which of the following practices? 1. SOAP charting 3. narrative charting 2. use of flow sheet 4 . use of checklist A. 3 & 4 B. 1 & 2 C. 1 & 3 D. 2 & 3 55. Which of the following qualities are relevant in documenting patients care? 1. Accuracy and consciousness 2. thoroughness and currentness 3. systematic and orderly 4. legibly, properly dated and signed 5. use of locally accepted abbreviation A. 1,3,4 & 5 B. 2,3,4 & 5 C. 1,2,3 & 5 D. 1,2,3 & 4 Situation 12: The practice of primary nurse in primary nursing is preferred by many nurses because it supports professional autonomy and accountability of the nurses> 56. What is the function of the primary nurse in primary nursing? A. acts as patient advocate and coordinate the health care team for specific group of patients B. act as the charge nurse, organizing staff assignments and help in solving problem in the unit
The nurse realizes the behavior and mannerism of Mr. Principe reminds him of his strict disciplinarian father who abused him physically. 66. The recognize that his feeling for the client is known as: A. denial B. counter transference C. Revenge D. transference 67. Seeing that his negative feelings for Mr. Principe could affect his nursing care, the nurse applies the concept of therapeutic use of self when: A. the nurse talks about his personal feelings towards the client B. the nurse suppresses his feelings and continue to take care of the client C. the nurse uses his awareness and asks to be reassigned to another client D. the nurse uses self-awareness to manage his feelings and thoughts towards the client 68. Mr. Principe is terminally ill and his family is coping with his impending death. The nurse has to deal with his own thoughts and personal feelings about death and grieving in order to: A. avoid sharing personal thought about their impending loss and feeling of grief since this is very subjective B. get self out of the way while he assists the client and his family express their feelings of impending loss C. prevent self from being affected by the familys grief and remain objective D. help the family plan for the funeral arrangement and burial services 69. One morning when the nurse enters the clients room. Mr. Principe asks the nurse to leave me alone and stop bothering me and I dont want your pity. The following response by the nurse would be MOST appropriate? A. You seem upset this morning and remains with the client B. You are probably upset because you dont feel well C. Why you are angry with me? What did I do anything to upset you? D. I understand and will leave you for a while 70. The nurse understands that the nurse-client relationship is a therapeutic alliance when: A. the nurse is a role model for a client B. this is an essential part of the nursing process C. the nurse has to be therapeutic at all times D. how the nurse thinks and feels affects her actions and behavior towards her client and her work Situation 15: Mr. Ong is for admission to the medical unit and you are his nurse. 71. The MOST important initial nursing approach when admitting client is to: A. introduce the client to the ward staff B. orient the client to the physical set up of the unit C. identify the most immediate needs of the client and implement the necessary intervention D. take V/S fro baseline assessment 72. When gathering baseline data, the BEST way for you to check if the client has pedal edema is to: A. talk to the relatives C. do auscultation B. interview the client D. do a physical assessment 73. You want to know the sleeping pattern of Mr. Ong You will: A. interview the clients and relatives B. take his BP before sleeping and upon waking up C. observe his sleeping pattern over a period of time D. perform physical assessment 74. Mr. Ong has severe pedal edema. Which accessory device would be appropriate for his condition?
A. footboard
B. cradle
C. bed board
D. rolled pillows
75. A student nurse is observed putting a standard size cuff on an obese client. The action would probably result in BP reading that is: A. false high B. false low C. normal D. undetectable Situation 16: Health is wealth specifically in this time of the century. The nurse is trained to promote well being of the people. 76. How does a nurse promote ones well being? A. periodic travels for rest and recreation B. faithful and observance of healthy simple lifestyle C. run away from polluted, stressful areas D. avoid sleepless, over fatigue nights 77. The nurse can be involved with health promotion as a significant person in helping the family: A. become a better family B. prevent disease C. control their symptoms D. modify health promotive behaviors
78. The nurse should NOT leave medication at the bedside because: a. the bedside table is not sterile b. it is convenient for the nurse c. the nurse will not be able to accurately document that the patient actually took the medication d. the patient may forget to take it. 79. Non-pharmacologic pain management includes all the following EXCEPT: a. relaxation techniques c. use of herbal medicines b. massage d. body movement 80. When assessing a clients blood pressure, the nurse finds it necessary to recheck the reading. How many seconds after deflating the cuff should the nurse wait before rechecking the pressure? a. 10 b. 30 c. 45 d. 60 Situation 17: Safe nursing practice involves an understanding of the law. 81. In the Philippines, this law is : a. The Philippine Nursing Act of 2002 or R.A. 9173 b. the Philippine Nursing Act of 1991 or R.A. 7164 c. IRR or Resolution 425 of 2003 d. Republic Act No. 8981 82. The Philippine Nursing Act delineates the scope of nursing. It specifies that independent practicing nurse is responsible for: a. health promotion and prevention of illness b. administration of written prescription for treatment and therapies c. rehabilitative aspect of care d. Collaborating with other healthcare providers for health restoration and alleviation of suffering
83. Standards of care provide the legal basis for evaluation of nursing practice or malpractice. Its functions include all EXCEPT: a. used by nurse experts to define what appropriate nursing practice is in a given situation b. used to measure or evaluate nursing conduct to determine if the nurse acted reasonably as any prudent nurse would under similar circumstances c. used to delineate the scope, function and role of the nurse d. use to measure or evaluate the conduct of nurse specialists who are certified in their own specialty fields 84. As a standard in ethics, this represents an understanding and agreement to respect another persons right to decide a course his or her own destiny: a. Autonomy b. justice c. Beneficence d. nonmalifecence 85. The Code of Ethics refers to standards of behavior or ideals of conduct. The ability to answer for and stand by ones action refers to: a. accountability c. advocacy b. veracity d. responsibility Situation 18: An understanding of the factors influencing the health care delivery system will enable nurses to adjust to change, create better ways of providing nursing care and develop new nursing roles. 86. Wellness clinics and health education activities have been integrated in government hospitals to render appropriate services. Which of the following purposes LEAST helps clients in cases of these health promotion activities? A. maintain maximum functions C. promote health habits B. reduce the costs of health care D. identify disease symptoms 87. With regards to illness prevention activities as part of nursing care, which of the following will help clients MOST? A. maintain maximum function C. promote habits related to health care B. reduce risk factor D. manage stress 88. By experience, which of the following nursing goals are MOST often overlooked by nurses and other members of the hospital team in the care of their clients in the hospital? A. illness prevention C. diagnosis and treatment B. health promotion D. rehabilitation of patients 89. Which of the following health care agencies is usually family-centered, relatively recent in popularity and oftentimes focuses on maintenance of comfort and satisfactory lifestyle of clients in the terminal phase of illness? A. non-government organization C. community health center B. hospice D. support group 90. Which of the following is NOT a legally binding document but nonetheless very important in the care of all patients in any setting? A. Bill of rights as provided in the Philippine Constitution B. Scope of nursing practice as defined in R.A. 9173 C. Patients Bill of Rights ( as adopted by American Nurses Association ) D. Board of Nursing resolution adopting the Code of Ethics Situation 19: One of the professional competencies that nurse must always demonstrate is in the area of communication:
91. Which communication technique would be MOST effective in eliciting detailed information from the client? A. open-ended questioning C. active listening B. verbalizing observations D. summarizing clients views 92. Which of the following terms refer to the senders attitude towards the self, the message and the listener? A. verbal communication C. non-verbal communication B. double-bind communication D. meta communication 93. In interacting with patients, the nurses should remember that a clients personal space is: A. that which revolves around the client C. clearly visible to others B. highly mobile depending upon certain situation D. the same as that of the nurse 94. In interpersonal communication is LEAST threatening during what type of relationship? A. social C. personal B. intimate D. professional 95. In demonstrating the method for deep breathing exercises, the nurse places the hands on the clients abdomen to explain diaphragmatic movement. This technique involves the use of which element of communication? A. appropriateness C. channel B. feedback D. message Situation 20: Roy, an adolescent, was diagnosed to have pneumonia. He constantly complains of chest pain and has a standing order of Morphine SO4. 96. Which of the following MOST appropriately describe pain sensation that has periods of remission and exacerbation? A. chronic C. acute B. intractable D. Psychosomatic 97. Roy is constantly asking to be relieved from pain. Since morphine is an addicting drug, which of the following is BEST for the patient? A. administer morphine SO4 PRN B. administer morphine on a routine schedule as ordered C. give instructions on relaxation technique to reduce frequency of pain sensation D. divert the attention by not limiting visitors 98. To get accurate information about the quality of pain the patient is experiencing, which of the following statements would be MOST APPROPRIATE? A. What cause you the pain? B. Tell me what your pain feels like C. Have you taken something to relieve the pain? D. Is it stubbing or radiating pain? 99. As the nurse assigned to Ray, which of the following can decrease his chest pain? A. supporting his rib cage when he coughs B. advising him C. teaching him D. encouraging him to breathe deeply 100. Which of the following is the nurses primary goal in caring for clients with chronic pain? A. change the clients perception of pain B. reduce the clients perception of pain
B. drink more milk, increased calcium intake prevents constipation C. eat more frequent small meals instead of three large ones daily D. walk for at least half an hour daily to stimulate peristalsis 9. A bilateral amputee is assisted by his wife and children to the commode for bowel evacuation. This example best demonstrates the familys assistance to meet which need? A. Elimination C. nutrition and metabolism B. activity D. health perception and health maintenance 10. Which of the following is the most important reason for doing a literature review for constructing a research study? A. helpful information on demographic instrument development could be uncovered B. existing knowledge about the identified problem can be found C. a determination of the studys feasibility could be extrapolated D. the research design can be copied from another study 11. Martina develops endometritis. What would be the best activity for her? A. lying in bed with a cold cloth on her forehead B. reading while resting in a trendelenburg position C. sitting with her feet elevated while playing cards D. walking around her room listening to music 12. Grace sustained a laceration on her leg from automobile accident. Why are lacerations of lower extremities potentially more serious among pregnant women than other? A. lacerations can provoke allergic responses due to gonadotropic hormone release B. a woman is less able to keep the laceration clean because of her fatigue C. healing is limited during pregnancy so these will not heal until after birth D. increased bleeding can occur from uterine pressure on leg veins 13. Fely has diarrhea for 2 days. She has sunken eyes, skin pinch goes back very slowly, and she is drinking poorly and irritable. She is not able to drink and there is no blood in the stool. How will you classify Felys illness? A. persistent diarrhea C. severe dehydration B. some dehydration D. no dehydration 14. The infectious agent that causes pulmonary tuberculosis is: A. mycobacterium tubercle C. Wuchereria bancrofti B. Hansens bacillus D. mycobacterium diphtheria 15. Your client, who happens to be female resident of the barangay you are covering, is an adult survivor who states: Why couldnt I make him stop the abuse? If I were stronger person, I would have been able to make him stop. Maybe it was my fault to be abused. Based on this, which would be your most appropriate nursing diagnosis? A. social isolation B. anxiety C. chronic low self-esteem D. ineffective family coping 16. Maybelle is also scheduled to have an amniocentesis to test for fetal maturity. What instructions would you give her before this procedure? A. void immediately before the procedure to reduce your bladder size B. no more amniotic fluid forms afterward, that is why only a small amount is removed
DECEMBER 2006 NP2COMMUNITY HEALTH NURSING AND CARE OF MOTHER AND CHILD 1. A child who is 13 months has fast breathing if he has: A. 30 breaths per minute or more B. 60 breaths per minute C. 40 breaths per minute or more D. 50 breaths per minute 2. Which of the following is true about discharge planning? A. basic discharge plans involve referral to community resources B. discharge plans involve referral to community resources C. simple referral involves use of a discharge planner D. complex referral includes interdisciplinary collaboration 3. A nurse may keep opened vials of OPV for use in the next session if: A. you have taken out the vaccine at the health center for some other reasons B. the expiry date has not passed C. the vaccines have been stored at a temperature between 0 deg C and 8 deg C D. the vaccines have change its color 4. The primary preventive measures against HIV-AIDS is: A. withdrawal C. foams and gels use B. virus killing drugs D. condom use 5. Ms. Amodia, RN works for a home health agency and cares for an older adult mental patient. On reporting to work, she observes numerous bruise and red marks on her patients face. Her patient seems upset. Ms. Amodia suspects that either abuse has occurred. Ms. Amodia should: A. contact the mobile police to investigate the abuse B. make an appointment with an elder adult counselor C. wake her son and ask him who would hurt his mother D. call her supervisor right away to report the findings 6. If there develops severe pre-eclampsia, what would be the drug you would anticipate to be prescribed and that you would have to administer? A. a loop diuretic C. ranitidine (zantac) B. magnesium sulfate D. a non-steroidal inflammatory agent 7. As a community health nurse you always bear in mind that the purpose of empowering victims of violence is to: A. tell them how to solve their problems B. convince victims to leave their abusers C. help clients become aware that they have control over their lives D. develop safety escape plans for them 8. Maria is developing constipation from being on bed rest. What measure would you suggest she take to help prevent this? A. drink 8 full glasses of fluid such as water daily
C. the intravenous fluid infused to dilate your uterus does not hurt the fetus D. the x-ray used to reveal your fetus position has no long-term effects 17. When planning teaching strategy for a pregnant woman, the nurse should do which of the following? A. give information about how the woman can manage the specific problems she identifies as relevant in her life B. omit information related to minor pains of pregnancy to prevent the woman from developing hypochondria C. provide all information to the woman in a group session with other pregnant women so she can have someone to discuss it with D. during the first prenatal visit, teach a woman the care measures necessary for health promotion throughout the pregnancy 18. Which of the following symptoms is LESS commonly noted in EARLY pregnancy? A. frequency of urination B. chills and fever C. varicosities D. Braxton Hicks Contractions 19. Bonnie, 3 months pregnant, has reported for her first prenatal visit. The nurse should instruct her to do which of the following? A. eat more dairy products and green leafy vegetables to provide an additional 300 calories each day B. increase her intake of carbohydrates-breads and sweets to prevent protein metabolism C. eat whenever she feels hungry because her body will let her know when she needs nutrients and extra calories D. limit intake of amino acids to prevent development of diabetic ketoacidosis 20. The nurse is assisting Mr. and Mrs. Cruz to prepare for childbirth in the home setting. Which of the following supplies should be readily available for the infant immediately after birth? A. vitamin K to avoid bleeding B. mild soap without perfume so as not to irritate the skin C. bulb syringe to suction fluid and mucous from the mouth D. heating lamp to avoid chilling from water evaporation 21. Which of the following could be included in the outcome criteria for a patient with a nursing diagnosis, Knowledge deficit related to potential for altered tissue perfusion in fetus or mother related to maternal cardiovascular disease? A. bedrest is maintained at home after the 36th week of gestation B. fetal heart rate will remain between 120 and 160 beats a minute C. jugular vein distention is evident when lying at 45 degrees D. maternal blood pressure maintained above 150 systolic 22. Pregnant women should be taught to be careful to avoid accidental injury. They are prone to falls for which of the following reasons? A. additional weight from pregnancy may disturb balance when walking B. fetal activity stimulates the nerves of the legs and causes weakness C. high levels of hormones often impair judgment resulting in reckless behavior D. increased adrenalin released during pregnancy causes women to move faster than usual 23. When a nurse uses the IMCI model, the IMCI chart uses illness classification, e.g. the pink row needs: A. no specific treatments such as antibiotics B. urgent referral C. appropriate antibiotics D. no urgent measures
24. Which of the four signs of good attachment is true in this statement? A. the chin should touch the breast while the mouth is wide open and while the lower lip is turned inward more areola is visible above than below B. the chin should touch the breast, the mouth is wide open while the lower lip turned outward and more areola visible above than below C. the chin should touch the breast while the mouth is wide open while the lower lip turned outward and more areola visible below than above D. the chin should touch the breast while the mouth is wide open and the lower lip turned inward, more areola is visible above than below 25. Which type of research inquiry investigates the issues of human complexity ( e. g. understanding the human expertise?) A. positivism C. logical position B. quantitative research D. natural inquiry 26. Carol is 15 months old and weighs 5.5 kgs and it is her initial visit. Her mother says that Carol is not eating well and unable to breastfeed, he has no vomiting, has no convulsion and not abnormally sleepy or difficult to awaken. Her temperature is 38.9 deg C. Using the integrated management of childhood illness or IMCI strategy, if you were the nurse in charge of Carol, how will you classify her illness? A. a child at a general danger sign C. severe pneumonia B. very severe febrile disease D. severe malnutrition 27. Why are small for gestational age newborns at risk for difficulty maintaining body temperature? A. their skin is more susceptible to conduction of cold B. they are preterm so are born relatively small in size C. they do not have as many fat stored as other infants D. they are more active than usual so they throw off comes 28. Oxytocin is administered to Rita to augment labor. What are the first symptoms of water intoxication to observe for during this procedure? A. headache and vomiting C. a high choking voice B. a swollen tender tongue D. abdominal bleeding and pain 29. Which of the following treatment should NOT be considered if the child has severe dengue hemorrhagic fever? A. use plan C if there is bleeding from the nose or gums B. give ORS if there is skin Petechiae, persistent vomiting, and positive tourniquet test C. give aspirin D. prevent low blood sugar 30. In assessing the patients condition using the Integrated Management of Childhood Illness approach strategy, the first thing that a nurse should do is to: A. ask what are the childs problem B. check the patients level of consciousness C. check for the four main symptoms D. check for the general danger signs 31. A child with diarrhea is observed for the following EXCEPT: A. how long the child has diarrhea C. presence of blood in the stool B. skin Petechiae D. signs of dehydration
32. The child with no dehydration needs home treatment. Which of the following is NOT included in the care for home management at this case? A. give drugs every 4 hours C. give the child more fluids B. continue feeding the child D. inform when to return to the health center 33. Ms. Jordan, RN, believes that a patient should be treated as individual. This ethical principle that the patient referred to: A. beneficence C. respect for person B. nonmaleficence D. autonomy 34. When patients cannot make decisions for themselves, the nurse advocate relies on the ethical principle of: A. justice and beneficence C. beneficence and nonmaleficence B. fidelity and nonmaleficence D. fidelity and justice 35. Being a community health nurse, you have the responsibility of participating in protecting the health of people. Consider this situation: Vendors selling bread with their bare hands. They receive money with these hands. You do not see them washing their hands. What should you say/do? A. Miss, may I get the bread myself because you have not washed your hands B. All of these C. Miss, it is better to use a pick up forceps/ bread tong D. Miss, your hands are dirty. Wash your hands first before getting the bread 36. If a child with diarrhea has 2 or more signs in the IMCI pink row chart, the classification will be: A. moderate dehydration C. no dehydration B. some dehydration D. severe dehydration 37. If the capillary refill takes more than 3 seconds it may mean: A. the child is in shock C. circulatory failure B. the child is dehydrated D. the child is alright 38. Leprosy is a chronic disease of the skin and peripheral nerves. Which of the following signs are present in the early stage? A. loss of eyebrows C. contractures B. clawing of fingers D. thickening or painful nerves 39. In asking the mother about her childs problem the following communication skills should be used EXCEPT: A. use words that the mother understand B. give time for the mother to answer the question C. listen attentively D. ask checking questions 40. Patients eligible under the short term chemotherapy (STC) are the following EXCEPT: A. all newly discovered and reconfirmed sputum positive cases B. those with cavitary lung findings after two successive negative sputum examination C. patients without having been given consent for anti-TB treatment D. patients willing to undergo treatment 41.When planning comfort measures to help the woman in active labor to tolerate her pain, the nurse must consider which of the following? A. early labor contractions are usually regular, coordinated, and very painful B. if women are properly prepared, they will require no pain medication to manage their pain C. pain medication given during the latent phase of labor is not likely to impair contractions
D. the acceleration phase of labor can be a time of true discomfort and high anxiety 42. Francis is admitted in active labor. The nurse locates fetal heart sounds in the upper left quadrant of the mothers abdomen. The nurse would recognize which of the following? A. Francis will probably deliver very quickly and without problems] B. This indicates Francis will probably have a breech delivery C. The fetus is in the most common anterior fetal positions D. this position is referred to as being left anteriopelvic 43. While interviewing a woman in labor, the nurse would address which of the following? A. whether the pregnancy was planned B. the use of medications during pregnancy C. maternal concerns regarding fetal health D. all of the above 44. If a woman will be placing her baby for adoption, which of the following nursing measures should be implemented during the labor stages? A. avoid discussing the baby during the historical assessment to minimize the womans anxiety B. support the woman as needed by accepting the decisions she makes regarding holding the baby C. protect the woman from visitors and family members who might try to change her mind D. take the baby away as soon as possible after birth to prevent bonding from occurring 45. During the third stage of labor, the nurse may have which of the following responsibilities? A. administration of intramuscular Oxytocin to facilitate uterine contractility B. monitoring for blood loss greater than 100 cc, which would indicate gross hemorrhage C. noting if the placenta makes a Schultz presentation, which is a sign of gross complication D. pushing down on the relaxed uterus to aid in the removal of the placenta 46. Immediately following episiotomy repair, the nurse would do which of the following? A. cleanse the womans anal area, then perineum and vulva, to remove any fecal incontinence or vaginal secretions B. monitor the woman for shaking and complaints of chill sensations, which may indicate an adverse reaction to medications C. palpate the uterus fundus for size, consistency and position and take vital signs to obtain baseline data D. remove all coverings except a clean, light hospital gown to prevent the development of postpartal fever 47. Mr. Tony has been hospitalized for months following special spinal cord surgery. The boys club in his hometown was renamed the Tony boys club, and a parade is planned to honor Mr. Tony. Such community action should positively influence Mr. Tonys: A. self-perception and self concept B. cognition and perception C. health perception and health maintenance D. coping and stress tolerance 48. Which of the following conditions is not true about contraindication to immunization? A. do not give BCG if the child has known hepatitis B. do not give BCG if the child has known AIDS C. do not give DPT to a child who has recurrent convulsion or active neurologic disease D. do not give DPT2 or DPT3 to a child who has had convulsions within 3 days of DPT1 49. Which of the following might prevent the conduct of a research study? A. in order to gather data for the research, excessive risk to subject is required
B. costs for conducting the study are low compared to the potential benefits from the researcher C. the identified problem is covered in the literature D. the research problem is based on untested nursing theories 50. Marsha is concerned she may loose an excessive amount of blood with cesarean surgery. What is the usual amount of blood loss with cesarean birth? A. 250 350 ml C. 100 220 ml C. 500 1000 ml D. 300 500 ml 51. If the child is 4 months, which of the following questions SHOULD NOT be included in checking the general danger signs? A. ask if the child is eating well during illness B. ask if the child is able to breastfeed C. ask if the child has had no convulsion D. ask if the child vomits everything 52. Arnie, like all newborns, can loose body heat by conduction. Under which conditions is this most apt to occur? A. if the nursery is cooled by air conditioning B. if the infant is wet from amniotic fluid C. if Arnie is placed in a cold bassinet D. if there is a breeze from an open window 53. You have just entered Mr. Tiangcos room and observed him lyin g on the floor next to the bed. The side rails on the bed are down. When you asked Mr. Tiangco what happened, he replies. I was asleep and the next thing I knew I was on the floor. Which of the following examples of documentation is MOST APPROPRIATE for this situation? A. Lying on floor next to bed. No complaints verbalized. Side rails down. Appears to have fallen out of bed while asleep. B. Mr. Tiangco was found lying on the floor next to his bed. When asked what happened, he stated I was asleep and the next thing I knew I was on the floor. C. Lying on the floor, side rails down. Rolled out of bed while asleep. D. Mr. Tiangco fell out of bed while asleep; both side rails were left down. 54. The application of public health, medical and engineering practices to health services and effectiveness of workers may be termed as: A. community health C. school health B. occupational health D. mental health 55. A literature review should be: A. brief and limited B. broad and theoretical
57. Every year we discover new methods or gadgets to improve mans life. The resear ch typed used of this nature is: A. applied C. experimental B. developmental D. quantitative 58. When should the mother give complementary foods to a 5 months old infant? A. if the child gives adequate weight for his age B. if the child shows interest in semi solid foods C. supplementary foods should be given before breastfeeding D. if the child is breastfed less than 8 times in 24 hours 59. Hepatitis A is differentiated from hepatitis B by their mode of transmission. Hepatitis B is transmitted through: A. insect bites C. transfusion and injection B. urine D. fecal waste 60. The nurse wants to immunize a 1 year old child for measles. The child has been classified as having pneumonia and no anemia and not very low weight. The childs mother do es not want her child to be immunized and instead they will just return as soon as the child is better. How will the nurse explain the importance of immunizing the child with measles now? A. the childs condition is not a hindrance to immunization according to W.H.O. B. the child has lower resistance and more prone to disease C. the child will recover faster if the child will be immunized D. it is the childs schedule to have the immunization 61. To implement the case finding aspect of TB control, sputum examination should be done to the following groups: A. children 0-9 years old with cough for 2 weeks or more B. all persons of all ages above 1 year with symptoms indicative of tuberculosis C. children below 10 years old with fever for 3-5 days D. all persons ages 10 years and over with progressive loss of weight 62. Mr. Barmonte was brought home with an advance directive, but the nurse is not sure that she can follow his wishes. The nurse should: A. follow the directive even though the nurse is uncomfortable with the directives B. call Mr. Barmontes lawyer C. discuss with the interdisciplinary team in charge of Mr. Barmonte and the organizations ethics committee D. ignore the advance directive 63. A term concerning body resistance which refers to protein present in the serum of the blood: A. antibodies C. antigen B. antitoxin D. allergen 64. A health care service in which risk factors are identified, occupational safety measures reduce, and a public education program begun is: A. health promotion B. illness prevention C. treatment facility D. rehabilitation
56. The Santiago Family lives in a makeshift house in Julugan, Tanza, Cavite. Composed of 8 members, the eldest son Rhio is 7 years old. Rhean is 6, Queenie and Quency are twins 5, Peter is 4 and the youngest is 6 months old named Oscar. Aling Rosa works in a laundry earning Php 1,500.00 a month and husband Mang Sony works as fish vendor earning Php 150.00 per day. Peter and the twins are enrolled in the day care. Rhio and Rhean stopped studying to help their parents for their younger brothers and sisters. With the current condition besetting the Santiago family, which of the following interventions can lend assistance to them? A. refer the children to a hospice care facility B. assist Aling Rosa to be referred to the DSWD for livelihood assistance C. give Aling Rosas family a Php 2,000.00 worth of capital for them to put a fishball stand D. advise Aling Rosa to use contraceptive pills
65. A community health nurse (CHN) visits the Gomez family weekly. Although family income seems adequate, Mrs. Gomez is unable to budget it over a 4-week period. The nurse asks what may be done to help Mrs. Gomez shrugs her shoulders and says, Tomorrow may never come. Mrs. Gomezs reaction is described as: A. reflecting her culture, values, and time orientation B. one of not caring about her familys needs C. her belief that income may not be adequate as perceived by the CHN D. indicating that her budget needs is a private matter 66. A positive or negative feeling toward a person, object, or idea is known as a/an: A. merit C. moral B. value D. attitude 67. When the nurse assists the clients in understanding personal values, this is an example of value: A. validation C. clarification B. discovery D. choice 68. While doing a nutritional assessment of a low-income family, the community health nurse determines the familys diet is inadequate in protein content. The nurse could suggest which of the following foods to increase protein content with little increase in food expenditure? A. oranges and potatoes C. rice and macaroni B. potatoes and rice D. peas and beans 69. A new mother who is breast-feeding her baby asks the nurse when she should start her feeding baby vegetables. The nurse would suggest the MOST APPROPRIATE age to begin vegetables is: A. 3 to 4 months C. 6 to 8 months B. 4 to 5 months D. 9 to 12 months 70. Assessment areas for the nurse is working with the family on health promotion strategies would include: A. the television shows that they watch B. the family and all the relatives statuses C. the perceived health status and illness patterns of the family D. the mental status of family and friends 71. The nurse manager wishes to implement a new way of determining the vacation schedule for the staff. The senior staff opposes the change while the newer staff seems more accepting of the change. An effective strategy for resolving this difference in acceptance would be to: A. explain that the change will occur as designed, regardless of the staffs preference B. tell the staff that if they really do not want the change, it will not be implemented C. provide extensive and detailed rationale for the proposed change D. encourage each side to share their views with each other 72. The following are the duties of the Public Health Nurse EXCEPT: A. leave to the BHW the responsibilities of educating the community B. provision of nursing care to the sick and well individuals C. provision of technical and administrative support to rural health midwives D. conduct of pre and post consultation conference for clinic patients 73. An 8 month old has fast breathing if he has: A. 40 breaths per minute B. 55 breaths per minute C. 38 breaths per minute D. 45 breaths per minute
74. The following are the concerns of the Public Health Nurse on the third trimester of pregnancy EXCEPT: A. advice for the mother to take oral contraceptive B. where to give birth C. proper timing in the separation of mother to other siblings D. type of feeding 75. When a child with persistent diarrhea returns for follow-up visit after 5 days, the nurse should ask the mother if the diarrhea has stopped when: A. the child has less than 3 loose bowels per day B. the child has 4 semi formed stool C. the child has 5 formed stools D. the child has 3 loose stools/day 76. In barangay Y, one of the identified problems is unavailability of toilet facility for the residents. The appropriate intervention is: A. secure donations in the form of toilet bowls B. ask help from local government C. none of the above D. conduct a community assembly and discuss the consequences of this problems 77. A home visit is a professional interaction between the community health nurse and his patient or the family. Where could the nurse get available information about the patient or the family to be visited? A. document file C. doctors office B. records and reports D. family health record 78. In planning a home visit, the nurse considers the individual needs. Which of the following is a priority? A. needs of all family members C. follow-up of medication and treatment B. needs recognized by the family D. clinic schedules after home visit 79. Which of the following is the FIRST action of the nurse during a home visit? A. greet the client or the household members B. state the purpose or objective of the visit C. give necessary health teaching D. inquire about welfare and health condition of the client 80. Which factor must be considered by the nurse as vital to determine frequency of the home visit? A. available resources C. acceptance of the family B. policy of the agency D. past nursing services 81. Eating habits of the family has changed due to the existing fast food establishment in the area. What health risk should you warn the family? A. food-borne infection C. increase weight B. indigestion D. hand washing 82. To show a mother how to help her to have good attachment of the infant during breast feeding. Which of the following statement SHOULD NOT be included? A. place the infant in your most convenient position B. touch the infants lips with her nipples C. wait until the infants mouth is widely open D. move the infant quickly onto her breast, aiming the infants lips well below the nipple
83. When members of the community identify needs, work on its solutions with confidence in the spirit of cooperation. The process is: A. nurses professional effort C. community organizing B. government assistance D. leadership through traditional leaders 84. In assessing the level of family cohesion, you have determined that the family is very close and has very high loyalty, and members are highly dependent on one another. You would document this as which level of cohesion: A. separated C. connected B. enmeshed D. disengaged 85. Mrs. Ayuyao, 77 year old, has been admitted with pneumonia. Her husband asks the nurse about the living will. As a license nurse, you remember that living wills: A. are legally binding in all states B. allow the court to decide when the care can be given C. allow the individual to express his or her wishes regarding care D. allow health workers to withhold fluids and medications 86. Maybelle is scheduled to have an ultrasound examination. What instructions would you give her before her examination? A. The intravenous fluid infused to dilate your uterus does not hurt the fetus B. you will need to drink at least 3 glasses of fluid before the procedure C. void immediately before the procedure to reduce your bladder size D. you can have medicine for pain for any contractions cause by the test 87. What is the most common type of health problem seen in the health care system? A. poor prenatal care C. immobility B. lack of information available to patients D. increased rate of chronic disease 88. Which of the following is the best type of disease prevention? A. immunization C. community social events B. yearly physical exam D. behavior that promotes health 89. Nurses who deliver community-based care must have which of the following qualities? A. adaptability C. ability to be self-directed B. tolerance of various lifestyle D. all of the above 90. A nurse has scheduled a hypertension clinic. This service would be an example of which of the following types of health care? A. tertiary prevention C. primary prevention B. secondary prevention D. protection 91. When providing care in a home, how might the nurse best implement infection control? A. cleanse the hands before and after giving direct patient care B. remove the patients wound dressings from the home C. dispose off patients syringes in the patients garbage D. disinfect all work areas in the patients home 92. Which of the following is a leading health problem of school-age children? A. ear aches C. obesity B. attention disorders D. malnutrition
93. If the child does not have ear problem, what should the nurse do? A. check for tender swelling behind the ear B. check for ear pain C. check for ear drainage D. got to diet question, check for malnutrition 94. Nona had her pelvic measurement taken. What size should the ischial tuberosity diameter be, to be considered adequate? A. have the width of symphysis pubis C. 11 cm B. 8 cm D. twice the width of the conjugate diameter 95. In classifying the childs illness using the IMCI color-coded triage, each illness is classified according to whether it requires the following EXCEPT: A. urgent pre-referral treatment and referral C. immunization B. simple advice on home management D. specific medical treatment 96. Which of the following is an example of hostile environment in terms of sexual harassment? A. the boss assures you of a big promotion if you go out on a couple of dates with him B. your supervisor makes masturbatory gestures every time you walk pass him C. the personnel manager hints that the job will be yours if you cooperate sexually with him D. your boss suggests that your raise is dependent upon having sex with him 97. Which among these activities is the concern of the Primary Level? A. administration of BCG vaccine for a 10 days old baby B. insertion of a nasogastric tubes to patients C. administer diuretics such as furosemide per doctors order D. regulate intravenous fluid drop rates 98. Which of the following vaccine in the Expanded Program of Immunization have a 4 weeks interval? A. OPV C. BCG B. AMV D. Tetanus Toxoid 99. The nurse who is planning a health promotion program with clients in the community will have the LEAST focus on: A. assisting the clients to make informed decisions B. organizing methods to achieve optimal mental health C. reducing genetic risk factors for illness D. providing information and skills to maintain lifestyle changes 100. A holistic belief system by the nurse would be most evident if the nurse: A. incorporates client perceptions of health when planning care B. encourages behavior modification program C. supports goal-directed learning to improve health D. accepts death as an outcome of life
DECEMBER 2006 NP3 NURSING CARE OF CLIENT WITH PHYSIOLOGICAL AND PSYCHOSOCIAL ALTERATIONS
1. A group of nurses are studying the case of a 16-year old nursing student who was accused of frustrated homicide. Benny can determine their understanding of circumstantial evidence if they can identify which of the following in the case? a. justifying circumstances c. exempting circumstances b. aggravating circumstances d. mitigating circumstances 2. E.M. is a 30-year old premenopausal female who is asking the nurse the most appropriate time of the month to do her self-examination of the breast. The MOST appropriate reply by the nurse would be: a. the 26th day of the menstrual cycle b. 7 to 8 days after conclusion of the menstrual period c. during her menstruation d. the same day each month 3. Copies of certain portions of the chart maybe released at the discretion of the hospital but may be limited to: a. x-ray result, treatment orders, and surgery technique b. laboratory results and abstract only c. laboratory results, OR reports and patients abstract d. OR reports, laboratory results, nurses notes 4. Jenny is reading the progress notes of her patient and reads that the physician had documented insensible f luid loss of approximately 800 ml daily. She understands that this type of fluid loss can occur through: a. urinary output c. the skin b. the gastrointestinal part d. wound drainage 5. Communication can be verbal and non-verbal. Examples of non-verbal communication in patient-nurse relationship are the following EXCEPT: a. signs c. symptoms b. restlessness d. using an interpreter like a family member 6. The perioperative nurse assumes responsibility and accountability for nursing judgments and actions exemplified by the following, EXCEPT: a. accepting on-call assignment b. accepting committee assignment c. selecting a.m. shift only d. maintaining basic nursing procedure
c. exposing the arm to sunlight to increase circulation d. wrapping the arm with elastic bandages during the night 10. Ms. De Leon is suffering from Bells palsy as indicated by a feeling of stiffness and a drawing sensation of the face. In teaching her about the disease, what would be important to tell her? a. There may be increased sensitivity to sound b. There is a heightened awareness of taste, so that foods must be bland c. The eye is susceptible to injury if the eyelid does not close d. Drooling from an increase of saliva on the affected side may occur 11. The patient is scheduled for adrenalectomy. In the preoperative period, the priority nursing action would be to monitor: a. urine for glucose and acetone b. vital signs c. intake and output d. blood urea nitrogen results 12. Virtue ethics gives us a special prospective in the parents role to decide for their children including decision of: a. professional choice of children b. spouse choice for children c. life and death prior to conception and birth d. gender choice for children 13. One of the reasons why behavior in the OR is so tightly controlled is: a. it is hard to move around in a OR gown b. the door of OR suite are closed c. everybody is busy doing their operation d. to prevent the cross-contamination of infection between OR staff and patient 14. One of the hidden dangers in the OR is missing instruments. What is the appropriate approach to this happening? a. correct labeling b. a place for everything and everything in its place c. install a flush sterilizer in the OR d. increase instrument inventory 15. Ms. W.O. is found on the floor of her room. She fell while crawling over the side rails of her bed. She is unconscious and has a large laceration to the head that is bleeding profusely. The nurses priority action would be: a. apply direct pressure to the laceration to her head b. ensure the patient has an open airway c. notify the physician d. check the patients vital signs 16. During admission of a patient with a severe head injury to the emergency department, the nurse places the highest priority on assessment for: a. presence of a neck injury b. neurological status with the Glasgow Coma Scale c. cerebrospinal fluid leakage from ears or nose d. patency of airway
7. What one condition besetting the nursing service prevents the use of team approach? a. fast turn-around of nurses c. understaffing b. no administrative support d. politics in the nursing department 8. Fe, a nurse at the PACU discovered that Luisa, 50 kilos who is 3 hours post cholecystectomy was in severe pain. Upon checking the chart, she found out that Luisa had Demerol 100 mg I.M. prn for pain. What should Fe do? a. verify the order from the M.D. b. inject 100 mg. Demerol I.M. to Luisa c. report to the nurse supervisor for opinion d. administer the recommended dose which is 50 mg because Luisa weighs 50 kilos 9. Postoperatively, the nurse teaches the patient with a modified radical mastectomy to prevent lymphedema by: a. avoiding unnecessary trauma (e.g. Venipuncture, BP) to the arm on the operative side b. using a sling to keep arm flexed at the side
17. In the hospital, the best indicator of quality is: a. patients recover but spend more on supplies b. patients come back with referral like their family and friends c. patients demand more use of technology d. patients come back of their doctors advice 18. A most critical strategy in nursing communication is: a. non-verbal communication b. giving stereotyped comments c. verbal communication d. active listening 19. Mr. T.O. has undergone surgery for lyses of adhesions. He is transferred from Post Anesthesia Care Unit (PACU) to the Surgical floor, the nurse should obtain blood pressure, pulse and respiration every: a. 3 minutes c. 15 minutes b. 30 minutes d. 20 minutes 20. Mr. K, age 13, is diagnosed with chronic bronchitis. He is very dyspneic and must sit up to breath. An abnormal condition in which there is discomfort in breathing in any bed or sitting position is: a. Cheyne-stokes c. eupnea b. orthopnea d. dyspnea
26. Following a fracture of the forearm or tibia, complaints of sharp, deep, unrelenting pain in the hand or foot unrelieved by analgesics or elevation of the extremity indicate which complication? a. cast syndrome b. compartment syndrome c. gangrene d. fat embolism 27. Another worthy study is the compliance to the principles of aseptic technique among the sterile OR team. Who does NOT belong to the sterile OR team? a. scrub nurse c. x-ray technician b. assistant surgeon d. surgeon 28. Circulation must be restored within 4 minutes of cardiopulmonary arrest because: a. the lungs fill with fluid b. the blood begins to coagulate c. brain cells begin to die d. irreversible kidney failure develops 29. Benny elaborated on the concept of informed consent. He determines that the nurses need more explanation if their response is one of the following: a. the consent should provide a description of alternative treatments or procedures b. the consent should offer a thorough explanation of the procedures to be done and the consequences of it. c. the consent should include the medical diagnosis and explanation of the patients condition d. the consent should describe the prognosis if the recommended care is refused. 30. Which of the assessment findings would indicate a need for possible glaucoma testing? a. intermittent loss of vision c. halos around lights b. presence of floaters d. pruritus and erythema of the conjunctiva 31. The diabetic patient asks for a snack and something to drink. The MOST appropriate choice for this client to meet nutritional needs would be which of the following: a. crackers with cheese and tea b. toast with peanut butter and cocoa c. vanilla wafers and coffee with cream d. graham crackers and warm milk 32. The patient demonstrates knowledge of the psychological response to the operation and other invasive procedure when she asks about: a. Who will be with me in the OR? b. How is the post operative pain over the site like? c. Will I be naked during the operation? d. Is it cold inside the 33. In teaching the mother the proper administration of tetracycline eye ointment, which of the following is MOST crucial? a. squirt a small amount on the inside of the infected eyes lower lid b. use clean, wet cloth to gently wipe away the pus c. wash hands before medication administration d. do not use other eye ointments or drops or put anything else in eyes. 34. The primary goal of nursing interventions after a craniotomy is: a. avoiding need for secondary surgery b. ensuring patient comfort c. preventing increased intracranial pressure d. prevention of infection
21. The nurse recognizes that the MOST common causative organism in pyelonephritis is: a. E.Coli c. Candida Albicans b. Klebsiella d. Pseudomonas 22. There is a global concern on AIDS. There are legal and ethical concerns specially: a. duty siblings and spouse c. confidentiality b. need for universal testing d. public support and understanding 23. Mr. WT is cleaning the garage and splashes a chemical to his eyes. The initial priority care following the chemical burn is to: a. irrigate with normal saline for 1 to 15 minutes b. transport to a physician immediately c. irrigate with water for 15 minutes or longer d. cover the eyes with a sterile gauze 24. Licensed nurses from foreign countries can practice nursing in the Philippines in the following condition: a. employed in state colleges and universities b. special projects with hospitals with a fixed fee c. employees by private hospitals d. medical mission whose services are free 25. A patient diagnosed with breast cancer has been offered the treatment choices of breast conservation surgery with radiation or a modified radical mastectomy. When questioned by the patient about these options, the nurse informs the patient that the lumpectomy with radiation: a. reduces the fear and anxiety that accompany the diagnosis and treatment of cancer b. has about the same 10-year survival rate as the modified radical mastectomy c. provides a shorter treatment period with a fewer long term complications d. preserves the normal appearance and sensitivity of the breast.
35. Mr. Salvo, a 35 year old male, has been admitted with the diagnosis of peptic ulcers. The nurse recognizes which drugs as those MOST commonly used in these patients to decrease acid secretions? a. erythromycin and flagyl b. Tagamet and zantac c. Maalox and kayexalate d. Dyazide and carafate 36. When reading the urinalysis report, the nurse recognizes this result as abnormal: a. red blood cells 15-20 c. glucose negative b. turbid d. ph 6.0 37. Mr. Hizon has had cataract surgery. Discharge teaching would include: a. wearing eye patches for the first 72 hours b. bending at the waist acceptable if done slowly c. bending at the knees and keeping the head straight d. lifting light objects is acceptable 38. Endoscopic minimally invasive surgery has evolved from diagnostic modality to a widespread surgical technique. What department should the nurse collaborate which is unusual in conventional surgery? a. engineering department c. blood bank services b. x-ray department d. linen section 39. When the client is discharged from the hospital and is not capable of doing the needed care services, the following can assume the role, EXCEPT: a. family members c. significant others b. chaplain d. responsible caregiver 40. R.N. denotes that a nurse: a. has satisfactorily completed with the requirements to practice nursing as set by the state. b. has a baccalaureate degree in nursing c. is professionally ready to practice nursing d. just a title 41. Urinary tract infection is the most common site of nosocomial infection particularly with urinary catheterization. It can be reduced significantly by through: a. intermittent drainage c. hanging system drainage b. open system drainage d. closed system drainage 42. The professional license of an RN is: a. transferable c. can be revoked for reasons stipulated in RA 9173 b. lifetime d. personal 43. In medical and nursing practice, code means a call for: a. DNR state c . clinical case b. call to order d. cardiopulmonary resuscitation 44. A thumb mark of a comatose patient in the informed consent is considered: a. a misrepresentation c. a not valid signature b. nothing d. a valid signature
45. The OR team collaborates from the first to the last surgical procedure. Who monitors the activities of each OR suite? a. scrub nurse c. circulating nurse b. anesthesiologist d. surgeon 46. Organ donation to save life was initially with the first transplant done by: a. Dr. Christian Barnard of the Union of South Africa b. Dr. Christian of the U.S.A. c. Dr. Christian Barnard of Soviet Union d. Dr. Christian Barnard of U.K. 47. Ms. C.O., age 45, is being evaluated to rule out pulmonary tuberculosis. Which finding is MOST closely associated with TB? a. green-colored sputum c. leg cramps b. night sweats d. skin discoloration 48. Following a renal angiography, the patient assessment priority is the: a. respiratory effort c. urinary output b. blood pressure d. puncture site 49. In patients with acute pancreatitis, the administration of the analgesic morphine may cause: a. addiction c. paralytic ileus b. urinary retention d. spasms of the sphincter of Oddi 50. Who is responsible in daily monitoring the standards of safe, nursing practice in the operating suite? a. surgeon c. OR nurse supervisor b. perioperative nurse d. chief nurse 51. Cathy is giving bed bath to an assigned client. A nursing aide enters the patients room and informs her that another patient is in pain needs pain medication. The appropriate action of Cathy is: a. ask the nursing aide to continue the bed bath after asking the permission of the patient so Cathy can attend to the other client b. Cover the client, raise side rails, tell the client that Cathy has to administer the pain medication first, then will return as soon as possible c. finish the bed bath, then administer the pain medication d. ask the nursing aide to stay with the other client while Cathy finishes the bed bath 52. Which of the following health teachings by the nurse will be MOST appropriate in home medication administration? a. determine the appropriate drug and dosage for the childs age or weight b. ask the mother to give the first dose of the drug to her child c. demonstrate to the mother how to measure a dose d. tell the mother the reason for giving the drug to the child 53. The patients medical record is the best evidence of the care that is given to the patient. It is the property of: a. the patient owns the record b. the physical property of the hospital c. the health team property d. the doctor owns the record 54. Edna classified the patient as having diarrhea with severe dehydration. Which of the following interventions would the nurse employ?
a. advise the mother regarding follow-up after 5 days b. give a tetracycline tablet c. refer urgently to the nearest hospital d. give vitamin A 55. A physician has prescribed propylthiouracil for a client with hyperthyroidism. A nurse develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding this medication is to assess for: a. signs of renal toxicity b. signs and symptoms of hyperglycemia c. relief of pain d. signs and symptoms of hypothyroidism 56. An external insulin pump is prescribed for a client with with diabetes mellitus. The client asks Eddie about the function of the pump. He bases the response on the information that the pump: a. is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. b. is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals c. continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels d. gives a small continuous dose of regular insulin, and the client can self-bolus with an additional dosage from the pump prior to each meal. 57. In evaluating the care of Ms. O.P., a young female executive admitted with bleeding peptic ulcer, the nurse focuses on nursing interventions. A nursing intervention associated with this type of patient is: a. frequently monitoring arterial blood levels b. checking the patients low residue diet. c. checking the blood pressure and pulse rates each shift d. observing vomitus for color, consistency, and volume 58. During surgery, movement of personnel should be: a. kept to a minimum c. monitored b. restricted d. eliminated when possible 59. Ms. Dee is a 27-year-old housewife and mother of two children. She is being seen by the nurse at the health maintenance organization for signs of fatigue. She has the history of iron deficiency anemia. Which of the following data from the nursing history indicates that the anemia is NOT currently managed effectively? a. pallor c. monitored b. poor skin turgor d. respirations 18 and regular 60. Which of the following would be MOST effective in promoting adequate respiratory function in an unconscious client recently admitted to the PACU with no contraindications to movement? a. extending clients chin while on his side and pillow at the back b. turning the client from side to side at 10-minute interval c. placing the client prone to facilitate drainage of secretions d. performing jaw thrust maneuver while client is supine 61. The patient has a right to information regarding the operation or other invasive procedure and potential effects. This right is achieved through: a. informed consent c. charting b. preoperative visit d. doctors rounds 62. Which statement about a persons character is evident in the OR team?
a. it assists in the control of feelings, thoughts and emotions in the face of difficulty b. it reflects the moral values and beliefs that are used as guides to personal behavior and actions c. it encourages the constructive use of the pleasure of the senses d. it refers to the quality of being righteous, correct, fair and impartial 63. Mrs. XP underwent D and C for dysfunctional bleeding. What is inserted vaginally to prevent postoperative bleeding? a. perineal pad c. vaginal suppository b. vaginal packing d. gelfoam 64. Reusable supplies/instruments are still widely used in the Philippine OR setting. A clear advantage of singleuse items is: a. transmission of infection during processing is avoided b. convenience c. guaranteed first class quality d. integrity and functionality is assured. 65. It is important to teach the patient the warning signs for skin cancer. Which of the following is a warning sign of cancer? a. smooth surface c. border irregularity b. decreasing diameter d. mole symmetry 66. In teaching the patient with Parkinsons disease, which response would indicate the need for further education? a. I should eat a diet high in fiber and roughage to decrease my constipation. b. I need to be sitting straight up and my chin slightly tucked so I wont choke when I eat or drink. c. I need to exercise at least some everyday. d. If I miss an occasional dose of the medication, it is not of much significance. 67. It is MOST important to assess the adolescent with acne for: a. change in weight c. suicide tendencies b. low self esteem d. increase intake of fatty foods 68. Communication can take many forms. Each has its own limitations. Which is a deterrent factor in written communications? a. e-mail c. suicide tendencies b. fax d. use of non-universal abbreviation 69. Monica shared with the interviewer her most recent experiences about a restless pediatric patient whom she puts up the side rails of the bed to prevent accidental falls. Which of the following attributes is shown by Monica? a. resourcefulness c. honesty b. prudence d. reliability 70. As experimental research designs have their strengths, so does non-experimental researches. Which of the following statements is NOT one of the strengths of non-experimental designs? a. can be completed in a short span of time b. less expensive c. useful for predictive purposes d. easier to gain cooperation of study subjects 71. Mr. E.O. age 52 had a laryngectomy due to cancer of the larynx. Discharge instructions are given to Mr.F.O. and his family. Which response by written communication from Mr. F.O. or verbal response from the family, will be a signal to the nurse that the instructions need to be reclarified?
a. it is acceptable to take over-the-counter medications now that condition is stable b. the suctioning at home must be a clean procedure, not sterile. c. report swelling, pain or excessive drainage d. cleans skin around stoma BID, use hydrogen peroxide and rinse with water, pat dry. 72. Dr. Tuazon scheduled Mrs. Poe for a right breast mass incision with frozen section and possible mastectomy on Monday, first case. As the nurse in-charge for scheduling you will collaborate with the following departments EXCEPT: a. pathology c. anesthesia b. dietary d. surgery 73. Charting should be legible and include only standard abbreviations. Which of the following is NOT a standard abbreviation? a. PRN c. NNO b. OD d. NPO 74. A mother who is pregnant and has ovarian cancer has to undergo surgery to treat the cancer. In the process the fetus died. The doctrine that justifies the death of the fetus is: a. justice c. exception to the rule b. anatomy d. double effect 75. A nurse is waiting for a report to be sent by fax. The machine activates but instead of the report, the nurse received a sexually oriented photograph. The MOST appropriate nursing action is to: a. call the nursing supervisor and report the incident b. cut the photograph and throw it away. c. call the police d. call the unit who sent it and ask for the name of person who sent the photograph 76. Ms. F.X.. has been admitted with right upper quadrant pain and has been placed on a low fat diet. Which of the following trays would be acceptable for her? a. liver, fried potatoes and avocado b. whole milk, rice and pastry c. ham, mashed potatoes, cream peas d. skim milk, lean fish, tapioca pudding 77. Negligence in the practice of nursing can be a ground for: a. revocation of license by the Ombudsman b. revocation of license by the BON c. revocation of license by the DOH d. revocation of license by the Nursing Department 78. One way of verifying that the right message/doctors order was communicated effectively is by: a. phrasing intelligently b. repeating the order message c. documenting d. speaking distinctly using enough volume 79. Kelly identified five categories of followers in an organization: sheep, yes people, alienated, survivor and effective followers. If we choose to be successful nursing professionals, we have to become one these and influence other: a. YES people c. effective followers b. alienated d. sheep
80. A research on Surgical Instrument Availability will help the surgical team: a. restructure OR scheduling system b. streamline instrument inventory c. improve instrument decontamination d. ensure efficient completion of surgical instrument 81. Maria is administering a cleansing enema to a patient with fecal impaction. Before administering the enema, she should place the patient in which of the following positions? a. on the right side of the body with the head of the bed elevated 45 degrees b. left Sims position c. on the left side of the body with the head of the bed elevated 45 degree d. right Sims position 82. The functionality and integrity of instruments and medical devices used in surgical procedure, is the responsibility of the: a. surgeon c. OR nurse b. bio-med technician d. scrub nurse 83. Maria will be preparing a patient for thoracentesis. She should assist the patient to which of the following positions for the procedure? a. prone with the head turned to the side and supported by a pillow b. lying in bed on the affected side with the head of the bed elevated 45 degrees c. Sims position with the head of the bed flat d. Lying in bed on the unaffected side with the head of the bed elevated 45 degrees 84. When a patient comes to the clinic for an eye examination, the ophthalmologists administers phenylephrine 2.5% drops to: a. dilate retinal blood vessels b. anesthetize the cornea c. dilate the pupil d. removed any obstruction on the cornea 85. Which of the following statements by Ms. S.O. a chemotherapy patient with a low WBC count, a low platelet count and a hemoglobin measurement of 5.6 g would indicate the need for further teaching? a. My lips are dry an d cracking. I need some lubricant b. My husband and I have been using vaginal lubrication before my intercourse c. I check my mouth and teeth after each meal d. Ive been very constipated and need an enema 86. Patients undergoing surgery display different levels of anxiety. This is researchable. At present, it has been found out that music can decreases anxiety. What other factors can reduce anxiety that is currently done among postoperative cases? a. pre-anesthetic drugs c. shower prior to surgery b. pre-operative visit d. presence of any members of the family 87. According to AORN recommended practices, surgical attire intended only for use within the surgical suite should be worn within the: a. restricted semi-restricted and unrestricted areas b. restricted area only c. operating room only d. restricted and semi-restricted areas
d. avoid diuretics to minimize calcium loss 88. A heavily researched topic in infection control is about the single most important procedure for preventing hospital acquired infections. What is this procedure called? a. handwashing c. use of facemask b. use of scrub suite d. brain washing 89. Surgical instruments are expensive and are a lifetime investment of the O.R. To ensure quality of these instruments, which criterion is evaluated? a. shelf life c. cost b. reusability d. integrity and functionality after each use and processing 90. Mr. Que, 61 years of age is suffering from rheumatoid arthritis. He asks if there is a cure for RA. The MOST appropriate response is: a. No, most patients with RA also develop osteoarthritis. b. Yes, but the patient must take medication for at least 10 years. c. Yes, new drugs being developed offer a cure. d. No, but new drugs being developed can interfere with the bodys reaction to inflammati on and better control the disease process. 91. Rita is assigned to care for group of patients. On review of the patients medical record, she determines that which patient is at risk for fluid volume deficit? a. A client with CHF b. A client receiving frequent wound irrigations c. A client with colostomy d. A client with decreased kidney function 92. In providing general information and assessing the patients level of interest or reaction to surgery, which of the following nursing intervention will received priority? a. tell the patient when the surgery is scheduled b. let the patient know that the family will be kept in formed c. explain details of perioperative preparation with a tour and viewing of area and equipments d. offer general information about the surgery 93. In the event of a fire, OR staff are instructed to follow the international RACE. What does R stand for? a. Rest b. Rescue c. respond d. run 94. In preparing the patient for endoscopic examinations of the upper GI tract, the patien ts pharynx is anesthesized with Xylocaine spray. Nursing interventions for post-endoscopic examination include: a. keeping patient NPO until gag reflex returns b. prohibiting smoking before the test c. withholding anticholinergic medications d. allowing fluids up to 4 hours before examination 95. Modern medicine has divided the human body into different systems/organs or the so called specialty medicine practice. Collaboration of the specialists will in effect treat the client as: a. multiple specialty c. one whole human being b. multi-organ d. compartmentalized body 96. Discharge teaching for the client with hypoparathyroidism should include which of the following instructions: a. use OTC vitamin D preparation b. avoid strenuous ex ercises c. supplement calcium intake 97. An important nursing intervention goal to establish for Mang Carlos who has iron-deficiency anemia is: a. alternate periods of rest and activity to balance oxygen supply and demand b. increase fluids to stimulate erythropoises c. decrease fluids to prevent sickling of RBCs d. use birth control to avoid pregnancy 98. KN is monitoring the status of a postoperative patient. He would become MOST concerned with which of the following signs which could indicate an evolving complication? a. a negative Homans sign b. BP of 110/170 mmHg and a pulse of 80 beats per minute c. increasing restlessness d. hypoactive bowel sounds in all four quadrants 99. The Patients Bill of rights helps practitioners provide more effective patient care. Which of the following should NOT be included in the list? a. be informed of administrative and policies and practices b. considerate and respectful ca re c. confidentiality of communications and records d. relevant current and understandable information concerning diagnosis, treatment diagnosis, specific procedures treatment and risks involved 100. Disposal of medical records in government hospitals/institutions must be done in close coordination with what agency? a. DOH b. Records Management and Archives Office (RMAO) c. DILG d. MMDA
DECEMBER 2006-NP4 NURSING CARE OF CLIENT WITH PHYSIOLOGICAL AND PSYCHOSOCIAL ALTERATIONS Situation 1: It is Cancer Consciousness Week and you are participating in an Early Cancer Detection Drive of the Department of Health. 1. Based on the DOH and World Health Organization (WHO) guidelines, the mainstay for early detection method for breast cancer that is recommended for developing countries is: A. a monthly breast self examination (BSE) and an annual health worker breast examination B. an annual hormone receptor assay C. an annual mammogram D. a physician conduct a breast clinical examination every 2 years
2. The purpose of performing the breast self examination (BSE) regularly is to discover: A. fibrocystic masses C. areas of thickness or fullness B. cancerous lumps D. changes from previous BSE 3. If you are to instruct a postmenopausal woman about BSE, when would you tell her to do BSE: A. on the same day of each month C. on the first day of her menstruation
4. During breast self-examination, the purpose of standing in front of the mirror it to observe the breast for: A. thickening of the tissue C. lumps in the breast tissue B. axillary D. change in size and contour 5. When preparing to examine the left breast in a reclining position, the purpose of placing a small folded towel under the clients left shoulder is to: A. bring the breast closer to the examiners right hand B. tense the pectoral muscle C. balance the breast tissue more evenly on the chest wall D. facilitate lateral positioning of the breast Situation 2: Ensuring safety is one of your most important responsibilities. You will need to provide instruction and information to your clients to prevent complications. 6. LM has chest tube attached to a pleural drainage system. When caring for LM you should: A. change the dressing daily using aseptic technique B. empty the drainage system at the end of the shift C. palpate the surrounding areas for crepitus D. clamp the chest tube when suctioning 7. After pelvic surgery, the sign that would be indicative of a developing thrombophlebitis would be: A. a tender, painful area on the leg C. a pitting edema of the ankle B. pruritus on the calf and ankle D. a reddened area of the ankle 8. To prevent recurrent attacks on FT who has glomerulonephritis, you should instruct her to: A. continue to take the same restrictions on fluid intake B. seek early treatment for respiratory infections C. avoid situations that involve physical activity D. take showers instead of tub bath 9. GT had a laryngectomy. He is now for discharge. He verbalized his concern regarding his laryngectomy tube being dislodged. What would you teach him FIRST? A. reinsert another tubing immediately B. keep calm because there is no immediate emergency C. recognize that prompt closure of the tracheal opening D. notify the physician at once 10. When caring for TU after an exploratory chest surgery and pneumonectomy, your PRIORITY would be to maintain: A. chest tube drainage C. ventilation exchange B. blood replacement D. supplementary oxygen Situation 3: Severe burn is one of the most devastating kinds of injury one can experience. It can affect any group. You have been ready to provide holistic care for patients with severe burns. 11. A burn that is white, painless, and leathery in texture describes a: A. second degree burn C. deep partial thickness burns B. third degree or full thickness burn D. first degree or superficial burns 12. Critically ill patients are at high risk for the following complication during the emergent phase:
13. The MOST effective method of delivering pain medication during the emergent phase is: A. intramuscularly C. orally B. subcutaneously D. intravenously 14. Edema presents a significant problem in burn wounds because: A. loss of protein prevents tissue repair B. edema impedes tissue perfusion/oxygenation C. edema provides a milieu for bacterial proliferation D. edema can produce a tourniquet effect 15. Which of the following can be a fatal complication of upper airway burns? A. stress ulcers C. shock B. hemorrhage D. laryngeal spasms and swelling Situation 4: You are assigned to take care of four patients with different conditions. 16. 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 C. until the supply is over B. during the preoperative period D. for the rest of my life 17. After the kidney transplant, you must observe KJ for signs of rejection which includes: A. fever and weight gain C. polyuria and jaundice B. hematuria and seizure D. moon face and muscle atrophy 18. 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 19. 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 20. 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 5. You are assigned in the neurology stroke unit. To prepare for this assignment, you should be able to answer the following questions. 21. Which of the following statements can BEST describe/define stroke or brain attack? A. it occurs when circulation to a part of the brain is disrupted B. it is usually caused by abuse of prescribed medications C. it is caused by a cerebral hemorrhage D. it may be the results of a transient ischemic attack (TIA) 22. Several diagnostic tests may be ordered for proper evaluation. The purpose of each of the following diagnostic examination is correct EXCEPT: A. Cerebral Angiography is used to identify collateral blood circulation and may reveal site of rupture or occlusion B. ECG may reveal abnormal electrical activity, such as focal slowing and assess amount of brain wave activity. C. MRI may reveal the site of infarction, hematoma and shift of brain structures D. PET Scanning may reveal information on cerebral metabolism and blood flow characteristics. 23. Which of the following is the MOST common cause of stroke or brain attack? A. embolism C. cerebral arterial spasm B. hemorrhage D. thrombosis 24. To guide you in your assessment, it is also important for you to remember that the clinical features of stroke vary with the following factors EXCEPT: A. severity of damage C. artery affected B. gender D. the extent of collateral circulation 25. It is important for you to also teach clients and their families who are at risk to observed primary prevention which includes the following EXCEPT: A. maintain serum cholesterol level between 220 and 180 mm/dL B. treat transient ischemic attacks (TIA) early C. teach preventive health behaviors (consequences of smoking, obesity, alcoholism, drug abuse) to children of patients with stroke D. screen for systolic hypertension Situation 6: 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 C. avoid use of cornstarch on the foot B. avoid using a nail clipper to cut toe nails 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 C. optic functions B. vascular functions D. motor functions
29. Peripheral neuropathy can BEST be controlled by: A. good glucose control C. vitamin supplement B. steroid therapy 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 C. liver disease B. hyperthyroidism D. diabetes insipidus Situation 7: You are assigned to take care of a group of elderly patients. Pain and urinary incontinence are their common concerns. You should be able to address their concerns in a holistic manner. 31. The WHO analgesic ladder provides the health professional with: A. specific pain management choices based on severity of pain B. general pain management choices based on level of pain C. pharmacologic and nonpharmacologic pain management choices D. nonpharmacologic interventions based on level of pain 32. As a nurse caring for patients in pain, you should evaluate for opioid side effects which include the following EXCEPT: A. pruritus C. constipation B. respiratory depression D. physical dependence 33. Which of the following statements about cancer pain is NOT true? A. opioids are drugs of choice for severe pain B. pain associated with cancer and the terminal phase of the disease occurs in majority of patients C. under treatment of pain is often due to a clinicians failure or inability to evaluate or appreciate the severity of the clients problem D. adjuvant medications such as steroids, anti convulsants, nonsteroidal anti-inflammatory drugs enhance pain perception 34. TR has been on morphine on a regular basis for several weeks. He is now complaining that the usual dose he has been receiving is no longer relieving his pain as effectively. Assuming that nothing has changed in his condition, you would suspect that TR is: A. becoming psychologically dependent C. needing to have the morphine discontinued B. developing tolerance to the morphine D. exaggerating his level of pain 35. The guidelines for choosing appropriate nonpharmacologic intervention for pain include all of the following EXPECT: A. effectiveness for patient C. skill of the clinician health professional B. pain problem identification D. type of opioid being used Situation 8: To be able to provide care for patients in the critical areas, you should look into factors that will enhance your ability to provide quality nursing care. 36. Research study show that nurses who work with critically patients as opposed to nurses who work with less acute patient: A. are more satisfied with their role C. are most acceptable to burn out B. move a greater support system D. experience greater stress 37. Which of the components of HARDINESS has been linked to burnout?
Situation 10 : You are taking care of LC who develops acute respiratory distress. An endotracheal tube had to be inserted to correct the hypoxia. 46. The primary purpose of the endotracheal tube cuff is to: A. seal off the oropharynx from the nasopharynx B. seal off the lower airway from the esophagus C. seal off the oropharynx from the esophagus D. seal off the lower airway from the upper airway 47. Endotracheal tube size indicated on the tube reflects what measurements: A. the circumference size of the tube C. the internal diameter of the tube B. the length of the tube D. the length of the persons airway 48. In adults, an inflated E-T tube cuff is necessary for mechanical ventilation primarily because: A. it seals off the lower airway from the upper airway B. it prevents air from getting into the stomach C. it seals off the nasopharynx from the oropharynx D. it prevents stomach contents from getting into the lungs 49. Endotracheal tube size indicated on the tube reflects what measurements: A. the internal diameter of the tube C. the circumference size of the tube B. the length of the persons airway D. the length of the tube 50. Which of the following statements is TRUE about securing the artificial airway? A. artificial airways must be secured directly to the patient B. the airway is generally sutured in place C. a nasotracheal tube does not require securing D. the inflated cuff provides sufficient securing Situation 11: Because of the serious effects of severe burns, management requires a multidisciplinary approach. You have important responsibilities as a nurse. 51. When caring for DS, who sustained 40% severe flame burn yesterday, which among these interventions should be your PRIORITY? A. provide a calm, efficient and safe environment B. keep the body parts in good alignment to prevent contractures C. assess for airway, breathing and circulation problems D. assess the injury for signs of sepsis 52. Your primary therapeutic goal for DS during the ACUTE PHASE is: a. wound healing c. emotional support b. reconstructive surgery d. fluid resuscitation 53. CV who sustained upper torso and neck burns. Which action is MOST likely to cause a functional contracture? a. hourly hyperextension neck exercises b. helping the patient to a position of comfort c. encouraging self-care d. discouraging pillows behind the head 54. AW, 3 year old boy just sustained full thickness burns of the face, chest and neck. What will be your PRIORITY nursing action? a. Risk for infection related to epidermal disruption
38. Nurses who work with critically ill patients should base their practice on all of the following EXCEPT: A. recognition and appreciation of a persons unique and social environmental relationships B. delegated responsibility C. thorough knowledge of the interrelatedness of body system D. appreciation of the collaborative role of all health team members 39. Common aspects of the critical care nursing role include: A. disaster management C. direct care provider B. staff liaison D. community referral 40. Which of the following interventions would support your patients circadian rhythm cycle? A. putting a wall clock up on your patients room B. decreasing environmental noise C. encouraging normal bowel movement D. dimming light during normal sleeping time Situation 9: To ensure continuity of care and for legal purposes, you have important responsibilities to accurately document all nursing activities. 41. For the past 24 hours, TD with dry skin and dry mucous membranes has had a urine output of 600 m and a fluid intake of 800 ml. TDs urine is dark amber. These assessments indicate which nursing diagnosis? A. Impaired urinary elimination C. Excessive fluid volume B. Deficient fluid volume D. Imbalanced nutrition: less than body requirement 42. Which document addresses the patients right to information, informed consent and treatment refusal? A. Code for Nurses C. Patients Bill of Rights B. Nursing Practice Act D. Standard of Nursing Practice 43. You are caring for GG with a history of falls. The FIRST PRIORITY when caring for GG who is at risk for falls is: A. instruct GG not to get out of bed unassisted B. keep the bedpan available so she does not have to get out of bed C. placing the call light for easy access D. keep the bed at the lowest position ever 44. Shortly after being admitted to the CCU for acute MI, JJ reports midsternal chest pain radiating down the left arm. You notice that JJ is restless, slightly diaphoretic, and has a temperature of 37.8 deg C, heart rate of 10 beats/min.; regular, slightly labored respirations at 26 breaths/min and a blood pressure of 150/90 mmHg. Which nursing diagnosis takes HIGHEST PRIORITY? A. decreased cardiac output C. acute pain B. anxiety D. risk for imbalanced body temperature 45. FF, has a nursing diagnosis of Risk for injury related to adverse effects of potassium-wasting diuretics. Whats the correct written client outcome for this diagnosis? A. FF states the importance of eating potassium rich foods daily B. Upon discharge, FF knows which food sources are rich in potassium C. Upon discharge, FF correctly identifies three potassium rich foods D. FF knows all the complications of the disease process
b. Impaired urinary elimination related to fluid loss c. Ineffective airway clearance related to edema d. Impaired body image related to physical appearance 55. FG, with a full thickness burns involving entire circumference of an extremity will require frequent peripheral vascular checks to detect: a. hypothermia c. arteriosclerotic changes b. ischemia d. adequate wound healing Situation 12: Infection can cause debilitating consequences when hosts resistance is compromised and environmental factors are favorable. As a nurse you have important roles and responsibilities in infection control. 56. EF was admitted to the hospital with a tentative diagnosis of acute pyelonephritis. To assess her risk factors, what question should you ask? a. Have you taken any analgesic recently? b. Do you have pain at your back? c. Do you hold your urine for a long time before voiding? d. Have you had any sore throat lately? 57. While caring for a patient with an infected surgical incision, you observe for signs of systemic response. These include all of the following EXCEPT: a. a febrile state due to release of pyrogens b. anorexia, malaise, and weakness c. loss of appetite and pain d. leukopenia due to increased WBC production 58. One of the MOST effective nursing procedures for reducing nosocomial infection is: a. proper handwashing technique b. aseptic wound care c. control of upper respiratory tract infection d. administration of prophylactic antibiotic 59. A wound that has hemorrhaged has increased risk for infection because: a. dead space and dead cells provide a culture medium b. retrograde bacterial contamination may occur c. the tissue becomes less resilient d. of reduced amounts of oxygen and nutrients are available 60. You are instructing EP regarding skin tests for hypersensitivity reactions. You should teach her to: a. stay out of the sun until the skin tests are read b. come back on the specified date to have the skin tests read c. wash skin test areas with soap and water daily d. keep skin test areas moist with mild lotion. Situation 13 : TR attends a Health Education Class on colostomy care. The following are taken up: types of ostomies, indications and care. 61. A colostomy can BEST be defined as: a. cutting the colon and bringing the proximal end through the abdominal wall b. creating a stomal orifice from the ileum c. excising a section of the colon and doing an end-to-end anastomosis d. removing the rectum and suturing the colon to the anus.
62. When an abdominoperineal resection is done, the patient should be informed he/she will have a; a. temporary colostomy c. transverse loop colostomy b. permanent colostomy d. double-barreled 63. A colostomy patient who wishes to avoid flatulence should not eat the following EXCEPT: a. corn and peanuts c. mangoes and pineapples b. cabbage and asparagus d. chewing gum and carbonated beverages 64. During the first post operative week, the nurse can BEST help the patient with a colostomy to accept the change in body image by: a. changing the dressing just prior to meals b. encouraging the patient to observe the stoma and its care c. deodorizing the room periodically with a spray can d. applying a large bulky dressing over the stoma to decrease odors Situation 14: These are gastrointestinal disease that can compromise life and that would necessitate extensive surgical anagement. You are assigned to take care of a patient with such a condition. 66. BC diagnosed with cancer of the sigmoid colon is to have an abdominoperineal resection with a permanent colostomy.Before surgery, a low residue diet is ordered. You explain to BC that this is necessary to: a. prevent irritation of the intestinal mucosa b. reduce the amount of stool in the large bowel c. limit production of flatus in the intestines d. lower the bacterial count in the GI tract 67. Several days prior to bowel surgery, the patient may be given sulfasuxidine and neomycin, primarily to: a. soften the stool by retaining water in the colon b. reduce the bacterial content of the colon c. empty the bowel of solid waste d. promote rest of the bowel by minimizing peristalsis 68. To promote perineal wound healing after an abdominoperineal resection, you should encourage BC to assume: a. dorsal recumbent position b. left or right Sims position c. left or right side lying position d. knee-chest position 69. BC returns from surgery with a permanent colostomy. During the 24 hours, the colostomy does not drain. You, as the nurse should realize that this is a result of: a. the absence of intestinal motility b. a presurgical decrease in fluid intake c. proper functioning of the nasogastric tube d. intestinal edema following surgery 70. On the second day following abdominoperineal resection, you anticipate that the colostomy stoma will appear: a. moist, pink, with flushed skin and painful when touched b. moist, red and raised above the skin surface c. dry, pale pink and with flushed skin d. dry, purple and depressed below the skin surface
Situation 15: 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. GM is scheduled to have lobectomy. The purpose of closed chest drainage following a lobectomy is: a. expansion of the remaining lung b. facilitation of coughing c. prevention of mediastinal shift d. promotion of wound healing 72. Following thoracic surgery, you can BEST help GM to reduce pian during the deep breathing and coughing exercises by: a. splinting the patients chest with both hands during the exercises b. administering the prescribed analgesic immediately prior to exercises c. providing rest for 6 hours before exercises d. placing the patient on his/her operative side during exercises 73. During the immediate post operative period following a pneumonectomy, deep tracheal suction should be done with extreme caution because: a. the remaining normal lung needs minimal stimulation b. the patient will not be able to tolerate coughing c. the tracheobronchial tree are dry d. the bronchial suture line maybe traumatized 74. What should you do as a nurse when the chest tubing is accidentally disconnected? a. reconnect the tube c. notify the physician b. change the tubing d. clamp the tubing 75. Which of the following observations indicates that the closed chest drainage system is functioning properly? a. less than 25 ml drainage in the drainage bottle b. absence of bubbling in the suction-control bottle c. the fluctuating movement of fluid in the long tube of the water-seal bottle during inspiration d. intermittent bubbling through the long tube of the suction control bottle. Situation 16: Renal stones can cause one of the most excruciating pain experienced by a patient. As a nurse of BL which of the following nursing diagnosis will be your PRIORITY? 76. BL was brought to the Emergency Room for severe left flunk pain, nausea and vomiting. The physician gave a tentative diagnosis of right ureterolithiasis. As the nurse of BL which of the following nursing diagnosis will be your PRIORITY? a. imbalance nutrition: less than body requirements b. impaired urinary elimination c. acute pain d. risk for infection
78. You are caring for YA, 30 year old business woman, with renal stones. Her skin and mucous membranes are dry and her 24 hour intake and output record reveal an oral intake of 900 ml and a urinary output of 700 ml. Her urine is dark amber. Based on the above data, your nursing diagnosis is: a. imbalance nutrition, less than body requirements b. fluid volume deficit c. impaired urinary elimination d. knowledge deficit regarding health 79. KJ has an indwelling urinary catheter and she is suspected of having urinary infection. How should you collect a urine specimen for culture and sensitivity? a. clump tubing for 60 minutes and insert a sterile needle into the tubing above the clamp to aspirate urine b. drain urine from the drainage bag into the sterile container c. disconnect the tubing from the urinary catheter and let urine flow into a sterile container d. wipe the self-sealing aspiration port with antiseptic solution and aspirate urine with a sterile needle 80. You are caring for WE, a 56 year old man who is dehydrated and with urinary incontinent. Upon physical examination, you noted perineal excoriation. What will be your PRIORITY intervention? a. orient him to time, person and place b. offer the bed pan every 4 hours c. encourage oral fluid intake d. keep the perineal area clean, and dry Situation 17: You are caring for several patients with various disease problems. 81. You are obtaining a history of MR. who is admitted with acute chest pain. Which question will be MOST HELPFUL for you to ask? a. Why do you think you had a heart attack? b. Do you need anything now? c. What seem you doing when the pain started? d. Has anyone in your family been sick lately? 82. BO who received general anesthesia returns from surgery. Post-operatively, which nursing diagnosis takes HIGHEST PRIORITY for BO? A. impaired physical mobility related to surgery B. decrease fluid volume related to blood and fluid loss from surgery C. risk for infection related to anesthesia D. acute pain related to surgery 83. WW is blind. She is admitted for treatment of gastroenteritis. Which nursing diagnosis takes HIGHEST PRIORITY for WW? A. anxiety C. activity intolerance B. risk for injury D. impaired physical mobility 84. You are documenting your care for CC who has iron deficiency anemia. Which nursing diagnosis is MOST appropriate? A. ineffective breathing pattern C. deficient fluid volume B. impaired gas exchange D. ineffective airway clearance 85. RR, age 89, has terminal cancer, he demonstrates signs of dementia. You should give HIGHEST PRIORITY to which nursing diagnosis: A. risk for injury C. ineffective cerebral tissue perfusion B. bathing or hygiene self care deficit D. dysfunctional grieving
77. Which of the following is the appropriate intervention for BL who has ureterolithiasis? a. inserting an indwelling urinary catheter b. administering opioid analgesics preferably intravenously c. administering intravenous solution at a keep vein open rate d. inserting a nasogastric tube (low suction)
B. hypercalcemia Situation 18: The physician has ordered 3 units of whole blood to be transfused to WQ following a repair of a dissecting aneurysm of the aorta. 86. 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 C. 4 hours B. 1 hour D. 2 hours 87. 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 88. 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 89. WQ is undergoing blood transfusions of the first unit. The EARLIEST signs of transfusion reactions are: A. oliguria and jaundice C. hypertension and flushing B. urticaria and wheezing D. headache, chills, fever 90. 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 19. 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. 91. 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 92. 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 93. 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 C. hypokalemia
D. hypernatremia
94. 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 C. monitor your fruit intake and eat plenty of bananas B. restrict your salt intake D. be sure to eat meat every meal 95. 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 20. You are assigned to take care of a group of elderly patients. Pain and urinary incontinence are common concerns experienced by them. You should be able to address the concerns in a holistic manner. 96. Pain in the elder persons require careful assessment because they: A. experienced reduce sensory perception C. are expected to experience chronic pain B. have increased sensory perception D. have a decreased pain threshold 97. Administration of analgesics to the older persons requires careful patient assessment because older people: A. are more sensitive to drugs B. have increased hepatic, renal and gastrointestinal function C. have increased sensory perception D. mobilize drugs more rapidly 98. The elderly patient is at higher risk for urinary incontinence because of: A. increased glomerular filtration C. decreased bladder capacity B. diuretic use D. dilated urethra 99. Which of the following is the MOST COMMON sign of infection among the elderly? A. decreased breath sounds with crackles C. pain B. fever D. change in mental status 100. Priorities when caring for the elderly trauma patient: A. circulation, airway, breathing C. airway, breathing, disability (neurologic) B. disability (neurologic), airway, breathing D. airway, breathing, circulation
DECEMBER 2006 NP5 NURSING CARE OF CLIENT WITH PHYSIOLOGICAL AND PSYCHOSOCIAL ALTERATIONS Situation 1: The nurse is envisioning a career path in mental health psychiatric nursing. As a beginning professional nurse, she is guided with basic beliefs about the practice. 1. Which of the following statement reflects the scope of mental health psychiatric nursing? A. it includes nursing actions aimed at returning the patient to his highest potential of productivity. B. it is an integral aspect of all nursing and a specialty service to all people affected by mental illness. C. it includes nursing actions to reduce the rate of new cases of mental disorder in population D. it consist of early recognition and treatment of mental disorders to reduce severity and duration of mental illness
2. The beginning professional nurse can do mental health counseling with the following clients, EXCEPT: A. actively psychotic patients C. parents with child rearing concerns B. out of school adolescents D. school children with behavioral problem 3. A professional responsibility of the mental health psychiatric nurse is to provide a safe and therapeutic environment. This is BEST reflected in: A. restraining patients who violates policies and do not follow schedule of activities. B. maintaining a closed door policy to prevent patients from absconding. C. keeping a restrictive environment to prevent patients from becoming assaultive and hostile D. ensuring physical safety and maintaining therapeutic attitude towards the patients 4. The foundation of the therapeutic process is the therapeutic relationship. What is the essential component that the nurse must bring to the relationship? A. humor C. reframing B. empathy D. confrontation 5. Which of these people, the highest in population groups that would need priority mental health therapy? A. adults going through active skills B. single elderly with no social support C. young professionals entering the workplace D. women preparing for overseas employment Situation 2: Some activity therapies are organized and conducted in groups where nurses may participate in. 6. A mental health nurse may not be a member of this self help group because help given to members comes from members themselves: A. Remotivation Group C. Activity Therapy Group B. Alcoholics Anonymous D. Art Therapy Group
D. to encourage expression of intrapsychic conflicts Situation 3: The patient who is depressed will undergo electroconvulsive therapy. 11. Studies on biological depression support electroconvulsive therapy as a mode of treatment. The rationale is: A. ECT produces massive brain damage which destroys the specific area containing memories related to the events surrounding the development of psychotic condition B. The treatment serves as a symbolic punishment for the client who feels guilty and worthless C. ECT relieves depression psychologically by increasing the norepinephrine level D. ECT is seen as a life-threatening experience and depressed patients mobilize all their bodily defenses to deal with this attack. 12. The preparation of a patient for ECT ideally is MOST similar to preparation for a patient for: A. electroencephalogram C. general anesthesia B. X-ray D. electrocardiogram 13. Which of the following is a possible side effect which you will discuss with the patient? A. hemorrhage within the brain B. robot-like body stiffness C. encephalitis D. confusion, disorientation and short term memory loss 14. Informed consent is necessary for the treatment for involuntary clients. When this cannot be obtained, permission may be taken from the: A. social worker B. doctor C. next of kin or guardian D. chief nurse 15. After ECT, the nurse should do this action before giving the client fluids, food or medication: A. assess the gag reflex C. next of kin or guardian B. assess the sensorium D. check O2 Sat with a pulse oximeter Situation 4: The community health nurse encounters special children in the community. 16. An individual with antisocial personality disorder lacks remorse, shame and guilt in going against the norms of society. Psychodynamically, this defect in the personality reflects a disturbance of the: A. ego C. ego ideal B. super ego D. id 17. The nurse teaches parents about childrens beginning concepts of right and wrong by emphasizing child rearing attitude and practices during the: A. school age C. infancy period B. toddler age D. latency period 18. It is BEST for parents to teach healthy interpersonal relationships to their children by: A. modeling to their children B. encouraging their children to attend secondary school C. encouraging their children at home to behave properly D. teaching their children good manners and right conduct 19. An important principle for the nurse to follow in interacting with retarded children is: A. seen that if the child appears contented, his needs are being met B. provide an environment appropriate to their development task as scheduled C. treat the child according to his chronological age
7. Which of the following determines the success of client government groups? A. willingness of psychiatric professionals to be open and receptive to clients ideas and suggestions B. a way of permitting clients provide themselves with a more creative and wholesome life C. means to acquire a variety of social skills D. opportunity to learn democratic living 8. Which of this client situation appropriately illustrate horticulture therapy? A. the therapist brings bongos, tambourine, and bells and encourages client participation B. Tommy, Karen, Jon and Pia play scrabble every night after supper C. every afternoon, Vic goes in the garden where he work with plants, seedlings, tree planting and watering them D. Paul finds sketching relaxing and rewarding 9. Eva is a member of a group who controls endless talking. Her role is that of a/an: A. blocker C. recognition seeker B. self-confessor D. monopolizer 10. Community meetings are held as a part of milieu therapy on an in-patient psychiatric unit. The purpose of these meetings would be: A. to focus on issue arising from group living B. to encourage expression on topics of interest C. to provide direction from the treatment plan
D. treat the child according to his developmental level 20. Mental retardation is: A. a delay in normal growth and development caused by an inadequate environment B. a lack of development of sensory abilities C. a condition of subaverage intellectual functioning that originates during the developmental period and is associated with impairment in adaptive behavior D. a severe lag in neuromuscular development and motor abilities Situation 5: The nurse recognizes the need to learn to cope with stress and change. She becomes interested to practice natural ways to enhance well being. 21. Lifestyle modification begins with: A. minimizing eating in fast food restaurants B. having an exercise regimen to follow regularly C. recognizing the impact of unhealthy habits D. avoiding pollutants in the environment 22. All of these are the behavior intervention to stress management. EXCEPT: A. guided imagery C. meditation B. pharmacotherapy D. progressive muscle relaxation 23. Basic to progressive muscle relaxation is: A. focusing on an image to relax C. use of industrial equipment B. relaxing muscles from tension D. stopping disturbing thoughts 24. Dietary practices are very important to the health of the Filipino family. The nurse needs to assess this lifestyle because: A. the nurse wants to change the eating patterns of the Filipino family B. the nurse knows that being overweight is a major health hazard C. the nurse wants to stop all the mainstream weight-loss diets D. the nurse has to find out what people are eating 25. A young overweight adult smokes 5-10 sticks of cigarettes/day, ambitious, looks at life as challenging and perfect and never considers change in his lifestyle, initially needs: A. commitment C. skills to attempt change B. information D. motivation Situation 6 : Bernie and John in their late 40s have been married for 20 years and at the peak of their careers. Suddenly, Bernie discovered that her husband was falling in love with another woman. Shaken by this situation, she started to have problems sleeping and could not function well at work and at the risk of losing her job. John asked forgiveness and regret very much the hurt his wife was going through and suffered guilt feelings: 26. Bernie and John are going through a: A. situational crisis C. anticipated crisis B. developmental crisis D. both developmental and situational crisis 27. All of these are characteristics of crisis EXCEPT: A. a hazardous or threatening event occurs B. it has a growth promoting potential C. usual problem solving methods and coping mechanisms produce a solution D. anxiety or depression continue to increase 28. The nurse employs this approach in crisis intervention: A. problem-solving C. role-playing B. behavior modification D. nurse-patient relationship 29. Assessment data of the nurse include all the following EXCEPT: A. coping mechanisms C. perception of the event B. situational support D. repressed problems 30. The duration of crisis usually lasts several days and usually: A. 2 4 weeks C. 1 2 months B. 1 2 weeks D. 4 6 weeks Situation 7: Felisa has a ritualistic pattern of constantly washing her hands with soap and water followed by rubbing alcohol. 31. This behavior is categorized as: A. delusional C. neurotic B. normal D. psychotic 32. A therapeutic intervention in this situation is: A. avoid limits on her behavior to release her anxiety B. call attention to her ritualistic pattern C. provide alternative behaviors to deal with increased anxiety D. ignore her behavior totally 33. The anxiety of Felisa is disabling and interferes with her job performance, interpersonal relationships and other activities of daily living. To minimize such problems, she is likely to be given: A. diazepam ( Valium ) C. imipramine Hcl ( Tofranil ) B. haloperidol ( Haldol ) D. chlorpromazine ( Thorazine ) 34. Felisa understands the effects of her medicine when expresses: A. I should watch out for signs of sore lips or sore throat B. I might have constipation C. I might feel changes in my body temperature D. I should not drive or operate machines 35. The level of anxiety that Felisa is experiencing is: A. Panic C. Mild B. Severe D. Moderate Situation 8: As a professional, it is imperative that the nurse is accountable to oneself hence the importance of personal and professional development. 36. Nurse: I feel personally involved with my clients problems demonstrates: A. counter transference C. transference B. empathy D. sympathy 37. The nurse has achieved self-awareness in which of the following verbalizations? A. every time people around me yell, I feel upset and withdrawn B. when the patient yelled at me I became speechless
C. with the patients tone of voice and stare, I got reminded of how my father would be so angry and this made me anxious D. I thought it was rude for the patient to yell hence I kept quiet 38. An accepting attitude requires being: A. aware of ones biases C. non judgmental B. tolerant of the faults of others D. in control of tendency to blame 39. Self-awareness, knowledge and understanding of human behavior and communication skills define what is essential in caring for every nurse to be able to demonstrate: A. positive self-projection C. therapeutic use of self B. assertiveness D. self-mastery 40. Considering that man is by nature social, it is BEST for the nurse to gain self-awareness by: A. participating in intensive group experiences B. individual psychotherapy C. hypnotherapy D. writing an autobiography for self introspection Situation 9: Recording and the nurse. 41. To facilitate identification of persons and relationships, the family nurse utilizes this diagrammatic representation of members of a family and their relationships: A. flowchart C. algorithm B. genogram D. kardex 42. A problem oriented recording system that utilizes the problem solving process as the basis of patient care management: A. NANDA Diagnosis C. Gordons Functional Health Patterns B. Nursing Care Plan D. Problem Oriented Medical Recording 43. This is a SOAP recording of the patients problem of Nervousness. Which is the subjective data? A. Mr. Z was nervous during the interview, he moved frequently in the bed and his palms were sweaty. B. Mr. Z does not seem to tolerate stress too well which will aggravate his cardiac condition. He understands Little about his health which may be increasing his state of anxiety. C. I am nervous at times. Exerts himself physically and is hesitant to discuss problems. D. Mr. Z should: 1. demonstrate an ability to cope with nervousness 2. demonstrate an understanding of the relationship between his nervousness and cardiac condition 44. The nurse researcher mutually agreed with the research subjects that all personal data of the subjects shall be kept confidential. To safeguard anonymity of data after the report is written, the nurse researcher should: A. throw the papers in a wastebasket B. keep the papers for 5 years and dispose of these after C. burnt or shred the papers D. have the papers recycle but not as writing scratch paper 45. A step by step procedure for the management of common problems is a : A. Gavin chart C. decision tree protocol B. pedigree chart D. problem listing Situation 10: The nurse works with Mina to help her work through termination of the nurse-patient relationship.
46. Preparation for termination of the nurse-patient relationship begins during the: A. termination phase C pre-orientation phase B. working phase D. orientation phase 47. Minas past reactions to ending relationships is withdrawal. The nurse assists he r to practice better ways of coping termination by providing opportunities to: A. test new patterns of behavior C. conceptualize her problem B. plan for alternatives D. value and find meaning in experience 48. During the early part of the interaction, the nurse asked after a period of silence. Perhaps we would talk about my leaving. The nurse utilized which communication technique: A. encouraging C. focusing on client B. suggesting D. understanding 49. Mina: (angrily) I am angry, I should never have gotten involved with you (silence) Nurse: You have reason to be disappointed and to feel angry. Just when we were getting somewhere. I leave you. A. reflecting words C. orienting B. understanding D. reflecting feelings 50. The objection of the nurse-patient relationship is to provide an opportunity of the patient to: A. clarify problems C. have a corrective emotional experience B. develop insights D. develop interpersonal relationship Situation 11: As a program manager, the mental health psychiatric nurse is tasked to provide general patient management. 51. The nurse is aware that identifying the aspects of general patient management and identifying interventions for meeting these basic needs are distinctions of: A. psychotherapy C. pharmacotherapy B. therapeutic milieu D. behavior therapy 52. In order to get active participation of the clients to carry out the objective of the program, it is BEST for the nurse to conduct a/an: A. community meeting C. observation B. survey D. selective interview of patients 53. Through the nurses role modeling of effective communication, the clients learned new ways of dealing with authority figures. This gives the clients a venue to: A. communicate C. identify their problems B. socialize D. test new patterns of behavior 54. This element of communication facilitates evaluation of the program: A. receiver C. sender B. message D. feedback 55. The nurses style of leadership in milieu therapy is: A. autocratic C. democratic B. laissez-faire D. benevolent
Situation 12: Loretta is a 28 years old, unemployed patient, admitted to the psychiatric unit with a diagnosis of chronic undifferentiated schizophrenia. She described herself as the Virgin Mary and her mission is to propa gate peace. She was observed laughing and talking to herself. Her thought processes were profoundly disorganized. She was also fearful and suspicious of others. 56. Lorettas claim of being the Virgin Mary is a/an: A. imagination C. hallucination B. delusion D. obsession 57. Her mission to propagate peace is: A. a serious call for a need of transformation B. an attempt to overcome low self-esteem
65. Considering that it is BEST to learn by example, it is MOST practical to: A. model good social skills throughout the session B. relate successful past experiences C. invite a resource person D. watch a movie Situation 14: Community health nurses integrate their knowledge of mental health with their clients in their practice when they do mental health counseling. 66. Who among these clients need immediate referral for psychotherapy? A. those who are plotting to commit suicide B. those who are not responding to usual motivators C. those who are not solving their problems which they have the resources to solve D. those who are engaging in self-defeating behaviors 67. All of these describe what counseling, EXCEPT: A. helping people manage their own problems B. assisting people to use their own resources C. a set of technique, skills and attitudes D. giving advices 68. This quality of the nurse allows connecting with others feelings: A. warmth C. sensitivity B. courage D. prudence 69. To refuse gossip is a reflection of the mental health nurses quality of: A. firmness C. judgment B. coolness D. trustworthiness 70. Which of the following concepts BEST describe the nurses interaction when she/he can recognize and identify feelings and emotions of another person without even having personally experienced those feelings and emotions? A. over involvement C. transference B. sympathy D. empathy Situation 15: Communicating effectively with dementia patients is a challenge to psychiatric nurses.
58. Which of this intervention would NOT be therapeutic in decreasing Lorettas anxiety? A. joke about her thought to help her feel at ease B. listen to her thoughts and feelings C. simply accept D. do not convince her that her perception is unreal 59. The nurse evaluates that Lorettas ready for a rehabilitation program when she: A. approaches the nurse at frequent intervals C. goes to the coffee shop alone more often B. ceases to talk about Virgin Mary D. carries a book The Purpose Driven Life 60. The nurse is leading a group meeting of patients to prepare them to be discharged. An appropriate goal for the group members is to develop: A. attitudes of society towards the mentally ill B. skills for maintaining daily living C. awareness of interpersonal patterns of interactions D. insight into personal problems Situation 13 : A group of adult chronic schizophrenic patients were recommended to undergo social skills training. 61. The following are the objectives of a social skills training program EXCEPT: A. explore deep seated intrapsychic conflicts C. help build self esteem and self confidence B. practice skills in relating with people D. develop and practice general coping skills 62. Social skills training is NOT primarily indicated for psychiatric patients who are: A. in acute stage of illness B. having difficulties starting and maintaining interpersonal relationships C. having chronic episodes of stress and anxiety while interacting with others D. experiencing recurrence of symptoms in front of particular people or among people in general 63. The focus of the group interaction is here and now. An appropriate topic would be: A. ways to celebrate Valentines Day in February B. how to spend the summer vacation C. an unforgettable experience as a child D. how to tell a joke 64. An appropriate technique for the participants to practice how to communicate effectively is through/a: A. lecture C. role play B. seminar D. psychodrama
71. Therapeutic ways to engage the elderly to be stimulated include all of the following EXCEPT: A. singing to or with the patients C. providing a picture album B. listening to old familiar music D. playing complex computer games 72. The LEAST area of satisfying communication with the elderly is on: A. recall of their courtship and love life C. fashion shown in personal pictures B. psychological trauma D. memories of their teenage parties 73. To maximize communication with the elderly, which of the following ways of verbal communication should the nurse use minimally? A. asking simple questions C. restating B. guiding the patient one step at a time D. asking for an open ended response
74. Unconditional positive regard for the elderly is BEST achieved when the nurse-patient relationship is based upon: A. vocational choices C. addressing economic problems B. keeping D. providing warmth and caring 75. An optimal supportive environment for a person with dementia includes all, EXCEPT: A. engaging the elderly in logical and abstract thinking B. developing a realistic uniformed and consistent daily schedule C. handling memory loss by distracting or diverting patients attention to something more positive D. simple nurse care for the patient day after day Situation 16: Harry, age 36 is admitted to the psychiatry unit in an acute manic episode of bipolar disorder. 76. Harrys condition is a disturbance of: A. sensorium B. cognition
B. patients should be allowed solely to decide what they want to do on their own C. ballgames should be limited to male patients only D. age and needs of patient should be considered in the choice of games 83. To encourage active participation among patients, it is BEST to plan activities they can engage in through a: A. one to one interaction C. checklist B. community meeting D. feedback evaluation forum 84. In planning activities for the patients, it is essential to consider FOREMOST: A. safety and security C. novelty and creativity B. variety and fun D. excitement and challenge 85. Adults, singing and acting like children is a form of: A. displacement C. sublimation B. regression D. compensation Situation 18: A research was conducted on. The effects of the nurse expressive role in the reduction of anxiety in patients who will undergo nasogastric tube insertion. 86. The research is experimental which means that utilized: A. an interview scheduled C. a questionnaire B. a survey D. control and experimental groups 87. The independent variable is: A. patients B. expressive role 88. The dependent variable is: A. nasogastric ingestion B. patients
77. In the ward, Harry manifests excess energy and is difficult for him to sit still. The MOST useful activity for him would be: A. delivering supply of linen to other rooms B. engaging in activity therapy and group exercises C. conducting a drama workshop D. painting a mural with other patients 78. Harrys disruptive behavior on the unit has been increasingly annoying other cli ents. Which of the following would the nurse do? A. set limits on his behavior and be consistent in approach B. make a rigid structured plan that he will have to follow C. ignore his behavior D. tell him that he is annoying other clients and isolate him in his room 79. Harry approaches you and says I have awarded Top Salesman of the Year. My boss will come and celebarate with me. You know for a fact that this is NOT true. Harry is demonstrating a delusion of: A. achievement C. influence B. reference D. grandeur 80. The defense mechanism utilized by manic patients to cover up depression is: A. displacement C. compensation B. denial D. reaction formation Situation 17: The nurse observed that Marie, age 28 years old had not been participating in activity therapies. 81. Which of the following remarks from the nursing attendants indicates a need for further teaching and observation? A. Marie made no response to an invitation to play B. Marie preferred to sit at the bench and watch the ballgame C. Marie is aloof and indifferent to co-patients D. Marie read a book while other patients played a ballgame 82. Marie said I dont like to be a part of it. Look, they are being laughed at because they are singing and acting like children. The nurse notes that in order for the activity therapy to be therapeutic: A. the staff should decide solely what activities to be done and what rules apply
89. This study was done to check the procedures of the research: A. protest study C. pilot study B. proposal D. test-retest 90. Which of the following is NOT a characteristic of experimental research? A. value plays a significant part in research B. research ideas are capable of being tested C. results of tests made on the groups are compared D. research subjects are randomly selected and placed into groups for the purpose of manipulation Situation 19: The client is walking to and fro along the hospital corridor and swinging her hands. She thinks she is going crazy. She is having palpitations, rapid pulse and hyperventilation. 91. Your nursing intervention should be to: A. encourage her to participate in an ongoing activity in the ward B. stay with her in a calm environment C. tell her to stop thinking that she is going crazy D. isolate the client in a quiet room 92. Which of the following is a behavioral manifestation of anxiety? A. hyperventilation C. panic
B. tachycardia
D. rapid pulse
93. Which of the following statements about anxiety is NOT true? A. anxiety is contagious B. repressed unresolved conflicts create anxiety C. anxiety at any level is destructive, hence a threat to a persons well being D. reactions to a perceived threat maybe real or imaginary 94. There is increased tension and reduced ability to perceive and communic ate, hence selective attention in this level of anxiety: A. moderate C. panic B. severe D. mild 95. This medication is indicated for anxious patients: A. Tofranil (Imipramine HCL) C. Valium (Diazepam) B. Haldol (Haloperidol) D. Thorazine (Chlorpromazine) Situation 20: Andy, 30 years old, was admitted to the Psychiatric Ward because of religious preoccupation, deterioration in self-care and disturbed thoughts. He believes that he has committed a lot of sins. He is threatened by people reaching out to him. His fasting for several days was not sufficient for him to feel forgiven. 96. Andy is demonstrating: A. religious delusion B. delusion of grandeur 97. A delusion is: A. psychomotor disturbance B. mood disturbance
98. The nursing goal for Andy is to: A. have him see a priest for confession B. encourage him to pray to atone for his sins C. help him develop a positive self image D. socialize him with a group to keep him in touch with reality 99. As Andy talks about his sins that he believes make people look down upon him. It is BEST to: A. agree with him and sympathize how sinful he has really been B. explore the nature of his sins C. explain that he is depreciating himself too much D. acknowledge how he feels and focus on reality oriented topics 100. The psychosocial task that Andy needs to work on is a sense of: A. identity C. autonomy B. trust D. intimacy
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