Nursing Practice 3

Situation: Ethical and moral issues are becoming a common scenario in practice setting so health
care providers have to be equipped with this competency.

1. In the clinical setting, when nurses are confronted with ethical dilemmas the BEST practical
guide she can use of is__.
A. PRC oath for professionals
B. Code of Ethics theological doctrine Florence Nightingale oath

2. Mr. RAD is admitted to the hospital complaining of chest pain due to clogged in his coronary
arteries. He is diabetic hypertensive and considered by the physician to be a high risk for
cardiovascular surgery. What PRIORITY action should the members of the health team do in this
situation?
A. Consult the family members and let them give their decision.
B. Proceed with the planned surgery, as this will save the patient.
C. Consult the Ethics committee on what to do with the patient.
D. Discuss with Mr. RAD his health status & let him decide.

3. Mrs. Agnes, 77 y/o is suffering from dementia and demonstrates unruly behavior. When Nurse
Gigi describes the patient in her shift report, as "That awful, dirty old woman in Bed 14" is an
example of what ethical behavior being employed by the nurse?
A. Stigma
B. Ageism
C. Gender bias
D. Depersonalization

4. Mr. Rey, who is on an end-stage of life has an order of "Do Not Resuscitate" and passed away
in your shift. He was declared dead by his physician at 8:30 AM. What should be your PRIORITY
nursing action in this situation?
A. Prepare the death certificate for the physician to sign.
B. Allow the family to have private moments with the deceased.
C. Request your nurse attendant to call the funeral parlor atonce.
D. Clean the body and remove all the IV lines, tubes and other appliances.

5. When a nurse is in full support of patient's care safety and personal rights throughout her
hospital stay, she is implementing what ethical principle?
A. Responsibility
B. Empathy
C. Advocacy
D. Accountability

Situation: A manager of an accounting firm is admitted to the hospital due to an acute abdominal
pain and passing out of bloody stools. After several diagnostic and laboratory examinations the
physician ordered him form exploratory laparotomy. You are the nurse on duty that day.
6. While performing your assessment you are guided that the organs found in the epigastrium
include which of the following?
A. A Portion of duodenum & jejunum, left kidney, appendix & ovary
B. Duodenum, pancreas, portion of the liver and pyloric end of the stomach.
C. Stomach, spleen, tail of pancreas and adrenal gland.
D. Gallbladder, duodenum, gallbladder and portion of the right kidney.

7. When conducting a nursing history on the Health Perception, Health Management pattern of
functioning what is the APPROPRIATE question to be asked pre-operatively? A. Do you experience
your wounds to heal quickly?
B. Do you have shortness of breath when exercising?
C. Are you aware of risk factors for your disease? Have you experience
weight changes in the past?

8. Patient was visited by the anesthesiologist and explained the anesthesia for his surgery. Which
of the following type of anesthesia would you expect to be ordered?
A. Spinal
B. Caudal
C. Local
D. General

9. There are pre-operative medications given to the patient. Which of the following drugs are given in
order to decrease intra-operative anesthetic requirements and pain?
A. Celebrex (Celecoxib)
B. Ibuprofen (Motrin)
C. Acetaminophen (Tylenol)
D. Demerol (Meperidine HC1)

10. The goals for patient's safety in the operating room is imperative for all members of the surgical
team. Which of the following Universal Safety Protocol are adopted and validated PRIOR to surgery?
I. Patient's identity
II. Surgical procedure
III. Surgical site
IV. Surgical equipment
A. II & III
B. I & II
C. I, II & IV
D. I, II & III

Situation: Crisostomo a 40 years old employee has been complaining of difficult painful urination for
almost a week now. He said he saw some fresh blood in his urine but was afraid to see a physician,
instead, he went to his neighbor who is a herbalist. After a week his condition worsen and his wife
brought him to a community clinic.
11. A community clinic does primary care for patients. Most often the one who manages this is which
of the following?
 A. Physician
B. Barangay health worker
C. Nurse
D. Midwife

12. Upon assessment, the patient was referred immediately to a 25-bed-capacity hospital, which
does not have any capacity to do intensive diagnostic examinations. You are a nurse in this hospital,
which you know is a LEVEL _________.
A. 3 C. 4
B. 1 D. 2

13. In the tertiary hospital where the patient was again referred, he was considered an emergency
case. The nurse immediately called for a specialist who is ________.
A. Neurologist B. Urologist Phlebotomist
Nephrologist

14. After a thorough assessment by the physician-specialist, an order for an immediate stonogram
was made. The nurse was instructed to call which of the following section of the hospital? A.
Operation Room
B. Laboratory
C. Intervention
D. CT scan

15. After the procedure the patient was ordered for Lithotripsy, under spinal anesthesia. The nurse
has to call the department of ________.
A. Internal medicine
B. Anesthesia
C. Surgery
D. Imagery

Situation: An alert 67 year-old woman with diabetes mellitus is discharged from the hospital. A
referral is made to a community nursing agency. You are asked to reinforce the teaching program
started in the hospital. The patient is using sulfonylurea compound tolbutamide (Orinase).
16. When the patient turned 69 years old. Orinase was discontinued and NPH insulin is prescribed for
her. After several months, she is determined to be suffering from the Somogyi effect. Which of the
following conditions will most likely result when the patient is receiving too much insulin?
A. Developing an elevation of the blood glucose level
B. Producing even more insulin
C. Becoming resistant to insulin
D. Conserving excessive amount of fluid

17. A few days later, the patient comes into the emergency department via ambulance stretcher and
reveals a work-up of a blood sugar level at 800mg/dl, ketones are absent in the urine, she is
dehydrated, and has an altered mental status. Based on the data, the patient is most likely suffering
from what specific medical condition?
 A. Hyperosmolar nonketotic coma (HNKC)
B. Diabetic retinopathy
C. Acute renal failure
D. Diabetic ketoacidosis (DKA)

18. Upon interview, the patient reported that she often felt nauseated, restless, perspired a lot, felt
fatigued, and was often hungry when she was younger. What do these signs indicate? A. Diabetic
nephropathy
B. Hyperglycemia
C. Hypoglycemia
D. Diabetic retinopathy

19. Upon further assessment, you noticed that she had many scratches on her right ankle, a resulting
infection and cellulitis. When you ask her about the scratches the patient states. "Oh, my cat must
have been using my leg as a scratching post again and I did not even feel it”. Which diabetic
complications suspect the patient to have?
A. Neuropathy
B. Macroangiopathy
C. Retinopathy
D. Ephropathy

20. You should check the patient for suspect disturbed thought processes related to depressed
metabolism and altered cardiovascular and respiratory status. What is the rationale for orienting the
patient to time, place, date, and events?
A. Shows improved cognitive functioning
B. Provides reality orientation to patient
C. Permits evaluation of the effectiveness of treatment
D. Lets the patient identify the time, place, date and events correctly

Situation: Nurse Pat is a newly hired Registered Nurse together with 5 licensed graduate nurses
coming from different regions. It is their first day of orientation in a big health facility. The continuing
nurse educator started the session by projecting the organizational structure of the medical center.
21. Which of the following is the MAJOR PURPOSE of an organizational structure? It is a ______.
A. blueprint representing committees for delegation of roles and functions
B. flow chart that shows interaction among members of major and minor groups
C. framework of relationship of units, departments and channels of communication D.
design that identifies roles, collaboration, interdependence between functions of people

22. Line and staff functions are identified in the presented Organizational Chart. What does line
authority mean?
A. Staff relationship in the organization is advisory in nature
B. Staff mix of personnel reporting to the "Boss".
C. Decisions are made from bottom to top in an organization.
D. A direct responsibility over a subordinate within an organization.
23. Which of the following statements is CORRECT of nursing service system in health care? A.
Informed leaders are more effective than formal leaders in an organization.
B. A shared governance tends to be controlling and with less autonomy.
C. Institutional policies are more powerful tool in nursing practice than laws and regulations.
D. A situational leadership style provides effective means in achieving patient
outcomes.

24. The mode of nursing service delivery system is being revisited in respond to patient's outcome.
Which of the following is NOT TRUE of the manager’s role in the health care delivery system?
A. Provides direct nursing care when needed.
B. Manages resource utilization.
C. Act as a liaison in litigation cases in court.
D. Collaborates with members of the health.

25. Budgeting is an important aspect of financial management. When a unit manager allocates
expenses for unit supplies, stocks and medical-surgical supplies. This is considered _________. A.
cash budget
B. operational budget
C. capital budget
D. flexible budget.

Situation: Mely, 68 -year-old, was admitted to the hospital because of decreased appetite, easy
fatigability, dehydration and weight loss of about 15 lbs for the past weeks. She was examined by
the physician and advised to be admitted. You are the nurse assigned to take care of her.
26. The physician ordered to start Ms. Mely on Total Parenteral Nutrition(TPN). What Is your INITIAL
step to be undertaken PRIOR to this intervention?
A. Determine if the family can afford the whole treatment.
B. Evaluate the tolerance of the patient to glucose.
C. Identify allergies of patient to the supplemental nutrition. D.
Assess the basic understanding of the patient regarding TPN

27. Choose from the following the primary goals of TPN?

I. promote weight gain
II. improve nutritional status
III. maintain muscle mass
IV. establish nitrogen balance V. enhance healing process
A. I, II, & III
B. I, II, III, & IV
C. I& II
D. I, II, III, IV & V

28. When a patient is undergoing TPN, you have to monitor closely for the _______.
A. serum creatinine
B. potassium level
 C. serum glucose level
D. sodium level

29. While Mrs. Mely is on TPN she suddenly complained of slight chest pain, dyspnea and
appears cyanotic. You suspect that she is experiencing what possible IMMEDIATE complication?
A. Sepsis due to IV line
B. Air embolism
C. Hyperglycemia
D. Allergic reaction to TPN

30. What PRIORITY nursing action should you do with the presenting clinical manifestations of the
patient?
A. Report to the physician status of the patient at once.
B. Take Blood pressure and respiratory rate.
C. Stop temporarily the Total Parenteral Nutrition
D. Administer Oxygen inhalation.

Situation: Ms. Monina is a retired Community Health nurse in barangay San Pablo. Due to her
commitment to the nursing profession, she has volunteered in their community to conduct health
education classes. One Saturday morning, several patients who are hypertensive and with pulmonary
health problems attended her session.
31. Mang Luis, is a newly diagnosed patient with Chronic Obstructive Lung Disease (COPD). Which
of the following PRIORITY teaching instructions should he be given in relation to his condition? A. He
should assume supine position when resting.
B. Know early signs of respiratory infection.
C. He has to be taught how to do Bronchial clapping.
D. Family should be advised that patient should sleep in a warm room.
32. Which of the following health interventions should be included in your teaching plan for Mang
Luis?
A. Be on prolonged corticosteroid therapy.
B. Lung exercises must be done with longer inhalation than exhalation.
C. Reduce risk for infection.
D. Have a high flow of oxygen administration.

33. Pulmonary Rehabilitation for COPD has a duration of at least 4 to 12weeks. Which of the
following should be avoided while patient is having this program?
A. Pursed lip breathing
B. Smoking cessation
C. Aerobic, upper and lower body conditioning
D. Peripheral muscle wasting

34. Weight loss and Malnutrition are commonly observed among patients with COPD. They should be
taught to avoid ________.
A. have full stomach even when in dyspneic condition
B. keeping body mass between 21-25 kg
 C. a high caloric and high protein diet
D. exercise one hour before and after eating

35. Which of the following energy conserving strategies should NOT be done by COPD patients?
A. Exhale when pushing or exerting effort when doing daily activities
B. Assume tripod position with elbows supported on the table when shaving or combing
C. Inhale when resting, sitting and lying down.
D. Stand in front of the mirror while shaving or combing hair

36. When performing an interview, which is the BEST initial question should you ask when a
patient is on pain?
A. How often do you feel the pain?
B. How would you describe your pain?
C. Did you take any drug to relieve the pain?
D. When did you first feel the abdominal pain?

37. Which of the following imaging test that uses transducer will be likely be ordered by the
physician to detect gallstones?
A. Computed Tomography C. Abdominal Ultrasound
B. Abdominal X-ray D. Doppler sonography

38. The test revealed presence of gallstones and inflamed gall bladder. The patient was advised
to undergo open cholecystectomy. This operation compared to laparoscopic cholecystectomy are
_________.
I. invasive
II. less pain
III. longer recovery IV. shorter
hospital stay
A. I, II, & IV
B. I & II

C. I, II & III D. I & III

39. After 2 hours post-operatively, the nurse observed reddish drainage from the
operative area of the patient. Which of the following nursing actions should you
performed FIRST? A. Check if stitches from the operation have come apart.
B. Check where is the source of possible bleeding.
C. Cover the operative area with sterile gauze bandage.
D. Put hand as a pressure on the operative area.

40. After several days in the hospital, the physician ordered for the patient to be
discharged. Which of the following is PRIORITY restriction that you should
emphasize when he goes home? A. Stool softener to induce bowel elimination.
B. Driving while using narcotic drug.
C. Take shower even if still with surgical drain.
D. Lifting of objects not more than 10 lbs.

Situation: Sarah, 18 year old, a teller from a bank is admitted to a tertiary hospital due
to hypertension and frequent hematoma of the lower extremities every time she bumps
herself in the workplace. The physician who examined her gave an impression of
Cushing disease.
41. Which of the following characteristics of Cushing disease is TRUE? I. The
disease occurs in women between 20 to 40 year of age.
II. The use of corticosteroids for multiple immune conditions is a cause of the disease
process.
III. Condition is aggravated by excessive production of ACTH.
IV. The surgical treatment of choice in Transphenoidal hypophysectomy A. II & III
B. I, II, & III
C. I, II, III, & IV
D. I & II

42. When one has a Cushing disease the focal structure affected is the __________.
A. hypothalamus C. adrenal gland
B. pituitary gland D. para thyroid gland

43. Which of the following clinical manifestations will NOT be a complaint from Sarah's
condition? A. Edema of the extremities
B. Poor wound healing
C. Decrease libido
D. Absence of growth in the pubic area

44. The attending physician ordered a Magnetic Resonance Imaging (MRI) to patient
Sarah in order to validate the medical impression. This imaging technique is done to
detect ________.
A. hemorrhagic injury in the brain C. level of oxygen in the brain
 B. electrical impulse in the brain D. non-hemorrhagic injury in the brain

45.While patient Sarah is confined in the hospital, the safety measure to be observed by
the nurses is prevention from fall. This is brought about by the patient being prone to
fracture as a result of ____. A. aging process
B. change in vision
C. osteoporosis
D. hematologic condition
Situation: Mr. Alda, 50 year old company driver is admitted in the Emergency Room
(ER) because of pain of the left chest and difficulty of breathing. History revealed that
the patient smokes one half to 1 pack of cigarette per day especially when he goes on
overtime. Vital signs: BP is 150/90, PR110/min. RR 38/ beats. Has clammy perspiration
and quite restless. The physician ordered chest Xray and revealed patient has
Pneumothorax. You are the nurse in-charge of the patient.
46. As a nurse you are guided that pain is usually described BEST as a phenomenon
which is a ______.
A. Neurologic activation of norciceptors
B. Subjective unpleasant experience
C. Adaptive mechanism to a stimulus
D. Creation of one's imagination

47. When a patient has a pneumothorax, the nurse's assessment findings will likely
reveal_______. I. absent breath sounds on the affected side
II. decreased chest expansion unilaterally
III. sharp chest pain
IV. burning chest pain
A. I, II,III
B. III &IV
C. I, II, IV
D. I & II

48. Which of the following statements is NOT true of Pneumothorax?

A. Atmospheric air within the pleural space can result to a rise in intra thoracic
pressure and reduce vital capacity in the lungs.
B. The loss of positive intra-pleural pressure can produce pneumothorax
C. The loss of negative intra pleural pressure can result to collapse of the lungs.
D. A spontaneous pneumothorax can occur with the rupture of pulmonary bleb.

49. The physician inserted a chest tube drainage to Mr. Alda in order to help re-
expand the lungs. Which of the following should you prepare FIRST as a nurse in case
of emergency when the tube is accidentally disconnected? A. sterile clamps.
B. Another chest tube.
 C. Sterile dressing.
D. A bottle of sterile water.

50. In order to relieve Mr. Alda of pain, the physician prescribed morphine. So4
2mg/IV PRN for untolerable pain. The overall goal of the Health Care Professional is to
provide adequate control so the patient can breathe easily. Which of the following
would indicate successful attainment of this goal?
A. Anxiety level of patient will be reduced.
B. Respiratory rate will be decreased to 20 breadths /min.
C. Oxygen saturation is at 76% level.
D. Pain scale will show 1to 2,in a rating scale of 10(highest, 0-lowest)