8/13/2019 nle2011 (1)

1/56

NURSING PRACTICE I: FOUNDATION OF NURSING PRACTICE

SITUATION: The nurse needs to understand that Basic health practices and health promotion is an essential part of

nursing and one of the most important responsibility of a nurse. The nurse should prioritize teaching health

promotion and primary pre!ention more than anything else.

". If you are going to modify your lifestyle it should begin in:

A. #a!e an acti!e lifestyle e$ercising regularly

B. A!oiding en!ironmental pollutants

C. recognizing the impact of nhea!th" ha#it$

%. &essening !isits in some fast food restaurants and limiting 'un( foods

). All of these are some beha!ior modification to the management of stress. *+,*-T:

A. -rogressi!e muscle rela$ation ,. Spiritual editation

%. Pharmacotherap" %. /uided Imagery

0. Basic to progressi!e muscle rela$ation is:

A. focusing on an image to rela$ ,. use of industrial e1uipment%. re!a&ing m$c!e$ from ten$ion %. stopping disturbing thoughts

2. A type of massage that in!ol!es a smooth long and circular stro(e used in the abdomen

of a client during labor is called:

A. -etrissage ,. Tapotement

B. Touch Therapy D. Eff!erage

3. If you are going to assess an incision you (no4 that 4hich of the follo4ing is a sign of inflammation5

A. There is a clear and yello4 drainage C. Re' an' (arm inci$ion

B. -allor around the incision %. Bro4n e$udates at incision site

Situation: 6ou are recently appointed as a chief nurse in a "77 bed hospital in anila. As a chief nurse (no4ledge

of the managerial process is essential.

8. One of the first things that you did 4as ob'ecti!e 4riting formulating goals and philosophy of nursing ser!ice.

This is an element of 4hich managerial process phase5

A. p!anning B. controlling ,. directing d. organizing

9. 6ou also come up 4ith the organizational structure defining the role and function of the different nursing

positions and lineup the position 4ith 1ualified people. This is included in 4hich element of the managerial

process5:

A. monitoring B. e!aluation C. organizing d. planning

;. After a 4ee( 6ou and the management committee assess the regulatory measures ta(en and correct 4hate!er

discrepancies are found. This is part of 4hich element of administration:

A. monitoring B. organizing ,. controlling d. planning

8/13/2019 nle2011 (1)

2/56

Situation: easurement of ?ital signs is necessary s(ill a nurse should possess. @emember that ta(ing ?ital signs

is one of the most common routine acti!ities that an entry le!el nurse 4ill do in practice.

"". =hen ta(ing the oral temperature of a client 4ho smo(e or drin( hot or cold fluids it is necessary that the

nurse should 4ait for ho4 many minutes5

A. "3 minutes %. +, minte$ ,. 3 minutes %. " hour

"). =hen ta(ing the blood pressure the nurse should properly 4ait for a period of time 4hen the client has 'ust

arri!ed to the health center. #o4 many minutes should a nurse 4ait before ta(ing the blood pressure of this client5

A. "3 minutes %. +, minte$ ,. 3 minutes %. " hour

"0. The nurse (no4s that he should pump the cuff of the sphygmomanometer abo!e:

A. "3 mm#g based on the -alpatory systolic B-

B. "3 mm#g based on the Auscultatory systolic B-

C. +, mm-g #a$e' on the Pa!pator" $"$to!ic %P

%. 07 mm#g based on the Auscultatory systolic B-

"2. The nurse should 4arp the B- ,uff e!enly around the clients arm ensuring that it is 4ell place appro$imately:

A. " cm abo!e the antecubital space ,. 2 cm abo!e the antecubital space

%. ) inch a#oe the antec#ita! $pace %. ) inches abo!e the antecubital space

"3. In ta(ing the blood pressure of an obese client the nurse used an ordinary size cuff and therefore an error 4ill

most li(ely occur. The nurse (no4s that if this is the case The Blood -ressure 4ill be:

A. Fa!$e high B. alse lo4 ,. Undetermined %. Normal

Situation: The human body is a comple$ system of interrelated cells tissues and organs that performs !ital

functions necessary to sustain life. no4ledge of basic anatomy is essential to understand ho4 4ell our body

adapts to the demands of life.

"8. =hat gland secretes the human gro4th hormone or the somatotropin5

A. #ypothalamus C. Anterior pititar" g!an'

B. -osterior -ituitary /land %. &i!er

"9. The gland responsible for synthesizing and producing !asopressin or antidiuretic hormone is the:

A. -"potha!am$ ,. Anterior pituitary gland

B. -osterior -ituitary /land %. -ancreas

";. @AAS or the renninangiotensinaldosterone mechanism produces 4hich effect in the body5

A. ?asodilation and increase sodium and 4ater reabsorption

B. ?asoconstriction and decrease sodium and 4ater reabsorption

,. ?asodilation and decrease sodium and 4ater resabsorption

D. /a$ocon$triction an' increa$e $o'im an' (ater rea#$oprtion

"

8/13/2019 nle2011 (1)

3/56

)". If a client is concerned that he cannot pay the bill in due time he 4ill need a prompt referral to 4hichdepartment5

A. -hysician B. &ibrary C. Socia! Serice %. %S=%

)). Agatha has breast cancer and is going through chemotherapy. She 4as referred by theOncology nurse to a selfhelp group of clients 4ith cancer to:

A. -ae an emotiona! $pport ,. or financial benefitsB. Be part of a research e$periment %. or legal benefits

)0. The nurse should be a4are the dietary department is also an important department in the collaborati!e team.

-atient needing special instructions in their diets are referred to 4hich of the follo4ing member of the collaborati!eteam5

A. The physician C. The ntritioni$tB. The dietician %. The pathologist

)2. =hen collaborating 4ith other health team members the best description of Nurse CulieDs role is:

A. *ncourages the clientDs in!ol!ement in his careB. Shares and implements orders of the health team to ensure 1uality care

,. She listens to the indi!idual !ie4s of the team members%. #elps client set goals of care and discharge

)3. Nurse Culie is successful in collaborating 4ith health team members about the care of r. Santos. This isbecause she has the follo4ing competencies:

A. Commnication1 tr$t1 an' 'eci$ion ma2ingB. ,onflict management trust negotiation,. Negotiation decision ma(ing%. utual respect negotiation and trust

SITUATION : At the O-% iss Cean @.N assisted in the -hysical e$amination of one patient for -aracentesis

&umbar tap and Thoracentesis.

)8. =hat instruction should the nurse include prior to paracentesis5

A. As( the client to drin(%. A$2 the c!ient to oi',. As( the client to be positioned on the unaffected side%. As( the client to be positioned on the affected side

)9. =hat is the position of the client prior to lumbar puncture5

A. 3a$ifeta!1 f!e&e' po$itionB. Cac(nife position,. -rone position%. Sidelying on the unaffected side

);. -rior to Thoracentesis the patient is placed on 4hat position5

A. Orthopneic po$ition B. %orsal recumbent positionB. -rone position ,. &ithotomy position

)

8/13/2019 nle2011 (1)

4/56

,. " tablespoon of salt 4ith some fish sauce and soy sauceD. ) tea$poon of $a!t (ith no fi$h $ace an' $o" $ace

0). 6ou 4ould educate r. @odriguez 4ith regards to lo4ering his salt inta(e using 4hich of the follo4ing

instruction *+,*-T:

A. *at foods 4ith little or no salt added%. 5imit ta#!e $a!t #t con'iment$ i$ a'i$a#!e

,. inimize the inta(e of tocino longanisa and other processed foods%. Use spices fruits !egetables and herbs instead

00. =hich of the follo4ing is the best method of teaching young mothers 4ith regards to nutrition education5

A. %iets limited in salt and fat

B. #armful effects of drugs and alcohol inta(e,. ,ommercial preparation of dishesD. Coo2ing 'emon$tration an' mea! p!anning

02. The cure of cancer 4ould depend on:

A. no4ing the 4arning signs of cancer

%. Ear!" 'etection an' ear!" treatment,. Utilization of alternati!e medicine%. -erforming Testicular self e$amination regularly

03. In health education 4hich of the follo4ing is a role of the Nurse5

A. ocusing on programs on drug rehabilitation and smo(ing cessation%. E'cate a$ man" peop!e a#ot (arning $ign$ of non6commnica#!e 'i$ea$e$,. onitoring client 4ith hypertension%. @eporting cases of TB &eprosy AI%S and other communicable diseases

Situation : Aling Aida. 2) years old. is 4aiting for her doctorDs appointment at the clinic 4here you 4or(.

08. 6ou are to inter!ie4 her as an initial nursing action so that you can.

A. %ocument important data in her client records for health team to read.

%. Gather 'ata a#ot her !ife$t"!e1 hea!th nee'$,!ife$t"!e1 hea!th nee'$ an' pro#!em$ to 'ee!op p!an

of care

,. pro!ide solutions to her immediate health concern

%. identify the most appropriate nurse diagnosis for her heath problem

09. %uring the inter!ie4 Aida e$periences 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. 6ou 4ill record this as:

A. ,lient complains of intermittent abdominal pain an hour alter eating fatty foods

B. After eating fatty food the client e$perienced se!ere abdominal pain

,. ,lient claims to ha!e sharp abdominal pains after eating fatty food unrelie!ed by pain medication

D. C!ient reporte' $harp a#'omina! pain on the right pper 7a'rant of a#'omen an hor after

inge$tion of fatt" foo'$.

0;. Aida tells you that she has been on a high protein F high fat F lo4 carbohydrate diet order to lose 4eight and

that she has successfully lost ; lbs during the past t4o 4ee(s. In planning a healthy balanced diet for her you 4ill:

A. Encorage her to eat (e!!6#a!ance' 'iet (ith a ariet" of foo' from the ma8or foo' grop$ an' ta2e

p!ent" of f!i'$.

B. As( her to shift to a macrobiotic diet rich in comple$ carbohydrates.

,. *ncourage her to cleanse her body to$ins by changing a !egetarian diet 4ith regular e$ercise.

%. *ncourage her to eat a high carbohydrate lo4 protein diet and lo4 fat diet.

0

8/13/2019 nle2011 (1)

5/56

27. #ealth education plan for Aida stresses pre!ention of N,% or Noncommunicable diseases that are influenced

by lifestyle. These include the follo4ing *+,*-T:

A. ,ancer C. IDD0

B. Osteoporosis %. ,ardio!ascular diseases

Situation : %ue to rapid changes in technology lifestyle of human beings e!ol!ed. This lead to the de!elopment

and e!olution of health care ser!ices to meet the ne4 demands of the society and nation in general.

2". At present go!ernment hospitals are e$pected to offer comprehensi!e health ser!ices to include illness

pre!ention and health promotion. In 4hich of the follo4ing unit of ser!ices are these ser!ices integrated5

A. 4e!!ne$$ center ,. @ehabilitation ,enter

B. Intensi!e ,are unit %. ne4born screening unit

2). =hich of the follo4ing is the OST recent go!ernment initiati!e to help subsidize the cost of health ser!ices for

both the employed and the unemployed5

A. Nationa! -ea!th In$rance Act ,. edicare Act

B. =or(erDs ,ompensation Act %. agna ,arta for -ublic #ealth =or(ers

20. The top ten morbidity cases in the -hil. Include TB diarrhea among children to name a fe4. any of these

conditions are pre!entable and ha!e implications are pre!entable and ha!e implications in the de!elopment of4hich nursing competencies5

A. *$ecution of nsg. procedure and techni1ue

B. Therapeutic use of self

,. Administration of treatment and medication

D. -ea!th e'cation

22. The cost of hospitalization is getting more e$pensi!e and unaffordable to many of our people. These facts 4ill

OST &I*&6 bring about de!elopment in 4hich of the follo4ing5

A. acute ser!ices ,. home care ser!ices

%. manage' care $erice$ %. ad!ance practice nursing

23. =hich of the follo4ing latest trend has e$panded health ser!ices based on prepaid fees 4ith emphasis onhealth promotion and illness pre!ention5

A. /o!ernment Insurance -lan C. -ea!th 0aintenance Organization

B. -referred -ro!ider Organization %. -ri!ate Insurance -lan

Situation: Safe nursing practice involves an understanding of the law.

28. In the -hilippines this la4 is :

A. The Phi!ippine Nr$ing Act of 9,,9 or R.A. );+

B. the -hilippine Nursing Act of "

8/13/2019 nle2011 (1)

6/56

2

8/13/2019 nle2011 (1)

7/56

39. The nurse is pro!iding care for a client 4ho under4ent mitral !al!e replacement. The best e$ample of ameasurable client outcome goal is to:

A. change his o4n dressing.

B. 4al( in the hall4ay.

,. (a!2 from hi$ room to the en' of the ha!! an' #ac2 #efore 'i$charge.

%. eat a special diet.

3;. =hich client characteristic 4ould be an e$ample of noncompliance5

A. Undesired drug action

B. ultiple 1uestions

C. Fai!re to progre$$

%. @esol!ed symptoms

3

8/13/2019 nle2011 (1)

8/56

A. %emocratic

B. -ermissi!e

,. &aissezfaire

D. Athoritarian

80. =hat is the most appropriate nursing diagnosis for the client 4ith acute pancreatitis5

A. Deficient f!i' o!me

B. *$cessi!e fluid !olume

,. %ecreased cardiac output

%. Ineffecti!e tissue perfusion

82. A client 4ith shoc( brought on by hemorrhage has a temperature of

8/13/2019 nle2011 (1)

9/56

8;. =hen performing an assessment the nurse identifies the follo4ing signs and symptoms: impairedcoordination decreased muscle strength limited range of motion and reluctance to mo!e. These signs andsymptoms indicate 4hich nursing diagnosis5

A. #ealthsee(ing beha!ior

%. Impaire' mo#i!it"

,. %isturbed sensory perception

%. %eficient (no4ledge

8

8/13/2019 nle2011 (1)

10/56

92. To assess a clientDs superficial lymph nodes the nurse 4ould:

A. %eeply palpate using the entire hand

B. %eeply palpate using a bimanual techni1ue

,. &ightly palpate using a bimanual techni1ue

D. Gent!" pa!pate $ing the pa'$ of the in'e& an' mi''!e finger$

93. The nurse is teaching the client to inspect all s(in surface and to report pigmented s(in lesions that:

A. Are symmetrical

%. -ae irreg!ar #or'er$

,. Are uniform in color

%. Are less than 8 mm in diameter

98. The client is being assessed for range of 'oint mo!ement. 6ou as( the client to mo!e the arm a4ay

from the body e!aluating the mo!ement of:

A. le$ion

B. *$tension

C. A#'ction

%. Adduction

99. =hen inspecting the adult clientDs thora$ the nurse obser!es for:

A. -resence of fremitus

B. -resence of breath sounds

C. 0oement of the 'iaphragm

%. Symmetry of chest e$cursion

9;. The nurse is auscultating the clientDs lung fields. The systematic pattern used for comparison is:

A. Si'e to $i'e

B. Top to bottom

,. Anterior to posterior

%. Interspace to interspace

9

8/13/2019 nle2011 (1)

11/56

;7. The nurse is conducting a general sur!ey on an adult client. The general sur!ey includes:

A. Appearance and beha!ior

B. easurement of !ital signs

,. Obser!ing specific body systems

D. Con'cting a 'etai!e' hea!th hi$tor"

SITUATION: medication is a substance used in the diagnosis treatment cure relief or pre!ention of health

alterations. No matter 4here clients recei!e their health care Ehospitals clinics or home the nurse plays an

essential role in medication preparation and administration medication teaching and e!aluating clientDs responses

to medications. The follo4ing 1uestions 4ill gauge your (no4ledge about medications.

;". =hich of the follo4ing rights has been added to the traditional fi!e rights of medication administration5

A. Right 'ocmentation

B. @ight route

,. @ight medication

%. @ight time

;). The nurse is ha!ing difficulty reading a physicianDs order for a medication. The nurse (no4s the

physician is !ery busy and does not 4ant to be called. The nurse should:

A. ,all a pharmacist to interpret the order

%. Ca!! the ph"$ician to hae the or'er c!arifie'

,. ,onsult the unit manager to help interpret the order

%. As( the unit secretary to interpret the physicianDs hand4riting

;0. The client has an order for ) tablespoons of il( of agnesia. The nurse con!erts this dose to the

metric system and 4ould gi!e the client:

A. ) ml

B. 3 ml

,. "8 ml

D. +, m!

;2. ost medication errors occur 4hen the nurse:

A. Fai!$ to fo!!o( rotine proce're$

B. Is responsible in administering numerous medications.

,. Is caring for too many clients

%. Is administering unfamiliar medications.

;3. A client is to recei!e cephale$in Gefle$H 377mg -O. The pharmacy has sent )37 mg tablets. The nurse

should gi!e:

A. tablet

B. " tablet

8/13/2019 nle2011 (1)

12/56

,. " tablet

D. 9 ta#!et$

;8. The nurse is responsible for follo4ing legal pro!isions 4hen administering controlled substances or

narcotics. ailure to do so may result in:

A. Fine$1 impri$onment1 an' !o$$ of nr$e !icen$re

B. &oss of employment

,. edication errors

%. -oor health outcomes resulting from narcotic use.

;9. -harmaco(inetics is the study of ho4 medications:

A. Are deri!ed from plants

%. Enter the #o'"1 reach their $ite of action1 are meta#o!ize'1 an' e&it the #o'".

,. Are used for certain disease processes.

%. Are manufactured and distributed to pharmaceutical companies.

;;. A nurse is going to teach a client ho4 to perform a breast self e$amination. The beha!ioral ob'ecti!e

that 4ould best measure that the clientDs ability to perform the e$amination is:

A. The client 4ill !erbalize the steps in!ol!ed in breast self e$amination 4ithin " 4ee(.

B. The nurse 4ill e$plain the importance of performing breast self e$amination once a month.

C. The c!ient (i!! perform #rea$t $e!f e&amination on her$e!f #efore the en' of the teaching

$e$$ion.

%. The nurse 4ill demonstrate breast self e$amination on a breast model pro!ided by the American

,ancer Association.

;

8/13/2019 nle2011 (1)

13/56

8/13/2019 nle2011 (1)

14/56

A. -igh c!ean$ing enema can i$ he!' )@ inche$ a#oe the in$ertion point

B. &o4 cleansing enema cleanses the entire colon from the anus and rectum up to the ileocecal !al!e

,. &o4 cleansing enema uses "777 ml of irrigating solution

%. #igh cleansing enema is usually performed to cleanse the anus rectum sigmoid colon and a portion ofthe descending colon.

8/13/2019 nle2011 (1)

15/56

NU@SIN/ -@A,TI,* II : ,OUNIT6 #*A&T# NU@SIN/ AN% ,A@* O T#* OT#*@ AN% ,#I&%

Situation : Immunization is necessary in order to sa!e li!es not only for children but also for the mother.

". Tetanus !accination is gi!en to the mother. #o4 many years 4ill TT2 last5

A. 0 B. 3 C. ), %. &ife

). TT" =ill gi!e ho4 many percent protection to the mother5

A. 93P %. @, ,.

8/13/2019 nle2011 (1)

16/56

"". Instruction to the mother prior to amniocentesis includes:

A. A$2 the (oman to oi' ,. As( the 4oman to drin(

B. Tell her that 07 ml of amniotic fluid 4ill be ta(en %. Instruct to lie in left lateral position

"). Amniocentesis can be done as early as:

A. 8;th4ee( %. ))6)9th(ee2 ,. "2"8th4ee(%. ";)7th4ee(

"0. The rationale of !oiding prior to amniocentesis is to:

A. -re!ent puncture to the !agina ,. -re!ent !ena ca!a syndrome

B. Preent pnctre to the #!a''er %. -romote comfort during the procedure

"2. After the procedure the 4oman is instructed the rest 1uietly for a period of:

A. ; hours %. +, minte$ ,. "3 minutes %. 2 hours

"3. If Amniocentesis re!eals a lo4 !alue the physician might suspect genetic or chromosomal

abnormality such as do4n syndrome. /enetic testing is another !iable option for the family. The nurse

should (no4 that genetic testing should only be done if:

A. Both parents 4ant it performed

%. It i$ in the #e$t intere$t of the chi!'

,. It is necessary for the child to sur!i!e

%. No one ob'ects

"8. rancis is admitted in acti!e labor. The nurse locates fetal heart sounds in the upper left 1uadrant of the

motherDs abdomen. The nurse 4ould recognize 4hich of the follo4ing5

A. rancis 4ill probably deli!er !ery 1uic(ly and 4ithout problemsR

%. Thi$ in'icate$ Franci$ (i!! pro#a#!" hae a #reech 'e!ier"

,. The fetus is in the most common anterior fetal positions%. this position is referred to as being left anteriopel!ic

"9. aybelle is scheduled to ha!e an ultrasound e$amination. =hat instructions 4ould you gi!e her before her

e$amination5

A. The intra!enous fluid infused to dilate your uterus does not hurt the fetus

%. "o (i!! nee' to 'rin2 at !ea$t + g!a$$e$ of f!i' #efore the proce're

,. !oid immediately before the procedure to reduce your bladder size

%. you can ha!e medicine for pain for any contractions cause by the test

";. At "9 4ee(sD gestation a type " diabetic undergoes an ultrasound e$amination. =hat information about the

fetus at this time in pregnancy 4ould be the results of this e$amination pro!ide5

A. -lacental maturity ,. /estational age%. E$timate' feta! (eight %. etal lung maturity

"

8/13/2019 nle2011 (1)

17/56

A. , #reath$ per minte or moreB. 37 breaths per minute,. 07 breaths per minute or more%. 87 breaths per minute

)0. Nina the )ndchild has diarrhea for 3 days. There is no blood in the stool. She is irritable and her eyes aresun(en. The nurse offered fluids and and the child drin(s eagerly. #o4 4ould you classify NinaDs illness5

A. Some 'eh"'ration ,. Se!ere dehydrationB. %ysentery %. No dehydration

)2. NinaDs treatment should include the follo4ing *+,*-T:A. reassess the child and classify him for dehydrationB. for infants under 8 months old 4ho are not breastfed gi!e "77)77 ml clean 4ater as 4ell during this period,. /i!e in the health center the recommended amount of O@S for 2 hours.

D. Do not gie an" other foo'$ to the chi!' for home treatment

)3. =hile on treatment Nina "; months old 4eighed "; (gs. and her temperature registered at 09 degrees ,.#er mother says she de!eloped cough 0 days ago. Nina has no general danger signs. She has 23 breathsFminuteno chest indra4ing no stridor. #o4 4ould you classify NinaDs manifestation.

A. No pneumonia C. PnemoniaB. Se!ere pneumonia %. Bronchopneumonia

Situation 8 E There are other important basic (no4ledge in the performance of our tas( as ,ommunity #ealth

Nurse in relation to IUNIATION these include:

)8. The correct temperature to store !accines in a refrigerator is:

A. bet4een 2 deg , and ; deg ,%. #et(een 9 'eg C an' @ 'eg C,. bet4een ; deg , and 7 deg ,%. bet4een ; deg , and 2 deg ,

)9. =hich of the follo4ing !accines is not done by intramuscular GIH in'ection5

A. 0ea$!e$ accineB. %-T,. #epaB !accine%. Tetanus to$oids

);. This !accine content is deri!ed from @NA recombinants.

A. easlesB. Tetanus to$oidsC. -epatiti$ % accine$%. %-T

)

8/13/2019 nle2011 (1)

18/56

0). The le!el of health of an indi!idual family group population or community is called:

A. health assets ,. 1uality of lifeB. hea!th $tat$ %. health needs

00. The nurse is teaching a group of e$pectant mothers about the pre!ention of diaper dermatitis. The nursee$plains that one of the pre!enti!e measures is the use of:

A. a#$or#ent 'i$po$a#!e 'iaper$ ,. plastic panties o!er diapersB. baby po4der or cornstarch %. cloth diaper

02. The ,ode of Nurses

A. delineates all obligations and responsibilities of the nurse%. i$ a #in'ing oath1 (hich te!!$ nr$e$ ho( to ma2e ethica! 'eci$ion$,. assists the nurse in formulating a personal belief system%. supports the concept of respect for all persons

03. The obligation to correctly perform oneDs assigned duties is:

A. %elegation C. re$pon$i#i!it"B. Assignment %. Accountability

Situation "" E 6ou are 4or(ing as a -ediatric Nurse in you o4n ,hild #ealth Nursing ,linic. The follo4ing cases

pertain to ASS*SS*NT AN% ,A@* O T#* N*=BO@N AT @IS conditions.

08. Theresa a mother 4ith a ) year old daughter as(s Mat 4hat age can I be able to ta(e the blood pressure of

my daughter as a routine procedure since hypertension is common in the family5 6our ans4er to this is:

A. At "7 years old you mayB. As early as " year old

C. 4hen $heB. orphine Sulfate,. Sodium ,hloride%. -enicillin /

0

8/13/2019 nle2011 (1)

19/56

D. encorage each $i'e to $hare their ie($ (ith each other

2). The follo4ing are the duties of the -ublic #ealth Nurse *+,*-T:

A. !eae to the %-4 the re$pon$i#i!itie$ of e'cating the commnit"

B. pro!ision of nursing care to the sic( and 4ell indi!iduals

,. pro!ision of technical and administrati!e support to rural health mid4i!es

%. conduct of pre and post consultation conference for clinic patients

20. An ; month old has fast breathing if he has:

A. 27 breaths per minute ,. 0; breaths per minute

%. #reath$ per minte %. 23 breaths per minute

22. The follo4ing are the concerns of the -ublic #ealth Nurse on the third trimester of pregnancy *+,*-T:

A. a'ice for the mother to ta2e ora! contraceptie

B. 4here to gi!e birth

,. proper timing in the separation of mother to other siblings

%. type of feeding

23. =hen a child 4ith persistent diarrhea returns for follo4up !isit after 3 days the nurse should as( the mother

if the diarrhea has stopped 4hen:

A. the chi!' ha$ !e$$ than + !oo$e #o(e!$ per 'a"

B. the child has 2 semi formed stool

,. the child has 3 formed stools

%. the child has 0 loose stoolsFday

28. In barangay 6 one of the identified problems is una!ailability of toilet facility for the residents. The appropriate

inter!ention is:

A. secure donations in the form of toilet bo4lsB. as( help from local go!ernment

,. none of the abo!e

D. con'ct a commnit" a$$em#!" an' 'i$c$$ the con$e7ence$ of thi$ pro#!em$

29. A home !isit is a professional interaction bet4een the community health nurse and his patient or the family.

=here could the nurse get a!ailable information about the patient or the family to be !isited5

A. document file ,. doctorDs office

B. records and reports D. fami!" hea!th recor'

2;. In planning a home !isit the nurse considers the indi!idual needs. =hich of the follo4ing is a priority5

A. needs of all family members ,. follo4up of medication and treatment

%. nee'$ recognize' #" the fami!" %. clinic schedules after home !isit

2

8/13/2019 nle2011 (1)

20/56

A. Increa$e' re$pirator" rate

B. Increased urine output

,. %ecreased 4eight

%. %ecreased heart rate

3). The physician prescribes digo$in G&ano$inH eli$ir for a toddler 4ith heart failure. Immediately before

administering this drug the nurse must chec( the toddlers:

A. serum sodium le!el.

B. urine output.

,. 4eight.

D. apica! p!$e.

30. A )yearold child 4ith a lo4 blood le!el of the immunosuppressi!e drug cyclosporine comes to a li!er

transplant clinic for her appointment. The mother says the child hasnt been !omiting and hasnt had diarrhea but

she admits that her daughter doesnt li(e ta(ing the li1uid medication. Based on (no4ledge of the drug 4hich of

the follo4ing 4ould the nurse instruct the mother to do5

A. &et your daughter ta(e her medication only 4hen she 4ants it its o(ay for her to miss some doses.

%. Offer the me'ication 'i!te' (ith reg!ar mi!21 choco!ate mi!21 or orange 8ice to ma2e it more

pa!ata#!e.

,. Insert a nasogastric GN/H tube and administer the medication using the tube as ordered by the physician.%. /i!e the ordered dose a little bit at a time o!er ) hours to ensure administration of the medication.

32. A toddler is hospitalized 4ith multiple in'uries. Although the parent states that the child fell do4n the stairs the

childs history and physical findings suggest abuse as the cause of the in'uries. =hat should the nurse do first5

A. @efer the parent to a support group such as -arents Anonymous.

%. Report the inci'ent to the proper athoritie$.

,. -repare the child for foster care placement.

%. @estrict the parent from the childs room.

33. The mother of a hospitalized 0yearold girl e$presses concern because her daughter is 4etting the bed. =hat

should the nurse tell her5

A. ?ItB$ common for a chi!' to e&hi#it regre$$ie #ehaior (hen an&io$ or $tre$$e'.?

B. J6our child is probably angry about being hospitalized. This is her 4ay of acting out.J

,. J%ont 4orry. Its common for a 0yearold child to not be fully toilettrained.J

%. JThe nurses probably ha!ent been ans4ering the call button soon enough. They 4ill try to respond more

1uic(ly.J

38. A )yearold child is brought to the emergency department 4ith a history of upper air4ay infection that has

4orsened o!er the last ) days. The nurse suspects the child has croup. Signs of croup include a hoarse !oice

inspiratory stridor and:

A. a #ar2ing cogh.

B. a high fe!er.

,. sudden onset.

%. dysphagia.

39. A toddler 4ith bacterial meningitis is admitted to the inpatient unit. =hich infection control measure should the

nurse be prepared to use5

A. @e!erse isolation

B. Strict hand 4ashing

,. Standard precautions

D. Re$pirator" i$o!ation

3;. An ";monthold male child is admitted to the pediatric unit 4ith a diagnosis of celiac disease. =hat finding

4ould the nurse e$pect in this child5

A. A conca!e abdomen

B. Bulges in the groin area

C. A prot#erant a#'omen

%. A palpable abdominal mass

3

8/13/2019 nle2011 (1)

21/56

,. hypertension.

%. hyperacti!ity.

87. or a child 4ith a circumferential chest burn 4hat is the most important factor for the nurse to assess5

A. =ound characteristics

B. Body temperature

C. %reathing pattern

%. #eart rate

SITUATION: *l!ira is as(ing 1uestions during labor and deli!ery.

8". *l!ira didnDt recognize for o!er an hour that she 4as in labor. A sign of true labor is:A. Sudden increase energy from epinephrine releaseB. MNagging but constant pain in the lo4er bac(.,. Urinary urgency from increased bladder pressure.D. Sho(H or re!ea$e of the cerica! mc$ p!g.

8). *l!ira as(s you 4hich fetal position and presentation are ideal. 6our best ans4er 4ould be:A. Right occipitoanterior (ith f!! f!e&ion.B. &eft trans!erse anterior in moderate fle$ion.,. @ight occipitoposterior 4ith no fle$ion.

%. &eft sacroanterior 4ith full fle$ion.

80. *l!ira is ha!ing long and hard uterine contractions. =hat length of contraction 4ould you report as abnormal5A. Any length o!er 07 seconds.%. A contraction oer ;, $econ'$ in !ength.,. A contraction that pea(s at )7 seconds.%. A contraction shorter than 87 seconds.

82. 6ou assess *l!iraDs uterine contractions. In relation to the contraction 4hen does a late deceleration begin5A. ortyfi!e seconds after the contraction is o!er.%. Thirt" $econ'$ after the $tart of a contraction.,. After e!ery tenth or more contraction.%. After a typical contraction ends.

83. *l!ira has an amniotomy. After this procedure 4hich of the follo4ing 4ould be an important nursingassessment5

A. As( her if her pain le!el is tolerable postprocedure.B. Assess maternal heart rate to detect possible bleeding.C. A$$e$$ feta! heart rate to 'etect po$$i#!e cor' pro!ap$e'.%. %ocument the amount of amniotic fluid that has been lost.

SITUATION : %onna is a client in labor

88. %onna as(s you 4hat is the purpose of a doula in labor. 6our best ans4er 4ould be:A. She times contractions and (eeps them from becoming too lengthy.B. She can coo( for a 4oman in labor to (eep her from becoming dehydrated.C. She can $ere a$ a $pport per$on an' coach 'ring !a#or.%. She replaces the husband as a 4omanDs support person.

89. %onna as(s you if she could use 4arm4ater tub bathing during labor. 6our best ans4er 4ould be:A. No. No one is allo4ed to tub bathe during labor.%. e$1 a$ !ong a$ her mem#rane$ are not rptre'.,. No because 4arm 4ater can diminish labor contractions%. 6es as long as the 4arm 4ater doesnDt raise her temperature.

8;. %onna chooses to ha!e epidural anesthesia. =hat are the t4o ris(s associated 4ith this5A. -"poten$ion an' pro!onge' $econ' $tage of !a#or.B. Se!ere headache and coldness of all e$tremities.,. ,ontinued bac( pain and short first stage of labor%. #ypertension and a reduced red blood cell count.

8

8/13/2019 nle2011 (1)

22/56

8/13/2019 nle2011 (1)

23/56

". %etermination of design

). Statement of the problem

0. %efinition of !ariables

2. ,ollection and analysis of data

3. @e!ie4 of related literature

A. 911+1)1

B. 032")

,. )302"

%. )3"02

;7. Studies done in natural setting such as this one posses difficulty of controlling 4hich !ariable5

A. Independent

B. %ependent

C. E&traneo$

%. Organismic

SITUATION : i(o 9 4ee(s old 4as brought by his mother to the health center because of diarrhea occurring 2 to

3 times a day.

;". 6our assessment re!ealed that i(o has sun(en eyes and he is restless and irritable. =hat 4ill be your

diagnosis5

A. No sign of dehydration

%. Some 'eh"'ration

,. Se!ere dehydration

%. 6ou need to asses him further to be able to ma(e a diagnosis

;). Based on your diagnosis 4hich of the follo4ing is best done for i(o5

A. Accompany ,hico to the nearest facility 4here I? fluids can be gi!en

%. Gie Chico 9,, to ,, m!. Ore$o! in hor$

,. /i!e ,hicoDs mother instruction in home management

%. eep him in your health center for close obser!ation

;0. In i(oDs assessment 4hat other problems do you ha!e to consider5

A. The presence of blood on his stools

B. Se!ere undernutrition

,. e!er or hypothermia

D. A!! of the$e

;2. i(oDs mother says ,hico has been ha!ing diarrhea for 8 days no4. 6ou 4ill decide that i(o has:

A. Acte 'iarrhea

B. 6ou cannot be certain

,. -ersistent %iarrhea

%. Subacute diarrhea

;3. After your management of i(oDs condition. 6our assessment re!ealed that he has no more sign of

dehydration. =hat instruction 4ill you gi!e to i(oDs mother5

A. ,ontinue breastfeeding him fre1uently

B. /i!e him Oresol 37"77ml after e!ery loose stool

,. Obser!ed him for danger signD. A!! of the$e in$trction

SITUATION : *ar infections are the most common cause of deafness in lo4 income areas. The nurse should be able

to assess early signs and symptoms of ear infection in order to pre!ent hearing loss 4hich in turn leads to

learning problems.

;8. Among the follo4ing the most serious complication of an ear infection is:

A. #earing loss

8/13/2019 nle2011 (1)

24/56

%. 0a$toi'iti$

,. -ain

%. %eafness leading to &earning problems

;9. =hich of the follo4ing beha!ior best suggests that the child is e$periencing ear pain5

A. Fre7ent tgging of the ear

B. Sleepiness

,. ?oracious appetite

%. Irritability

;;. An ear infection of "3 days is classified as:

A. Acute otitis media

%. Chronic otiti$ me'ia

,. astoiditis

%. Subacute otitis media

;

8/13/2019 nle2011 (1)

25/56

A. Pro#!em$ in mo#i!it" ,. inor problemsB. Shortterm needs %. ,linically apparent disease

8/13/2019 nle2011 (1)

26/56

NU@SIN/ -@A,TI,* III: ,A@* O ,&I*NTS =IT# -#6SIO&O/I, AN% -S6,#OSO,IA&

A&T*@ATION

Situation E One learns by doing especially 4hen you practice the best methods.

". =hich action by a ne4 nurse signifies a need for further teaching in infection control5

A. The nurse places the side rails the time to an unconscious patient

B. The nurse ele!ates the head of the bed to chec( the B-.

C. The nr$e $e$ her #are han'$ to change the 're$$ing%. The nurse applies o$ygen catheter to the mouth.

). 6ou are on - shift and about 3 patients are of discharge. 6ou noted that the orderly 4as loo(ing through the

items of one of the patients. =hich action should you pursue5

A. Ca!! the attention of the or'er!" in priateB. Ignore the situation because you are busy,. @eport this beha!ior to the nurse in charge%. onitor the situation and note 4hether any other items are reported missing.

0. =hat appropriate action should you do 4hen you o!erhear the nursing attendant spea(ing harshly to an elderly

patient5

A. Tr" to e&p!ore the interaction (ith the nr$ing atten'ant concerne'B. ,hange the attendantDs assignment,. Initiate a group discussion 4ith all other nursing attendants%. %iscuss the matter 4ith the patientDs family

2. %isposal of edical @ecords in the /o!ernment hospital needs collaboration 4ith 4hich of the follo4ing

department e$cept:

A. %O# ,. DI5G

B. 00DA %. R0AO

3. 6ou sa4 one colleague charting medication administration that she has not yet administered. After tal(ing to

her you also report the incident to the charge nurse. The charge nurse should:

A. Re7ire the $taff to $#mit an inci'ent reportB. Terminate the nurse,. ,harge the erring nurse 4ith dishonesty%. @epot to the Board of Nursing

Situation E 6ou are assigned at the -A,U.

8. =hich nursing diagnosis has priority among client in the -A,U5

A. Acute pain related to discomfort off 4ound and immobilityB. Body image disturbance because of 4ound dressing and drains.C. Ineffectie air(a" c!earance re!ate' to genera! ane$the$ia.%. no4ledge deficit related to lac( of information because patients are all sedated.

8/13/2019 nle2011 (1)

27/56

9. =hich of the follo4ing clients at the -A,U 4ill demonstrate the effecti!eness of nurse teaching5

A. The c!ient 'emon$trate' 'eep #reathing1 coghing1 $p!intering an' !eg e&erci$e$.B. The client manifests normal temperature,. The client sleeps 4ell%. The client has good balance I and O

;. =hich of the follo4ing remar( indicates that the clientDs relati!e understood the discharge instruction for 4ound

care5

A. MIf the 4ound is painful I 4ill say it is normalB. MIt is alright to use adhesi!e tape o!er the 4ound to (eep it intact,. MIt is o( for his pet to remain at his bedside to (eep him companyD. I (i!! report an" re'ne$$ or $(e!!ing of the (on'H

8/13/2019 nle2011 (1)

28/56

"8. r. Que 8" years of age is suffering from rheumatoid arthritis. #e as(s if there is a cure for @A. The OST

appropriate response is:

A. MNo most patients 4ith @A also de!elop osteoarthritis.

B. M6es but the patient must ta(e medication for at least "7 years.

,. M6es ne4 drugs being de!eloped offer a cure.

D. No1 #t ne( 'rg$ #eing 'ee!ope' can interfere (ith the #o'"

8/13/2019 nle2011 (1)

29/56

8/13/2019 nle2011 (1)

30/56

SITUATION : ,onsider the follo4ing components of research:

I. M@ecent research on this problem sho4s that 4oman post mastectomy de!elops chronic lo4 self esteem

problems that e!entually lead to depression According toW. GACN )77;: C Tobias Suzares et al.H

II. The more positi!e the body Image of 4oman 4ho has e$perienced a mastectomy the higher is their self

esteem le!el.

III. MIs there a correlation bet4een body Image and self esteem le!els of 4omen 4ho ha!e e$perienced

mastectomy5

I?. MAn$iety is termed as the fear of the un(no4n

?. MAn$iety 4ill be measured by using the le!els of an$iety description and 4ill be categorized as either I&%

O%*@AT* or S*?*@*

?I. -ost mastectomy 4oman ages 07 to 37.

?II. "7 -ost mastectomy 4oman ages 07 to 37 namely : agda aria #enerosa Cade Alena atrina agda

?ioleta %ana and %e!ita.

?III. Aling Alena

I+. The relationship bet4een Body Image and Self *steem le!els of 4oman postmastectomy

+. aslo4 noted t4o !ersions of esteem needs a lo4er one and a higher one. The lo4er one is the need for the

respect of others the need for status fame glory recognition attention reputation appreciation dignity e!en

dominance. The higher form in!ol!es the need for selfrespect including such feelings as confidence competence

achie!ement mastery independence and freedom.

+I. A miniature trial !ersion of the study 4as conducted before the actual research. This is to pre!ent any future

disaster that might results from incorrect data analysis data collection procedures and research design.

08. =hich statement deli!ers the title of the research5

A. II B. ?I C. IL %. I?

09. -aragraph number + is your:

A. ,onceptual frame4or( ,. @e!ie4 of related literature

%. Theoretica! frame(or2 %. Introduction

0;. -aragraph number I? is your:

A. Theoretica! 'efinition ,. Operational %efinition

B. ,onceptual definition %. %escription

0

8/13/2019 nle2011 (1)

31/56

20. -aragraph number +I is your:

A. %esign ,. Introduction

B. -opulation D. Pi!ot St'"

22. =hich paragraph sho4s your problem statement5

A. I B. II C. III %. I+

23. An appropriate title for this study is best sho4n by 4hich paragraph5

A. I B. II ,. III D. IL

28. =hich is your Independent !ariable5

A. Po$itie #o'" image ,. #igher self esteem

B. -ost mastectomy 4oman %. astectomy

29. =hich is your %ependent !ariable5

A. -ositi!e body image C. -igher $e!f e$teemB. -ost mastectomy 4oman %. astectomy

2;. =hat is the uni!erse5

A. -ositi!e body image ,. #igher self esteem

%. Po$t ma$tectom" (oman %. astectomy

2

8/13/2019 nle2011 (1)

32/56

,. @espiration of "2 breathsFminute

D. The patient

8/13/2019 nle2011 (1)

33/56

80. A mother 4ho is pregnant and has o!arian cancer has to undergo surgery to treat the cancer. In the process

the fetus died. The doctrine that 'ustifies the death of the fetus is:

a. 'ustice c. e$ception to the role

b. anatomy '. 'o#!e effect

82. A nurse is 4aiting for a report to be sent by fa$. The machine acti!ates but instead of the report the nurse

recei!ed a se$ually oriented photograph. The OST appropriate nursing action is to:

a. ca!! the nr$ing $peri$or an' report the inci'ent

b. cut the photograph and thro4 it a4ay.

c. call the police

d. call the unit 4ho sent it and as( for the name of person 4ho sent the photograph

83. s. .+.. has been admitted 4ith right upper 1uadrant pain and has been placed on a lo4 fat diet. =hich of the

follo4ing trays 4ould be acceptable for her5

a. li!er fried potatoes and a!ocado

b. 4hole mil( rice and pastry

c. ham mashed potatoes cream peas

'. $2im mi!21 !ean fi$h1 tapioca p''ing

88. aria is administering a cleansing enema to a patient 4ith fecal impaction. Before administering the enema

she should place the patient in 4hich of the follo4ing positions5

a. on the right side of the body 4ith the head of the bed ele!ated 23 degrees

#. !eft Sim

8/13/2019 nle2011 (1)

34/56

,. -harmacologic and nonpharmacologic pain management choices

%. Nonpharmacologic inter!entions based on le!el of pain

9). As a nurse caring for patients in pain you should e!aluate for opioid side effects 4hich include the follo4ing

*+,*-T:

A. -ruritus ,. ,onstipation

B. @espiratory depression D. Ph"$ica! 'epen'ence

90. =hich of the follo4ing statements about cancer pain is NOT true5

A. Opioids are drugs of choice for se!ere pain

B. -ain associated 4ith cancer and the terminal phase of the disease occurs in

ma'ority of patients

,. Under treatment of pain is often due to a clinicianDs failure or inability to e!aluate

or appreciate the se!erity of the clientDs problem

D. A'8ant me'ication$ $ch a$ $teroi'$1 anti con!$ant$1 non$teroi'a!

Anti6inf!ammator" 'rg$ enhance pain perception

92. T@ has been on morphine on a regular basis for se!eral 4ee(s. #e is no4 complaining that the usual dose he

has been recei!ing is no longer relie!ing his pain as effecti!ely. Assuming that nothing has changed in hiscondition you 4ould suspect that T@ is:

A. Becoming psychologically dependent

B. Needing to ha!e the morphine discontinued

C. Dee!oping to!erance to the morphine

%. *$aggerating his le!el of pain

93. The guidelines for choosing appropriate nonpharmacologic inter!ention for pain includes all of the follo4ing

*+-*,T:

A. *ffecti!eness for patient ,. S(ill of the clinician health professional

B. -ain problem identification D. T"pe of opioi' #eing $e'

Situation : -roblems 4ith immobility are !ery common in post operati!e patients. @ecognizing the complications

the impact and 4ays to pre!ent them are necessary aspect of nursing care.

98. =hat is inertia5

A. The a#i!it" of an o#8ect to $ta" in motion (hi!e in motion an' $ta" at re$t (hi!e at re$t.

B. The force that resist mo!ements.

,. A fi$ed point 4here a le!er mo!es.

%. *fficient and coordinated use of the body to accomplish mo!ements.

99. =hich of the follo4ing is used to raise the body of a client from the bed either to change the linen or perform arange of motion e$ercises5

A. I? -ole B. Sandbag ,. Trochanter @oll D. Trapeze #ar

9;. In mo!ing a client from a lying position 4hich of the follo4ing 4ill most li(ely cause an in'ury to the nurse5

A. bending at the (nees

B. using body 4eight to assist 4ith the mo!ement

C. $tan'ing (ith feet together

%. standing 4ith feet apart

9

8/13/2019 nle2011 (1)

35/56

A. *$tension B. @otation ,. ,ircumduction D. F!e&ion

;). It means increasing the degree from the fulcrum:

A. E&ten$ion B. @otation ,. ,ircumduction %. le$ion

;0. =hich of the follo4ing is a /OO% sign that a nurse is a4are of the principle of body mechanics5

A. Pi!!o($ n'er the 2nee$ or at the #ac2 are recommen'e' for $pport

B. Coints should be hypere$tended

,. -illo4s abo!e the 'oint is used to immobilize it

%. The position of the client should be changed 0 to 2 times a day

;2. In a client 4ith mobility problems 4hich of the follo4ing is a good nursing goal5

A. de!eloping of contractures ,. sensory alterations

%. proper #o'" a!ignment %. decrease in acti!ity tolerance

;3. In an immobilized client forcing fluid is necessary to:

A. pre!ent pneumonia ,. pre!ent s(in brea(do4n

%. preent rinar" $ta$i$ %. maintain peristalsis

Situation : Some e1uipments and materials in our hospital are color coded this is to increase the safety andproficiency of rendering patients care.

;8. In case a fire has bro(e out in the 4ard the nurse (no4s that the typical color of a fire e$tinguisher is:

A. Re' B. /reen ,. Blue %. =hite

;9. If a nurse has been ordered to prepare a spinal set gauge "8 the nurse (ne4 that the color for that spinal setis coded at:

A. @ed %. Pin2 ,. 6ello4 %. Blue

;;. If the anaesthesiologist as(ed for a )) gauge spinal set the nurse (ne4 that the color of the set that she 4illobtain is:

A. @ed B. -in( ,. 6ello4 D. %!e

;

8/13/2019 nle2011 (1)

36/56

8/13/2019 nle2011 (1)

37/56

NU@SIN/ -@A,TI,* I? : ,A@* O ,&I*NT =IT# -#6SIO&O/I, AN% -S6,#OSO,IA& A&T*@ATION B

Situation : Safety is a priority in non emergency situation. As a nurse you should (no4 that safety is

communicated using different signs and symbols.

". =hen in the road you noticed that a signage has a big capital M# on it you (no4 that this means:

A. That there should be no blo4ing of horn because this is a church zone.

%. That Thi$ i$ a ho$pita! zone1 there i$ a ho$pita! near#".

,. A hospice is nearby

%. This is a helicopter landing zone

). A trefoil signifies that:

A. There i$ a ra'ioactie hazar'.

B. That the room is for triage and emergency management.,. That there is an emergency situation that means nobody can enter the room.

%. It is a sign of a dead client ready to be mo!ed to4ards the crematory.

0. A s(ull 4ith ) crossing bone underneath it means:

A. That the medicine is poisonous.

B. That the substance is radioacti!e.

,. That the concoction is edible and tasty.

D. It

8/13/2019 nle2011 (1)

38/56

A. #I?FAI%S A4areness ,. -rostate cancer a4areness

B. ,hild abuse a4areness D. %rea$t cancer a(arene$$

8/13/2019 nle2011 (1)

39/56

A. rench ,. Units

B. /auge D. Size mmID

)7. The function of the obturator is:

A. To 'irect the oter cann!a to traer$e the cratre of the trachea for ea$ier in$ertion

B. In cases of emergency 4hen outer cannula accidentally dislodges

,. To facilitate dilation of the stoma for the insertion of the outer cannula

%. To pre!ent too much pressure on the 'ugular !ein after the tie has been placed

Situation : Organ donation is a ne4 form of treatment that pro!ides multiple complication such as re'ection.

)". Organ donation to sa!e life 4as initially 4ith the first transplant done by:

A. Dr. Chri$tian %arnar' of the Union of Soth Africa

B. %r. ,hristian of the U.S.A.

,. %r. ,hristian Barnard of So!iet Union

%. %r. ,hristian Barnard of U..

)). In "

8/13/2019 nle2011 (1)

40/56

8/13/2019 nle2011 (1)

41/56

A. informe' con$ent ,. charting

B. preoperati!e !isit %. doctorDs rounds

2). =hich statement about a personDs character is e!ident in the O@ team5

A. it assists in the control of feelings thoughts and emotions in the face of difficulty

%. it ref!ect$ the mora! a!e$ an' #e!ief$ that are $e' a$ gi'e$ to per$ona! #ehaior an' action$

,. it encourages the constructi!e use of the pleasure of the senses

%. it refers to the 1uality of being righteous correct fair and impartial

20. 6ou continuously e!aluate the clientDs adaptation to pain. =hich of the follo4ing beha!iors indicate appropriate

adaptation5

A. The client reports pain reduction and decreased acti!ityB. The client denies e$istence of painC. The c!ient can 'i$tract him$e!f 'ring pain epi$o'e$%. The client reports independence from 4atchers

22. -ain in ortho cases may not be mainly due to the surgery. There might be other factors such as cultural or

psychological that influence pain. #o4 can you alter these factors as the nurse5

A. *$plain all the possible inter!entions that may cause the client to 4orryB. *stablish trusting relationship by gi!ing his medication on time,. Stay 4ith the client during pain episodesD. Promote c!ient

8/13/2019 nle2011 (1)

42/56

diagnosed of ha!ing #epatitis A. his 4ife as(s you about gamma globulin for herself and her household help. 6our

most appropriate response 4ould be:

A. M%onDt 4orry your husbandDs type of hepatitis is no longer communicableB. M/amma globulin pro!ides passi!e immunity for hepatitis BC. o $ho!' contact "or ph"$ician imme'iate!" a#ot getting gammag!o#!in.H%. MA !accine has been de!eloped for this type of hepatitis

3). ?oltaire de!elops a nosocomial respiratory tract infection. #e as( you 4hat that means5 6our #e$tresponse4ould be:

A. o ac7ire' the infection after "o hae #een a'mitte' to the ho$pita!.HB. MThis is a highly contagious infection re1uiring complete isolation.,. MThe infection you had prior to hospitalization flared up.

%. MAs a result of medical treatment you ha!e ac1uired a secondary infection.D

30. As a nurse you (no4 that one of the complications that you ha!e to 4atch out for 4hen caring for Omar 4ho is

recei!ing total parenteral nutrition is:

A. stomatitisB. hepatitis

,. dysrhythmiaD. infection

32. A solution used to treat -seudomonas 4ound infection is:

A. Da2in

8/13/2019 nle2011 (1)

43/56

87. @@ age ;

8/13/2019 nle2011 (1)

44/56

b. the patient 4ill not be able to tolerate coughing

c. the tracheobronchial tree are dry

'. the #ronchia! $tre !ine ma"#e tramatize'

8

8/13/2019 nle2011 (1)

45/56

4hich managerial phase5

A. -lanning B. Organizing C. Directing %. ,ontrolling

;7. Quality assurance the nursing audit standards such as process structure and outcome are all utilized and

performed during 4hich managerial phase5

A. -lanning B. Organizing ,. %irecting D. Contro!!ing

;". Budgeting is formulated during 4hich managerial phase5

A. P!anning B. Organizing ,. %irecting %. ,ontrolling

;). The hospital 'ust ac1uired a ne4 !entilator as 4ell as an anaesthesia machine. This is co!ered using 4hich type

of budget5

A. Capita! B. ,ash ,. Operational %. -ersonnel

;0. The salary of the employee employee benefits as 4ell as in ser!ice education programs are all co!ered using

4hich budget5

A. ,apital B. ,ash C. Operationa! %. -ersonnel

;2. This budget is the cash on hand or the amount of money to be collected from the patient in the hospital.

A. ,apital %. Ca$h ,. Operational %. -ersonnel

;3. The monthly fees such as electricity 4ater internet and magazine subscription bills are all co!ered using

4hich type of budget5

A. ,apital B. ,ash C. Operationa! %. -ersonnel

Situation The nurseDs accurate assessment is !ery crucial in pre!enting complication during the se!ere post burnperiod.

;8. %ino sustained circumferential thermal burns of the left upper e$tremity and chest. 6ou noted that pulsecould not be appreciated in his in'ured e$tremity. =hich of the follo4ing 4ill you do I@ST5

A. *le!ate the in'ured e$tremity to increase blood flo4 to the heartB. @emo!e the dead tissues 4hich impede circulation,. Try to ta(e the pulse in the unin'ured e$tremityD. Notif" the ph"$ician imme'iate!" a$ thi$ re7ire$ emergenc" interention

;9. =hile unloading containers 4ith chemicals from a truc( ar( accidentally spilled the 4hole can of corrosi!echemicals all o!er his body. =hich of the follo4ing 4ould you consider as the priority inter!ention in the

emergency management of ar(5

A. aintain a patent air4ayB. =ash the chemical off 4ith cool 4ater,. Assess for associated in'uriesD. Remoe c!othing$ containing the chemica!

;;. 6ou are assigned in the Burn Unit and you are going to e!aluate the status of @aymond 4ho sustained a burnin'ury ") hours ago and has a urinary output of )77 ml since the in'ury. =hich of the follo4ing 4ill you do I@ST5

A. Increase the rate of the I? fluidB. Administer the prescribed urosemide G&asi$HC. Chec2 catheter for 2in2$%. Increase the oral inta(e to 07Fhr

;

8/13/2019 nle2011 (1)

46/56

8/13/2019 nle2011 (1)

47/56

A. Na$a! cann!a1 accor'ing to the American 8orna! of nr$ing an' me'icineB. ace mas(s according to a nursing blog site,. ?enturi mas( according to =i(ipedia%. O$ygen tents according to a personal 4ebsite from yahoo search engine

NU@SIN/ -@A,TI,* ? : ,A@* O ,&I*NT =IT# -#6SIO&O/I, AN% -S6,#OSO,IA& A&T*@ATION ,

Situation : astery of -sychotropic medications is necessary for the therapeutic impro!ement in the health of the

psychiatric clients.

". &ithium is only gi!en:

A. P.O B. I ,. I? %. SQ

). The nurse should e$pect that a client 4ho chee(s the medication is a noncomplaint patient. no4ing the non

compliance is the single most important factor for e$acerbation and rehospitalisation the doctor ordered -roli$in

Zluphenazine %ecanoateR. The nurse (no4s that is it gi!en:

A. Orally B. Sublingually ,. I? D. I0

0. =hich of the follo4ing is an antidepressant5

A. Serenace G#aloperidolHB. ?alium G%iazepamHC. Tofrani! =Imipramine -C!>

%. Trilaton G-herpenazineH

2. The nurse (no4s that the relationship bet4een sodium and lithium is that:

A. =hen lithium increases sodium also increasesB. =hen sodium increases lithium also increasesC. The" are iner$e!" proportiona!%. They are directly proportional

3. =hich of the follo4ing class of antidepressant is the least sedating5

A. SSRI B. AOI ,. T,A %. Neuroleptics

Situation : A nurse is 4or(ing 4ith an aggressi!e client in the psychiatric unit.

8. All of the follo4ing concepts are true *+,*-T:

A. #ostility is destructi!e

B. rustration de!elops in response to unmet needs 4ants and desire

C. Anger i$ a!(a"$ incompati#!e (ith !oe

%. Aggression can be e$pressed in a constructi!e as 4ell as a destructi!e manner.

9. ,arlo is acting out hostile and aggressi!e feeling by (ic(ing the chairs in the room. the OST effecti!e 4ay todeal 4ith ,arloDs beha!ior is initially to:

A. Set !imit$ on the #ehaior #" er#a! comman'

B. Administer -@N tran1uilizer

,. @emo!e the chairs from the room

%. @estrain the patient and place him in the MIsolation @oom

;. rs. %izon 4as !isiting her son at the -sychiatry =ard. =hich of the follo4ing items 4ill the nurse not allo4 to

be brought inside the 4ard5

8/13/2019 nle2011 (1)

48/56

A. String rosary bracelet C. %ott!e of co2e

B. Bo$ of ca(e %. @ubber shoes

8/13/2019 nle2011 (1)

49/56

B. This is a form of the manipulation of the physical en!ironmental setting

,. These are communities led by staff nurses and physicians as officers

%. /o!ernment officials from the baranggay or municipality lead patients in the therapeutic milieu

";. =hich of the follo4ing determines the success of client go!ernment groups5

A. (i!!ingne$$ of p$"chiatric profe$$iona!$ to #e open an' receptie to c!ient

8/13/2019 nle2011 (1)

50/56

B. ha!ing difficulties starting and maintaining interpersonal relationships

,. ha!ing chronic episodes of stress and an$iety 4hile interacting 4ith others

%. e$periencing recurrence of symptoms in front of particular people or among people in

general

);. The focus of the group interaction is Mhere and no4. An appropriate topic 4ould be:

A. 4ays to celebrate ?alentineDs %ay in ebruary

B. ho4 to spend the summer !acation

,. an unforgettable e$perience as a child

D. ho( to te!! a 8o2e

)

8/13/2019 nle2011 (1)

51/56

A. Contro!$ na$ea ,. controls muscle spasmB. ,ontrols pain %. controls edema

0

8/13/2019 nle2011 (1)

52/56

3". Cacob is a client 4ith hypochondriasis !erbalized MAng sa(it sa(itV Na(a(aramdam a(o ng sa(itV The nurseDs

best response is:

A. MNasaan ang masa(it sayo5

B. M-4ede mo ba sa(ing inguso (ung ano ang sumasa(it5

,. M#u4ag mo masyadong isipin yang sa(it mo /uni guni mo lamang yan

D. Sa#ihin mo $a2in1 ano ang nararam'aman mo at pa2i tro gamit ang i$ang 'a!iri 2ng $aan mo ito

nararam'aman.H

3). One morning Cacob stated M#alima4V #alima4V #alima4 (a nurseV this is a sign of:

A. Neurosis ,. Co(e

%. P$"cho$e$ %. #allucination

30. The nurseDs best response 4hen Cacob shouts M#alima4 (a nurseV is:

A. Maari mo ba sa(ing sabihin paano a(ong naging halima45

%. Na(a(a!an 2a na ng 2ontro! $a $ari!i mo a2o#H

,. M#indi (a nanaman siguro nabigyan ng nurse ng pang pa (alma mo

%. M#indi a(o halima4 Ca(ob a(o ay ang iyong nurse.

32. =hen the nurse entered another clientDs room @odrigo he said Mlea!e me alone and stop bothering me and I

donDt 4ant your pity. The follo4ing response by the nurse 4ould be OST appropriate5

A. o $eem p$et thi$ morningH an' remain$ (ith the c!ient

B. M6ou are probably upset because you donDt feel 4ell

,. M=hy you angry 4ith me5 =hat did I do anything to upset you5

%. MI understand and 4ill lea!e you for a 4hile

33. The nurse understands that the use of self a4areness is a therapeutic alliance because:

A. the nurse is a role model for a clientB. this is an essential part of the nursing process

,. the nurse has to be therapeutic at all times

D. ho( the nr$e thin2$ an' fee!$ affect$ her action$ an' #ehaior to(ar'$ her c!ient an' her (or2

Situation 8" %ernie and &ohn in their late '()s have been married for *( years and at the pea$ of their careers.

Suddenly, %ernie discovered that her husband was falling in love with another woman. Sha$en by this situation,

she started to have problems sleeping and could not function well at wor$ and at the ris$ of losing her job. &ohn

as$ed forgiveness and regret very much the hurt his wife was going through and suffered guilt feelings"

38. Bernie and Cohn are going through a:

A. $itationa! cri$i$ ,. anticipated crisis

B. de!elopmental crisis %. both de!elopmental and situational crisis

39. All of these are characteristics of crisis *+,*-T:

A. a hazardous or threatening e!ent occurs

B. it has a gro4th promoting potential

C. $a! pro#!em $o!ing metho'$ an' coping mechani$m$ pro'ce a $o!tion

%. an$iety or depression continue to increase

3;. The nurse employs this approach in crisis inter!ention:

A. pro#!em6$o!ing ,. roleplaying

B. beha!ior modification %. nursepatient relationship

3

8/13/2019 nle2011 (1)

53/56

8". This beha!ior is categorized as:

A. delusional C. nerotic

B. normal %. psychotic

8). A therapeutic inter!ention in this situation is:

A. a!oid limits on her beha!ior to release her an$iety

B. call attention to her ritualistic pattern

C. proi'e a!ternatie #ehaior$ to 'ea! (ith increa$e' an&iet"

%. ignore her beha!ior totally

80. The an$iety of elisa is disabling and interferes 4ith her 'ob performance interpersonal relationships and other

acti!ities of daily li!ing. To minimize such problems she is li(ely to be gi!en:

A. diazepam G ?alium H ,. imipramine #cl G Tofranil H

B. haloperidol G #aldol H %. chlorpromazine G Thorazine H

82. elisa understands the effects of her medicine 4hen e$presses:

A. MI should 4atch out for signs of sore lips or sore throat

B. MI might ha!e constipation

,. MI might feel changes in my body temperature

D. I $ho!' not 'rie or operate machine$H

83. The le!el of an$iety that elisa is e$periencing is:

A. -anic ,. ild

B. Se!ere D. 0o'erate

88. =hich of the follo4ing is the difference bet4een obsession and compulsion5

A. O#$e$$ion are recrrent1 per$i$tent1 intr$ie an' n(ante' thoght$ image$ or imp!$e$ (hi!ecomp!$ion$ are rita!i$tic an' repetitie #ehaior$ or action$.B. Obsession is not repetiti!e 4hile compulsion is repetiti!e.,. ,ompulsions are recurrent persistent intrusi!e and un4anted thoughts images or impulses 4hile Obsessionsare ritualistic and repetiti!e beha!iours or actions.

%. The patient can control obsessions but cannot control the compulsions.

89. =hich psychomodality is recommended for clients 4ith O,%5

A. %ehaior therap" ,. ,ogniti!e therapyB. Systematic desensitization %. A!ersion therapy

8;. =hich of the follo4ing is the drug of choice for people suffering from O,%5

A. C!omipramine = Anafrani! > ,. ,hlordiazepo$ide G &ibrium HB. %iazepam G ?alium H %. O$azepam G Sera$ H

8

8/13/2019 nle2011 (1)

54/56

B. gradual diminution of the retina,. damage to the proteins in the lensD. increa$e pro'ction of a7eo$ f!i'

90. %iamo$ is a drug used in the treatment of glaucoma. =hich of these is the effect of this drug5

A. ,onstricts the pupilB. Acts as osmotic diureticC. Re'ce$ the pro'ction of a7eo$ hmor%. acilitates outflo4 of a1ueous humor

92. -ublic health nurses should identify 4hich of these patients as a ris( group for de!elopment of glaucomahence the need for annual eye e$aminations:

A. -atient 4ith -ar(insonDs diseaseB. ,ancer patients

C. Dia#etic an' h"perten$ie patient$%. -atient 4ith ,O-%

93. The appropriate method of instilling eye drops is: Instilling into an opened eye 4ith the head held bac( and4ith the eye loo(ing:

A. p(ar' ,. aggressi!enessB. do4n4ard %. suspiciousness

Sitation A nurse 4as interested to study the research 1uestion: M=hat are the

differences and similarities bet4een aggressi!e and nonaggressi!e cogniti!ely

impaired elderly institutionalized people5

98. In!estigation of cogniti!ely impaired indi!idual presented some ethical dilemmas. =hich of the follo4ingprotocol 4ould be considered unethical5

A. @ecording interaction 4ith the elderly 4ith their permission%. /er#a! permi$$ion from the $#8ect i$ nnece$$ar",. %ata coded and recorded solely by the in!estigation

%. A 4ritten consent from the institution and a significant other

99. semistructured inter!ie4 4as conducted. This means that:

A. Inter!ie4 is conducted precisely in the same mannerB. Inter!ie4er is not held to any specific 1uestion,. Sub'ect is allo4ed to e$press 4ithout any suggestion from inter!ie4erD. Interie(er i$ free to pro#e #e"on' a nm#er of $pecific ma8or 7e$tion$

9;. The type of study conducted is:

A. De$criptie ,. e$perimentalB. Quasie$perimental %. case study

9

8/13/2019 nle2011 (1)

55/56

%. To impro!e procedure techni1ues and enhance accuracy and speed of operations

;). icroorganism gro4s the fastest in a temperature of 09 degree ,elsius. The nurse (no4s that thetemperature in the procedure room should be maintained 4ithin the range of:

A. )8 to ); %egrees ,elsius ,. 07 to 02 %egrees ,elsius%. 9, to 9 Degree$ Ce!$i$ %. 7 to ; %egrees ,elsius

;0. =hich of the follo4ing gear is e$pected that the nurse should 4ear in the semirestricted area5

A. Scr# $it1 OR $hoe$1 hea' cap B. #ead cap scrub suit mas( O@ shoes ,. as( O@ shoes scrub suit %. ,ap mas( glo!es shoes

;2. =hat O@ attires are 4orn in the restricted area5

A. Scrub suit O@ shoes head cap

%. -ea' cap1 $cr# $it1 ma$21 OR $hoe$ ,. as( O@ shoes scrub suit %. ,ap mas( glo!es shoes

;3. =hich of the follo4ing is NOT an O@ Attire5

A. Scrub Suit B. Surgical as( ,. Shoe co!ers D. G!oe$

;8. According to the three concept zone of the surgical suite design the dressing rooms are located in the:

A. @estricted area ,. Semirestricted areaB. ,lean area D. Nonre$tricte' area

;9. The follo4ing techni1ues illustrates the concept Mconfine and contain *+,*-T:

A. ,ontaminated items li(e sponges are handled using /lo!esB. All blood tissue and body fluid specimens should be placed in lea(proof containersC. Srgeon$ con'ct their patient

8/13/2019 nle2011 (1)

56/56