Philippine NLE Board Exam: Psychiatric Nursing Question & Answer w/ rationale | Exams Nursing | Docsity (2024)

Download Philippine NLE Board Exam: Psychiatric Nursing Question & Answer w/ rationale and more Exams Nursing in PDF only on Docsity! Philippine NLE Board Exam: Psychiatric Nursing Question & Answer w/ rationale PSYCHIATRIC NURSING 1. Mental health is defined as: A. The ability to distinguish what is real from what is not. B. A state of well-being where a person can realize his own abilities can cope with normal stresses of life and work productively. C. Is the promotion of mental health, prevention of mental disorders, nursing care of patients during illness and rehabilitation D. Absence of mental illness Answer: (B) A state of well-being where a person can realize his own abilities can cope with normal stresses of life and work productively. Mental health is a state of emotional and psychosocial well being. A mentally healthy individual is self aware and self directive, has the ability to solve problems, can cope with crisis without assistance beyond the support of family and friends fulfill the capacity to love and work and sets goals and realistic limits. A. This describes the ego function reality testing. C. This is the definition of Mental Health and Psychiatric Nursing. D. Mental health is not just the absence of mental illness. 2. Which of the following describes the role of a technician? A. Administers medications to a schizophrenic patient. B. The nurse feeds and bathes a catatonic client C. Coordinates diverse aspects of care rendered to the patient D. Disseminates information about alcohol and its effects. Answer: (A) Administers medications to a schizophrenic patient. Administration of medications and treatments, assessment, documentation are the activities of the nurse as a technician. B. Activities as a parent surrogate. C. Refers to the ward manager role. D. Role as a teacher. 3. Liza says, “Give me 10 minutes to recall the name of our college professor who failed many students in our anatomy class.” She is operating on her: A. Subconscious B. Conscious C. Unconscious D. Ego Answer: (A) Subconscious Subconscious refers to the materials that are partly remembered partly forgotten but these can be recalled spontaneously and voluntarily. B. This functions when one is awake. One is aware of his thoughts, feelings actions and what is going on in the environment. C. The largest potion of the mind that contains the memories of one’s past particularly the unpleasant. It is difficult to recall the unconscious content. D. The conscious self that deals and tests reality. 4. The superego is that part of the psyche that: A. Uses defensive function for protection. B. Is impulsive and without morals. C. Determines the circ*mstances before making decisions. D. The censoring portion of the mind. Answer: (D) The censoring portion of the mind. The critical censoring portion of one’s personality; the conscience. A. This refers to the ego function that protects itself from anything that threatens it.. B. The Id is composed of the untamed, primitive pg. 1 drives and impulses. C. This refers to the ego that acts as the moderator of the struggle between the id and the superego. 5. Primary level of prevention is exemplified by: A. Helping the client resume self care. B. Ensuring the safety of a suicidal client in the institution. C. Teaching the client stress management techniques D. Case finding and surveillance in the community Answer: (C) Teaching the client stress management techniques Primary level of prevention refers to the promotion of mental health and prevention of mental illness. This can be achieved by rendering health teachings such as modifying ones responses to stress. A. This is tertiary level of prevention that deals with rehabilitation. B and D. Secondary level of prevention which involves reduction of actual illness through early detection and treatment of illness. pg. 2 When planning school interventions for a child with a diagnosis of attention deficit hyperactivity disorder, a guide to remember is to: A. provide as much structure as possible for the child B. ignore the child’s overactivity. C. encourage the child to engage in any play activity to dissipate energy D. remove the child from the classroom when disruptive behavior occurs Answer: (A) provide as much structure as possible for the child Decrease stimuli for behavior control thru an environment that is free of distractions, a calm non – confrontational approach and setting limit to time allotted for activities. B. The child will not benefit from a lenient approach. C. Dissipate energy through safe activities. D. This indicates that the classroom environment lacks structure. 17. The child with conduct disorder will likely demonstrate: A. Easy distractibility to external stimuli. B. Ritualistic behaviors C. Preference for inanimate objects. D. Serious violations of age related norms. Answer: (D) Serious violations of age related norms. This is a disruptive disorder among children characterized by more serious violations of social standards such as aggression, vandalism, stealing, lying and truancy. A. This is characteristic of attention deficit disorder. B and C. These are noted among children with autistic disorder. 18. Ritalin is the drug of choice for chidren with ADHD. The side effects of the following may be noted: A. increased attention span and concentration B. increase in appetite C. sleepiness and lethargy D. bradycardia and diarrhea Answer: (A) increased attention span and concentration The medication has a paradoxic effect that decrease hyperactivity and impulsivity among children with ADHD. B, C, D. Side effects of Ritalin include anorexia, insomnia, diarrhea and irritability. 19. School phobia is usually treated by: A. Returning the child to the school immediately with family support. B. Calmly explaining why attendance in school is necessary C. Allowing the child to enter the school before the other children D. Allowing the parent to accompany the child in the classroom Answer: (A) Returning the child to the school immediately with family support. Exposure to the feared situation can help in overcoming anxiety. A. This will not help in relieving the anxiety due separation from a significant other. C. and C. Anxiety in school phobia is not due to being in school but due to separation from parents/caregivers so these interventions are not applicable. D. This will not help the child overcome the fear 20. A 10 year old child has very limited vocabulary and interaction skills. She has an I.Q. of 45. She is diagnosed to have Mental retardation of this classification: A. Profound B. Mild C. Moderate D. Severe Answer: (C) Moderate The child with moderate mental retardation has an I.Q. of 35-50 Profound Mental retardation has an I.Q. of below 20; Mild mental retardation 50-70 and Severe mental retardation has an I.Q. of pg. 5 20-35. 21. The nurse teaches the parents of a mentally retarded child regarding her care. The following guidelines may be taught except: A. overprotection of the child B. patience, routine and repetition C. assisting the parents set realistic goals D. giving reasonable compliments Answer: (A) overprotection of the child The child with mental retardation should not be overprotected but need protection from injury and the teasing of other children. B,C, and D Children with mental retardation have learning difficulty. They should be taught with patience and repetition, start from simple to complex, use visuals and compliment them for motivation. Realistic expectations should be set and optimize their capability. 22. The parents express apprehensions on their ability to care for their maladaptive child. The nurse identifies what nursing diagnosis: A. hopelessness B. altered parenting role C. altered family process D. ineffective coping Answer: (B) altered parenting role Altered parenting role refers to the inability to create an environment that promotes optimum growth and development of the child. This is reflected in the parent’s inability to care for the child. A. This refers to lack of choices or inability to mobilize one’s resources. C. Refers to change in family relationship and function. D. Ineffective coping is the inability to form valid appraisal of the stressor or inability to use available resources 23. A 5 year old boy is diagnosed to have autistic disorder. Which of the following manifestations may be noted in a client with autistic disorder? A. argumentativeness, disobedience, angry outburst B. intolerance to change, disturbed relatedness, stereotypes C. distractibility, impulsiveness and overactivity D. aggression, truancy, stealing, lying Answer: (B) intolerance to change, disturbed relatedness, stereotypes These are manifestations of autistic disorder. A. These manifestations are noted in Oppositional Defiant Disorder, a disruptive disorder among children. C. These are manifestations of Attention Deficit Disorder D. These are the manifestations of Conduct Disorder 24. The therapeutic approach in the care of an autistic child include the following EXCEPT: A. Engage in diversionary activities when acting -out B. Provide an atmosphere of acceptance C. Provide safety measures D. Rearrange the environment to activate the child Answer: (D) Rearrange the environment to activate the child The child with autistic disorder does not want change. Maintaining a consistent environment is therapeutic. A. Angry outburst can be rechannelled through safe activities. B. Acceptance enhances a trusting relationship. C. Ensure safety from self-destructive behaviors like head banging and hair pulling. 25. According to Piaget a 5 year old is in what stage of development: A. Sensory motor stage B. Concrete operations C. Pre-operational D. Formal operation Answer: (C) Pre-operational pg. 6 Pre-operational stage (2-7 years) is the stage when the use of language, the use of symbols and the concept of time occur. A. Sensory-motor stage (0-2 years) is the stage when the child uses the senses in learning about the self and the environment through exploration. B. Concrete operations (7-12 years) when inductive reasoning develops. D. Formal operations (2 till adulthood) is when abstract thinking and deductive reasoning develop. 26. Situation : The nurse assigned in the detoxification unit attends to various patients with substance-related disorders. A 45 years old male revealed that he experienced a marked increase in his intake of alcohol to achieve the desired effect This indicates: A. withdrawal B. tolerance C. intoxication D. psychological dependence Answer: (B) tolerance tolerance refers to the increase in the amount of the substance to achieve the same effects. A. Withdrawal refers to the physical signs and symptoms that occur when the addictive substance is reduced or withheld. B. Intoxication refers to the behavioral changes that occur upon recent ingestion of a substance. D. Psychological dependence refers to the intake of the substance to prevent the onset of withdrawal symptoms. 27. The client admitted for alcohol detoxification develops increased tremors, irritability, hypertension and fever. The nurse should be alert for impending: A. delirium tremens B. Korsakoff’s syndrome C. esophageal varices D. Wernicke’s syndrome Answer: (A) delirium tremens Delirium Tremens is the most extreme central nervous system irritability due to withdrawal from alcohol B. This refers to an amnestic syndrome associated with chronic alcoholism due to a deficiency in Vit. B C. This is a complication of liver cirrhosis which may be secondary to alcoholism . D. This is a complication of alcoholism characterized by irregularities of eye movements and lack of coordination. 28. The care for the client places priority to which of the following: A. Monitoring his vital signs every hour B. Providing a quiet, dim room C. Encouraging adequate fluids and nutritious foods D. Administering Librium as ordered Answer: (A) Monitoring his vital signs every hour Pulse and blood pressure are usually elevated during withdrawal, Elevation may indicate impending delirium tremens B. Client needs quiet, well lighted, consistent and secure environment. Excessive stimulation can aggravate anxiety and cause illusions and hallucinations. C. Adequate nutrition with sulpplement of Vit. B should be ensured. D. Sedatives are used to relieve anxiety. 29. Another client is brought to the emergency room by friends who state that he took something an hour ago. He is actively hallucinating, agitated, with irritated nasal septum. A. Heroin B. cocaine C. LSD D. marijuana Answer: (B) cocaine The manifestations indicate intoxication with cocaine, a CNS stimulant. A. Intoxication with heroine is manifested by euphoria then impairment in judgment, attention and the presence of papillary constriction. C. Intoxication with hallucinogen like LSD is manifested by grandiosity, hallucinations, pg. 7 C. have peculiar food handling patterns D. have threatened self-esteem Answer: (A) have episodic binge eating and purging Bulimia is characterized by binge eating which is characterized by taking in a large amount of food over a short period of time. B and C are characteristics of a client with anorexia nervosa D. Low esteem is noted in both eating disorders 40. A nursing diagnosis for bulimia nervosa is powerlessness related to feeling not in control of eating habits. The goal for this problem is: A. Patient will learn problem solving skills B. Patient will have decreased symptoms of anxiety. C. Patient will perform self care activities daily. D. Patient will verbalize how to set limits on others. Answer: (A) Patient will learn problem solving skills if the client learns problem solving skills she will gain a sense of control over her life. (B) Anxiety is caused by powerlessness. (C) Performing self care activities will not decrease ones powerlessness (D) Setting limits to control imposed by others is a necessary skill but problem solving skill is the priority. 41. In the management of bulimic patients, the following nursing interventions will promote a therapeutic relationship EXCEPT: A. Establish an atmosphere of trust B. Discuss their eating behavior. C. Help patients identify feelings associated with binge-purge behavior D. Teach patient about bulimia nervosa Answer: (B) Discuss their eating behavior. The client is often ashamed of her eating behavior. Discussion should focus on feelings. A,C and D promote a therapeutic relationship 42. Situation: A 35 year old male has intense fear of riding an elevator. He claims “ As if I will die inside.” This has affected his studies The client is suffering from: A. agoraphobia B. social phobia C. Claustrophobia D. xenophobia Answer: (C) Claustrophobia Claustrophobia is fear of closed space. A. Agoraphobia is fear of open space or being a situation where escape is difficult. B. Social phobia is fear of performing in the presence of others in a way that will be humiliating or embarrassing. D. Xenophobia is fear of strangers. 43. Initial intervention for the client should be to: A. Encourage to verbalize his fears as much as he wants. B. Assist him to find meaning to his feelings in relation to his past. C. Establish trust through a consistent approach. D. Accept her fears without criticizing. Answer: (D) Accept her fears without criticizing. The client cannot control her fears although the client knows its silly and can joke about it. A. Allow expression of the client’s fears but he should focus on other productive activities as well. B and C. These are not the initial interventions. 44. The nurse develops a countertransference reaction. This is evidenced by: A. Revealing personal information to the client B. Focusing on the feelings of the client. pg. 10 C. Confronting the client about discrepancies in verbal or non-verbal behavior D. The client feels angry towards the nurse who resembles his mother. Answer: (A) Revealing personal information to the client A. Countertransference is an emotional reaction of the nurse on the client based on her unconscious needs and conflicts. B and C. These are therapeutic approaches. D. This is transference reaction where a client has an emotional reaction towards the nurse based on her past. 45. Which is the desired outcome in conducting desensitization: A. The client verbalize his fears about the situation B. The client will voluntarily attend group therapy in the social hall. C. The client will socialize with others willingly D. The client will be able to overcome his disabling fear. Answer: (D) The client will be able to overcome his disabling fear. The client will overcome his disabling fear by gradual exposure to the feared object. A,B and C are not the desired outcome of desensitization. 46. Which of the following should be included in the health teachings among clients receiving Valium: A. Avoid taking CNS depressant like alcohol. B. There are no restrictions in activities. C. Limit fluid intake. D. Any beverage like coffee may be taken Answer: (A) Avoid taking CNS depressant like alcohol. Valium is a CNS depressant. Taking it with other CNS depressants like alcohol; potentiates its effect. B. The client should be taught to avoid activities that require alertness. C. Valium causes dry mouth so the client must increase her fluid intake. D. Stimulants must not be taken by the client because it can decrease the effect of Valium. 47. Situation: A 20 year old college student is admitted to the medical ward because of sudden onset of paralysis of both legs. Extensive examination revealed no physical basis for the complaint. The nurse plans intervention based on which correct statement about conversion disorder? A. The symptoms are conscious effort to control anxiety B. The client will experience high level of anxiety in response to the paralysis. C. The conversion symptom has symbolic meaning to the client D. A confrontational approach will be beneficial for the client. Answer: (C) The conversion symptom has symbolic meaning to the client the client uses body symptoms to relieve anxiety. A. The condition occurs unconsciously. B. The client is not distressed by the lost or altered body function. D. The client should not be confronted by the underlying cause of his condition because this can aggravate the client’s anxiety. 48. Nina reveals that the boyfriend has been pressuring her to engage in premarital sex. The most therapeutic response by the nurse is: A. “I can refer you to a spiritual counselor if you like.” B. “You shouldn’t allow anyone to pressure you into sex.” C. “It sounds like this problem is related to your paralysis.” D. “How do you feel about being pressured into sex by your boyfriend?” Answer: (D) “How do you feel about being pressured into sex by your boyfriend?” Focusing on expression of feelings is therapeutic. The central force of the client’s condition is anxiety. A. This is not therapeutic because the nurse passes the responsibility to the counselor. B. Giving advice is not therapeutic. C. This is not therapeutic because it confronts the underlying cause. 49. Malingering is different from somatoform disorder because the former: A. Has evidence of an organic basis. B. It is a deliberate effort to handle upsetting events C. Gratification from the environment are obtained. pg. 11 D. Stress is expressed through physical symptoms. Answer: (B) It is a deliberate effort to handle upsetting events Malingering is a conscious simulation of an illness while somatoform disorder occurs unconscious. A. Both disorders do not have an organic or structural basis. C. Both have primary gains. D. This is a characteristic of somatoform disorder. 50. Unlike psychophysiologic disorder Linda may be best managed with: A. medical regimen B. milieu therapy C. stress management techniques D. psychotherapy Answer: (C) stress management techniques Stree management techniques is the best management of somatoform disorder because the disorder is related to stress and it does not have a medical basis. A. This disorder is not supported by organic pathology so no medical regimen is required. B and D. Milieu therapy and psychotherapy may be used a therapeutic modalities but these are not the best. 51. Which is the best indicator of success in the long term management of the client? A. His symptoms are replaced by indifference to his feelings B. He participates in diversionary activities. C. He learns to verbalize his feelings and concerns D. He states that his behavior is irrational. Answer: (C) He learns to verbalize his feelings and concerns C. The client is encouraged to talk about his feelings and concerns instead of using body symptoms to manage his stressors. A. The client is encouraged to acknowledge feelings rather than being indifferent to her feelings. B. Participation in activities diverts the client’s attention away from his bodily concerns but this is not the best indicator of success. D. Help the client recognize that his physical symptoms occur because of or are exacerbated by specific stressor, not as irrational. 52. Situation: A young woman is brought to the emergency room appearing depressed. The nurse learned that her child died a year ago due to an accident. The initial nursing diagnosis is dysfunctional grieving. The statement of the woman that supports this diagnosis is: A. “I feel envious of mothers who have toddlers” B. “I haven’t been able to open the door and go into my baby’s room “ C. “I watch other toddlers and think about their play activities and I cry.” D. “I often find myself thinking of how I could have prevented the death. Answer: (B) “I haven’t been able to open the door and go into my baby’s room “ This indicates denial. This defense is adaptive as an initial reaction to loss but an extended, unsuccessful use of denial is dysfunctional. A. This indicates acknowledgement of the loss. Expressing feelings openly is acceptable. C. This indicates the stage of depression in the grieving process. D. Remembering both positive and negative aspects of the deceased love one signals successful mourning. 53. The client said “I can’t even take care of my baby. I’m good for nothing.” Which is the appropriate nursing diagnosis? A. Ineffective individual coping related to loss. B. Impaired verbal communication related to inadequate social skills. C. Low esteem related to failure in role performance D. Impaired social interaction related to repressed anger. Answer: (C) Low esteem related to failure in role performance pg. 12 63. One morning the nurse sees the client in a depressed mood. The nurse asks her “What are you thinking about?” This communication technique is: A. focusing B. validating C. reflecting D. giving broad opening Answer: (D) giving broad opening Broad opening technique allows the client to take the initiative in introducing the topic. A,B and C are all therapeutic techniques but these are not exemplified by the nurse’s statement. 64. The client says to the nurse ” Pray for me” and entrusts her wedding ring to the nurse. The nurse knows that this may signal which of the following: A. anxiety B. suicidal ideation C. Major depression D. Hopelessness Answer: (B) suicidal ideation The client’s statement is a verbal cue of suicidal ideation not anxiety. While suicide is common among clients with major depression, this occurs when their depression starts to lift. Hopelessness indicates no alternatives available and may lead to suicide, the statement and non verbal cue of the client indicate suicide. 65. Which of the following interventions should be prioritized in the care of the suicidal client? A. Remove all potentially harmful items from the client’s room. B. Allow the client to express feelings of hopelessness. C. Note the client’s capabilities to increase self esteem. D. Set a “no suicide” contract with the client. Answer: (A) Remove all potentially harmful items from the client’s room. Accessibility of the means of suicide increases the lethality. Allowing patient to express feelings and setting a no suicide contract are interventions for suicidal client but blocking the means of suicide is priority. Increasing self esteem is an intervention for depressed clients bur not specifically for suicide. 66. Situation: A 14 year old male was admitted to a medical ward due to bronchial asthma after learning that his mother was leaving soon for U.K. to work as nurse. The client has which of the following developmental focus: A. Establishing relationship with the opposite sex and career planning. B. Parental and societal responsibilities. C. Establishing ones sense of competence in school. D. Developing initial commitments and collaboration in work Answer: (A) Establishing relationship with the opposite sex and career planning. The client belongs to the adolescent stage. The adolescent establishes his sense of identity by making decisions regarding familial, occupational and social roles. The adolescent emancipates himself from the family and decides what career to pursue, what set of friends to have and what value system to uphold. B. This refers to the middle adulthood stage concerned with transmitting his values to the next generation to ensure his immortality through the perpetuation of his culture. C. This reflects school age which is concerned with the pursuit of knowledge and skills to deal with the environment both in the present and in the future. D. The stage of young adulthood is concerned with development of intimate relationship with the opposite sex, establishment of a safe and congenial family environment and building of one’s lifework. 67. The personality type of Ryan is: A. conforming B. dependent C. perfectionist pg. 15 D. masoch*stic Answer: (B) dependent A client with dependent personality is predisposed to develop asthma. A. The conforming non- assertive client is predisposed to develop hypertension because of the tendency to repress rage. C. The perfectionist and compulsive tend to develop migraine. D. The masoch*stic, self sacrificing type are prone to develop rheumatoid arthritis. 68. The nurse ensures a therapeutic environment for the client. Which of the following best describes a therapeutic milieu? A. A therapy that rewards adaptive behavior B. A cognitive approach to change behavior C. A living, learning or working environment. D. A permissive and congenial environment Answer: (C) A living, learning or working environment. A therapeutic milieu refers to a broad conceptual approach in which all aspects of the environment are channeled to provide a therapeutic environment for the client. The six environmental elements include structure, safety, norms, limit setting, balance and unit modification. A. Behavioral approach in psychiatric care is based on the premise that behavior can be learned or unlearned through the use of reward and punishment. B. Cognitive approach to change behavior is done by correcting distorted perceptions and irrational beliefs to correct maladaptive behaviors. D. This is not congruent with therapeutic milieu. 69. Included as priority of care for the client will be: A. Encourage verbalization of concerns instead of demonstrating them through the body B. Divert attention to ward activities C. Place in semi-fowlers position and render O2 inhalation as ordered D. Help her recognize that her physical condition has an emotional component Answer: (C) Place in semi-fowlers position and render O2 inhalation as ordered Since psychopysiologic disorder has organic basis, priority intervention is directed towards disease- specific management. Failure to address the medical condition of the client may be a life threat. A and B. The client has physical symptom that is adversely affected by psychological factors. Verbalization of feelings in a non threatening environment and involvement in relaxing activities are adaptive way of dealing with stressors. However, these are not the priority. D. Helping the client connect the physical symptoms with the emotional problems can be done when the client is ready. 70. The client is concerned about his coming discharge, manifested by being unusually sad. Which is the most therapeutic approach by the nurse? A. “You are much better than when you were admitted so there’s no reason to worry.” B. “What would you like to do now that you’re about to go home?” C. “You seem to have concerns about going home.” D. “Aren’t you glad that you’re going home soon?” Answer: (C) “You seem to have concerns about going home.” . This statement reflects how the client feels. Showing empathy can encourage the client to talk which is important as an alternative more adaptive way of coping with stressors.. A. Giving false reassurance is not therapeutic. B. While this technique explores plans after discharge, it does not focus on expression of feelings. D. This close ended question does not encourage verbalization of feelings. 71. Situation: The nurse may encounter clients with concerns on sexuality. The most basic factor in the intervention with clients in the area of sexuality is: A. Knowledge about sexuality. B. Experience in dealing with clients with sexual problems C. Comfort with one’s sexuality D. Ability to communicate effectively pg. 16 Answer: (C) Comfort with one’s sexuality The nurse must be accepting, empathetic and non-judgmental to patients who disclose concerns regarding sexuality. This can happen only when the nurse has reconciled and accepted her feelings and beliefs related to sexuality. A,B and D are important considerations but these are not the priority. 72. Which of the following statements is true for gender identity disorder? A. It is the sexual pleasure derived from inanimate objects. B. It is the pleasure derived from being humiliated and made to suffer C. It is the pleasure of shocking the victim with exposure of the genitalia D. It is the desire to live or involve in reactions of the opposite sex Answer: (D) It is the desire to live or involve in reactions of the opposite sex Gender identity disorder is a strong and persistent desire to be the other sex. A. This is fetishism. B. This refers to masochism. C. This describes exhibitionism. 73. The sexual response cycle in which the sexual interest continues to build: A. Sexual Desire B. Sexual arousal C. org*sm D. Resolution Answer: (B) Sexual arousal Sexual arousal or excitement refers to attaining and maintaining the physiologic requirements for sexual intercourse. A. Sexual Desire refers to the ability, interest or willingness for sexual stimulation. C. org*sm refers to the peak of the sexual response where the female has vagin*l contractions for the female and ejacul*tory contractions for the male. D. Resolution is the final phase of the sexual response in which the organs and the body systems gradually return to the unaroused state. 74. The inability to maintain the physiologic requirements in sexual intercourse is: A. Sexual Desire Disorder B. Sexual Arousal Disorder C. org*sm Disorder D. Sexual Pain disorder Answer: (B) Sexual Arousal Disorder This describes sexual arousal disorder. A. Sexual Desire Disorder refers to the persistent and recurrent lack of desire or willingness for sexual intercourse. C. org*sm Disorder is the inability to complete the sexual response cycle because of the inability to achieve an org*sm. D. Sexual Pain Disorder is characterized by genital pain before, during or after sexual intercourse. 75. The nurse asks a client to roll up his sleeves so she can take his blood pressure. The client replies “If you want I can go naked for you.” The most therapeutic response by the nurse is: A. “You’re attractive but I’m not interested.” B. “You wouldn’t be the first that I will see naked.” C. “I will report you to the guard if you don’t control yourself.” D. “I only need access to your arm. Putting up your sleeve is fine.” Answer: (D) “I only need access to your arm. Putting up your sleeve is fine.” The nurse needs to deal with the client with sexually connotative behavior in a casual, matter of fact way. A and B. These responses are not therapeutic because they are challenging and rejecting. C. Threatening the client is not therapeutic. 76. Situation: Knowledge and skills in the care of violent clients is vital in the psychiatric unit. A nurse observes that a client with a potential for violence is agitated, pacing up and down the hallway and making aggressive remarks. Which of the following statements is most appropriate to make to this patient? A. What is causing you to become agitated? pg. 17 The client is manipulative. The client must be informed about the policies, expectations, rules and regulation upon admission. A. Limits should be firmly and consistently implemented. Flexibility and bargaining are not therapeutic in dealing with a manipulative client. B. There is no specific medication prescribed for this condition. C. This is not part of the care plan. Interaction with other clients are allowed but the client should be observed and given limits in her attempt to manipulate and dominate others. 86. Situation: A 42 year old male client, is admitted in the ward because of bizarre behaviors. He is given a diagnosis of schizophrenia paranoid type. The client should have achieved the developmental task of: A. Trust vs. mistrust B. Industry vs. inferiority C. Generativity vs. stagnation D. Ego integrity vs. despair Answer: (D) Ego integrity vs. despair The client belongs to the middle adulthood stage (30 to 65 yrs.) The developmental task generativity is characterized by concern and care for others. It is a productive and creative stage. (A) Infancy stage (0 – 18 mos.) is concerned with gratification of oral needs (B) School Age child (6 – 12 yrs.) is characterized by acquisition of school competencies and social skills (C) Late adulthood ( 60 and above) Concerned with reflection on the past and his contributions to others and face the future. 87. Clients who are suspicious primarily use projection for which purpose: A. deny reality B. to deal with feelings and thoughts that are not acceptable C. to show resentment towards others D. manipulate others Answer: (B) to deal with feelings and thoughts that are not acceptable Projection is a defense mechanism where one attributes ones feelings and inadequacies to others to reduce anxiety. A. This is not true in all instances of projection C and D. This focuses on the self rather than others 88. The client says “ the NBI is out to get me.” The nurse’s best response is: A. “The NBI is not out to catch you.” B. “I don’t believe that.” C. “I don’t know anything about that. You are afraid of being harmed.” D. “ What made you think of that.” Answer: (C) “I don’t know anything about that. You are afraid of being harmed.” This presents reality and acknowledges the clients feeling A and B. are not therapeutic responses because these disagree with the client’s false belief and makes the client feel challenged D. unnecessary exploration of the false 89. The client on Haldol has pill rolling tremors and muscle rigidity. He is likely manifesting: A. tardive dyskinesia B. Pseudoparkinsonism C. akinesia D. dystonia Answer: (B) Pseudoparkinsonism Pseudoparkinsonism is a side effect of antipsychotic drugs characterized by mask-like facies, pill rolling tremors, muscle rigidity A. Tardive dyskinesia is manifested by lip smacking, wormlike movement of the tongue C. Akinesia is characterized by feeling of weakness and muscle fatigue D. Dystonia is manifested by torticollis and rolling back of the eyes 90. The client is very hostile toward one of the staff for no apparent reason. The client is manifesting: A. Splitting pg. 20 B. Transference C. Countertransference D. Resistance Answer: (B) Transference Transference is a positive or negative feeling associated with a significant person in the client’s past that are unconsciously assigned to another A. Splitting is a defense mechanism commonly seen in a client with personality disorder in which the world is perceived as all good or all bad C. Counterttransference is a phenomenon where the nurse shifts feelings assigned to someone in her past to the patient D. Resistance is the client’s refusal to submit himself to the care of the nurse 91. Situation: An 18 year old female was sexually attacked while on her way home from work. She is brought to the hospital by her mother. Rape is an example of which type of crisis: A. Situational B. Adventitious C. Developmental D. Internal Answer: (B) Adventitious Adventitious crisis is a crisis involving a traumatic event. It is not part of everyday life. A. Situational crisis is from an external source that upset ones psychological equilibrium C and D. Are the same. They are transitional or developmental periods in life 92. During the initial care of rape victims the following are to be considered EXCEPT: A. Assure privacy. B. Touch the client to show acceptance and empathy C. Accompany the client in the examination room. D. Maintain a non-judgmental approach. Answer: (B) Touch the client to show acceptance and empathy The client finds touch intrusive and therefore should be avoided. A. Privacy is one of the rights of a victim of rape. C.The client is anxious. Accompanying the client in a quiet room ensures safety and offers emotional support. D. Guilt feeling is common among rape victims. They should not be blamed. 93. The nurse acts as a patient advocate when she does one of the following: A. She encourages the client to express her feeling regarding her experience. B. She assesses the client for injuries. C. She postpones the physical assessment until the client is calm D. Explains to the client that her reactions are normal Answer: (C) She postpones the physical assessment until the client is calm The nurse acts as a patient advocate as she protects the client from psychological harm A. The nurse acts a a counselor B. The nurse acts as a technician D. This exemplifies the role of a teacher 94. Crisis intervention carried out to the client has this primary goal: A. Assist the client to express her feelings B. Help her identify her resources C. Support her adaptive coping skills D. Help her return to her pre-rape level of function Answer: (D) Help her return to her pre-rape level of function The goal of crisis intervention to help the client return to her level of function prior to the crisis. A,B and C are interventions or strategies to attain the goal 95. Five months after the incident the client complains of difficulty to concentrate, poor appetite, inability to sleep and guilt. She is likely suffering from: A. Adjustment disorder B. Somatoform Disorder pg. 21 C. Generalized Anxiety Disorder D. Post traumatic disorder Answer: (D) Post traumatic disorder Post traumatic stress disorder is characterized by flashback, irritability, difficulty falling asleep and concentrating following an extremely traumatic event. This lasts for more that one month A. Adjustment disorder is the maladaptive reaction to stressful events characterized by anxiety, depression and work or social impairments. This occurs within 3 months after the event B. Somatoform disorders are anxiety related disorders characterized by presence of physical symptoms without demonstrable organic basis C. Generalized anxiety disorder is characterized by chronic, excessive anxiety for at least 6 months 96. Situation: A 29 year old client newly diagnosed with breast cancer is pacing, with rapid speech headache and inability to focus with what the doctor was saying. The nurse assesses the level of anxiety as: A. Mild B. Moderate C. Severe D. Panic Answer: (C) Severe The client’s manifestations indicate severe anxiety. A Mild anxiety is manifested by slight muscle tension, slight fidgeting, alertness, ability to concentrate and capable of problem solving. B. Moderate muscle tension, increased vital signs, periodic slow pacing, increased rate of speech and difficulty in concentrating are noted in moderate anxiety. D. Panic level of anxiety is characterized immobilization, incoherence, feeling of being overwhelmed and disorganization 97. Anxiety is caused by: A. an objective threat B. a subjectively perceived threat C. hostility turned to the self D. masked depression Answer: (B) a subjectively perceived threat Anxiety is caused by a subjectively perceived threat A. Fear is caused by an objective threat C. A depressed client internalizes hostility D. Mania is due to masked depression 98. It would be most helpful for the nurse to deal with a client with severe anxiety by: A. Give specific instructions using speak in concise statements. B. Ask the client to identify the cause of her anxiety. C. Explain i detail the plan of care developed D. Urge the client to focus on what the nurse is saying Answer: (A) Give specific instructions using speak in concise statements. The client has narrowed perceptual field. Lengthy explanations cannot be followed by the client. B. The client will not be able to identify the cause of anxiety C and D. The client has difficulty concentrating and will not be able to focus. 99. Which of the following medications will likely be ordered for the client?” A. Prozac B. Valium C. Risperdal D. Lithium Answer: (B) Valium Antianxiety A. Antidepressant C. Antipsychotic D. Antimanic pg. 22 A. Age-specific mortality rate B. Proportionate mortality rate C. Swaroop’s index D. Case fatality rate Answer: (C) Swaroop’s index Swaroop’s index is the percentage of the deaths aged 50 years or older. Its inverse represents the percentage of untimely deaths (those who died younger than 50 years). 11. Which of the following is the most prominent feature of public health nursing? A. It involves providing home care to sick people who are not confined in the hospital. B. Services are provided free of charge to people within the catchment area. C. The public health nurse functions as part of a team providing a public health nursing services. D. Public health nursing focuses on preventive, not curative, services. Answer: (D) Public health nursing focuses on preventive, not curative, services. The catchment area in PHN consists of a residential community, many of whom are well individuals who have greater need for preventive rather than curative services. 12. According to Margaret Shetland, the philosophy of public health nursing is based on which of the following? A. Health and longevity as birthrights B. The mandate of the state to protect the birthrights of its citizens C. Public health nursing as a specialized field of nursing D. The worth and dignity of man Answer: (D) The worth and dignity of man This is a direct quote from Dr. Margaret Shetland’s statements on Public Health Nursing. 13. Which of the following is the mission of the Department of Health? A. Health for all Filipinos B. Ensure the accessibility and quality of health care C. Improve the general health status of the population D. Health in the hands of the Filipino people by the year 2020 Answer: (B) Ensure the accessibility and quality of health care (none) 14. Region IV Hospital is classified as what level of facility? A. Primary B. Secondary C. Intermediate D. Tertiary Answer: (D) Tertiary Regional hospitals are tertiary facilities because they serve as training hospitals for the region. 15. Which is true of primary facilities? A. They are usually government-run. B. Their services are provided on an out-patient basis. C. They are training facilities for health professionals. D. A community hospital is an example of this level of health facilities. Answer: (B) Their services are provided on an out-patient basis. Primary facilities government and non-government facilities that provide basic out-patient services. 16. Which is an example of the school nurse’s health care provider functions? A. Requesting for BCG from the RHU for school entrant immunization B. Conducting random classroom inspection during a measles epidemic C. Taking remedial action on an accident hazard in the school playground D. Observing places in the school where pupils spend their free time pg. 25 Answer: (B) Conducting random classroom inspection during a measles epidemic Random classroom inspection is assessment of pupils/students and teachers for signs of a health problem prevalent in the community. 17. When the nurse determines whether resources were maximized in implementing Ligtas Tigdas, she is evaluating A. Effectiveness B. Efficiency C. Adequacy D. Appropriateness Answer: (B) Efficiency Efficiency is determining whether the goals were attained at the least possible cost. 18. You are a new B.S.N. graduate. You want to become a Public Health Nurse. Where will you apply? A. Department of Health B. Provincial Health Office C. Regional Health Office D. Rural Health Unit Answer: (D) Rural Health Unit R.A. 7160 devolved basic health services to local government units (LGU’s ). The public health nurse is an employee of the LGU. 19. R.A. 7160 mandates devolution of basic services from the national government to local government units. Which of the following is the major goal of devolution? A. To strengthen local government units B. To allow greater autonomy to local government units C. To empower the people and promote their self-reliance D. To make basic services more accessible to the people Answer: (C) To empower the people and promote their self-reliance People empowerment is the basic motivation behind devolution of basic services to LGU’s. 20. Who is the Chairman of the Municipal Health Board? A. Mayor B. Municipal Health Officer C. Public Health Nurse D. Any qualified physician Answer: (A) Mayor The local executive serves as the chairman of the Municipal Health Board. 21. Which level of health facility is the usual point of entry of a client into the health care delivery system? A. Primary B. Secondary C. Intermediate D. Tertiary Answer: (A) Primary The entry of a person into the health care delivery system is usually through a consultation in outpatient services. 22. The public health nurse is the supervisor of rural health midwives. Which of the following is a supervisory function of the public health nurse? A. Referring cases or patients to the midwife B. Providing technical guidance to the midwife C. Providing nursing care to cases referred by the midwife D. Formulating and implementing training programs for midwives Answer: (B) Providing technical guidance to the midwife pg. 26 The nurse provides technical guidance to the midwife in the care of clients, particularly in the implementation of management guidelines, as in Integrated Management of Childhood Illness. 23. One of the participants in a hilot training class asked you to whom she should refer a patient in labor who develops a complication. You will answer, to the A. Public Health Nurse B. Rural Health Midwife C. Municipal Health Officer D. Any of these health professionals Answer: (C) Municipal Health Officer A public health nurse and rural health midwife can provide care during normal childbirth. A physician should attend to a woman with a complication during labor. 24. You are the public health nurse in a municipality with a total population of about 20,000. There are 3 rural health midwives among the RHU personnel. How many more midwife items will the RHU need? A. 1 B. 2 C. 3 D. The RHU does not need any more midwife item. Answer: (A) 1 Each rural health midwife is given a population assignment of about 5,000. 25. If the RHU needs additional midwife items, you will submit the request for additional midwife items for approval to the A. Rural Health Unit B. District Health Office C. Provincial Health Office D. Municipal Health Board Answer: (D) Municipal Health Board As mandated by R.A. 7160, basic health services have been devolved from the national government to local government units. 26. As an epidemiologist, the nurse is responsible for reporting cases of notifiable diseases. What law mandates reporting of cases of notifiable diseases? A. Act 3573 B. R.A. 3753 C. R.A. 1054 D. R.A. 1082 Answer: (A) Act 3573 Act 3573, the Law on Reporting of Communicable Diseases, enacted in 1929, mandated the reporting of diseases listed in the law to the nearest health station. 27. According to Freeman and Heinrich, community health nursing is a developmental service. Which of the following best illustrates this statement? A. The community health nurse continuously develops himself personally and professionally. B. Health education and community organizing are necessary in providing community health services. C. Community health nursing is intended primarily for health promotion and prevention and treatment of disease. D. The goal of community health nursing is to provide nursing services to people in their own places of residence. Answer: (B) Health education and community organizing are necessary in providing community health services. pg. 27 39. The de los Reyes couple have a 6-year old child entering school for the first time. The de los Reyes family has a A. Health threat B. Health deficit C. Foreseeable crisis D. Stress point Answer: (C) Foreseeable crisis Entry of the 6-year old into school is an anticipated period of unusual demand on the family. 40. Which of the following is an advantage of a home visit? A. It allows the nurse to provide nursing care to a greater number of people. B. It provides an opportunity to do first hand appraisal of the home situation. C. It allows sharing of experiences among people with similar health problems. D. It develops the family’s initiative in providing for health needs of its members. Answer: (B) It provides an opportunity to do first hand appraisal of the home situation. Choice A is not correct since a home visit requires that the nurse spend so much time with the family. Choice C is an advantage of a group conference, while choice D is true of a clinic consultation. 41. Which is CONTRARY to the principles in planning a home visit? A. A home visit should have a purpose or objective. B. The plan should revolve around family health needs. C. A home visit should be conducted in the manner prescribed by the RHU. D. Planning of continuing care should involve a responsible family member. Answer: (C) A home visit should be conducted in the manner prescribed by the RHU. The home visit plan should be flexible and practical, depending on factors, such as the family’s needs and the resources available to the nurse and the family. 42. The PHN bag is an important tool in providing nursing care during a home visit. The most important principle of bag technique states that it A. Should save time and effort. B. Should minimize if not totally prevent the spread of infection. C. Should not overshadow concern for the patient and his family. D. May be done in a variety of ways depending on the home situation, etc. Answer: (B) Should minimize if not totally prevent the spread of infection. Bag technique is performed before and after handling a client in the home to prevent transmission of infection to and from the client. 43. To maintain the cleanliness of the bag and its contents, which of the following must the nurse do? A. Wash his/her hands before and after providing nursing care to the family members. B. In the care of family members, as much as possible, use only articles taken from the bag. C. Put on an apron to protect her uniform and fold it with the right side out before putting it back into the bag. D. At the end of the visit, fold the lining on which the bag was placed, ensuring that the contaminated side is on the outside. Answer: (A) Wash his/her hands before and after providing nursing care to the family members. Choice B goes against the idea of utilizing the family’s resources, which is encouraged in CHN. Choices C and D goes against the principle of asepsis of confining the contaminated surface of objects. 44. The public health nurse conducts a study on the factors contributing to the high mortality rate due to heart disease in the municipality where she works. Which branch of epidemiology does the nurse practice in this situation? A. Descriptive B. Analytical C. Therapeutic pg. 30 D. Evaluation Answer: (B) Analytical Analytical epidemiology is the study of factors or determinants affecting the patterns of occurrence and distribution of disease in a community. 45. Which of the following is a function of epidemiology? A. Identifying the disease condition based on manifestations presented by a client B. Determining factors that contributed to the occurrence of pneumonia in a 3 year old C. Determining the efficacy of the antibiotic used in the treatment of the 3 year old client with pneumonia D. Evaluating the effectiveness of the implementation of the Integrated Management of Childhood Illness Answer: (D) Evaluating the effectiveness of the implementation of the Integrated Management of Childhood Illness Epidemiology is used in the assessment of a community or evaluation of interventions in community health practice. 46. Which of the following is an epidemiologic function of the nurse during an epidemic? A. Conducting assessment of suspected cases to detect the communicable disease B. Monitoring the condition of the cases affected by the communicable disease C. Participating in the investigation to determine the source of the epidemic D. Teaching the community on preventive measures against the disease Answer: (C) Participating in the investigation to determine the source of the epidemic Epidemiology is the study of patterns of occurrence and distribution of disease in the community, as well as the factors that affect disease patterns. The purpose of an epidemiologic investigation is to identify the source of an epidemic, i.e., what brought about the epidemic. 47. The primary purpose of conducting an epidemiologic investigation is to A. Delineate the etiology of the epidemic B. Encourage cooperation and support of the community C. Identify groups who are at risk of contracting the disease D. Identify geographical location of cases of the disease in the community Answer: (A) Delineate the etiology of the epidemic Delineating the etiology of an epidemic is identifying its source. 48. Which is a characteristic of person-to-person propagated epidemics? A. There are more cases of the disease than expected. B. The disease must necessarily be transmitted through a vector. C. The spread of the disease can be attributed to a common vehicle. D. There is a gradual build up of cases before the epidemic becomes easily noticeable. Answer: (D) There is a gradual build up of cases before the epidemic becomes easily noticeable. A gradual or insidious onset of the epidemic is usually observable in person-to-person propagated epidemics. 49. In the investigation of an epidemic, you compare the present frequency of the disease with the usual frequency at this time of the year in this community. This is done during which stage of the investigation? A. Establishing the epidemic B. Testing the hypothesis C. Formulation of the hypothesis D. Appraisal of facts Answer: (A) Establishing the epidemic pg. 31 Establishing the epidemic is determining whether there is an epidemic or not. This is done by comparing the present number of cases with the usual number of cases of the disease at the same time of the year, as well as establishing the relatedness of the cases of the disease. 50. The number of cases of Dengue fever usually increases towards the end of the rainy season. This pattern of occurrence of Dengue fever is best described as A. Epidemic occurrence B. Cyclical variation C. Sporadic occurrence D. Secular variation Answer: (B) Cyclical variation A cyclical variation is a periodic fluctuation in the number of cases of a disease in the community. 51. In the year 1980, the World Health Organization declared the Philippines, together with some other countries in the Western Pacific Region, “free” of which disease? A. Pneumonic plague B. Poliomyelitis C. Small pox D. Anthrax Answer: (C) Small pox The last documented case of Small pox was in 1977 at Somalia. 52. In the census of the Philippines in 1995, there were about 35,299,000 males and about 34,968,000 females. What is the sex ratio? A. 99.06:100 B. 100.94:100 C. 50.23% D. 49.76% Answer: (B) 100.94:100 Sex ratio is the number of males for every 100 females in the population. 53. Primary health care is a total approach to community development. Which of the following is an indicator of success in the use of the primary health care approach? A. Health services are provided free of charge to individuals and families. B. Local officials are empowered as the major decision makers in matters of health. C. Health workers are able to provide care based on identified health needs of the people. D. Health programs are sustained according to the level of development of the community. Answer: (D) Health programs are sustained according to the level of development of the community. Primary health care is essential health care that can be sustained in all stages of development of the community. 54. Sputum examination is the major screening tool for pulmonary tuberculosis. Clients would sometimes get false negative results in this exam. This means that the test is not perfect in terms of which characteristic of a diagnostic examination? A. Effectiveness B. Efficacy C. Specificity D. Sensitivity Answer: (D) Sensitivity Sensitivity is the capacity of a diagnostic examination to detect cases of the disease. If a test is 100% sensitive, all the cases tested will have a positive result, i.e., there will be no false negative results. 55. Use of appropriate technology requires knowledge of indigenous technology. Which medicinal herb is given for fever, headache and cough? A. Sambong B. Tsaang gubat C. Akapulko pg. 32 67. In the past year, Barangay A had an average population of 1655. 46 babies were born in that year, 2 of whom died less than 4 weeks after they were born. There were 4 recorded stillbirths. What is the neonatal mortality rate? A. 27.8/1,000 B. 43.5/1,000 C. 86.9/1,000 D. 130.4/1,000 Answer: (B) 43.5/1,000 To compute for neonatal mortality rate, divide the number of babies who died before reaching the age of 28 days by the total number of live births, then multiply by 1,000. 68. Which statistic best reflects the nutritional status of a population? A. 1-4 year old age-specific mortality rate B. Proportionate mortality rate C. Infant mortality rate D. Swaroop’s index Answer: (A) 1-4 year old age-specific mortality rate Since preschoolers are the most susceptible to the effects of malnutrition, a population with poor nutritional status will most likely have a high 1-4 year old age-specific mortality rate, also known as child mortality rate. 69. What numerator is used in computing general fertility rate? A. Estimated midyear population B. Number of registered live births C. Number of pregnancies in the year D. Number of females of reproductive age Answer: (B) Number of registered live births To compute for general or total fertility rate, divide the number of registered live births by the number of females of reproductive age (15-45 years), then multiply by 1,000. 70. You will gather data for nutritional assessment of a purok. You will gather information only from families with members who belong to the target population for PEM. What method of data gathering is best for this purpose? A. Census B. Survey C. Record review D. Review of civil registry Answer: (B) Survey A survey, also called sample survey, is data gathering about a sample of the population. 71. In the conduct of a census, the method of population assignment based on the actual physical location of the people is termed A. De jure B. De locus C. De facto D. De novo Answer: (C) De facto The other method of population assignment, de jure, is based on the usual place of residence of the people. 72. The Field Health Services and Information System (FHSIS) is the recording and reporting system in public health care in the Philippines. The Monthly Field Health Service Activity Report is a form used in which of the components of the FHSIS? A. Tally report B. Output report pg. 35 C. Target/client list D. Individual health record Answer: (A) Tally report A tally report is prepared monthly or quarterly by the RHU personnel and transmitted to the Provincial Health Office. 73. To monitor clients registered in long-term regimens, such as the Multi-Drug Therapy, which component will be most useful? A. Tally report B. Output report C. Target/client list D. Individual health record Answer: (C) Target/client list The MDT Client List is a record of clients enrolled in MDT and other relevant data, such as dates when clients collected their monthly supply of drugs. 74. Civil registries are important sources of data. Which law requires registration of births within 30 days from the occurrence of the birth? A. P.D. 651 B. Act 3573 C. R.A. 3753 D. R.A. 3375 Answer: (A) P.D. 651 P.D. 651 amended R.A. 3753, requiring the registry of births within 30 days from their occurrence. 75. Which of the following professionals can sign the birth certificate? A. Public health nurse B. Rural health midwife C. Municipal health officer D. Any of these health professionals Answer: (D) Any of these health professionals D. R.A. 3753 states that any birth attendant may sign the certificate of live birth. 76. Which criterion in priority setting of health problems is used only in community health care? A. Modifiability of the problem B. Nature of the problem presented C. Magnitude of the health problem D. Preventive potential of the health problem Answer: (C) Magnitude of the health problem Magnitude of the problem refers to the percentage of the population affected by a health problem. The other choices are criteria considered in both family and community health care. 77. The Sentrong Sigla Movement has been launched to improve health service delivery. Which of the following is/are true of this movement? A. This is a project spearheaded by local government units. B. It is a basis for increasing funding from local government units. C. It encourages health centers to focus on disease prevention and control. D. Its main strategy is certification of health centers able to comply with standards. Answer: (D) Its main strategy is certification of health centers able to comply with standards. Sentrong Sigla Movement is a joint project of the DOH and local government units. Its main strategy is certification of health centers that are able to comply with standards set by the DOH. 78. Which of the following women should be considered as special targets for family planning? A. Those who have two children or more B. Those with medical conditions such as anemia C. Those younger than 20 years and older than 35 years pg. 36 D. Those who just had a delivery within the past 15 months Answer: (D) Those who just had a delivery within the past 15 months The ideal birth spacing is at least two years. 15 months plus 9 months of pregnancy = 2 years. 79. Freedom of choice is one of the policies of the Family Planning Program of the Philippines. Which of the following illustrates this principle? A. Information dissemination about the need for family planning B. Support of research and development in family planning methods C. Adequate information for couples regarding the different methods D. Encouragement of couples to take family planning as a joint responsibility Answer: (C) Adequate information for couples regarding the different methods To enable the couple to choose freely among different methods of family planning, they must be given full information regarding the different methods that are available to them, considering the availability of quality services that can support their choice. 80. A woman, 6 months pregnant, came to the center for consultation. Which of the following substances is contraindicated? A. Tetanus toxoid B. Retinol 200,000 IU C. Ferrous sulfate 200 mg D. Potassium iodate 200 mg. capsule Answer: (B) Retinol 200,000 IU Retinol 200,000 IU is a form of megadose Vitamin A. This may have a teratogenic effect. 81. During prenatal consultation, a client asked you if she can have her delivery at home. After history taking and physical examination, you advised her against a home delivery. Which of the following findings disqualifies her for a home delivery? A. Her OB score is G5P3. B. She has some palmar pallor. C. Her blood pressure is 130/80. D. Her baby is in cephalic presentation. Answer: (A) Her OB score is G5P3. Only women with less than 5 pregnancies are qualified for a home delivery. It is also advisable for a primigravida to have delivery at a childbirth facility. 82. Inadequate intake by the pregnant woman of which vitamin may cause neural tube defects? A. Niacin B. Riboflavin C. Folic acid D. Thiamine Answer: (C) Folic acid It is estimated that the incidence of neural tube defects can be reduced drastically if pregnant women have an adequate intake of folic acid. 83. You are in a client’s home to attend to a delivery. Which of the following will you do first? A. Set up the sterile area. B. Put on a clean gown or apron. C. Cleanse the client’s vulva with soap and water. D. Note the interval, duration and intensity of labor contractions. Answer: (D) Note the interval, duration and intensity of labor contractions. Assessment of the woman should be done first to determine whether she is having true labor and, if so, what stage of labor she is in. 84. In preparing a primigravida for breastfeeding, which of the following will you do? A. Tell her that lactation begins within a day after delivery. B. Teach her nipple stretching exercises if her nipples are everted. pg. 37 95. A 2-month old infant was brought to the health center for immunization. During assessment, the infant’s temperature registered at 38.1°C. Which is the best course of action that you will take? A. Go on with the infant’s immunizations. B. Give Paracetamol and wait for his fever to subside. C. Refer the infant to the physician for further assessment. D. Advise the infant’s mother to bring him back for immunization when he is well. Answer: (A) Go on with the infant’s immunizations. In the EPI, fever up to 38.5°C is not a contraindication to immunization. Mild acute respiratory tract infection, simple diarrhea and malnutrition are not contraindications either. 96. A pregnant woman had just received her 4th dose of tetanus toxoid. Subsequently, her baby will have protection against tetanus for how long? A. 1 year B. 3 years C. 10 years D. Lifetime Answer: (A) 1 year The baby will have passive natural immunity by placental transfer of antibodies. The mother will have active artificial immunity lasting for about 10 years. 5 doses will give the mother lifetime protection. 97. A 4-month old infant was brought to the health center because of cough. Her respiratory rate is 42/minute. Using the Integrated Management of Child Illness (IMCI) guidelines of assessment, her breathing is considered A. Fast B. Slow C. Normal D. Insignificant Answer: (C) Normal In IMCI, a respiratory rate of 50/minute or more is fast breathing for an infant aged 2 to 12 months. 98. Which of the following signs will indicate that a young child is suffering from severe pneumonia? A. Dyspnea B. Wheezing C. Fast breathing D. Chest indrawing Answer: (D) Chest indrawing In IMCI, chest indrawing is used as the positive sign of dyspnea, indicating severe pneumonia. 99. Using IMCI guidelines, you classify a child as having severe pneumonia. What is the best management for the child? A. Prescribe an antibiotic. B. Refer him urgently to the hospital. C. Instruct the mother to increase fluid intake. D. Instruct the mother to continue breastfeeding. Answer: (B) Refer him urgently to the hospital. Severe pneumonia requires urgent referral to a hospital. Answers A, C and D are done for a client classified as having pneumonia. 100. A 5-month old infant was brought by his mother to the health center because of diarrhea occurring 4 to 5 times a day. His skin goes back slowly after a skin pinch and his eyes are sunken. Using the IMCI guidelines, you will classify this infant in which category? A. No signs of dehydration B. Some dehydration C. Severe dehydration D. The data is insufficient. pg. 40 Answer: (B) Some dehydration Using the assessment guidelines of IMCI, a child (2 months to 5 years old) with diarrhea is classified as having SOME DEHYDRATION if he shows 2 or more of the following signs: restless or irritable, sunken eyes, the skin goes back slow after a skin pinch. 101. Based on assessment, you classified a 3-month old infant with the chief complaint of diarrhea in the category of SOME DEHYDRATION. Based on IMCI management guidelines, which of the following will you do? A. Bring the infant to the nearest facility where IV fluids can be given. B. Supervise the mother in giving 200 to 400 ml. of Oresol in 4 hours. C. Give the infant’s mother instructions on home management. D. Keep the infant in your health center for close observation. Answer: (B) Supervise the mother in giving 200 to 400 ml. of Oresol in 4 hours. In the IMCI management guidelines, SOME DEHYDRATION is treated with the administration of Oresol within a period of 4 hours. The amount of Oresol is best computed on the basis of the child’s weight (75 ml/kg body weight). If the weight is unknown, the amount of Oresol is based on the child’s age. 102. A mother is using Oresol in the management of diarrhea of her 3-year old child. She asked you what to do if her child vomits. You will tell her to A. Bring the child to the nearest hospital for further assessment. B. Bring the child to the health center for intravenous fluid therapy. C. Bring the child to the health center for assessment by the physician. D. Let the child rest for 10 minutes then continue giving Oresol more slowly. Answer: (D) Let the child rest for 10 minutes then continue giving Oresol more slowly. If the child vomits persistently, that is, he vomits everything that he takes in, he has to be referred urgently to a hospital. Otherwise, vomiting is managed by letting the child rest for 10 minutes and then continuing with Oresol administration. Teach the mother to give Oresol more slowly. 103. A 1 ½ year old child was classified as having 3rd degree protein energy malnutrition, kwashiorkor. Which of the following signs will be most apparent in this child? A. Voracious appetite B. Wasting C. Apathy D. Edema Answer: (D) Edema Edema, a major sign of kwashiorkor, is caused by decreased colloidal osmotic pressure of the blood brought about by hypoalbuminemia. Decreased blood albumin level is due a protein- deficient diet. 104. Assessment of a 2-year old child revealed “baggy pants”. Using the IMCI guidelines, how will you manage this child? A. Refer the child urgently to a hospital for confinement. B. Coordinate with the social worker to enroll the child in a feeding program. C. Make a teaching plan for the mother, focusing on menu planning for her child. D. Assess and treat the child for health problems like infections and intestinal parasitism. Answer: (A) Refer the child urgently to a hospital for confinement. “Baggy pants” is a sign of severe marasmus. The best management is urgent referral to a hospital. 105. During the physical examination of a young child, what is the earliest sign of xerophthalmia that you may observe? A. Keratomalacia B. Corneal opacity C. Night blindness D. Conjunctival xerosis Answer: (D) Conjunctival xerosis pg. 41 The earliest sign of Vitamin A deficiency (xerophthalmia) is night blindness. However, this is a functional change, which is not observable during physical examination.The earliest visible lesion is conjunctival xerosis or dullness of the conjunctiva due to inadequate tear production. 106. To prevent xerophthalmia, young children are given Retinol capsule every 6 months. What is the dose given to preschoolers? A. 10,000 IU B. 20,000 IU C. 100,000 IU D. 200,000 IU Answer: (D) 200,000 IU Preschoolers are given Retinol 200,000 IU every 6 months. 100,000 IU is given once to infants aged 6 to 12 months. The dose for pregnant women is 10,000 IU. 107. The major sign of iron deficiency anemia is pallor. What part is best examined for pallor? A. Palms B. Nailbeds C. Around the lips D. Lower conjunctival sac Answer: (A) Palms The anatomic characteristics of the palms allow a reliable and convenient basis for examination for pallor. 108. Food fortification is one of the strategies to prevent micronutrient deficiency conditions. R.A. 8976 mandates fortification of certain food items. Which of the following is among these food items? A. Sugar B. Bread C. Margarine D. Filled milk Answer: (A) Sugar R.A. 8976 mandates fortification of rice, wheat flour, sugar and cooking oil with Vitamin A, iron and/or iodine. 109. What is the best course of action when there is a measles epidemic in a nearby municipality? A. Give measles vaccine to babies aged 6 to 8 months. B. Give babies aged 6 to 11 months one dose of 100,000 I.U. of Retinol C. Instruct mothers to keep their babies at home to prevent disease transmission. D. Instruct mothers to feed their babies adequately to enhance their babies’ resistance. Answer: (A) Give measles vaccine to babies aged 6 to 8 months. Ordinarily, measles vaccine is given at 9 months of age. During an impending epidemic, however, one dose may be given to babies aged 6 to 8 months. The mother is instructed that the baby needs another dose when the baby is 9 months old. 110. A mother brought her daughter, 4 years old, to the RHU because of cough and colds. Following the IMCI assessment guide, which of the following is a danger sign that indicates the need for urgent referral to a hospital? A. Inability to drink B. High grade fever C. Signs of severe dehydration D. Cough for more than 30 days Answer: (A) Inability to drink A sick child aged 2 months to 5 years must be referred urgently to a hospital if he/she has one or more of the following signs: not able to feed or drink, vomits everything, convulsions, abnormally sleepy or difficult to awaken. 111. Management of a child with measles includes the administration of which of the following? pg. 42 Answer: (C) Proper use of sanitary toilets The ova of the parasite get out of the human body together with feces. Cutting the cycle at this stage is the most effective way of preventing the spread of the disease to susceptible hosts. 123. When residents obtain water from an artesian well in the neighborhood, the level of this approved type of water facility is A. I B. II C. III D. IV Answer: (B) II A communal faucet or water standpost is classified as Level II. 124. For prevention of hepatitis A, you decided to conduct health education activities. Which of the following is IRRELEVANT? A. Use of sterile syringes and needles B. Safe food preparation and food handling by vendors C. Proper disposal of human excreta and personal hygiene D. Immediate reporting of water pipe leaks and illegal water connections Answer: (A) Use of sterile syringes and needles Hepatitis A is transmitted through the fecal oral route. Hepatitis B is transmitted through infected body secretions like blood and sem*n. 126. Which biological used in Expanded Program on Immunization (EPI) should NOT be stored in the freezer? A. DPT B. Oral polio vaccine C. Measles vaccine D. MMR Answer: (A) DPT DPT is sensitive to freezing. The appropriate storage temperature of DPT is 2 to 8° C only. OPV and measles vaccine are highly sensitive to heat and require freezing. MMR is not an immunization in the Expanded Program on Immunization. 127. You will conduct outreach immunization in a barangay with a population of about 1500. Estimate the number of infants in the barangay. A. 45 B. 50 C. 55 D. 60 Answer: (A) 45 To estimate the number of infants, multiply total population by 3%. 128. In Integrated Management of Childhood Illness, severe conditions generally require urgent referral to a hospital. Which of the following severe conditions DOES NOT always require urgent referral to a hospital? A. Mastoiditis B. Severe dehydration C. Severe pneumonia D. Severe febrile disease Answer: (B) Severe dehydration The order of priority in the management of severe dehydration is as follows: intravenous fluid therapy, referral to a facility where IV fluids can be initiated within 30 minutes, Oresol/nasogastric tube, Oresol/orem. When the foregoing measures are not possible or effective, tehn urgent referral to the hospital is done. pg. 45 129. A client was diagnosed as having Dengue fever. You will say that there is slow capillary refill when the color of the nailbed that you pressed does not return within how many seconds? A. 3 B. 5 C. 8 D. 10 Answer: (A) 3 Adequate blood supply to the area allows the return of the color of the nailbed within 3 seconds. 130. A 3-year old child was brought by his mother to the health center because of fever of 4-day duration. The child had a positive tourniquet test result. In the absence of other signs, which is the most appropriate measure that the PHN may carry out to prevent Dengue shock syndrome? A. Insert an NGT and give fluids per NGT. B. Instruct the mother to give the child Oresol. C. Start the patient on intravenous fluids STAT. D. Refer the client to the physician for appropriate management. Answer: (B) Instruct the mother to give the child Oresol. Since the child does not manifest any other danger sign, maintenance of fluid balance and replacement of fluid loss may be done by giving the client Oresol. 131. The pathognomonic sign of measles is Koplik’s spot. You may see Koplik’s spot by inspecting the . A. Nasal mucosa B. Buccal mucosa C. Skin on the abdomen D. Skin on the antecubital surface Answer: (B) Buccal mucosa Koplik’s spot may be seen on the mucosa of the mouth or the throat. 132. Among the following diseases, which is airborne? A. Viral conjunctivitis B. Acute poliomyelitis C. Diphtheria D. Measles Answer: (D) Measles Viral conjunctivitis is transmitted by direct or indirect contact with discharges from infected eyes. Acute poliomyelitis is spread through the fecal-oral route and contact with throat secretions, whereas diphtheria is through direct and indirect contact with respiratory secretions. 133. Among children aged 2 months to 3 years, the most prevalent form of meningitis is caused by which microorganism? A. Hemophilus influenzae B. Morbillivirus C. Steptococcus pneumoniae D. Neisseria meningitidis Answer: (A) Hemophilus influenzae Hemophilus meningitis is unusual over the age of 5 years. In developing countries, the peak incidence is in children less than 6 months of age. Morbillivirus is the etiology of measles. Streptococcus pneumoniae and Neisseria meningitidis may cause meningitis, but age distribution is not specific in young children. 134. Human beings are the major reservoir of malaria. Which of the following strategies in malaria control is based on this fact? A. Stream seeding B. Stream clearing C. Destruction of breeding places pg. 46 D. Zooprophylaxis Answer: (D) Zooprophylaxis Zooprophylaxis is done by putting animals like cattle or dogs close to windows or doorways just before nightfall. The Anopheles mosquito takes his blood meal from the animal and goes back to its breeding place, thereby preventing infection of humans. 135. The use of larvivorous fish in malaria control is the basis for which strategy of malaria control? A. Stream seeding B. Stream clearing C. Destruction of breeding places D. Zooprophylaxis Answer: (A) Stream seeding Stream seeding is done by putting tilapia fry in streams or other bodies of water identified as breeding places of the Anopheles mosquito 136. Mosquito-borne diseases are prevented mostly with the use of mosquito control measures. Which of the following is NOT appropriate for malaria control? A. Use of chemically treated mosquito nets B. Seeding of breeding places with larva-eating fish C. Destruction of breeding places of the mosquito vector D. Use of mosquito-repelling soaps, such as those with basil or citronella Answer: (C) Destruction of breeding places of the mosquito vector Anopheles mosquitoes breed in slow-moving, clear water, such as mountain streams. 137. A 4- year old client was brought to the health center with the chief complaint of severe diarrhea and the passage of “rice water” stools. The client is most probably suffering from which condition? A. Giardiasis B. Cholera C. Amebiasis D. Dysentery Answer: (B) Cholera Passage of profuse watery stools is the major symptom of cholera. Both amebic and bacillary dysentery are characterized by the presence of blood and/or mucus in the stools. Giardiasis is characterized by fat malabsorption and, therefore, steatorrhea. 138. In the Philippines, which specie of schistosoma is endemic in certain regions? A. S. mansoni B. S. japonicum C. S. malayensis D. S. haematobium Answer: (B) S. japonicum S. mansoni is found mostly in Africa and South America; S. haematobium in Africa and the Middle East; and S. malayensis only in peninsular Malaysia. 139. A 32-year old client came for consultation at the health center with the chief complaint of fever for a week. Accompanying symptoms were muscle pains and body malaise. A week after the start of fever, the client noted yellowish discoloration of his sclera. History showed that he waded in flood waters about 2 weeks before the onset of symptoms. Based on his history, which disease condition will you suspect? A. Hepatitis A B. Hepatitis B C. Tetanus D. Leptospirosis Answer: (D) Leptospirosis Leptospirosis is transmitted through contact with the skin or mucous membrane with water or moist soil contaminated with urine of infected animals, like rats. pg. 47 LEADERSHIP, MANAGEMENT, BIOETHICS AND RESEARCH 1. Ms. Castro is newly-promoted to a patient care manager position. She updates her knowledge on the theories in management and leadership in order to become effective in her new role. She learns that some managers have low concern for services and high concern for staff. Which style of management refers to this? A. Organization Man B. Impoverished Management C. Country Club Management D. Team Management Answer: (C) Country Club Management Country club management style puts concern for the staff as number one priority at the expense of the delivery of services. He/she runs the department just like a country club where every one is happy including the manager. 2. Her former manager demonstrated passion for serving her staff rather than being served. She takes time to listen, prefers to be a teacher first before being a leader, which is characteristic of Transformational leader A. Transactional leader B. Servant leader C. Charismatic leader Answer: (C) Servant leader Servant leaders are open-minded, listen deeply, try to fully understand others and not being judgmental 3. On the other hand, Ms. Castro notices that the Chief Nurse Executive has charismatic leadership style. Which of the following behaviors best describes this style? A. Possesses inspirational quality that makes followers gets attracted of him and regards him with reverence B. Acts as he does because he expects that his behavior will yield positive results C. Uses visioning as the core of his leadership D. Matches his leadership style to the situation at hand. Answer: (A) Possesses inspirational quality that makes followers gets attracted of him and regards him with reverence Charismatic leaders make the followers feel at ease in their presence. They feel that they are in good hands whenever the leader is around. 4. Which of the following conclusions of Ms. Castro about leadership characteristics is TRUE? A. There is a high correlation between the communication skills of a leader and the ability to get the job done. B. A manager is effective when he has the ability to plan well. C. Assessment of personal traits is a reliable tool for predicting a manager’s potential. D. There is good evidence that certain personal qualities favor success in managerial role. Answer: (C) Assessment of personal traits is a reliable tool for predicting a manager’s potential. It is not conclusive that certain qualities of a person would make him become a good manager. It can only predict a manager’s potential of becoming a good one. 5. She reads about Path Goal theory. Which of the following behaviors is manifested by the leader who uses this theory? A. Recognizes staff for going beyond expectations by giving them citations B. Challenges the staff to take individual accountability for their own practice C. Admonishes staff for being laggards. D. Reminds staff about the sanctions for non performance. Answer: (A) Recognizes staff for going beyond expectations by giving them citations Path Goal theory according to House and associates rewards good performance so that others would do the same pg. 50 6. One leadership theory states that “leaders are born and not made,” which refers to which of the following theories? A. Trait B. Charismatic C. Great Man D. Situational Answer: (C) Great Man Leaders become leaders because of their birth right. This is also called Genetic theory or the Aristotelian theory 7. She came across a theory which states that the leadership style is effective dependent on the situation. Which of the following styles best fits a situation when the followers are selfdirected, experts and arematured individuals? A. Democratic B. Authoritarian C. Laissez faire D. Bureaucratic Answer: (C) Laissez faire Laissez faire leadership is preferred when the followers know what to do and are experts in the field. This leadership style is relationship-oriented rather than task-centered. 8. She surfs the internet for more information about leadership styles. She reads about shared leadership as a practice in some magnet hospitals. Which of the following describes this style of leadership? A. Leadership behavior is generally determined by the relationship between the leader’s personality and the specific situation B. Leaders believe that people are basically good and need not be closely controlled C. Leaders rely heavily on visioning and inspire members to achieve results D. Leadership is shared at the point of care. Answer: (D) Leadership is shared at the point of care. Shared governance allows the staff nurses to have the authority, responsibility and accountability for their own practice. 9. Ms. Castro learns that some leaders are transactional leaders. Which of the following does NOT characterize a transactional leader? A. Focuses on management tasks B. Is a caretaker C. Uses trade-offs to meet goals D. Inspires others with vision Answer: (D) Inspires others with vision Inspires others with a vision is characteristic of a transformational leader. He is focused more on the day-to-day operations of the department/unit. 10. She finds out that some managers have benevolent-authoritative style of management. Which of the following behaviors will she exhibit most likely? A. Have condescending trust and confidence in their subordinates B. Gives economic or ego awards C. Communicates downward to the staff D. Allows decision making among subordinates Answer: (A) Have condescending trust and confidence in their subordinates Benevolent-authoritative managers pretentiously show their trust and confidence to their followers 11. Harry is a Unit Manager I the Medical Unit. He is not satisfied with the way things are going in his unit. Patient satisfaction rate is 60% for two consecutive months and staff morale is at its lowest. pg. 51 He decides to plan and initiate changes that will push for a turnaround in the condition of the unit. Which of the following actions is a priority for Harry? A. Call for a staff meeting and take this up in the agenda. B. Seek help from her manager. C. Develop a strategic action on how to deal with these concerns. D. Ignore the issues since these will be resolved naturally. Answer: (A) Call for a staff meeting and take this up in the agenda. This will allow for the participation of every staff in the unit. If they contribute to the solutions of the problem, they will own the solutions; hence the chance for compliance would be greater. 12. She knows that there are external forces that influence changes in his unit. Which of the following is NOT an external force? A. Memo from the CEO to cut down on electrical consumption B. Demands of the labor sector to increase wages C. Low morale of staff in her unit D. Exacting regulatory and accreditation standards Answer: (C) Low morale of staff in her unit Low morale of staff is an internal factor that affects only the unit. All the rest of the options emanate from the top executive or from outside the institution. 13. After discussing the possible effects of the low patient satisfaction rate, the staff started to list down possible strategies to solve the problems head-on. Should they decide to vote on the best change strategy, which of the following strategies is referred to this? A. Collaboration B. Majority rule C. Dominance D. Compromise Answer: (B) Majority rule Majority rule involves dividing the house and the highest vote wins.1/2 + 1 is a majority. 14. One staff suggests that they review the pattern of nursing care that they are using, which is described as a A. job description B. system used to deliver care C. manual of procedure D. rules to be followed Answer: (B) system used to deliver care A system used to deliver care. In the 70’s it was termed as methods of patient assignment; in the early 80’s it was called modalities of patient care then patterns of nursing care in the 90’s until recently authors called it nursing care systems. 15. Which of the following is TRUE about functional nursing? A. Concentrates on tasks and activities B. Emphasizes use of group collaboration C. One-to-one nurse-patient ratio D. Provides continuous, coordinated and comprehensive nursing services Answer: (A) Concentrates on tasks and activities Functional nursing is focused on tasks and activities and not on the holistic care of the patients 16. Functional nursing has some advantages, which one is an EXCEPTION? A. Psychological and sociological needs are emphasized. B. Great control of work activities. C. Most economical way of delivering nursing services. D. Workers feel secure in dependent role pg. 52 Hierarchy refers to the pattern of reporting or the formal line of authority in an organizational structure. 27. He emphasizes to the team that they need to put their efforts together towards the attainment of the goals of the program. Which of the following principles refers to this? A. Span of control B. Unity of direction C. Unity of command D. Command responsibility Answer: (B) Unity of direction Unity of direction means having one goal or one objective for the team to pursue; hence all members of the organization should put their efforts together towards the attainment of their common goal or objective. 28. Julius stresses the importance of promoting ‘esprit d corps’ among the members of the unit. Which of the following remarks of the staff indicates that they understand what he pointed out? A. “Let’s work together in harmony; we need to be supportive of one another” B. “In order that we achieve the same results; we must all follow the directives of Julius and not from other managers.” C. “We will ensure that all the resources we need are available when needed.” D. “We need to put our efforts together in order to raise the bar of excellence in the care we provide to all our patients.” Answer: (A) “Let’s work together in harmony; we need to be supportive of one another” The principle of ‘esprit d’ corps’ refers to promoting harmony in the workplace, which is essential in maintaining a climate conducive to work. 29. He discusses the goal of the department. Which of the following statements is a goal? A. Increase the patient satisfaction rate B. Eliminate the incidence of delayed administration of medications C. Establish rapport with patients. D. Reduce response time to two minutes. Answer: (A) Increase the patient satisfaction rate Goal is a desired result towards which efforts are directed. Options AB, C and D are all objectives which are aimed at specific end. 30. He wants to influence the customary way of thinking and behaving that is shared by the members of the department. Which of the following terms refer to this? A. Organizational chart B. Cultural network C. Organizational structure D. Organizational culture Answer: (D) Organizational culture An organizational culture refers to the way the members of the organization think together and do things around them together. It’s their way of life in that organization 31. He asserts the importance of promoting a positive organizational culture in their unit. Which of the following behaviors indicate that this is attained by the group? A. Proactive and caring with one another B. Competitive and perfectionist C. Powerful and oppositional D. Obedient and uncomplaining Answer: (A) Proactive and caring with one another Positive culture is based on humanism and affiliative norms pg. 55 32. Stephanie is a new Staff Educator of a private tertiary hospital. She conducts orientation among new staff nurses in her department. Joseph, one of the new staff nurses, wants to understand the channel of communication, span of control and lines of communication. Which of the following will provide this information? A. Organizational structure B. Policy C. Job description D. Manual of procedures Answer: (A) Organizational structure Organizational structure provides information on the channel of authority, i.e., who reports to whom and with what authority; the number of people who directly reports to the various levels of hierarchy and the lines of communication whether line or staff. 33. Stephanie is often seen interacting with the medical intern during coffee breaks and after duty hours. What type of organizational structure is this? A. Formal B. Informal C. Staff D. Line Answer: (B) Informal This is usually not published and oftentimes concealed. 34. She takes pride in saying that the hospital has a decentralized structure. Which of the following is NOT compatible with this type of model? A. Flat organization B. Participatory approach C. Shared governance D. Tall organization Answer: (D) Tall organization Tall organizations are highly centralized organizations where decision making is centered on one authority level. 35. Centralized organizations have some advantages. Which of the following statements are TRUE? 1. Highly cost-effective 2. Makes management easier 3. Reflects the interest of the worker 4. Allows quick decisions or actions. A. 1 & 2 B. 2 & 4 C. 2, 3& 4 D. 1, 2, & 4 Answer: (A) 1 & 2 Centralized organizations are needs only a few managers hence they are less expensive and easier to manage 36. Stephanie delegates effectively if she has authority to act, which is BEST defined as: A. having responsibility to direct others B. being accountable to the organization C. having legitimate right to act D. telling others what to do Answer: (C) having legitimate right to act Authority is a legitimate or official right to give command. This is an officially sanctioned responsibility pg. 56 37. Regardless of the size of a work group, enough staff must be available at all times to accomplish certain purposes. Which of these purposes in NOT included? A. Meet the needs of patients B. Provide a pair of hands to other units as needed C. Cover all time periods adequately. D. Allow for growth and development of nursing staff. Answer: (B) Provide a pair of hands to other units as needed Providing a pair of hands for other units is not a purpose in doing an effective staffing process. This is a function of a staffing coordinator at a centralized model. 38. Which of the following guidelines should be least considered in formulating objectives for nursing care? A. Written nursing care plan B. Holistic approach C. Prescribed standards D. Staff preferences Answer: (D) Staff preferences Staff preferences should be the least priority in formulating objectives of nursing care. Individual preferences should be subordinate to the interest of the patients. 41. Stephanie considers shifting to transformational leadership. Which of the following statements best describes this type of leadership? A. Uses visioning as the essence of leadership. B. Serves the followers rather than being served. C. Maintains full trust and confidence in the subordinates D. Possesses innate charisma that makes others feel good in his presence. Answer: (A) Uses visioning as the essence of leadership. Transformational leadership relies heavily on visioning as the core of leadership. 42. As a manager, she focuses her energy on both the quality of services rendered to the patients as well as the welfare of the staff of her unit. Which of the following management styles does she adopt? A. Country club management B. Organization man management C. Team management D. Authority-obedience management Answer: (C) Team management Team management has a high concern for services and high concern for staff. 43. Katherine is a young Unit Manager of the Pediatric Ward. Most of her staff nurses are senior to her, very articulate, confident and sometimes aggressive. Katherine feels uncomfortable believing that she is the scapegoat of everything that goes wrong in her department. Which of the following is the best action that she must take? A. Identify the source of the conflict and understand the points of friction B. Disregard what she feels and continue to work independently C. Seek help from the Director of Nursing D. Quit her job and look for another employment. Answer: (A) Identify the source of the conflict and understand the points of friction This involves a problem solving approach, which addresses the root cause of the problem. 44. As a young manager, she knows that conflict occurs in any organization. Which of the following statements regarding conflict is NOT true? A. Can be destructive if the level is too high B. Is not beneficial; hence it should be prevented at all times pg. 57 Record of RLE is not required for employment purposes but it is required for the nurse’s licensure examination. 55. Which phase of the employment process includes getting on the payroll and completing documentary requirements? A. Orientation B. Induction C. Selection D. Recruitment Answer: (B) Induction This step in the recruitment process gives time for the staff to submit all the documentary requirements for employment. 56. She tries to design an organizational structure that allows communication to flow in all directions and involve workers in decision making. Which form of organizational structure is this? A. Centralized B. Decentralized C. Matrix D. Informal Answer: (B) Decentralized Decentralized structures allow the staff to make decisions on matters pertaining to their practice and communicate in downward, upward, lateral and diagonal flow. 57. In a horizontal chart, the lowest level worker is located at the A. Leftmost box B. Middle C. Rightmost box D. Bottom Answer: (C) Rightmost box The leftmost box is occupied by the highest authority while the lowest level worker occupies the rightmost box. 58. She decides to have a decentralized staffing system. Which of the following is an advantage of this system of staffing? A. greater control of activities B. Conserves time C. Compatible with computerization D. Promotes better interpersonal relationship Answer: (D) Promotes better interpersonal relationship Decentralized structures allow the staff to solve decisions by themselves, involve them in decision making; hence they are always given opportunities to interact with one another. 59. Aubrey thinks about primary nursing as a system to deliver care. Which of the following activities is NOT done by a primary nurse? A. Collaborates with the physician B. Provides care to a group of patients together with a group of nurses C. Provides care for 5-6 patients during their hospital stay. D. Performs comprehensive initial assessment Answer: (B) Provides care to a group of patients together with a group of nurses This function is done in team nursing where the nurse is a member of a team that provides care for a group of patients. 60. Which pattern of nursing care involves the care given by a group of paraprofessional workers led by a professional nurse who take care of patients with the same disease conditions and are located geographically near each other? A. Case method pg. 60 B. Modular nursing C. Nursing case management D. Team nursing Answer: (B) Modular nursing Modular nursing is a variant of team nursing. The difference lies in the fact that the members in modular nursing are paraprofessional workers. 61. St. Raphael Medical Center just opened its new Performance Improvement Department. Ms. Valencia is appointed as the Quality Control Officer. She commits herself to her new role and plans her strategies to realize the goals and objectives of the department. Which of the following is a primary task that they should perform to have an effective control system? A. Make an interpretation about strengths and weaknesses B. Identify the values of the department C. Identify structure, process, outcome standards & criteria D. Measure actual performances Answer: (B) Identify the values of the department Identify the values of the department will set the guiding principles within which the department will operate its activities 62. Ms. Valencia develops the standards to be followed. Among the following standards, which is considered as a structure standard? A. The patients verbalized satisfaction of the nursing care received B. Rotation of duty will be done every four weeks for all patient care personnel. C. All patients shall have their weights taken recorded D. Patients shall answer the evaluation form before discharge Answer: (B) Rotation of duty will be done every four weeks for all patient care personnel. Structure standards include management system, facilities, equipment, materials needed to deliver care to patients. Rotation of duty is a management system. 63. When she presents the nursing procedures to be followed, she refers to what type of standards? A. Process B. Outcome C. Structure D. Criteria Answer: (A) Process Process standards include care plans, nursing procedure to be done to address the needs of the patients. 64. The following are basic steps in the controlling process of the department. Which of the following is NOT included? A. Measure actual performance B. Set nursing standards and criteria C. Compare results of performance to standards and objectives D. Identify possible courses of action Answer: (D) Identify possible courses of action This is a step in a quality control process and not a basic step in the control process. 65. Which of the following statements refers to criteria? A. Agreed on level of nursing care B. Characteristics used to measure the level of nursing care C. Step-by-step guidelines D. Statement which guide the group in decision making and problem solving Answer: (B) Characteristics used to measure the level of nursing care Criteria are specific characteristics used to measure the standard of care. pg. 61 66. She wants to ensure that every task is carried out as planned. Which of the following tasks is NOT included in the controlling process? A. Instructing the members of the standards committee to prepare policies B. Reviewing the existing policies of the hospital C. Evaluating the credentials of all nursing staff D. Checking if activities conform to schedule Answer: (A) Instructing the members of the standards committee to prepare policies Instructing the members involves a directing function. 67. Ms. Valencia prepares the process standards. Which of the following is NOT a process standard? A. Initial assessment shall be done to all patients within twenty four hours upon admission. B. Informed consent shall be secured prior to any invasive procedure C. Patients’ reports 95% satisfaction rate prior to discharge from the hospital. D. Patient education about their illness and treatment shall be provided for all patients and their families. Answer: (C) Patients’ reports 95% satisfaction rate prior to discharge from the hospital. This refers to an outcome standard, which is a result of the care that is rendered to the patient. 68. Which of the following is evidence that the controlling process is effective? A. The things that were planned are done B. Physicians do not complain. C. Employees are contended D. There is an increase in customer satisfaction rate. Answer: (A) The things that were planned are done Controlling is defined as seeing to it that what is planned is done. 69. Ms. Valencia is responsible to the number of personnel reporting to her. This principle refers to: A. Span of control B. Unity of command C. Carrot and stick principle D. Esprit d’ corps Answer: (A) Span of control Span of control refers to the number of workers who report directly to a manager. 70. She notes that there is an increasing unrest of the staff due to fatigue brought about by shortage of staff. Which action is a priority? A. Evaluate the overall result of the unrest B. Initiate a group interaction C. Develop a plan and implement it D. Identify external and internal forces. Answer: (B) Initiate a group interaction Initiate a group interaction will be an opportunity to discuss the problem in the open. 71. Kevin is a member of the Nursing Research Council of the hospital. His first assignment is to determine the level of patient satisfaction on the care they received from the hospital. He plans to include all adult patients admitted from April to May, with average length of stay of 3-4 days, first admission, and with no complications. Which of the following is an extraneous variable of the study? A. Date of admission B. Length of stay C. Age of patients D. Absence of complications Answer: (C) Age of patients pg. 62 B. Focuses on the meaning of experiences as those who experience it C. Involves an in-depth study of an individual or group D. Involves collecting and analyzing data that aims to develop theories grounded in real-world observations Answer: (B) Focuses on the meaning of experiences as those who experience it Phenomenological study involves understanding the meaning of experiences as those who experienced the phenomenon. 84. He systematically plans his sampling plan. Should he decides to include whoever patients are admitted during the study he uses what sampling method? A. Judgment B. Accidental C. Random D. Quota Answer: (B) Accidental Accidental sampling is a non-probability sampling method which includes those who are at the site during data collection. 85. He finally decides to use judgment sampling. Which of the following actions of Raphael is correct? A. Plans to include whoever is there during his study. B. Determines the different nationality of patients frequently admitted and decides to get representations samples from each. C. Assigns numbers for each of the patients, place these in a fishbowl and draw 10 from it. D. Decides to get 20 samples from the admitted patients Answer: (B) Determines the different nationality of patients frequently admitted and decides to get representations samples from each. Judgment sampling involves including samples according to the knowledge of the investigator about the participants in the study. 86. He knows that certain patients who are in a specialized research setting tend to respond psychologically to the conditions of the study. This is referred to as A. Bias B. Hawthorne effect C. Halo effect D. Horns effect Answer: (B) Hawthorne effect Hawthorne effect is based on the study of Elton Mayo and company about the effect of an intervention done to improve the working conditions of the workers on their productivity. It resulted to an increased productivity but not due to the intervention but due to the psychological effects of being observed. They performed differently because they were under observation. 87. Which of the following items refer to the sense of closure that Raphael experiences when data collection ceases to yield any new information? A. Saturation B. Precision C. Limitation D. Relevance Answer: (A) Saturation Saturation is achieved when the investigator can not extract new responses from the informants, but instead, gets the same responses repeatedly. 88. In qualitative research the actual analysis of data begins with: pg. 65 A. search for themes B. validation of thematic analysis C. weave the thematic strands together D. quasi statistics Answer: (A) search for themes The investigator starts data analysis by looking for themes from the verbatim responses of the informants. 89. Raphael is also interested to know the coping abilities of patients who are newly diagnosed to have terminal cancer. Which of the following types of research is appropriate? A. Phenomenological B. Ethnographic C. Grounded Theory D. Case Study Answer: (C) Grounded Theory Grounded theory inductively develops a theory based on the observed processes involving selected people 90. Which of the following titles of the study is appropriate for this study? A. Lived Experiences of Terminally-Ill Cancer Patients B. Coping Skills of Terminally-Ill Cancer Patients in a Selected Hospital C. Two Case Studies of Terminally-Ill Patients in Manila D. Beliefs & Practices of Patients with Terminal Cancer Answer: (B) Coping Skills of Terminally-Ill Cancer Patients in a Selected Hospital The title has a specific phenomenon, sample and research locale. 91. Ms. Montana plans to conduct a research on the use of a new method of pain assessment scale. Which of the following is the second step in the conceptualizing phase of the research process? A. Formulating the research hypothesis B. Review related literature C. Formulating and delimiting the research problem D. Design the theoretical and conceptual framework Answer: (B) Review related literature After formulating and delimiting the research problem, the researcher conducts a review of related literature to determine the extent of what has been done on the study by previous researchers. 92. Which of the following codes of research ethics requires informed consent in all cases governing human subjects? A. Helsinki Declaration B. Nuremberg Code C. Belmont Report D. ICN Code of Ethics Answer: (A) Helsinki Declaration Helsinki Declaration is the first international attempt to set up ethical standards in research involving human research subjects. 93. Which of the following ethical principles was NOT articulated in the Belmont Report? A. Beneficence B. Respect for human dignity C. Justice D. Non-maleficence Answer: (D) Non-maleficence Non-maleficence is not articulated in the Belmont Report. It only includes beneficence, respect for human dignity and justice. pg. 66 39. Which one of the following criteria should be considered as a top priority in nursing care? A. Avoidance of destructive changes B. Preservation of life C. Assurance of safety D. Preservation of integrity Answer: (B) Preservation of life The preservation of life at all cost is a primary responsibility of the nurse. This is embodied in the Code of Ethics for registered nurses ( BON Resolution 220 s. 2004). 40. Which of the following procedures ensures that the investigator has fully described to prospective subjects the nature of the study and the subject's rights? A. Debriefing B. Full disclosure C. Informed consent D. Cover data collection Answer: (B) Full disclosure Full disclosure is giving the subjects of the research information that they deserve to know prior to the conduct of the study. 94. After the review session has been completed, Karen and the staff signed the document. Which of the following is the purpose of this? A. Agree about the content of the evaluation. B. Signify disagreement of the content of the evaluation. C. Document that Karen and the staff reviewed the evaluation. D. Serve as basis for future evaluation. Answer: (C) Document that Karen and the staff reviewed the evaluation. Signing the document is done to serve as a proof that performance review was conducted during that date and time. 95. A nurse who would like to practice nursing in the Philippines can obtain a license to practice by: A. Paying the professional tax after taking the board exams B. Passing the board exams and taking the oath of professionals C. Paying the examination fee before taking the board exams D. Undergoing the interview conducted by the Board of Nursing and taking the board exams Answer: (B) Passing the board exams and taking the oath of professionals For a nurse to obtain a license to practice nursing in the Philippines, s/he must pass the board examinations and then take the oath of professionals before the Board of Nursing. 96. Reciprocity of license to practice requires that the country of origin of the interested foreign nurse complies with the following conditions: A. The country of origin has similar preparation for a nurse and has laws allowing Filipino nurses to practice in their country. B. The Philippines is recognized by the country of origin as one that has high quality of nursing education C. The country of origin requires Filipinos to take their own board examination D. The country of origin exempts Filipinos from passing their licensure examination Answer: (A) The country of origin has similar preparation for a nurse and has laws allowing Filipino nurses to practice in their country. According to the Philippine Nurses Act of 2002, foreign nurses wanting to practice in the Philippines must show proof that his/her country of origin meets the two essential conditions: a) the requirements for registration between the two countries are substantially the same; and b) the country of origin of the foreign nurse has laws allowing the Filipino nurse to practice in his/her country just like its own citizens. pg. 67 Answer: (A) Non-maleficence Non-maleficence means do not cause harm or do any action that will cause any harm to the patient/client. To do good is referred as beneficence. 107. When the patient is asked to testify in court, s/he must abide by the ethical principle of: A. Privileged communication B. Informed consent C. Solidarity D. Autonomy Answer: (A) Privileged communication All confidential information that comes to the knowledge of the nurse in the care of her/his patients is considered privileged communications. Hence, s/he is not allowed to just reveal the confidential information arbitrarily. S/he may only be allowed to break the seal of secrecy in certain conditions. One such condition is when the court orders the nurse to testify in a criminal or medico-legal case. 108. When the doctor orders “do not resuscitate”, this means that A. The nurse need not give due care to the patient since s/he is terminally ill B. The patient need not be given food and water after all s/he is dying C. The nurses and the attending physician should not do any heroic or extraordinary measures for the patient D. The patient need not be given ordinary care so that her/his dying process is hastened Answer: (C) The nurses and the attending physician should not do any heroic or extraordinary measures for the patient Do not resuscitate” is a medical order which is written on the chart after the doctor has consulted the family and this means that the members of the health team are not required to give extraordinary measures but cannot withhold the basic needs like food, water, and air. It also means that the nurse is still duty bound to give the basic nursing care to the terminally ill patient and ensure that the spiritual needs of the patient is taken cared of. 109. Which of the following statements is TRUE of abortion in the Philippines? A. Induced abortion is allowed in cases of rape and incest B. Induced abortion is both a criminal act and an unethical act for the nurse C. Abortion maybe considered acceptable if the mother is unprepared for the pregnancy D. A nurse who performs induced abortion will have no legal accountability if the mother requested that the abortion done on her. Answer: (B) Induced abortion is both a criminal act and an unethical act for the nurse Induced abortion is considered a criminal act which is punishable by imprisonment which maybe up to a maximum of 12 years if the nurse gets paid for it. Also, the PRC Code of Ethics states that the nurse must respect life and must not do any action that will destroy life. Abortion is an act that destroys life albeit at the beginning of life. 110. Which of the following is NOT true about a hypothesis? Hypothesis is: A. testable B. proven C. stated in a form that it can be accepted or rejected D. states a relationship between variables Answer: (B) proven Hypothesis is not proven; it is either accepted or rejected. Hypothesis is testable and is defined as a statement that predicts the relationship between variables 111. Which of the following measures will best prevent manipulation of vulnerable groups? A. Secure informed consent B. Payment of stipends for subjects C. Protect privacy of patient D. Ensure confidentiality of data pg. 70 Answer: (A) Secure informed consent Securing informed consent will free the researcher from being accused of manipulating the subjects because by so doing he/she gives ample opportunity for the subjects to weigh the advantages/disadvantages of being included in the study prior to giving his consent. This is done without any element of force, coercion, threat or even inducement. 112. Which of the following procedures ensures that Ms. Montana has fully described to prospective subjects the nature of the study and the subject’s rights? A. Debriefing B. Full disclosure C. Informed consent D. Covert data collection Answer: (B) Full disclosure Full disclosure is giving the subjects of the research information that they deserve to know prior to the conduct of the study 113. This technique refers to the use of multiple referents to draw conclusions about what constitutes the truth A. Triangulation B. Experiment C. Meta-analysis D. Delphi technique Answer: (A) Triangulation Triangulation makes use of different sources of information such as triangulation in design, researcher and instrument. 114. The statement, “Ninety percent (90%) of the respondents are female staff nurses validates previous research findings (Santos, 2001; Reyes, 2005) that the nursing profession is largely a female dominated profession is an example of A. implication B. interpretation C. analysis D. conclusion Answer: (B) interpretation Interpretation includes the inferences of the researcher about the findings of the study. 115. The study is said to be completed when Ms. Montana achieved which of the following activities? A. Published the results in a nursing journal. B. Presented the study in a research forum. C. The results of the study is used by the nurses in the hospital D. Submitted the research report to the CEO. Answer: (C) The results of the study is used by the nurses in the hospital The last step in the research process is the utilization of the research findings. 116. Situation : Stephanie is a nurse researcher of the Patient Care Services Division. She plans to conduct a literature search for her study. Which of the following is the first step in selecting appropriate materials for her review? A. Track down most of the relevant resources B. Copy relevant materials C. Organize materials according to function D. Synthesize literature gathered. Answer: (A) Track down most of the relevant resources The first step in the review of related literature is to track down relevant sources before copying these. The last step is to synthesize the literature gathered. 117. She knows that the most important categories of information in literature review is the: pg. 71 A. research findings B. theoretical framework C. methodology D. opinions Answer: (A) research findings The research findings is the most important category of information that the researcher should copy because this will give her valuable information as to what has been discovered in past studies about the same topic. 118. She also considers accessing electronic data bases for her literature review. Which of the following is the most useful electronic database for nurses? A. CINAHL B. MEDLINE C. HealthSTAR D. EMBASE Answer: (A) CINAHL This refers to Cumulative Index to Nursing and Allied Health Literature which is a rich source for literature review for nurses. The rest of the sites are for medicine, pharmacy and other healthrelated sites. 119. While reviewing journal articles, Stephanie got interested in reading the brief summary of the article placed at the beginning of the journal report. Which of the following refers to this? A. Introduction B. Preface C. Abstract D. Background Answer: (C) Abstract Abstract contains concise description of the background of the study, research questions, research objectives, methods, findings, implications to nursing practice as well as keywords used in the study. 120. She notes down ideas that were derived from the description of an investigation written by the person who conducted it. Which type of reference source refers to this? A. Footnote B. Bibliography C. Primary source D. Endnotes Answer: (C) Primary source . This refers to a primary source which is a direct account of the investigation done by the investigator. In contrast to this is a secondary source, which is written by someone other than the original researcher. 121. She came across a study which is referred to as meta-analysis. Which of the following statements best defines this type of study? A. Treats the findings from one study as a single piece of data B. Findings from multiple studies are combined to yield a data set which is analyzed as individual data C. Represents an application of statistical procedures to findings from each report D. Technique for quantitatively combining and thus integrating the results of multiple studies on a given topic. Answer: (D) Technique for quantitatively combining and thus integrating the results of multiple studies on a given topic. Though all the options are correct, the best definition is option D because it combines quantitatively the results and at the same time it integrates the results of the different studies as pg. 72 Determining budgetary allocation for the study is not a purpose of doing a pretesting of the instruments. This is done at an earlier stage of the design and planning phase. 132. She tests the instrument whether it looks as though it is measuring appropriate constructs. Which of the following refers to this? A. Face validity B. Content validity C. Construct Validity D. Criterion-related validity Answer: (A) Face validity Face validity measures whether the instrument appears to be measuring the appropriate construct. It is the easiest type of validity testing. 133. Which of the following questions would determine the construct validity of the instrument? A. “What is this instrument really measuring?” B. “How representative are the questions on this test of the universe of questions on this topic?” C. “Does the question asked looks as though it is measuring the appropriate construct?” D. “Does the instrument correlate highly with an external criterion? Answer: (A) “What is this instrument really measuring?” Construct validity aims to validate what the instrument is really measuring. The more abstract the concept, the more difficult to measure the construct. 134. Which of the following experimental research designs would be appropriate for this study if she wants to find out a cause and effect relationship between the structured discharge plan and compliance to home care regimen among the subjects? A. True experiment B. Quasi experiment C. Post-test only design D. Solomon four-group Answer: (C) Post-test only design Post- Test only design is appropriate because it is impossible to measure the compliance to home care regimen variable prior to the discharge of the patient from the hospital. 135. One hypothesis that she formulated is “Compliance to home care regimen is greater among patients who received the structured discharge plan than those who received verbal discharge instructions.’ Which is the independent variable in this study? A. Structured discharge plan B. Compliance to home care regimen C. Post-open heart surgery patients D. Greater compliance Answer: (A) Structured discharge plan Structured discharge plan is the intervention or the ‘cause’ in the study that results to an ‘effect’, which is compliance to home care regimen or the dependent variable. 136. Situation : Alyssa plans to conduct a study about nursing practice in the country. She decides to refresh her knowledge about the different types of research in order to choose the most appropriate design for her study. She came across surveys, like the Social Weather Station and Pulse Asia Survey. Which of the following is the purpose of this kind of research? A. Obtains information regarding the prevalence, distribution and interrelationships of variables within a population at a particular time B. Get an accurate and complete data about a phenomenon. C. Develop a tool for data gathering. D. Formulate a framework for the study pg. 75 Answer: (A) Obtains information regarding the prevalence, distribution and interrelationships of variables within a population at a particular time Surveys are done to gather information on people’s actions, knowledge, intentions, opinions and attitudes. 137. She will likely use self-report method. Which of the following self-report methods is the most respected method used in surveys? A. Personal interviews B. Questionnaires C. Telephone interviews D. Rating Scale Answer: (A) Personal interviews Personal interviews is the best method of collecting survey data because the quality of information they yield is higher than other methods and because relatively few people refuse to be interviewed in person. 138. Alyssa reads about exploratory research. Which of the following is the purpose of doing this type of research? A. Inductively develops a theory based on observations about processes involving selected people B. Makes new knowledge useful and practical. C. Identifies the variables in the study D. Finds out the cause and effect relationship between variables Answer: (C) Identifies the variables in the study Exploratory research is the first level of investigation and it deals with identifying the variables in the study. 139. She reviews qualitative design of research. Which of the following is true about ethnographic study? A. Develops theories that increase the knowledge about a certain phenomenon. B. Focuses on the meanings of life experiences of people C. Deals with patterns and experiences of a defined cultural group in a holistic fashion D. In-depth investigation of a single entity Answer: (C) Deals with patterns and experiences of a defined cultural group in a holistic fashion Ethnographic research deals with the cultural patterns and beliefs of certain culture groups. 140. She knows that the purpose of doing ethnographic study is to: A. Understand the worldview of a cultural group B. Study the life experiences of people C. Determine the relationship between variables D. Investigate intensively a single entity Answer: (A) Understand the worldview of a cultural group The aim of ethnographers is to learn from the members of a cultural group by understanding their way of life as they perceive and live it. 141. Alyssa wants to learn more about experimental design. Which is the purpose of this research? A. Test the cause and effect relationship among the variable under a controlled situation B. Identify the variables in the study C. Predicts the future based on current intervention D. Describe the characteristics, opinions, attitudes or behaviors of certain population about a current issue or event Answer: (A) Test the cause and effect relationship among the variable under a controlled situation Experimental research is a Level III investigation which determines the cause and effect relationship between variables. 142. She knows that there are three elements of experimental research. Which is NOT included? pg. 76 A. Manipulation B. Randomization C. Control D. Trial Answer: (D) Trial Trial is not an element of experimental research. Manipulation of variables, randomization and control are the three elements of this type of research 143. Alyssa knows that there are times when only manipulation of study variables is possible and the elements of control or randomization are not attendant. Which type of research is referred to this? A. Field study B. Quasi-experiment C. Solomon-Four group design D. Post-test only design Answer: (B) Quasi-experiment Quasi-experiment is done when randomization and control of the variables are not possible. 144. One of the related studies that she reads is a phenomenological research. Which of the following questions is answered by this type of qualitative research? A. ” What is the way of life of this cultural group?” B. “What is the effect of the intervention to the dependent variable?” C. “What the essence of the phenomenon is as experienced by these people?” D. “What is the core category that is central in explaining what is going on in that social scene?” Answer: (C) “What the essence of the phenomenon is as experienced by these people?” Phenomenological research deals with the meaning of experiences as those who experienced the phenomenon understand it. 145. Other studies are categorized according to the time frame. Which of the following refers to a study of variables in the present which is linked to a variable that occurred in the past? A. Prospective design B. Retrospective design C. Cross sectional study D. Longitudinal study Answer: (B) Retrospective design Retrospective studies are done in order to establish a correlation between present variables and the antecedent factors that have caused it. 146. Situation : Harry a new research staff of the Research and Development Department of a tertiary hospital is tasked to conduct a research study about the increased incidence of nosocomial infection in the hospital. Which of the following ethical issues should he consider in the conduct of his study? 1. Confidentiality of information given to him by the subjects 2. Self-determination which includes the right to withdraw from the study group 3. Privacy or the right not to be exposed publicly 4. Full disclosure about the study to be conducted A. 1, 2, 3 B. 1, 3, 4 C. 2, 3, 4 D. 1, 2, 3, 4 Answer: (D) 1, 2, 3, 4 pg. 77 Degenerative changes occur in the elderly. The response to pain in the elderly maybe lessened because of reduced acuity of touch, alterations in neural pathways and diminished processing of sensory data. 3. Mary received AtropineSO4 as a pre-medication 30 minutes ago and is now complaining of dry mouth and her PR is higher, than before the medication was administered. The nurse’s best A. The patient is having an allergic reaction to the drug. B. The patient needs a higher dose of this drug C. This is normal side-effect of AtSO4 D. The patient is anxious about upcoming surgery Answer: (C) This is normal side-effect of AtSO4 Atropine sulfate is a vagolytic drug that decreases oropharyngeal secretions and increases the heart rate. 4. Ana’s postoperative vital signs are a blood pressure of 80/50 mm Hg, a pulse of 140, and respirations of 32. Suspecting shock, which of the following orders would the nurse question? A. Put the client in modified Trendelenberg's position. B. Administer oxygen at 100%. C. Monitor urine output every hour. D. Administer Demerol 50mg IM q4h Answer: (D) Administer Demerol 50mg IM q4h Administering Demerol, which is a narcotic analgesic, can depress respiratory and cardiac function and thus not given to a patient in shock. What is needed is promotion for adequate oxygenation and perfusion. All the other interventions can be expected to be done by the nurse. 5. Mr. Pablo, diagnosed with Bladder Cancer, is scheduled for a cystectomy with the creation of an ileal conduit in the morning. He is wringing his hands and pacing the floor when the nurse enters his room. What is the best approach? A. "Good evening, Mr. Pablo. Wasn't it a pleasant day, today?" B. "Mr, Pablo, you must be so worried, I'll leave you alone with your thoughts. C. “Mr. Pablo, you'll wear out the hospital floors and yourself at this rate." D. "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?" Answer: (D) "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?" The client is showing signs of anxiety reaction to a stressful event. Recognizing the client’s anxiety conveys acceptance of his behavior and will allow for verbalization of feelings and concerns. 6. After surgery, Gina returns from the Post-anesthesia Care Unit (Recovery Room) with a nasogastric tube in place following a gall bladder surgery. She continues to complain of nausea. Which action would the nurse take? A. Call the physician immediately. B. Administer the prescribed antiemetic. C. Check the patency of the nasogastric tube for any obstruction. D. Change the patient’s position. Answer: (C) Check the patency of the nasogastric tube for any obstruction. Nausea is one of the common complaints of a patient after receiving general anesthesia. But this complaint could be aggravated by gastric distention especially in a patient who has undergone abdominal surgery. Insertion of the NGT helps relieve the problem. Checking on the patency of the NGT for any obstruction will help the nurse determine the cause of the problem and institute the necessary intervention. 7. Mr. Perez is in continuous pain from cancer that has metastasized to the bone. Pain medication provides little relief and he refuses to move. The nurse should plan to: A. Reassure him that the nurses will not hurt him B. Let him perform his own activities of daily living pg. 80 C. Handle him gently when assisting with required care D. Complete A.M. care quickly as possible when necessary Answer: (C) Handle him gently when assisting with required care Patients with cancer and bone metastasis experience severe pain especially when moving. Bone tumors weaken the bone to appoint at which normal activities and even position changes can lead to fracture. During nursing care, the patient needs to be supported and handled gently. 8. A client returns from the recovery room at 9AM alert and oriented, with an IV infusing. His pulse is 82, blood pressure is 120/80, respirations are 20, and all are within normal range. At 10 am and at 11 am, his vital signs are stable. At noon, however, his pulse rate is 94, blood pressure is 116/74, and respirations are 24. What nursing action is most appropriate? A. Notify his physician. B. Take his vital signs again in 15 minutes. C. Take his vital signs again in an hour. D. Place the patient in shock position. Answer: (B) Take his vital signs again in 15 minutes. Monitoring the client’s vital signs following surgery gives the nurse a sound information about the client’s condition. Complications can occur during this period as a result of the surgery or the anesthesia or both. Keeping close track of changes in the VS and validating them will help the nurse initiate interventions to prevent complications from occurring. 9. A 56 year old construction worker is brought to the hospital unconscious after falling from a 2- story building. When assessing the client, the nurse would be most concerned if the assessment revealed: A. Reactive pupils B. A depressed fontanel C. Bleeding from ears D. An elevated temperature Answer: (C) Bleeding from ears The nurse needs to perform a thorough assessment that could indicate alterations in cerebral function, increased intracranial pressures, fractures and bleeding. Bleeding from the ears occurs only with basal skull fractures that can easily contribute to increased intracranial pressure and brain herniation 10. Which of the ff. statements by the client to the nurse indicates a risk factor for CAD? A. “I exercise every other day.” B. “My father died of Myasthenia Gravis.” C. “My cholesterol is 180.” D. “I smoke 1 1/2 packs of cigarettes per day.” Answer: (D) “I smoke 1 1/2 packs of cigarettes per day.” Smoking has been considered as one of the major modifiable risk factors for coronary artery disease. Exercise and maintaining normal serum cholesterol levels help in its prevention. 11. Mr. Braga was ordered Digoxin 0.25 mg. OD. Which is poor knowledge regarding this drug? A. It has positive inotropic and negative chronotropic effects B. The positive inotropic effect will decrease urine output C. Toxixity can occur more easily in the presence of hypokalemia, liver and renal problems D. Do not give the drug if the apical rate is less than 60 beats per minute. Answer: (B) The positive inotropic effect will decrease urine output Inotropic effect of drugs on the heart causes increase force of its contraction. This increases cardiac output that improves renal perfusion resulting in an improved urine output. pg. 81 12. Valsalva maneuver can result in bradycardia. Which of the following activities will not stimulate Valsalva's maneuver? A. Use of stool softeners. B. Enema administration C. Gagging while toothbrushing. D. Lifting heavy objects Answer: (A) Use of stool softeners. Straining or bearing down activities can cause vagal stimulation that leads to bradycardia. Use of stool softeners promote easy bowel evacuation that prevents straining or the valsalva maneuver. 13. The nurse is teaching the patient regarding his permanent artificial pacemaker. Which information given by the nurse shows her knowledge deficit about the artificial cardiac pacemaker? A. take the pulse rate once a day, in the morning upon awakening B. may be allowed to use electrical appliances C. have regular follow up care D. may engage in contact sports Answer: (D) may engage in contact sports The client should be advised by the nurse to avoid contact sports. This will prevent trauma to the area of the pacemaker generator. 14. A patient with angina pectoris is being discharged home with nitroglycerine tablets. Which of the following instructions does the nurse include in the teaching? A. “When your chest pain begins, lie down, and place one tablet under your tongue. If the pain continues, take another tablet in 5 minutes.” B. “Place one tablet under your tongue. If the pain is not relieved in 15 minutes, go to the hospital.” C. “Continue your activity, and if the pain does not go away in 10 minutes, begin taking the nitro tablets one every 5 minutes for 15 minutes, then go lie down.” D. “Place one Nitroglycerine tablet under the tongue every five minutes for three doses. Go to the hospital if the pain is unrelieved. Answer: (D) “Place one Nitroglycerine tablet under the tongue every five minutes for three doses. Go to the hospital if the pain is unrelieved. Angina pectoris is caused by myocardial ischemia related to decreased coronary blood supply. Giving nitroglycerine will produce coronary vasodilation that improves the coronary blood flow in 3 – 5 mins. If the chest pain is unrelieved, after three tablets, there is a possibility of acute coronary occlusion that requires immediate medical attention. 15. A client with chronic heart failure has been placed on a diet restricted to 2000mg. of sodium per day. The client demonstrates adequate knowledge if behaviors are evident such as not salting food and avoidance of which food? A. Whole milk B. Canned sardines C. Plain nuts D. Eggs Answer: (B) Canned sardines Canned foods are generally rich in sodium content as salt is used as the main preservative. 16. A student nurse is assigned to a client who has a diagnosis of thrombophlebitis. Which action by this team member is most appropriate? A. Apply a heating pad to the involved site. B. Elevate the client's legs 90 degrees. C. Instruct the client about the need for bed rest. D. Provide active range-of-motion exercises to both legs at least twice every shift. pg. 82 26. The nurse is preparing her plan of care for her patient diagnosed with pneumonia. Which is the most appropriate nursing diagnosis for this patient? A. Fluid volume deficit B. Decreased tissue perfusion. C. Impaired gas exchange. D. Risk for infection Answer: (C) Impaired gas exchange. Pneumonia, which is an infection, causes lobar consolidation thus impairing gas exchange between the alveoli and the blood. Because the patient would require adequate hydration, this makes him prone to fluid volume excess. 27. A nurse at the weight loss clinic assesses a client who has a large abdomen and a rounded face. Which additional assessment finding would lead the nurse to suspect that the client has Cushing’s syndrome rather than obesity? A. large thighs and upper arms B. pendulous abdomen and large hips C. abdominal striae and ankle enlargement D. posterior neck fat pad and thin extremities Answer: (D) posterior neck fat pad and thin extremities “Buffalo hump” is the accumulation of fat pads over the upper back and neck. Fat may also accumulate on the face. There is truncal obesity but the extremities are thin. All these are noted in a client with Cushing’s syndrome. 28. Which statement by the client indicates understanding of the possible side effects of Prednisone therapy? A. “I should limit my potassium intake because hyperkalemia is a side-effect of this drug.” B. “I must take this medicine exactly as my doctor ordered it. I shouldn’t skip doses.” C. “This medicine will protect me from getting any colds or infection.” D. “My incision will heal much faster because of this drug.” Answer: (B) “I must take this medicine exactly as my doctor ordered it. I shouldn’t skip doses.” The possible side effects of steroid administration are hypokalemia, increase tendency to infection and poor wound healing. Clients on the drug must follow strictly the doctor’s order since skipping the drug can lower the drug level in the blood that can trigger acute adrenal insufficiency or Addisonian Crisis 29. A client, who is suspected of having Pheochromocytoma, complains of sweating, palpitation and headache. Which assessment is essential for the nurse to make first? A. Pupil reaction B. Hand grips C. Blood pressure D. Blood glucose Answer: (C) Blood pressure Pheochromocytoma is a tumor of the adrenal medulla that causes an increase secretion of catecholamines that can elevate the blood pressure. 30. The nurse is attending a bridal shower for a friend when another guest, who happens to be a diabetic, starts to tremble and complains of dizziness. The next best action for the nurse to take is to: A. Encourage the guest to eat some baked macaroni B. Call the guest’s personal physician C. Offer the guest a cup of coffee D. Give the guest a glass of orange juice Answer: (D) Give the guest a glass of orange juice pg. 85 In diabetic patients, the nurse should watch out for signs of hypoglycemia manifested by dizziness, tremors, weakness, pallor diaphoresis and tachycardia. When this occurs in a conscious client, he should be given immediately carbohydrates in the form of fruit juice, hard candy, honey or, if unconscious, glucagons or dextrose per IV. 31. An adult, who is newly diagnosed with Graves disease, asks the nurse, “Why do I need to take Propanolol (Inderal)?” Based on the nurse’s understanding of the medication and Grave’s disease, the best response would be: A. “The medication will limit thyroid hormone secretion.” B. “The medication limit synthesis of the thyroid hormones.” C. “The medication will block the cardiovascular symptoms of Grave’s disease.” D. “The medication will increase the synthesis of thyroid hormones.” Answer: (C) “The medication will block the cardiovascular symptoms of Grave’s disease.” Propranolol (Inderal) is a beta-adrenergic blocker that controls the cardiovascular manifestations brought about by increased secretion of the thyroid hormone in Grave’s disease. 32. During the first 24 hours after thyroid surgery, the nurse should include in her care: A. Checking the back and sides of the operative dressing B. Supporting the head during mild range of motion exercise C. Encouraging the client to ventilate her feelings about the surgery D. Advising the client that she can resume her normal activities immediately Answer: (A) Checking the back and sides of the operative dressing Following surgery of the thyroid gland, bleeding is a potential complication. This can best be assessed by checking the back and the sides of the operative dressing as the blood may flow towards the side and back leaving the front dry and clear of drainage. 33. On discharge, the nurse teaches the patient to observe for signs of surgically induced hypothyroidism. The nurse would know that the patient understands the teaching when she states she should notify the MD if she develops: A. Intolerance to heat B. Dry skin and fatigue C. Progressive weight gain D. Insomnia and excitability Answer: (C) Progressive weight gain Hypothyroidism, a decrease in thyroid hormone production, is characterized by hypometabolism that manifests itself with weight gain. 34. What is the best reason for the nurse in instructing the client to rotate injection sites for insulin? A. Lipodystrophy can result and is extremely painful B. Poor rotation technique can cause superficial hemorrhaging C. Lipodystrophic areas can result, causing erratic insulin absorption rates from these D. Injection sites can never be reused Answer: (C) Lipodystrophic areas can result, causing erratic insulin absorption rates from these Lipodystrophy is the development of fibrofatty masses at the injection site caused by repeated use of an injection site. Injecting insulin into these scarred areas can cause the insulin to be poorly absorbed and lead to erratic reactions. 35. Which of the following would be inappropriate to include in a diabetic teaching plan? A. Change position hourly to increase circulation B. Inspect feet and legs daily for any changes C. Keep legs elevated on 2 pillows while sleeping D. Keep the insulin not in use in the refrigerator pg. 86 Answer: (C) Keep legs elevated on 2 pillows while sleeping The client with DM has decreased peripheral circulation caused by microangiopathy. Keeping the legs elevated during sleep will further cause circulatory impairment. 36. Included in the plan of care for the immediate post-gastroscopy period will be: A. Maintain NGT to intermittent suction B. Assess gag reflex prior to administration of fluids C. Assess for pain and medicate as ordered D. Measure abdominal girth every 4 hours Answer: (B) Assess gag reflex prior to administration of fluids The client, after gastroscopy, has temporary impairment of the gag reflex due to the anesthetic that has been sprayed into his throat prior to the procedure. Giving fluids and food at this time can lead to aspiration. 36. Included in the plan of care for the immediate post-gastroscopy period will be: A. Maintain NGT to intermittent suction B. Assess gag reflex prior to administration of fluids C. Assess for pain and medicate as ordered D. Measure abdominal girth every 4 hours Answer: (B) Assess gag reflex prior to administration of fluids The client, after gastroscopy, has temporary impairment of the gag reflex due to the anesthetic that has been sprayed into his throat prior to the procedure. Giving fluids and food at this time can lead to aspiration. 37. Which description of pain would be most characteristic of a duodenal ulcer? A. Gnawing, dull, aching, hungerlike pain in the epigastric area that is relieved by food intake B. RUQ pain that increases after meal C. Sharp pain in the epigastric area that radiates to the right shoulder D. A sensation of painful pressure in the midsternal area Answer: (A) Gnawing, dull, aching, hungerlike pain in the epigastric area that is relieved by food intake Duodenal ulcer is related to an increase in the secretion of HCl. This can be buffered by food intake thus the relief of the pain that is brought about by food intake. 38. The client underwent Billroth surgery for gastric ulcer. Post-operatively, the drainage from his NGT is thick and the volume of secretions has dramatically reduced in the last 2 hours and the client feels like vomiting. The most appropriate nursing action is to: A. Reposition the NGT by advancing it gently NSS B. Notify the MD of your findings C. Irrigate the NGT with 50 cc of sterile D. Discontinue the low-intermittent suction Answer: (B) Notify the MD of your findings The client’s feeling of vomiting and the reduction in the volume of NGT drainage that is thick are signs of possible abdominal distention caused by obstruction of the NGT. This should be reported immediately to the MD to prevent tension and rupture on the site of anastomosis caused by gastric distention. 39. After Billroth II Surgery, the client developed dumping syndrome. Which of the following should the nurse exclude in the plan of care? A. Sit upright for at least 30 minutes after meals B. Take only sips of H2O between bites of solid food C. Eat small meals every 2-3 hours D. Reduce the amount of simple carbohydrate in the diet Answer: (A) Sit upright for at least 30 minutes after meals pg. 87 49. Days after abdominal surgery, the client’s wound dehisces. The safest nursing intervention when this occurs is to A. Cover the wound with sterile, moist saline dressing B. Approximate the wound edges with tapes C. Irrigate the wound with sterile saline D. Hold the abdominal contents in place with a sterile gloved hand Answer: (A) Cover the wound with sterile, moist saline dressing Dehiscence is the partial or complete separation of the surgical wound edges. When this occurs, the client is placed in low Fowler’s position and instructed to lie quietly. The wound should be covered to protect it from exposure and the dressing must be sterile to protect it from infection and moist to prevent the dressing from sticking to the wound which can disturb the healing process. 50. An intravenous pyelogram reveals that Paulo, age 35, has a renal calculus. He is believed to have a small stone that will pass spontaneously. To increase the chance of the stone passing, the nurse would instruct the client to force fluids and to A. Strain all urine. B. Ambulate. C. Remain on bed rest. D. Ask for medications to relax him. Answer: (B) Ambulate. Free unattached stones in the urinary tract can be passed out with the urine by ambulation which can mobilize the stone and by increased fluid intake which will flush out the stone during urination. 51. A female client is admitted with a diagnosis of acute renal failure. She is awake, alert, oriented, and complaining of severe back pain, nausea and vomiting and abdominal cramps. Her vital signs are blood pressure 100/70 mm Hg, pulse 110, respirations 30, and oral temperature 100.4°F (38°C). Her electrolytes are sodium 120 mEq/L, potassium 5.2 mEq/L; her urinary output for the first 8 hours is 50 ml. The client is displaying signs of which electrolyte imbalance? A. Hyponatremia B. Hyperkalemia C. Hyperphosphatemia D. Hypercalcemia Answer: (A) Hyponatremia The normal serum sodium level is 135 – 145 mEq/L. The client’s serum sodium is below normal. Hyponatremia also manifests itself with abdominal cramps and nausea and vomiting 52. Assessing the laboratory findings, which result would the nurse most likely expect to find in a client with chronic renal failure? A. BUN 10 to 30 mg/dl, potassium 4.0 mEq/L, creatinine 0.5 to 1.5 mg/dl B. Decreased serum calcium, blood pH 7.2, potassium 6.5 mEq/L C. BUN 15 mg/dl, increased serum calcium, creatinine l.0 mg/dl D. BUN 35 to 40 mg/dl, potassium 3.5 mEq/L, pH 7.35, decreased serum calcium Answer: (B) Decreased serum calcium, blood pH 7.2, potassium 6.5 mEq/L Chronic renal failure is usually the end result of gradual tissue destruction and loss of renal function. With the loss of renal function, the kidneys ability to regulate fluid and electrolyte and acid base balance results. The serum Ca decreases as the kidneys fail to excrete phosphate, potassium and hydrogen ions are retained. 53. Treatment with hemodialysis is ordered for a client and an external shunt is created. Which nursing action would be of highest priority with regard to the external shunt? A. Heparinize it daily. B. Avoid taking blood pressure measurements or blood samples from the affected arm. pg. 90 C. Change the Silastic tube daily. D. Instruct the client not to use the affected arm. Answer: (B) Avoid taking blood pressure measurements or blood samples from the affected arm. In the client with an external shunt, don’t use the arm with the vascular access site to take blood pressure readings, draw blood, insert IV lines, or give injections because these procedures may rupture the shunt or occlude blood flow causing damage and obstructions in the shunt. 54. Romeo Diaz, age 78, is admitted to the hospital with the diagnosis of benign prostatic hyperplasia (BPH). He is scheduled for a transurethral resection of the prostate (TURP). It would be inappropriate to include which of the following points in the preoperative teaching? A. TURP is the most common operation for BPH. B. Explain the purpose and function of a two-way irrigation system. C. Expect bloody urine, which will clear as healing takes place. D. He will be pain free. Answer: (D) He will be pain free. Surgical interventions involve an experience of pain for the client which can come in varying degrees. Telling the pain that he will be pain free is giving him false reassurance. 55. Roxy is admitted to the hospital with a possible diagnosis of appendicitis. On physical examination, the nurse should be looking for tenderness on palpation at McBurney’s point, which is located in the A. left lower quadrant B. left upper quadrant C. right lower quadrant D. right upper quadrant Answer: (C) right lower quadrant To be exact, the appendix is anatomically located at the Mc Burney’s point at the right iliac area of the right lower quadrant. 56. Mr. Valdez has undergone surgical repair of his inguinal hernia. Discharge teaching should include A. telling him to avoid heavy lifting for 4 to 6 weeks B. instructing him to have a soft bland diet for two weeks C. telling him to resume his previous daily activities without limitations D. recommending him to drink eight glasses of water daily Answer: (A) telling him to avoid heavy lifting for 4 to 6 weeks The client should avoid lifting heavy objects and any strenuous activity for 4-6 weeks after surgery to prevent stress on the inguinal area. There is no special diet required. The fluid intake of eight glasses a day is good advice but is not a priority in this case. 57. A 30-year-old homemaker fell asleep while smoking a cigarette. She sustained severe burns of the face,neck, anterior chest, and both arms and hands. Using the rule of nines, which is the best estimate of total body-surface area burned? A. 18% B. 22% C. 31% D. 40% Answer: (C) 31% Using the Rule of Nine in the estimation of total body surface burned, we allot the following: 9% head; 9% - each upper extremity; 18%- front chest and abdomen; 18% - entire back; 18% - each lower extremity and 1% - perineum. 58. Nursing care planning is based on the knowledge that the first 24-48 hours post-burn are characterized by: A. An increase in the total volume of intracranial plasma pg. 91 B. Excessive renal perfusion with diuresis C. Fluid shift from interstitial space D. Fluid shift from intravascular space to the interstitial space Answer: (D) Fluid shift from intravascular space to the interstitial space This period is the burn shock stage or the hypovolemic phase. Tissue injury causes vasodilation that results in increase capillary permeability making fluids shift from the intravascular to the interstitial space. This can lead to a decrease in circulating blood volume or hypovolemia which decreases renal perfusion and urine output. 59. If a client has severe bums on the upper torso, which item would be a primary concern? A. Debriding and covering the wounds B. Administering antibiotics C. Frequently observing for hoarseness, stridor, and dyspnea D. Establishing a patent IV line for fluid replacement Answer: (C) Frequently observing for hoarseness, stridor, and dyspnea Burns located in the upper torso, especially resulting from thermal injury related to fires can lead to inhalation burns. This causes swelling of the respiratory mucosa and blistering which can lead to airway obstruction manifested by hoarseness, noisy and difficult breathing. Maintaining a patent airway is a primary concern. 60. Contractures are among the most serious long-term complications of severe burns. If a burn is located on the upper torso, which nursing measure would be least effective to help prevent contractures? A. Changing the location of the bed or the TV set, or both, daily B. Encouraging the client to chew gum and blow up balloons C. Avoiding the use of a pillow for sleep, or placing the head in a position of hyperextension D. Helping the client to rest in the position of maximal comfort Answer: (D) Helping the client to rest in the position of maximal comfort Mobility and placing the burned areas in their functional position can help prevent contracture deformities related to burns. Pain can immobilize a client as he seeks the position where he finds less pain and provides maximal comfort. But this approach can lead to contracture deformities and other complications. 61. An adult is receiving Total Parenteral Nutrition (TPN). Which of the following assessment is essential? A. evaluation of the peripheral IV site B. confirmation that the tube is in the stomach C. assess the bowel sound D. fluid and electrolyte monitoring Answer: (D) fluid and electrolyte monitoring Total parenteral nutrition is a method of providing nutrients to the body by an IV route. The admixture is made up of proteins, carbohydrates, fats, electrolytes, vitamins, trace minerals and sterile water based on individual client needs. It is intended to improve the clients nutritional status. Because of its composition, it is important to monitor the clients fluid intake and output including electrolytes, blood glucose and weight. 62. Which drug would be least effective in lowering a client's serum potassium level? A. Glucose and insulin B. Polystyrene sulfonate (Kayexalate) C. Calcium glucomite D. Aluminum hydroxide Answer: (D) Aluminum hydroxide pg. 92 A. Frequent ambulation B. Unlimited visitors C. Low residue diet D. vagin*l irrigation every shift Answer: (C) Low residue diet It is important for the nurse to remember that the implant be kept intact in the cervix during therapy. Mobility and vagin*l irrigations are not done. A low residue diet will prevent bowel movement that could lead to dislodgement of the implant. Patient is also strictly isolated to protect other people from the radiation emissions 73. Which nursing measure would avoid constriction on the affected arm immediately after mastectomy? A. Avoid BP measurement and constricting clothing on the affected arm B. Active range of motion exercises of the arms once a day. C. Discourage feeding, washing or combing with the affected arm D. Place the affected arm in a dependent position, below the level of the heart Answer: (A) Avoid BP measurement and constricting clothing on the affected arm A BP cuff constricts the blood vessels where it is applied. BP measurements should be done on the unaffected arm to ensure adequate circulation and venous and lymph drainage in the affected arm 74. A client suffering from acute renal failure has an unexpected increase in urinary output to 150ml/hr. The nurse assesses that the client has entered the second phase of acute renal failure. Nursing actions throughout this phase include observation for signs and symptoms of A. Hypervolemia, hypokalemia, and hypernatremia. B. Hypervolemia, hyperkalemia, and hypernatremia. C. Hypovolemia, wide fluctuations in serum sodium and potassium levels. D. Hypovolemia, no fluctuation in serum sodium and potassium levels. Answer: (C) Hypovolemia, wide fluctuations in serum sodium and potassium levels. The second phase of ARF is the diuretic phase or high output phase. The diuresis can result in an output of up to 10L/day of dilute urine. Loss of fluids and electrolytes occur. 75. An adult has just been brought in by ambulance after a motor vehicle accident. When assessing the client, the nurse would expect which of the following manifestations could have resulted from sympathetic nervous system stimulation? A. A rapid pulse and increased RR B. Decreased physiologic functioning C. Rigid posture and altered perceptual focus D. Increased awareness and attention Answer: (A) A rapid pulse and increased RR The fight or flight reaction of the sympathetic nervous system occurs during stress like in a motor vehicular accident. This is manifested by increased in cardiovascular function and RR to provide the immediate needs of the body for survival. 76. Ms. Sy undergoes surgery and the abdominal aortic aneurysm is resected and replaced with a graft. When she arrives in the RR she is still in shock. The nurse's priority should be A. placing her in a trendeleburg position B. putting several warm blankets on her C. monitoring her hourly urine output D. assessing her VS especially her RR Answer: (D) assessing her VS especially her RR pg. 95 Shock is characterized by reduced tissue and organ perfusion and eventual organ dysfunction and failure. Checking on the VS especially the RR, which detects need for oxygenation, is a priority to help detect its progress and provide for prompt management before the occurrence of complications. 77. A major goal for the client during the first 48 hours after a severe bum is to prevent hypovolemic shock. The best indicator of adequate fluid balance during this period is A. Elevated hematocrit levels. B. Urine output of 30 to 50 ml/hr. C. Change in level of consciousness. D. Estimate of fluid loss through the burn eschar. Answer: (B) Urine output of 30 to 50 ml/hr. Hypovolemia is a decreased in circulatory volume. This causes a decrease in tissue perfusion to the different organs of the body. Measuring the hourly urine output is the most quantifiable way of measuring tissue perfusion to the organs. Normal renal perfusion should produce 1ml/kg of BW/min. An output of 30-50 ml/hr is considered adequate and indicates good fluid balance. 78. A thoracentesis is performed on a chest-injured client, and no fluid or air is found. Blood and fluids is administered intravenously (IV), but the client's vital signs do not improve. A central venous pressure line is inserted, and the initial reading is 20 cm H^O. The most likely cause of these findings is which of the following? A. Spontaneous pneumothorax B. Ruptured diaphragm C. Hemothorax D. Pericardial tamponade Answer: (D) Pericardial tamponade Pericardial tamponade occurs when there is presence of fluid accumulation in the pericardial space that compresses on the ventricles causing a decrease in ventricular filling and stretching during diastole with a decrease in cardiac output. . This leads to right atrial and venous congestion manifested by a CVP reading above normal. 79. Intervention for a pt. who has swallowed a Muriatic Acid includes all of the following except A. administering an irritant that will stimulate vomiting B. aspirating secretions from the pharynx if respirations are affected C. neutralizing the chemical D. washing the esophagus with large volumes of water via gastric lavage Answer: (A) administering an irritant that will stimulate vomiting Swallowing of corrosive substances causes severe irritation and tissue destruction of the mucous membrane of the GI tract. Measures are taken to immediately remove the toxin or reduce its absorption. For corrosive poison ingestion, such as in muriatic acid where burn or perforation of the mucosa may occur, gastric emptying procedure is immediately instituted, This includes gastric lavage and the administration of activated charcoal to absorb the poison. Administering an irritant with the concomitant vomiting to remove the swallowed poison will further cause irritation and damage to the mucosal lining of the digestive tract. Vomiting is only indicated when non-corrosive poison is swallowed. 80. Which initial nursing assessment finding would best indicate that a client has been successfully resuscitated after a cardio-respiratory arrest? A. Skin warm and dry B. Pupils equal and react to light C. Palpable carotid pulse D. Positive Babinski's reflex pg. 96 Answer: (C) Palpable carotid pulse Presence of a palpable carotid pulse indicates the return of cardiac function which, together with the return of breathing, is the primary goal of CPR. Pulsations in arteries indicates blood flowing in the blood vessels with each cardiac contraction. Signs of effective tissue perfusion will be noted after. 81. Chemical burn of the eye are treated with A. local anesthetics and antibacterial drops for 24 – 36 hrs. B. hot compresses applied at 15-minute intervals C. Flushing of the lids, conjunctiva and cornea with tap or preferably sterile water D. cleansing the conjunctiva with a small cotton-tipped applicator Answer: (C) Flushing of the lids, conjunctiva and cornea with tap or preferably sterile water Prompt treatment of ocular chemical burns is important to prevent further damage. Immediate tap- water eye irrigation should be started on site even before transporting the patient to the nearest hospital facility. In the hospital, copious irrigation with normal saline, instillation of local anesthetic and antibiotic is done. 82. The Heimlich maneuver (abdominal thrust), for acute airway obstruction, attempts to: A. Force air out of the lungs B. Increase systemic circulation C. Induce emptying of the stomach D. Put pressure on the apex of the heart Answer: (A) Force air out of the lungs The Heimlich maneuver is used to assist a person choking on a foreign object. The pressure from the thrusts lifts the diaphragm, forces air out of the lungs and creates an artificial cough that expels the aspirated material. 83. John, 16 years old, is brought to the ER after a vehicular accident. He is pronounced dead on arrival. When his parents arrive at the hospital, the nurse should: A. ask them to stay in the waiting area until she can spend time alone with them B. speak to both parents together and encourage them to support each other and express their emotions freely C. Speak to one parent at a time so that each can ventilate feelings of loss without upsetting the other D. ask the MD to medicate the parents so they can stay calm to deal with their son’s death. Answer: (B) speak to both parents together and encourage them to support each other and express their emotions freely Sudden death of a family member creates a state of shock on the family. They go into a stage of denial and anger in their grieving. Assisting them with information they need to know, answering their questions and listening to them will provide the needed support for them to move on and be of support to one another. 84. An emergency treatment for an acute asthmatic attack is Adrenaline 1:1000 given hypodermically. This is given to: A. increase BP B. decrease mucosal swelling C. relax the bronchial smooth muscle D. decrease bronchial secretions Answer: (C) relax the bronchial smooth muscle Acute asthmatic attack is characterized by severe bronchospasm which can be relieved by the immediate administration of bronchodilators. Adrenaline or Epinephrine is an adrenergic agent that causes bronchial dilation by relaxing the bronchial smooth muscles. 85. A nurse is performing CPR on an adult patient. When performing chest compressions, the pg. 97