Memoir of a Schizo

Psychiatric Nursing 4

noreply@blogger.com (GINO) — Sat, 10 Oct 2009 00:49:30 PDT

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?
B. You need to stop that behavior now.
C. You will need to be restrained if you do not change your behavior.
D. You will need to be placed in seclusion.

Answer: (A) What is causing you to become agitated?
In a non-violent aggressive behavior, help the client identify the stressor or the true object of hostility. This helps reveal unresolved issues so that they may be confronted. B. Pacing is a tension relieving measure for an agitated client. C. This is a threatening statement that can heighten the client’s tension. D. Seclusion is used when less restrictive measures have failed.

77. The nurse closely observes the client who has been displaying aggressive behavior. The nurse observes that the client’s anger is escalating. Which approach is least helpful for the client at this time?
A. Acknowledge the client’s behavior
B. Maintain a safe distance from the client
C. Assist the client to an area that is quiet
D. Initiate confinement measures

Answer: (D) Initiate confinement measures
The proper procedure for dealing with harmful behavior is to first try to calm patient verbally. . When verbal and psychopharmacologic interventions are not adequate to handle the aggressiveness, seclusion or restraints may be applicable. A, B and C are appropriate approaches during the escalation phase of aggression.

78. The charge nurse of a psychiatric unit is planning the client assignment for the day. The most appropriate staff to be assigned to a client with a potential for violence is which of the following:
A. A timid nurse
B. A mature experienced nurse
C. an inexperienced nurse
D. a soft spoken nurse

Answer: (B) A mature experienced nurse
The unstable, aggressive client should be assigned to the most experienced nurse. A, C and D. A shy, inexperienced, soft spoken nurse may feel intimidated by the angry patient.

79. The nurse exemplifies awareness of the rights of a client whose anger is escalating by:
A. Taking a directive role in verbalizing feelings
B. Using an authoritarian, confrontational approach
C. Putting the client in a seclusion room
D. Applying mechanical restraints

Answer: (A) Taking a directive role in verbalizing feelings
Taking a directive role in the client’s verbalization of feelings can deescalate the client’s anger. B. A confrontational approach can be threatening and adds to the client’s tension. C and D. Use of restraints and isolation may be required if less restrictive interventions are unsuccessful.

80. The client jumps up and throws a chair out of the window. He was restrained after his behavior can no longer be controlled by the staff. Which of these documentations indicates the safeguarding of the patient’s rights?
A. There was a doctor’s order for restraints/seclusion
B. The patient’s rights were explained to him.
C. The staff observed confidentiality
D. The staff carried out less restrictive measures but were unsuccessful.

Answer: (D) The staff carried out less restrictive measures but were unsuccessful.
This documentation indicates that the client has been placed on restraints after the least restrictive measures failed in containing the client’s violent behavior.

81. Situation: Clients with personality disorders have difficulties in their social and occupational functions.
Clients with personality disorder will most likely:
A. recover with therapeutic intervention
B. respond to antianxiety medication
C. manifest enduring patterns of inflexible behaviors
D. Seek treatment willingly from some personally distressing symptoms

Answer: (C) manifest enduring patterns of inflexible behaviors
Personality disorders are characterized by inflexible traits and characteristics that are lifelong. A and D. This disorder is manifested by life-long patterns of behavior. The client with this disorder will not likely present himself for treatment unless something has gone wrong in his life so he may not recover from therapeutic intervention. B. Medications are generally not recommended for personality disorders.

82. A client tends to be insensitive to others, engages in abusive behaviors and does not have a sense of remorse. Which personality disorder is he likely to have?
A. Narcissistic
B. Paranoid
C. Histrionic
D. Antisocial

Answer: (D) Antisocial
These are the characteristics of an individual with antisocial personality. A. Narcissistic personality disorder is characterized by grandiosity and a need for constant admiration from others. B. Individuals with paranoid personality demonstrate a pattern of distrust and suspiciousness and interprets others motives as threatening. C. Individuals with histrionic have excessive emotionality, and attention-seeking behaviors.

83. The client joins a support group and frequently preaches against abuse, is demonstrating the use of:
A. denial
B. reaction formation
C. rationalization
D. projection

Answer: (B) reaction formation
Reaction formation is the adoption of behavior or feelings that are exactly opposite of one’s true emotions. A. Denial is refusal to accept a painful reality. C. Rationalization is attempting to justify one’s behavior by presenting reasons that sounds logical. D. Projection is attributing of one’s behaviors and feelings to another person.

84. A teenage girl is diagnosed to have borderline personality disorder. Which manifestations support the diagnosis?
A. Lack of self esteem, strong dependency needs and impulsive behavior
B. social withdrawal, inadequacy, sensitivity to rejection and criticism
C. Suspicious, hypervigilance and coldness
D. Preoccupation with perfectionism, orderliness and need for control

Answer: (A) Lack of self esteem, strong dependency needs and impulsive behavior
These are the characteristics of client with borderline personality. B. This describes the avoidant personality. C. These are the characteristics of a client with paranoid personality D. This describes the obsessive compulsive personality

85. The plan of care for clients with borderline personality should include:
A. Limit setting and flexibility in schedule
B. Giving medications to prevent acting out
C. Restricting her from other clients
D. Ensuring she adheres to certain restrictions

Answer: (D) Ensuring she adheres to certain restrictions
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
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
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 in 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

100. Which of the following is included in the health teachings among clients receiving Valium?:
A. Avoid foods rich in tyramine.
B. Take the medication after meals.
C. It is safe to stop it anytime after long term use.
D. Double up the dose if the client forgets her medication.

Answer: (B) Take the medication after meals.
Antianxiety medications cause G.I. upset so it should be taken after meals. A. This is specific for antidepressant MAOI. Taking tyramine rich food can cause hypertensive crisis. C. Valium causes dependency. In which case, the medication should be gradually withdrawn to prevent the occurrence of convulsion. D The dose of Valium should not be doubled if the previous dose was not taken. It can intensify the CNS depressant effects.

Psychiatric Nursing 3

noreply@blogger.com (GINO) — Sat, 10 Oct 2009 00:47:12 PDT

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
This indicates the client’s negative self evaluation. A sense of worthlessness may accompany depression. A,B and D are not relevant. The cues do not indicate inability to use coping resources, decreased ability to transmit/process symbols, nor insufficient quality of social exchange

54. The following medications will likely be prescribed for the client EXCEPT:
A. Prozac
B. Tofranil
C. Parnate
D. Zyprexa

Answer: (D) Zyprexa
This is an antipsychotic. A. This is a SSRI antidepressant. B. This antidepressant belongs to the Tricyclic group. C. This is a MAOI antidepressant.

55. Which is the highest priority in the post ECT care?
A. Observe for confusion
B. Monitor respiratory status
C. Reorient to time, place and person
D. Document the client’s response to the treatment

Answer: (B) Monitor respiratory status
A side effect of ECT which is life threatening is respiratory arrest. A and C. Confusion and disorientation are side effects of ECT but these are not the highest priority.

56. Situation: A 27 year old writer is admitted for the second time accompanied by his wife. He is demanding, arrogant talked fast and hyperactive.

Initially the nurse should plan this for a manic client:

A. set realistic limits to the client’s behavior
B. repeat verbal instructions as often as needed
C. allow the client to get out feelings to relieve tension
D. assign a staff to be with the client at all times to help maintain control

Answer: (A) set realistic limits to the client’s behavior
The manic client is hyperactive and may engage in injurious activities. A quiet environment and consistent and firm limits should be set to ensure safety. B. Clear, concise directions are given because of the distractibility of the client but this is not the priority. C. The manic client tend to externalize hostile feelings, however only non-destructive methods of expression should be allowed D. Nurses set limit as needed. Assigning a staff to be with the client at all times is not realistic.

57. An activity appropriate for the client is:
A. table tennis
B. painting
C. chess
D. cleaning

Answer: (D) cleaning
The client’s excess energy can be rechanelled through physical activities that are not competitive like cleaning. This is also a way to dissipate tension. A. Tennis is a competitive activity which can stimulate the client.

58. The client is arrogant and manipulative. In ensuring a therapeutic milieu, the nurse does one of the following:
A. Agree on a consistent approach among the staff assigned to the client.
B. Suggest that the client take a leading role in the social activities
C. Provide the client with extra time for one on one sessions
D. Allow the client to negotiate the plan of care

Answer: (A) Agree on a consistent approach among the staff assigned to the client.
A consistent firm approach is appropriate. This is a therapeutic way of to handle attempts of exploiting the weakness in others or create conflicts among the staff. Bargaining should not be allowed. B. This is not therapeutic because the client tends to control and dominate others. C. Limits are set for interaction time. D. Allowing the client to negotiate may reinforce manipulative behavior.

59. The nurse exemplifies awareness of the rights of a client whose anger is escalating by:
A. Taking a directive role in verbalizing feelings
B. Using an authoritarian, confrontational approach
C. Putting the client in a seclusion room
D. Applying mechanical restraints

Answer: (A) Taking a directive role in verbalizing feelings
The client has the right to be free from unnecessary restraints. Verbalization of feelings or “talking down” in a non-threatening environment is helpful to relieve the client’s anger. B. This is a threatening approach. C and D. Seclusion and application restraints are done only when less restrictive measures have failed to contain the client’s anger.

60. A client on Lithium has diarrhea and vomiting. What should the nurse do first:
A. Recognize this as a drug interaction
B. Give the client Cogentin
C. Reassure the client that these are common side effects of lithium therapy
D. Hold the next dose and obtain an order for a stat serum lithium level

Answer: (D) Hold the next dose and obtain an order for a stat serum lithium level
Diarrhea and vomiting are manifestations of Lithium toxicity. The next dose of lithium should be withheld and test is done to validate the observation. A. The manifestations are not due to drug interaction. B. Cogentin is used to manage the extra pyramidal symptom side effects of antipsychotics. C. The common side effects of Lithium are fine hand tremors, nausea, polyuria and polydipsia.

61. Situation: A widow age 28, whose husband died one year ago due to AIDS, has just been told that she has AIDS.
Pamela says to the nurse, “Why me? How could God do this to me?” This reaction is one of:
A. Depression
B. Denial
C. anger
D. bargaining

Answer: (C) anger
Anger is experienced as reality sets in. This may either be directed to God, the deceased or displaced on others. A. Depression is a painful stage where the individual mourns for what was lost. B. Denial is the first stage of the grieving process evidenced by the statement “No, it can’t be true.” The individual does not acknowledge that the loss has occurred to protect self from the psychological pain of the loss. D. In bargaining the individual holds out hope for additional alternatives to forestall the loss, evidenced by the statement “If only…”

62. The nurse’s therapeutic response is:
A. “I will refer you to a clergy who can help you understand what is happening to you.”
B. “ It isn’t fair that an innocent like you will suffer from AIDS.”
C. “That is a negative attitude.”
D. ”It must really be frustrating for you. How can I best help you?”

Answer: (D) ”It must really be frustrating for you. How can I best help you?”
This response reflects the pain due to loss. A helping relationship can be forged by showing empathy and concern. A. This is not therapeutic since it passes the buck or responsibility to the clergy. B. This response is not therapeutic because it gives the client the impression that she is right which prevents the client from reconsidering her thoughts. C. This statement passes judgment on the client.

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
D. masochistic

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 masochistic, 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

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. Orgasm
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. Orgasm refers to the peak of the sexual response where the female has vaginal contractions for the female and ejaculatory 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. Orgasm 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. Orgasm Disorder is the inability to complete the sexual response cycle because of the inability to achieve an orgasm. 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.

Psychiatric Nursing 2

noreply@blogger.com (GINO) — Sat, 10 Oct 2009 00:44:34 PDT

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, synesthesia and increase in vital signs D. Intoxication with Marijuana, a cannabinoid is manifested by sensation of slowed time, conjunctival redness, social withdrawal, impaired judgment and hallucinations.

30. A client is admitted with needle tracts on his arm, stuporous and with pin point pupil will likely be managed with:
A. Naltrexone (Revia)
B. Narcan (Naloxone)
C. Disulfiram (Antabuse)
D. Methadone (Dolophine)

Answer: (B) Narcan (Naloxone)
Narcan is a narcotic antagonist used to manage the CNS depression due to overdose with heroin. A. This is an opiate receptor blocker used to relieve the craving for heroine C. Disulfiram is used as a deterrent in the use of alcohol. D. Methadone is used as a substitute in the withdrawal from heroine

31. Situation: An old woman was brought for evaluation due to the hospital for evaluation due to increasing forgetfulness and limitations in daily function.

The daughter revealed that the client used her toothbrush to comb her hair. She is manifesting:
A. apraxia
B. aphasia
C. agnosia
D. amnesia

Answer: (C) agnosia
This is the inability to recognize objects. A. Apraxia is the inability to execute motor activities despite intact comprehension. B. Aphasia is the loss of ability to use or understand words. D. Amnesia is loss of memory.

32. She tearfully tells the nurse “I can’t take it when she accuses me of stealing her things.” Which response by the nurse will be most therapeutic?
A. ”Don’t take it personally. Your mother does not mean it.”
B. “Have you tried discussing this with your mother?”
C. “This must be difficult for you and your mother.”
D. “Next time ask your mother where her things were last seen.”

Answer: (C) “This must be difficult for you and your mother.”
This reflecting the feeling of the daughter that shows empathy. A and D. Giving advise does not encourage verbalization. B. This response does not encourage verbalization of feelings.

33. The primary nursing intervention in working with a client with moderate stage dementia is ensuring that the client:
A. receives adequate nutrition and hydration
B. will reminisce to decrease isolation
C. remains in a safe and secure environment
D. independently performs self care

Answer: (C) remains in a safe and secure environment
Safety is a priority consideration as the client’s cognitive ability deteriorates.. A is appropriate interventions because the client’s cognitive impairment can affect the client’s ability to attend to his nutritional needs, but it is not the priority B. Patient is allowed to reminisce but it is not the priority. D. The client in the moderate stage of Alzheimer’s disease will have difficulty in performing activities independently

34. She says to the nurse who offers her breakfast, “Oh no, I will wait for my husband. We will eat together” The therapeutic response by the nurse is:
A. “Your husband is dead. Let me serve you your breakfast.”
B. “I’ve told you several times that he is dead. It’s time to eat.”
C. “You’re going to have to wait a long time.”
D. “What made you say that your husband is alive?

Answer: (A) “Your husband is dead. Let me serve you your breakfast.”
The client should be reoriented to reality and be focused on the here and now.. B. This is not a helpful approach because of the short term memory of the client. C. This indicates a pompous response. D. The cognitive limitation of the client makes the client incapable of giving explanation.

35. Dementia unlike delirium is characterized by:
A. slurred speech
B. insidious onset
C. clouding of consciousness
D. sensory perceptual change

Answer: (B) insidious onset
Dementia has a gradual onset and progressive deterioration. It causes pronounced memory and cognitive disturbances. A,C and D are all characteristics of delirium.

36. Situation: A 17 year old gymnast is admitted to the hospital due to weight loss and dehydration secondary to starvation.

Which of the following nursing diagnoses will be given priority for the client?
A. altered self-image
B. fluid volume deficit
C. altered nutrition less than body requirements
D. altered family process

Answer: (B) fluid volume deficit
Fluid volume deficit is the priority over altered nutrition (A) since the situation indicates that the client is dehydrated. A and D are psychosocial needs of a client with anorexia nervosa but they are not the priority.

37. What is the best intervention to teach the client when she feels the need to starve?
A. Allow her to starve to relieve her anxiety
B. Do a short term exercise until the urge passes
C. Approach the nurse and talk out her feelings
D. Call her mother on the phone and tell her how she feels

Answer: (C) Approach the nurse and talk out her feelings
The client with anorexia nervosa uses starvation as a way of managing anxiety. Talking out feelings with the nurse is an adaptive coping. A. Starvation should not be encouraged. Physical safety is a priority. Without adequate nutrition, a life threatening situation exists. B. The client with anorexia nervosa is preoccupied with losing weight due to disturbed body image. Limits should be set on attempts to lose more weight. D. The client may have a domineering mother which causes the client to feel ambivalent. The client will not discuss her feelings with her mother.

38. The client with anorexia nervosa is improving if:
A. She eats meals in the dining room.
B. Weight gain
C. She attends ward activities.
D. She has a more realistic self concept.

Answer: (B) Weight gain
Weight gain is the best indication of the client’s improvement. The goal is for the client to gain 1-2 pounds per week. (A)The client may purge after eating. (C) Attending an activity does not indicate improvement in nutritional state. (D) Body image is a factor in anorexia nervosa but it is not an indicator for improvement.

39. The characteristic manifestation that will differentiate bulimia nervosa from anorexia nervosa is that bulimic individuals
A. have episodic binge eating and purging
B. have repeated attempts to stabilize their weight
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.
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.
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.

noreply@blogger.com (GINO) — Sat, 10 Oct 2009 00:44:20 PDT

Review Your Psychiatric Nursing

noreply@blogger.com (GINO) — Sat, 10 Oct 2009 00:39:47 PDT

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 circumstances 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 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.

6. Situation: In a home visit done by the nurse, she suspects that the wife and her child are victims of abuse.

Which of the following is the most appropriate for the nurse to ask?
A. “Are you being threatened or hurt by your partner?
B. “Are you frightened of you partner”
C. “Is something bothering you?”
D. “What happens when you and your partner argue?”

Answer: (A) “Are you being threatened or hurt by your partner?
The nurse validates her observation by asking simple, direct question. This also shows empathy. B, C, and D are indirect questions which may not lead to the discussion of abuse.

7. The wife admits that she is a victim of abuse and opens up about her persistent distaste for sex. This sexual disorder is:
A. Sexual desire disorder
B. Sexual arousal Disorder
C. Orgasm Disorder
D. Sexual Pain Disorder

Answer: (A) Sexual desire disorder
Has little or no sexual desire or has distaste for sex. B. Failure to maintain the physiologic requirements for sexual intercourse. C. Persistent and recurrent inability to achieve an orgasm. D. Also called dyspareunia. Individuals with this disorder suffer genital pain before, during and after sexual intercourse.

8. What would be the best approach for a wife who is still living with her abusive husband?
A. “Here’s the number of a crisis center that you can call for help .”
B. “Its best to leave your husband.”
C. “Did you discuss this with your family?”
D. “ Why do you allow yourself to be treated this way”

Answer: (A) “Here’s the number of a crisis center that you can call for help .”
Protection is a priority concern in abuse. Help the victim to develop a plan to ensure safety. B. Do not give advice to leave the abuser. Making decisions for the victim further erodes her esteem. However discuss options available. C. The victim tends to isolate from friends and family. D. This is judgmental. Avoid in anyway implying that she is at fault.

9. Which comment about a 3 year old child if made by the parent may indicate child abuse?
A. “Once my child is toilet trained, I can still expect her to have some"
B. “When I tell my child to do something once, I don’t expect to have to tell"
C. “My child is expected to try to do things such as, dress and feed.”
D. “My 3 year old loves to say NO.”

Answer: (B) “When I tell my child to do something once, I don’t expect to have to tell"
Abusive parents tend to have unrealistic expectations on the child. A,B and C are realistic expectations on a 3 year old.

10. The primary nursing intervention for a victim of child abuse is:
A. Assess the scope of the problem
B. Analyze the family dynamics
C. Ensure the safety of the victim
D. Teach the victim coping skills

Answer: (C) Ensure the safety of the victim
The priority consideration is the safety of the victim. Attend to the physical injuries to ensure the physiologic safety and integrity of the child. Reporting suspected case of abuse may deter recurrence of abuse. A,B and D may be addressed later.

11. Situation: A 30 year old male employee frequently complains of low back pain that leads to frequent absences from work. Consultation and tests reveal negative results.

The client has which somatoform disorder?
A. Somatization Disorder
B. Hypochondriaisis
C. Conversion Disorder
D. Somatoform Pain Disorder

Answer: (D) Somatoform Pain Disorder
This is characterized by severe and prolonged pain that causes significant distress. A. This is a chronic syndrome of somatic symptoms that cannot be explained medically and is associated with psychosocial distress. B. This is an unrealistic preoccupation with a fear of having a serious illness. C. Characterized by alteration or loss in sensory or motor function resulting from a psychological conflict.

12. Freud explains anxiety as:
A. Strives to gratify the needs for satisfaction and security
B. Conflict between id and superego
C. A hypothalamic-pituitary-adrenal reaction to stress
D. A conditioned response to stressors

Answer: (B) Conflict between id and superego
Freud explains anxiety as due to opposing action drives between the id and the superego. A. Sullivan identified 2 types of needs, satisfaction and security. Failure to gratify these needs may result in anxiety. C. Biomedical perspective of anxiety. D. Explanation of anxiety using the behavioral model.

13. The following are appropriate nursing diagnosis for the client EXCEPT:
A. Ineffective individual coping
B. Alteration in comfort, pain
C. Altered role performance
D. Impaired social interaction

Answer: (D) Impaired social interaction
The client may not have difficulty in social exchange. The cues do not support this diagnosis. A. The client maladaptively uses body symptoms to manage anxiety. B. The client will have discomfort due to pain. C. The client may fail to meet environmental expectations due to pain.

14. The following statements describe somatoform disorders:
A. Physical symptoms are explained by organic causes
B. It is a voluntary expression of psychological conflicts
C. Expression of conflicts through bodily symptoms
D. Management entails a specific medical treatment

Answer: (C) Expression of conflicts through bodily symptoms
Bodily symptoms are used to handle conflicts. A. Manifestations do not have an organic basis. B. This occurs unconsciously. D. Medical treatment is not used because the disorder does not have a structural or organic basis.

15. What would be the best response to the client’s repeated complaints of pain:
A. “I know the feeling is real tests revealed negative results.”
B. . “I think you’re exaggerating things a little bit.”
C. “Try to forget this feeling and have activities to take it off your mind”
D. “So tell me more about the pain”

Answer: (A) “I know the feeling is real tests revealed negative results.”
Shows empathy and offers information. B. This is a demeaning statement. C. This belittles the client’s feelings. D. Giving undue attention to the physical symptom reinforces the complaint.

16. Situation: A nurse may encounter children with mental disorders. Her knowledge of these various disorders is vital.

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 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
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.

Maternal and Child Health Nursing Part III

noreply@blogger.com (GINO) — Fri, 25 Sep 2009 08:55:06 PDT

101. Postpartum Period:

The fundus of the uterus is expected to go down normally postpartally about __ cm per day.

A. 1.0 cm
B. 2.0 cm
C. 2.5 cm
D. 3.0 cm

Answer: (A) 1.0 cm
The uterus will begin involution right after delivery. It is expected to regress/go down by 1 cm. per day and becomes no longer palpable about 1 week after delivery.

102. The lochia on the first few days after delivery is characterized as
A. Pinkish with some blood clots
B. Whitish with some mucus
C. Reddish with some mucus
D. Serous with some brown tinged mucus

Answer: (C) Reddish with some mucus
Right after delivery, the vaginal discharge called lochia will be reddish because there is some blood, endometrial tissue and mucus. Since it is not pure blood it is non-clotting.

103. Lochia normally disappears after how many days postpartum?
A. 5 days
B. 7-10 days
C. 18-21 days
D. 28-30 days

Answer: (B) 7-10 days
Normally, lochia disappears after 10 days postpartum. What’s important to remember is that the color of lochia gets to be lighter (from reddish to whitish) and scantier everyday.

104. After an Rh(-) mother has delivered her Rh (+) baby, the mother is given RhoGam. This is done in order to:
A. Prevent the recurrence of Rh(+) baby in future pregnancies
B. Prevent the mother from producing antibodies against the Rh(+) antigen that she may have gotten when she delivered to her Rh(+) baby
C. Ensure that future pregnancies will not lead to maternal illness
D. To prevent the newborn from having problems of incompatibility when it breastfeeds

Answer: (B) Prevent the mother from producing antibodies against the Rh(+) antigen that she may have gotten when she delivered to her Rh(+) baby
In Rh incompatibility, an Rh(-) mother will produce antibodies against the fetal Rh (+) antigen which she may have gotten because of the mixing of maternal and fetal blood during labor and delivery. Giving her RhoGam right after birth will prevent her immune system from being permanently sensitized to Rh antigen.

105. To enhance milk production, a lactating mother must do the following interventions EXCEPT:
A. Increase fluid intake including milk
B. Eat foods that increases lactation which are called galactagues
C. Exercise adequately like aerobics
D. Have adequate nutrition and rest

Answer: (C) Exercise adequately like aerobics
All the above nursing measures are needed to ensure that the mother is in a healthy state. However, aerobics does not necessarily enhance lactation.

106. The nursing intervention to relieve pain in breast engorgement while the mother continues to breastfeed is
A. Apply cold compress on the engorged breast
B. Apply warm compress on the engorged breast
C. Massage the breast
D. Apply analgesic ointment

Answer: (B) Apply warm compress on the engorged breast
Warm compress is applied if the purpose is to relieve pain but ensure lactation to continue. If the purpose is to relieve pain as well as suppress lactation, the compress applied is cold.

107. A woman who delivered normally per vagina is expected to void within ___ hours after delivery.
A. 3 hrs
B. 4 hrs.
C. 6-8 hrs
D. 12-24 hours

Answer: (C) 6-8 hrs
A woman who has had normal delivery is expected to void within 6-8 hrs. If she is unable to do so after 8 hours, the nurse should stimulate the woman to void. If nursing interventions to stimulate spontaneous voiding don’t work, the nurse may decide to catheterize the woman.

108. To ensure adequate lactation the nurse should teach the mother to:
A. Breast feed the baby on self-demand day and night
B. Feed primarily during the day and allow the baby to sleep through the night
C. Feed the baby every 3-4 hours following a strict schedule
D. Breastfeed when the breast are engorged to ensure adequate supply

Answer: (A) Breast feed the baby on self-demand day and night
Feeding on self-demand means the mother feeds the baby according to baby’s need. Therefore, this means there will be regular emptying of the breasts, which is essential to maintain adequate lactation.

109. An appropriate nursing intervention when caring for a postpartum mother with thrombophlebitis is:
A. Encourage the mother to ambulate to relieve the pain in the leg
B. Instruct the mother to apply elastic bondage from the foot going towards the knee to improve venous return flow
C. Apply warm compress on the affected leg to relieve the pain
D. Elevate the affected leg and keep the patient on bedrest

Answer: (D) Elevate the affected leg and keep the patient on bedrest
If the mother already has thrombophlebitis, the nursing intervention is bedrest to prevent the possible dislodging of the thrombus and keeping the affected leg elevated to help reduce the inflammation.

110. The nurse should anticipate that hemorrhage related to uterine atony may occur postpartally if this condition was present during the delivery:
A. Excessive analgesia was given to the mother
B. Placental delivery occurred within thirty minutes after the baby was born
C. An episiotomy had to be done to facilitate delivery of the head
D. The labor and delivery lasted for 12 hours

Answer: (A) Excessive analgesia was given to the mother
Excessive analgesia can lead to uterine relaxation thus lead to hemorrhage postpartally. Both B and D are normal and C is at the vaginal introitus thus will not affect the uterus.

111. According to Rubin’s theory of maternal role adaptation, the mother will go through 3 stages during the post partum period. These stages are:
A. Going through, adjustment period, adaptation period
B. Taking-in, taking-hold and letting-go
C. Attachment phase, adjustment phase, adaptation phase
D. Taking-hold, letting-go, attachment phase

Answer: (B) Taking-in, taking-hold and letting-go
Rubin’s theory states that the 3 stages that a mother goes through for maternal adaptation are: taking-in, taking-hold and letting-go. In the taking-in stage, the mother is more passive and dependent on others for care. In taking-hold, the mother begins to assume a more active role in the care of the child and in letting-go, the mother has become adapted to her maternal role.

112. The neonate of a mother with diabetes mellitus is prone to developing hypoglycemia because:
A. The pancreas is immature and unable to secrete the needed insulin
B. There is rapid diminution of glucose level in the baby’s circulating blood and his pancreas is normally secreting insulin
C. The baby is reacting to the insulin given to the mother
D. His kidneys are immature leading to a high tolerance for glucose

Answer: (B) There is rapid diminution of glucose level in the baby’s circulating blood and his pancreas is normally secreting insulin
If the mother is diabetic, the fetus while in utero has a high supply of glucose. When the baby is born and is now separate from the mother, it no longer receives a high dose of glucose from the mother. In the first few hours after delivery, the neonate usually does not feed yet thus this can lead to hypoglycemia.

113. Which of the following is an abnormal vital sign in postpartum?
A. Pulse rate between 50-60/min
B. BP diastolic increase from 80 to 95mm Hg
C. BP systolic between 100-120mm Hg
D. Respiratory rate of 16-20/min

Answer: (B) BP diastolic increase from 80 to 95mm Hg
All the vital signs given in the choices are within normal range except an increase of 15mm Hg in the diastolic which is a possible sign of hypertension in pregnancy.

114. The uterine fundus right after delivery of placenta is palpable at
A. Level of Xyphoid process
B. Level of umbilicus
C. Level of symphysis pubis
D. Midway between umbilicus and symphysis pubis

Answer: (B) Level of umbilicus
Immediately after the delivery of the placenta, the fundus of the uterus is expected to be at the level of the umbilicus because the contents of the pregnancy have already been expelled. The fundus is expected to recede by 1 fingerbreadths (1cm) everyday until it becomes no longer palpable above the symphysis pubis.

115. After how many weeks after delivery should a woman have her postpartal check-up based on the protocol followed by the DOH?
A. 2 weeks
B. 3 weeks
C. 6 weeks
D. 12 weeks

Answer: (C) 6 weeks
According to the DOH protocol postpartum check-up is done 6-8 weeks after delivery to make sure complete involution of the reproductive organs has be achieved.

116. In a woman who is not breastfeeding, menstruation usually occurs after how many weeks?
A. 2-4 weeks
B. 6-8 weeks
C. 6 months
D. 12 months

Answer: (B) 6-8 weeks
When the mother does not breastfeed, the normal menstruation resumes about 6-8 weeks after delivery. This is due to the fact that after delivery, the hormones estrogen and progesterone gradually decrease thus triggering negative feedback to the anterior pituitary to release the Folicle-Stimulating Hormone (FSH) which in turn stimulates the ovary to again mature a graafian follicle and the menstrual cycle post pregnancy resumes.

117. The following are nursing measures to stimulate lactation EXCEPT
A. Frequent regular breast feeding
B. Breast pumping
C. Breast massage
D. Application of cold compress on the breast

Answer: (D) Application of cold compress on the breast
To stimulate lactation, warm compress is applied on the breast. Cold application will cause vasoconstriction thus reducing the blood supply consequently the production of milk.

118. When the uterus is firm and contracted after delivery but there is vaginal bleeding, the nurse should suspect
A. Laceration of soft tissues of the cervix and vagina
B. Uterine atony
C. Uterine inversion
D. Uterine hypercontractility

Answer: (A) Laceration of soft tissues of the cervix and vagina
When uterus is firm and contracted it means that the bleeding is not in the uterus but other parts of the passageway such as the cervix or the vagina.

119. The following are interventions to make the fundus contract postpartally EXCEPT
A. Make the baby suck the breast regularly
B. Apply ice cap on fundus
C. Massage the fundus vigorously for 15 minutes until contracted
D. Give oxytocin as ordered

Answer: (C) Massage the fundus vigorously for 15 minutes until contracted
Massaging the fundus of the uterus should not be vigorous and should only be done until the uterus feel firm and contracted. If massaging is vigorous and prolonged, the uterus will relax due to over stimulation.

120. The following are nursing interventions to relieve episiotomy wound pain EXCEPT
A. Giving analgesic as ordered
B. Sitz bath
C. Perineal heat
D. Perineal care

Answer: (D) Perineal care
Perineal care is primarily done for personal hygiene regardless of whether there is pain or not; episiotomy wound or not.

121. Postpartum blues is said to be normal provided that the following characteristics are present. These are
1. Within 3-10 days only;
2. Woman exhibits the following symptoms- episodic tearfulness, fatigue, oversensitivity, poor appetite;
3. Maybe more severe symptoms in primpara

A. All of the above
B. 1 and 2
C. 2 only
D. 2 and 3

Answer: (A) All of the above
All the symptoms 1-3 are characteristic of postpartal blues. It will resolve by itself because it is transient and is due to a number of reasons like changes in hormonal levels and adjustment to motherhood. If symptoms lasts more than 2 weeks, this could be a sign of abnormality like postpartum depression and needs treatment.

122. The neonatal circulation differs from the fetal circulation because
A. The fetal lungs are non-functioning as an organ and most of the blood in the fetal circulation is mixed blood.
B. The blood at the left atrium of the fetal heart is shunted to the right atrium to facilitate its passage to the lungs
C. The blood in left side of the fetal heart contains oxygenated blood while the blood in the right side contains unoxygenated blood.
D. None of the above

Answer: (A) The fetal lungs are non-functioning as an organ and most of the blood in the fetal circulation is mixed blood.
The fetal lungs is fluid-filled while in utero and is still not functioning. It only begins to function in extra uterine life. Except for the blood as it enters the fetus immediately from the placenta, most of the fetal blood is mixed blood.

123. The normal respiration of a newborn immediately after birth is characterized as:
A. Shallow and irregular with short periods of apnea lasting not longer than 15 seconds, 30-60 breaths per minute
B. 20-40 breaths per minute, abdominal breathing with active use of intercostals muscles
C. 30-60 breaths per minute with apnea lasting more than 15 seconds, abdominal breathing
D. 30-50 breaths per minute, active use of abdominal and intercostal muscles

Answer: (A) Shallow and irregular with short periods of apnea lasting not longer than 15 seconds, 30-60 breaths per minute
A newly born baby still is adjusting to extra uterine life and the lungs are just beginning to function as a respiratory organ. The respiration of the baby at this time is characterized as usually shallow and irregular with short periods of apnea, 30-60 breaths per minute. The apneic periods should be brief lasting not more than 15 seconds otherwise it will be considered abnormal.

124. The anterior fontanelle is characterized as:
A. 3-4 cm antero-posterior diameter and 2-3 cm transverse diameter, diamond shape
B. 2-3 cm antero-posterior diameter and 3-4 cm transverse diameter and diamond shape
C. 2-3 cm in both antero-posterior and transverse diameter and diamond shape
D. none of the above

Answer: (A) 3-4 cm antero-posterior diameter and 2-3 cm transverse diameter, diamond shape
The anterior fontanelle is diamond shape with the antero-posterior diameter being longer than the transverse diameter. The posterior fontanelle is triangular shape.

125. The ideal site for vitamin K injection in the newborn is:
A. Right upper arm
B. Left upper arm
C. Either right or left buttocks
D. Middle third of the thigh

Answer: (D) Middle third of the thigh
Neonates do not have well developed muscles of the arm. Since Vitamin K is given intramuscular, the site must have sufficient muscles like the middle third of the thigh.

126. At what APGAR score at 5 minutes after birth should resuscitation be initiated?
A. 1-3
B. 7-8
C. 9-10
D. 6-7

Answer: (A) 1-3
An APGAR of 1-3 is a sign of fetal distress which requires resuscitation. The baby is alright if the score is 8-10.

127. Right after birth, when the skin of the baby’s trunk is pinkish but the soles of the feet and palm of the hands are bluish this is called:
A. Syndactyly
B. Acrocyanosis
C. Peripheral cyanosis
D. Cephalo-caudal cyanosis

Answer: (B) Acrocyanosis
Acrocyanosis is the term used to describe the baby’s skin color at birth when the soles and palms are bluish but the trunk is pinkish.

128. The minimum birth weight for full term babies to be considered normal is:
A. 2,000gms
B. 1,500gms
C. 2,500gms
D. 3,000gms

Answer: (C) 2,500gms
According to the WHO standard, the minimum normal birth weight of a full term baby is 2,500 gms or 2.5 Kg.

129. The procedure done to prevent ophthalmia neonatorum is:
A. Marmet’s technique
B. Crede’s method
C. Ritgen’s method
D. Ophthalmic wash

Answer: (B) Crede’s method
Crede’s method/prophylaxis is the procedure done to prevent ophthalmia neonatorum which the baby can acquire as it passes through the birth canal of the mother. Usually, an ophthalmic ointment is used.

130. Which of the following characteristics will distinguish a postmature neonate at birth?
A. Plenty of lanugo and vernix caseosa
B. Lanugo mainly on the shoulders and vernix in the skin folds
C. Pinkish skin with good turgor
D. Almost leather-like, dry, cracked skin, negligible vernix caseosa

Answer: (D) Almost leather-like, dry, cracked skin, negligible vernix caseosa
A post mature fetus has the appearance of an old person with dry wrinkled skin and the vernix caseosa has already diminished.

131. According to the Philippine Nursing Law, a registered nurse is allowed to handle mothers in labor and delivery with the following considerations:
1. The pregnancy is normal.;
2. The labor and delivery is uncomplicated;
3. Suturing of perineal laceration is allowed provided the nurse had special training;
4. As a delivery room nurse she is not allowed to insert intravenous fluid unless she had special training for it.
A. 1 and 2
B. 1, 2, and 3
C. 3 and 4
D. 1, 2, and 4

Answer: (B) 1, 2, and 3
To be allowed to handle deliveries, the pregnancy must be normal and uncomplicated. And in RA9172, the nurse is now allowed to suture perineal lacerations provided s/he has had the special training. Also, in this law, there is no longer an explicit provision stating that the nurse still needs special training for IV insertion.

132. Birth Control Methods and Infertility:

In basal body temperature (BBT) technique, the sign that ovulation has occurred is an elevation of body temperature by

A. 1.0-1.4 degrees centigrade
B. 0.2-0.4 degrees centigrade
C. 2.0-4.0 degrees centigrade
D. 1.0-4.0 degrees centigrade

Answer: (B) 0.2-0.4 degrees centigrade
The release of the hormone progesterone in the body following ovulation causes a slight elevation of basal body temperature of about 0.2 – 0.4 degrees centigrade

133. Lactation Amenorrhea Method(LAM) can be an effective method of natural birth control if
A. The mother breast feeds mainly at night time when ovulation could possibly occur
B. The mother breastfeeds exclusively and regularly during the first 6 months without giving supplemental feedings
C. The mother uses mixed feeding faithfully
D. The mother breastfeeds regularly until 1 year with no supplemental feedings

Answer: (B) The mother breastfeeds exclusively and regularly during the first 6 months without giving supplemental feedings
A mother who breastfeeds exclusively and regularly during the first 6 months benefits from lactation amenorrhea. There is evidence to support the observation that the benefits of lactation amenorrhea lasts for 6 months provided the woman has not had her first menstruation since delivery of the baby.

134. Intra-uterine device prevents pregnancy by the ff. mechanism EXCEPT
A. Endometrium inflames
B. Fundus contracts to expel uterine contents
C. Copper embedded in the IUD can kill the sperms
D. Sperms will be barred from entering the fallopian tubes

Answer: (D) Sperms will be barred from entering the fallopian tubes
An intrauterine device is a foreign body so that if it is inserted into the uterine cavity the initial reaction is to produce inflammatory process and the uterus will contract in order to try to expel the foreign body. Usually IUDs are coated with copper to serve as spermicide killing the sperms deposited into the female reproductive tract. But the IUD does not completely fill up the uterine cavity thus sperms which are microscopic in size can still pass through.

135. Oral contraceptive pills are of different types. Which type is most appropriate for mothers who are breastfeeding?
A. Estrogen only
B. Progesterone only
C. Mixed type- estrogen and progesterone
D. 21-day pills mixed type

Answer: (B) Progesterone only
If mother is breastfeeding, the progesterone only type is the best because estrogen can affect lactation.

136. The natural family planning method called Standard Days (SDM), is the latest type and easy to use method. However, it is a method applicable only to women with regular menstrual cycles between ___ to ___ days.
A. 21-26 days
B. 26-32 days
C. 28-30 days
D. 24- 36 days

Answer: (B) 26-32 days
Standard Days Method (SDM) requires that the menstrual cycles are regular between 26-32 days. There is no need to monitor temperature or mucus secretion. This natural method of family planning is very simple since all that the woman pays attention to is her cycle. With the aid of CycleBeads, the woman can easily monitor her cycles.

137. Which of the following are signs of ovulation?

1. Mittelschmerz;
2. Spinnabarkeit;
3. Thin watery cervical mucus;
4. Elevated body temperature of 4.0 degrees centigrade
A. 1 & 2
B. 1, 2, & 3
C. 3 & 4
D. 1, 2, 3, 4

Answer: (B) 1, 2, & 3
Mittelschmerz, spinnabarkeit and thin watery cervical mucus are signs of ovulation. When ovulation occurs, the hormone progesterone is released which can cause a slight elevation of temperature between 0.2-0.4 degrees centigrade and not 4 degrees centigrade.

138. The following methods of artificial birth control works as a barrier device EXCEPT:
A. Condom
B. Cervical cap
C. Cervical Diaphragm
D. Intrauterine device (IUD)

Answer: (D) Intrauterine device (IUD)
Intrauterine device prevents pregnancy by not allowing the fertilized ovum from implanting on the endometrium. Some IUDs have copper added to it which is spermicidal. It is not a barrier since the sperms can readily pass through and fertilize an ovum at the fallopian tube.

139. Which of the following is a TRUE statement about normal ovulation?
A. It occurs on the 14th day of every cycle
B. It may occur between 14-16 days before next menstruation
C. Every menstrual period is always preceded by ovulation
D. The most fertile period of a woman is 2 days after ovulation

Answer: (B) It may occur between 14-16 days before next menstruation
Not all menstrual cycles are ovulatory. Normal ovulation in a woman occurs between the 14th to the 16th day before the NEXT menstruation. A common misconception is that ovulation occurs on the 14th day of the cycle. This is a misconception because ovulation is determined NOT from the first day of the cycle but rather 14-16 days BEFORE the next menstruation.

140. If a couple would like to enhance their fertility, the following means can be done:

1. Monitor the basal body temperature of the woman everyday to determine peak period of fertility;
2. Have adequate rest and nutrition;
3. Have sexual contact only during the dry period of the woman;
4. Undergo a complete medical check-up to rule out any debilitating disease

A. 1 only
B. 1 & 4
C. 1,2,4
D. 1,2,3,4

Answer: (C) 1,2,4
All of the above are essential for enhanced fertility except no. 3 because during the dry period the woman is in her infertile period thus even when sexual contact is done, there will be no ovulation, thus fertilization is not possible.

141. In sympto-thermal method, the parameters being monitored to determine if the woman is fertile or infertile are:
A. Temperature, cervical mucus, cervical consistency
B. Release of ovum, temperature and vagina
C. Temperature and wetness
D. Temperature, endometrial secretion, mucus

Answer: (A) Temperature, cervical mucus, cervical consistency
The 3 parameters measured/monitored which will indicate that the woman has ovulated are- temperature increase of about 0.2-0.4 degrees centigrade, softness of the cervix and cervical mucus that looks like the white of an egg which makes the woman feel “wet”.

142. The following are important considerations to teach the woman who is on low dose (mini-pill) oral contraceptive EXCEPT:
A. The pill must be taken everyday at the same time
B. If the woman fails to take a pill in one day, she must take 2 pills for added protection
C. If the woman fails to take a pill in one day, she needs to take another temporary method until she has consumed the whole pack
D. If she is breast feeding, she should discontinue using mini-pill and use the progestin-only type

Answer: (B) If the woman fails to take a pill in one day, she must take 2 pills for added protection
If the woman fails to take her usual pill for the day, taking a double dose does not give additional protection. What she needs to do is to continue taking the pills until the pack is consumed and use at the time another temporary method to ensure that no pregnancy will occur. When a new pack is started, she can already discontinue using the second temporary method she employed.

143. To determine if the cause of infertility is a blockage of the fallopian tubes, the test to be done is
A. Huhner’s test
B. Rubin’s test
C. Postcoital test
D. None of the above

Answer: (B) Rubin’s test
Rubin’s test is a test to determine patency of fallopian tubes. Huhner’s test is also known as post-coital test to determine compatibility of the cervical mucus with sperms of the sexual partner.

144. Infertility can be attributed to male causes such as the following EXCEPT:
A. Cryptorchidism
B. Orchitis
C. Sperm count of about 20 million per milliliter
D. Premature ejaculation

Answer: (C) Sperm count of about 20 million per milliliter
Sperm count must be within normal in order for a male to successfully sire a child. The normal sperm count is 20 million per milliliter of seminal fluid or 50 million per ejaculate.

145. Spinnabarkeit is an indicator of ovulation which is characterized as:
A. Thin watery mucus which can be stretched into a long strand about 10 cm
B. Thick mucus that is detached from the cervix during ovulation
C. Thin mucus that is yellowish in color with fishy odor
D. Thick mucus vaginal discharge influence by high level of estrogen

Answer: (A) Thin watery mucus which can be stretched into a long strand about 10 cm
At the midpoint of the cycle when the estrogen level is high, the cervical mucus becomes thin and watery to allow the sperm to easily penetrate and get to the fallopian tubes to fertilize an ovum. This is called spinnabarkeit. And the woman feels “wet”. When progesterone is secreted by the ovary, the mucus becomes thick and the woman will feel “dry”.

146. Vasectomy is a procedure done on a male for sterilization. The organ involved in this procedure is
A. Prostate gland
B. Seminal vesicle
C. Testes
D. Vas deferens

Answer: (D) Vas deferens
Vasectomy is a procedure wherein the vas deferens of the male is ligated and cut to prevent the passage of the sperms from the testes to the penis during ejaculation.

147. Breast self examination is best done by the woman on herself every month during
A. The middle of her cycle to ensure that she is ovulating
B. During the menstrual period
C. Right after the menstrual period so that the breast is not being affected by the increase in hormones particularly estrogen
D. Just before the menstrual period to determine if ovulation has occurred

Answer: (C) Right after the menstrual period so that the breast is not being affected by the increase in hormones particularly estrogen
The best time to do self breast examination is right after the menstrual period is over so that the hormonal level is low thus the breasts are not tender.

148. A woman is considered to be menopause if she has experienced cessation of her menses for a period of
A. 6 months
B. 12 months
C. 18 months
D. 24 months

Answer: (B) 12 months
If a woman has not had her menstrual period for 12 consecutive months, she is considered to be in her menopausal stage.

149. Which of the following is the correct practice of self breast examination in a menopausal woman?
A. She should do it at the usual time that she experiences her menstrual period in the past to ensure that her hormones are not at its peak .
B. Any day of the month as long it is regularly observed on the same day every month
C. Anytime she feels like doing it ideally every day
D. Menopausal women do not need regular self breast exam as long as they do it at least once every 6 months

Answer: (B) Any day of the month as long it is regularly observed on the same day every month
Menopausal women still need to do self examination of the breast regularly. Any day of the month is alright provided that she practices it monthly on the same day that she has chosen. The hormones estrogen and progesterone are already diminished during menopause so there is no need to consider the time to do it in relation to the menstrual cycle.

150. In assisted reproductive technology (ART), there is a need to stimulate the ovaries to produce more than one mature ova. The drug commonly used for this purpose is:
A. Bromocriptine
B. Clomiphene
C. Provera
D. Esrogen

Answer: (B) Clomiphene
Clomiphene or Clomid acts as an ovarian stimulant to promote ovulation. The mature ova are retrieved and fertilized outside the fallopian tube (in-vitro fertilization) and after 48 hours the fertilized ovum is inserted into the uterus for implantation.

Maternal and Child Health Nursing Part II

noreply@blogger.com (GINO) — Fri, 25 Sep 2009 08:52:07 PDT

51. Which of the following conditions will lead to a small-for-gestational age fetus due to less blood supply to the fetus?
A. Diabetes in the mother
B. Maternal cardiac condition
C. Premature labor
D. Abruptio placenta

Answer: (B) Maternal cardiac condition
In general, when the heart is compromised such as in maternal cardiac condition, the condition can lead to less blood supply to the uterus consequently to the placenta which provides the fetus with the essential nutrients and oxygen. Thus if the blood supply is less, the baby will suffer from chronic hypoxia leading to a small-for-gestational age condition.

52. The lower limit of viability for infants in terms of age of gestation is:
A. 21-24 weeks
B. 25-27 weeks
C. 28-30 weeks
D. 38-40 weeks

Answer: (A) 21-24 weeks
Viability means the capability of the fetus to live/survive outside of the uterine environment. With the present technological and medical advances, 21 weeks AOG is considered as the minimum fetal age for viability.

53. Which provision of our 1987 constitution guarantees the right of the unborn child to life from conception is
A. Article II section 12
B. Article II section 15
C. Article XIII section 11
D. Article XIII section 15

Answer: (A) Article II section 12
The Philippine Constitution of 1987 guarantees the right of the unborn child from conception equal to the mother as stated in Article II State Policies, Section 12.

54. In the Philippines, if a nurse performs abortion on the mother who wants it done and she gets paid for doing it, she will be held liable because
A. Abortion is immoral and is prohibited by the church
B. Abortion is both immoral and illegal in our country
C. Abortion is considered illegal because you got paid for doing it
D. Abortion is illegal because majority in our country are catholics and it is prohibited by the church

Answer: (B) Abortion is both immoral and illegal in our country
Induced Abortion is illegal in the country as stated in our Penal Code and any person who performs the act for a fee commits a grave offense punishable by 10-12 years of imprisonment.

55. The preferred manner of delivering the baby in a gravido-cardiac is vaginal delivery assisted by forceps under epidural anesthesia. The main rationale for this is:

A. To allow atraumatic delivery of the baby
B. To allow a gradual shifting of the blood into the maternal circulation
C. To make the delivery effort free and the mother does not need to push with contractions
D. To prevent perineal laceration with the expulsion of the fetal head

Answer: (C) To make the delivery effort free and the mother does not need to push with contractions
Forceps delivery under epidural anesthesia will make the delivery process less painful and require less effort to push for the mother. Pushing requires more effort which a compromised heart may not be able to endure.

56. When giving narcotic analgesics to mother in labor, the special consideration to follow is:
A. The progress of labor is well established reaching the transitional stage
B. Uterine contraction is progressing well and delivery of the baby is imminent
C. Cervical dilatation has already reached at least 8 cm. and the station is at least (+)2
D. Uterine contractions are strong and the baby will not be delivered yet within the next 3 hours.

Answer: (D) Uterine contractions are strong and the baby will not be delivered yet within the next 3 hours.
Narcotic analgesics must be given when uterine contractions are already well established so that it will not cause stoppage of the contraction thus protracting labor. Also, it should be given when delivery of fetus is imminent or too close because the fetus may suffer respiratory depression as an effect of the drug that can pass through placental barrier.

57. The cervical dilatation taken at 8:00 A.M. in a G1P0 patient was 6 cm. A repeat I.E. done at 10 A.M. showed that cervical dilation was 7 cm. The correct interpretation of this result is:
A. Labor is progressing as expected
B. The latent phase of Stage 1 is prolonged
C. The active phase of Stage 1 is protracted
D. The duration of labor is normal

Answer: (C) The active phase of Stage 1 is protracted
The active phase of Stage I starts from 4cm cervical dilatation and is expected that the uterus will dilate by 1cm every hour. Since the time lapsed is already 2 hours, the dilatation is expected to be already 8 cm. Hence, the active phase is protracted.

58. Which of the following techniques during labor and delivery can lead to uterine inversion?
A. Fundal pressure applied to assist the mother in bearing down during delivery of the fetal head
B. Strongly tugging on the umbilical cord to deliver the placenta and hasten placental separation
C. Massaging the fundus to encourage the uterus to contract
D. Applying light traction when delivering the placenta that has already detached from the uterine wall

Answer: (B) Strongly tugging on the umbilical cord to deliver the placenta and hasten placental separation
When the placenta is still attached to the uterine wall, tugging on the cord while the uterus is relaxed can lead to inversion of the uterus. Light tugging on the cord when placenta has detached is alright in order to help deliver the placenta that is already detached.

59. The fetal heart rate is checked following rupture of the bag of waters in order to:
A. Check if the fetus is suffering from head compression
B. Determine if cord compression followed the rupture
C. Determine if there is utero-placental insufficiency
D. Check if fetal presenting part has adequately descended following the rupture

Answer: (B) Determine if cord compression followed the rupture
After the rupture of the bag of waters, the cord may also go with the water because of the pressure of the rupture and flow. If the cord goes out of the cervical opening, before the head is delivered (cephalic presentation), the head can compress on the cord causing fetal distress. Fetal distress can be detected through the fetal heart tone. Thus, it is essential do check the FHB right after rupture of bag to ensure that the cord is not being compressed by the fetal head.

60. Upon assessment, the nurse got the following findings: 2 perineal pads highly saturated with blood within 2 hours post partum, PR= 80 bpm, fundus soft and boundaries not well defined. The appropriate nursing diagnosis is:
A. Normal blood loss
B. Blood volume deficiency
C. Inadequate tissue perfusion related to hemorrhage
D. Hemorrhage secondary to uterine atony

Answer: (D) Hemorrhage secondary to uterine atony
All the signs in the stem of the question are signs of hemorrhage. If the fundus is soft and boundaries not well defined, the cause of the hemorrhage could be uterine atony.

61. The following are signs and symptoms of fetal distress EXCEPT:
A. Fetal heart rate (FHR) decreased during a contraction and persists even after the uterine contraction ends
B. The FHR is less than 120 bpm or over 160 bpm
C. The pre-contraction FHR is 130 bpm, FHR during contraction is 118 bpm and FHR after uterine contraction is 126 bpm
D. FHR is 160 bpm, weak and irregular

Answer: (C) The pre-contraction FHR is 130 bpm, FHR during contraction is 118 bpm and FHR after uterine contraction is 126 bpm
The normal range of FHR is 120-160 bpm, strong and regular. During a contraction, the FHR usually goes down but must return to its pre-contraction rate after the contraction ends.

62. If the labor period lasts only for 3 hours, the nurse should suspect that the following conditions may occur:
1.Laceration of cervix
2.Laceration of perineum
3.Cranial hematoma in the fetus
4.Fetal anoxia

A. 1 & 2
B. 2 & 4
C. 2,3,4
D. 1,2,3,4

Answer: (D) 1,2,3,4
all the above conditions can occur following a precipitate labor and delivery of the fetus because there was little time for the baby to adapt to the passageway. If the presentation is cephalic, the fetal head serves as the main part of the fetus that pushes through the birth canal which can lead to cranial hematoma, and possible compression of cord may occur which can lead to less blood and oxygen to the fetus (hypoxia). Likewise the maternal passageway (cervix, vaginal canal and perineum) did not have enough time to stretch which can lead to laceration.

63. The primary power involved in labor and delivery is
A. Bearing down ability of mother
B. Cervical effacement and dilatation
C. Uterine contraction
D. Valsalva technique

Answer: (C) Uterine contraction
Uterine contraction is the primary force that will expel the fetus out through the birth canal Maternal bearing down is considered the secondary power/force that will help push the fetus out.

64. The proper technique to monitor the intensity of a uterine contraction is
A. Place the palm of the hands on the abdomen and time the contraction
B. Place the finger tips lightly on the suprapubic area and time the contraction
C. Put the tip of the fingers lightly on the fundal area and try to indent the abdominal wall at the height of the contraction
D. Put the palm of the hands on the fundal area and feel the contraction at the fundal area

Answer: (C) Put the tip of the fingers lightly on the fundal area and try to indent the abdominal wall at the height of the contraction
In monitoring the intensity of the contraction the best place is to place the fingertips at the fundal area. The fundus is the contractile part of the uterus and the fingertips are more sensitive than the palm of the hand.

65. To monitor the frequency of the uterine contraction during labor, the right technique is to time the contraction
A. From the beginning of one contraction to the end of the same contraction
B. From the beginning of one contraction to the beginning of the next contraction
C. From the end of one contraction to the beginning of the next contraction
D. From the deceleration of one contraction to the acme of the next contraction

Answer: (B) From the beginning of one contraction to the beginning of the next contraction
Frequency of the uterine contraction is defined as from the beginning of one contraction to the beginning of another contraction.

66. The peak point of a uterine contraction is called the
A. Acceleration
B. Acme
C. Deceleration
D. Axiom

Answer: (B) Acme
Acme is the technical term for the highest point of intensity of a uterine contraction.

67. When determining the duration of a uterine contraction the right technique is to time it from
A. The beginning of one contraction to the end of the same contraction
B. The end of one contraction to the beginning of another contraction
C. The acme point of one contraction to the acme point of another contraction
D. The beginning of one contraction to the end of another contraction

Answer: (A) The beginning of one contraction to the end of the same contraction
Duration of a uterine contraction refers to one contraction. Thus it is correctly measure from the beginning of one contraction to the end of the same contraction and not of another contraction.

68. When the bag of waters ruptures, the nurse should check the characteristic of the amniotic fluid. The normal color of amniotic fluid is
A. Clear as water
B. Bluish
C. Greenish
D. Yellowish

Answer: (A) Clear as water
The normal color of amniotic fluid is clear like water. If it is yellowish, there is probably Rh incompatibility. If the color is greenish, it is probably meconium stained.

69. When the bag of waters ruptures spontaneously, the nurse should inspect the vaginal introitus for possible cord prolapse. If there is part of the cord that has prolapsed into the vaginal opening the correct nursing intervention is:
A. Push back the prolapse cord into the vaginal canal
B. Place the mother on semifowler’s position to improve circulation
C. Cover the prolapse cord with sterile gauze wet with sterile NSS and place the woman on trendellenberg position
D. Push back the cord into the vagina and place the woman on sims position

Answer: (C) Cover the prolapse cord with sterile gauze wet with sterile NSS and place the woman on trendellenberg position
The correct action of the nurse is to cover the cord with sterile gauze wet with sterile NSS. Observe strict asepsis in the care of the cord to prevent infection. The cord has to be kept moist to prevent it from drying. Don’t attempt to put back the cord into the vagina but relieve pressure on the cord by positioning the mother either on trendellenberg or sims position

70. The fetal heart beat should be monitored every 15 minutes during the 2nd stage of labor. The characteristic of a normal fetal heart rate is
A. The heart rate will decelerate during a contraction and then go back to its pre-contraction rate after the contraction
B. The heart rate will accelerate during a contraction and remain slightly above the pre-contraction rate at the end of the contraction
C. The rate should not be affected by the uterine contraction.
D. The heart rate will decelerate at the middle of a contraction and remain so for about a minute after the contraction

Answer: (A) The heart rate will decelerate during a contraction and then go back to its pre-contraction rate after the contraction
The normal fetal heart rate will decelerate (go down) slightly during a contraction because of the compression on the fetal head. However, the heart rate should go back to the pre-contraction rate as soon as the contraction is over since the compression on the head has also ended.

71. The mechanisms involved in fetal delivery is
A. Descent, extension, flexion, external rotation
B. Descent, flexion, internal rotation, extension, external rotation
C. Flexion, internal rotation, external rotation, extension
D. Internal rotation, extension, external rotation, flexion

Answer: (B) Descent, flexion, internal rotation, extension, external rotation
The mechanism of fetal delivery begins with descent into the pelvic inlet which may occur several days before true labor sets in the primigravida. Flexion, internal rotation and extension are mechanisms that the fetus must perform as it accommodates through the passageway/birth canal. Eternal rotation is done after the head is delivered so that the shoulders will be easily delivered through the vaginal introitus.

72. The first thing that a nurse must ensure when the baby’s head comes out is
A. The cord is intact
B. No part of the cord is encircling the baby’s neck
C. The cord is still attached to the placenta
D. The cord is still pulsating

Answer: (B) No part of the cord is encircling the baby’s neck
The nurse should check right away for possible cord coil around the neck because if it is present, the baby can be strangulated by it and the fetal head will have difficulty being delivered.

73. To ensure that the baby will breath as soon as the head is delivered, the nurse’s priority action is to
A. Suction the nose and mouth to remove mucous secretions
B. Slap the baby’s buttocks to make the baby cry
C. Clamp the cord about 6 inches from the base
D. Check the baby’s color to make sure it is not cyanotic

Answer: (A) Suction the nose and mouth to remove mucous secretions
Suctioning the nose and mouth of the fetus as soon as the head is delivered will remove any obstruction that maybe present allowing for better breathing. Also, if mucus is in the nose and mouth, aspiration of the mucus is possible which can lead to aspiration pneumonia. (Remember that only the baby’s head has come out as given in the situation.)

74. When doing perineal care in preparation for delivery, the nurse should observe the following EXCEPT
A. Use up-down technique with one stroke
B. Clean from the mons veneris to the anus
C. Use mild soap and warm water
D. Paint the inner thighs going towards the perineal area

Answer: (D) Paint the inner thighs going towards the perineal area
Painting of the perineal area in preparation for delivery of the baby must always be done but the stroke should be from the perineum going outwards to the thighs. The perineal area is the one being prepared for the delivery and must be kept clean

75. What are the important considerations that the nurse must remember after the placenta is delivered?
1.Check if the placenta is complete including the membranes
2.Check if the cord is long enough for the baby
3.Check if the umbilical cord has 3 blood vessels
4.Check if the cord has a meaty portion and a shiny portion

A. 1 and 3
B. 2 and 4
C. 1, 3, and 4
D. 2 and 3

Answer: (A) 1 and 3
The nurse after delivering the placenta must ensure that all the cotyledons and the membranes of the placenta are complete. Also, the nurse must check if the umbilical cord is normal which means it contains the 3 blood vessels, 2 veins and 1 artery.

76. The following are correct statements about false labor EXCEPT
A. The pain is irregular in intensity and frequency.
B. The duration of contraction progressively lengthens over time
C. There is no vaginal bloody discharge
D. The cervix is still closed.

Answer: (B) The duration of contraction progressively lengthens over time
In false labor, the contractions remain to be irregular in intensity and duration while in true labor, the contractions become stronger, longer and more frequent.

77. The passageway in labor and deliver of the fetus include the following EXCEPT
A. Distensibility of lower uterine segment
B. Cervical dilatation and effacement
C. Distensibility of vaginal canal and introitus
D. Flexibility of the pelvis

Answer: (D) Flexibility of the pelvis
The pelvis is a bony structure that is part of the passageway but is not flexible. The lower uterine segment including the cervix as well as the vaginal canal and introitus are all part of the passageway in the delivery of the fetus.

78. The normal umbilical cord is composed of:
A. 2 arteries and 1 vein
B. 2 veins and 1 artery
C. 2 arteries and 2 veins
D. none of the above

Answer: (A) 2 arteries and 1 vein
the umbilical cord is composed of 2 arteries and 1 vein.

79. At what stage of labor and delivery does a primigravida differ mainly from a multigravida?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4

Answer: (A) Stage 1
In stage 1 during a normal vaginal delivery of a vertex presentation, the multigravida may have about 8 hours labor while the primigravida may have up to 12 hours labor.

80. The second stage of labor begins with ___ and ends with __?
A. Begins with full dilatation of cervix and ends with delivery of placenta
B. Begins with true labor pains and ends with delivery of baby
C. Begins with complete dilatation and effacement of cervix and ends with delivery of baby
D. Begins with passage of show and ends with full dilatation and effacement of cervix

Answer: (C) Begins with complete dilatation and effacement of cervix and ends with delivery of baby
Stage 2 of labor and delivery process begins with full dilatation of the cervix and ends with the delivery of baby. Stage 1 begins with true labor pains and ends with full dilatation and effacement of the cervix.

81. The following are signs that the placenta has detached EXCEPT:
A. Lengthening of the cord
B. Uterus becomes more globular
C. Sudden gush of blood
D. Mother feels like bearing down

Answer: (D) Mother feels like bearing down
Placental detachment does not require the mother to bear down. A normal placenta will detach by itself without any effort from the mother.

82. When the shiny portion of the placenta comes out first, this is called the ___ mechanism.
A. Schultze
B. Ritgens
C. Duncan
D. Marmets

Answer: (A) Schultze
There are 2 mechanisms possible during the delivery of the placenta. If the shiny portion comes out first, it is called the Schultze mechanism; while if the meaty portion comes out first, it is called the Duncan mechanism.

83. When the baby’s head is out, the immediate action of the nurse is
A. Cut the umbilical cord
B. Wipe the baby’s face and suction mouth first
C. Check if there is cord coiled around the neck
D. Deliver the anterior shoulder

Answer: (C) Check if there is cord coiled around the neck
The nurse should check if there is a cord coil because the baby will not be delivered safely if the cord is coiled around its neck. Wiping of the face should be done seconds after you have ensured that there is no cord coil but suctioning of the nose should be done after the mouth because the baby is a “nasal obligate” breather. If the nose is suctioned first before the mouth, the mucus plugging the mouth can be aspirated by the baby.

84. When delivering the baby’s head the nurse supports the mother’s perineum to prevent tear. This technique is called
A. Marmet’s technique
B. Ritgen’s technique
C. Duncan maneuver
D. Schultze maneuver

Answer: (B) Ritgen’s technique
Ritgen’s technique is done to prevent perineal tear. This is done by the nurse by support the perineum with a sterile towel and pushing the perineum downard with one hand while the other hand is supporting the baby’s head as it goes out of the vaginal opening.

85. The basic delivery set for normal vaginal delivery includes the following instruments/articles EXCEPT:
A. 2 clamps
B. Pair of scissors
C. Kidney basin
D. Retractor

Answer: (D) Retractor
For normal vaginal delivery, the nurse needs only the instruments for cutting the umbilical cord such as: 2 clamps (straight or curve) and a pair of scissors as well as the kidney basin to receive the placenta. The retractor is not part of the basic set. In the hospital setting, needle holder and tissue forceps are added especially if the woman delivering the baby is a primigravida wherein episiotomy is generally done.

86. As soon as the placenta is delivered, the nurse must do which of the following actions?
A. Inspect the placenta for completeness including the membranes
B. Place the placenta in a receptacle for disposal
C. Label the placenta properly
D. Leave the placenta in the kidney basin for the nursing aide to dispose properly

Answer: (A) Inspect the placenta for completeness including the membranes
The placenta must be inspected for completeness to include the membranes because an incomplete placenta could mean that there is retention of placental fragments which can lead to uterine atony. If the uterus does not contract adequately, hemorrhage can occur.

87. In vaginal delivery done in the hospital setting, the doctor routinely orders an oxytocin to be given to the mother parenterally. The oxytocin is usually given after the placenta has been delivered and not before because:
A. Oxytocin will prevent bleeding
B. Oxytocin can make the cervix close and thus trap the placenta inside
C. Oxytocin will facilitate placental delivery
D. Giving oxytocin will ensure complete delivery of the placenta

Answer: (B) Oxytocin can make the cervix close and thus trap the placenta inside
The action of oxytocin is to make the uterus contract as well make the cervix close. If it is given prior to placental delivery, the placenta will be trapped inside because the action of the drug is almost immediate if given parentally.

88. In a gravido-cardiac mother, the first 2 hours postpartum (4th stage of labor and delivery) particularly in a cesarean section is a critical period because at this stage
A. There is a fluid shift from the placental circulation to the maternal circulation which can overload the compromised heart.
B. The maternal heart is already weak and the mother can die
C. The delivery process is strenuous to the mother
D. The mother is tired and weak which can distress the heart

Answer: (A) There is a fluid shift from the placental circulation to the maternal circulation which can overload the compromised heart.
During the pregnancy, there is an increase in maternal blood volume to accommodate the need of the fetus. When the baby and placenta have been delivered, there is a fluid shift back to the maternal circulation as part of physiologic adaptation during the postpartum period. In cesarean section, the fluid shift occurs faster because the placenta is taken out right after the baby is delivered giving it less time for the fluid shift to gradually occur.

89. The drug usually given parentally to enhance uterine contraction is:
A. Terbutalline
B. Pitocin
C. Magnesium sulfate
D. Lidocaine

Answer: (B) Pitocin
The common oxytocin given to enhance uterine contraction is pitocin. This is also the drug given to induce labor.

90. The partograph is a tool used to monitor labor. The maternal parameters measured/monitored are the following EXCEPT:
A. Vital signs
B. Fluid intake and output
C. Uterine contraction
D. Cervical dilatation

Answer: (B) Fluid intake and output
Partograph is a monitoring tool designed by the World Health Organization for use by health workers when attending to mothers in labor especially the high risk ones. For maternal parameters all of the above is placed in the partograph except the fluid intake since this is placed in a separate monitoring sheet.

91. The following are natural childbirth procedures EXCEPT:
A. Lamaze method
B. Dick-Read method
C. Ritgen’s maneuver
D. Psychoprophylactic method

Answer: (C) Ritgen’s maneuver
Ritgen’s method is used to prevent perineal tear/laceration during the delivery of the fetal head. Lamaze method is also known as psychoprophylactic method and Dick-Read method are commonly known natural childbirth procedures which advocate the use of non-pharmacologic measures to relieve labor pain.

92. The following are common causes of dysfunctional labor. Which of these can a nurse, on her own manage?
A. Pelvic bone contraction
B. Full bladder
C. Extension rather than flexion of the head
D. Cervical rigidity

Answer: (B) Full bladder
Full bladder can impede the descent of the fetal head. The nurse can readily manage this problem by doing a simple catheterization of the mother.

93. At what stage of labor is the mother is advised to bear down?
A. When the mother feels the pressure at the rectal area
B. During a uterine contraction
C. In between uterine contraction to prevent uterine rupture
D. Anytime the mother feels like bearing down

Answer: (B) During a uterine contraction
The primary power of labor and delivery is the uterine contraction. This should be augmented by the mother’s bearing down during a contraction.

94. The normal dilatation of the cervix during the first stage of labor in a nullipara is
A. 1.2 cm./hr
B. 1.5 cm./hr.
C. 1.8 cm./hr
D. 2.0 cm./hr

Answer: (A) 1.2 cm./hr
For nullipara the normal cervical dilatation should be 1.2 cm/hr. If it is less than that, it is considered a protracted active phase of the first stage. For multipara, the normal cervical dilatation is 1.5 cm/hr.

95. When the fetal head is at the level of the ischial spine, it is said that the station of the head is
A. Station –1
B. Station “0”
C. Station +1
D. Station +2

Answer: (B) Station “0”
Station is defined as the relationship of the fetal head and the level of the ischial spine. At the level of the ischial spine, the station is “0”. Above the ischial spine it is considered (-) station and below the ischial spine it is (+) station.

96. During an internal examination, the nurse palpated the posterior fontanel to be at the left side of the mother at the upper quadrant. The interpretation is that the position of the fetus is:
A. LOA
B. ROP
C. LOP
D. ROA

Answer: (A) LOA
The landmark used in determine fetal position is the posterior fontanel because this is the nearest to the occiput. So if the nurse palpated the occiput (O) at the left (L) side of the mother and at the upper/anterior (A) quadrant then the fetal position is LOA.

97. The following are types of breech presentation EXCEPT:
A. Footling
B. Frank
C. Complete
D. Incomplete

Answer: (D) Incomplete
Breech presentation means the buttocks of the fetus is the presenting part. If it is only the foot/feet, it is considered footling. If only the buttocks, it is frank breech. If both the feet and the buttocks are presenting it is called complete breech.

98. When the nurse palpates the suprapubic area of the mother and found that the presenting part is still movable, the right term for this observation that the fetus is
A. Engaged
B. Descended
C. Floating
D. Internal Rotation

Answer: (C) Floating
The term floating means the fetal presenting part has not entered/descended into the pelvic inlet. If the fetal head has entered the pelvic inlet, it is said to be engaged.

99. The placenta should be delivered normally within ___ minutes after the delivery of the baby.
A. 5 minutes
B. 30 minutes
C. 45 minutes
D. 60 minutes

Answer: (B) 30 minutes
The placenta is delivered within 30 minutes from the delivery of the baby. If it takes longer, probably the placenta is abnormally adherent and there is a need to refer already to the obstetrician.

100. When shaving a woman in preparation for cesarean section, the area to be shaved should be from ___ to ___
A. Under breast to mid-thigh including the pubic area
B. The umbilicus to the mid-thigh
C. Xyphoid process to the pubic area
D. Above the umbilicus to the pubic area

Answer: (A) Under breast to mid-thigh including the pubic area
Shaving is done to prevent infection and the area usually shaved should sufficiently cover the area for surgery, cesarean section. The pubic hair is definitely to be included in the shaving

Maternal and Child Health Nursing Part I

noreply@blogger.com (GINO) — Fri, 25 Sep 2009 08:49:04 PDT

1. You performed the leopold’s maneuver and found the following: breech presentation, fetal back at the right side of the mother. Based on these findings, you can hear the fetal heart beat (PMI) BEST in which location?
A. Left lower quadrant
B. Right lower quadrant
C. Left upper quadrant
D. Right upper quadrant

Answer: (B) Right lower quadrant
Right lower quadrant. The landmark to look for when looking for PMI is the location of the fetal back in relation to the right or left side of the mother and the presentation, whether cephalic or breech. The best site is the fetal back nearest the head.

2. In Leopold’s maneuver step #1, you palpated a soft broad mass that moves with the rest of the mass. The correct interpretation of this finding is:
A. The mass palpated at the fundal part is the head part.
B. The presentation is breech.
C. The mass palpated is the back
D. The mass palpated is the buttocks.

Answer: (D) The mass palpated is the buttocks.
The palpated mass is the fetal buttocks since it is broad and soft and moves with the rest of the mass.

3. In Leopold’s maneuver step # 3 you palpated a hard round movable mass at the supra pubic area. The correct interpretation is that the mass palpated is:
A. The buttocks because the presentation is breech.
B. The mass palpated is the head.
C. The mass is the fetal back.
D. The mass palpated is the fetal small part

Answer: (B) The mass palpated is the head.
When the mass palpated is hard round and movable, it is the fetal head.

4. The hormone responsible for a positive pregnancy test is:
A. Estrogen
B. Progesterone
C. Human Chorionic Gonadotropin
D. Follicle Stimulating hormone

Answer: (C) Human Chorionic Gonadotropin
Human chorionic gonadotropin (HCG) is the hormone secreted by the chorionic villi which is the precursor of the placenta. In the early stage of pregnancy, while the placenta is not yet fully developed, the major hormone that sustains the pregnancy is HCG.

5. The hormone responsible for the maturation of the graafian follicle is:
A. Follicle stimulating hormone
B. Progesterone
C. Estrogen
D. Luteinizing hormone

Answer: (A) Follicle stimulating hormone
The hormone that stimulates the maturation if the of the graafian follicle is the Follicle Stimulating Hormone which is released by the anterior pituitary gland.

7. The most common normal position of the fetus in utero is:
A. Transverse position
B. Vertical position
C. Oblique position
D. None of the above

Answer: (B) Vertical position
Vertical position means the fetal spine is parallel to the maternal spine thus making it easy for the fetus to go out the birth canal. If transverse or oblique, the fetus can’t be delivered normally per vagina.

8. In the later part of the 3rd trimester, the mother may experience shortness of breath. This complaint maybe explained as:
A. A normal occurrence in pregnancy because the fetus is using more oxygen
B. The fundus of the uterus is high pushing the diaphragm upwards
C. The woman is having allergic reaction to the pregnancy and its hormones
D. The woman maybe experiencing complication of pregnancy

Answer: (B) The fundus of the uterus is high pushing the diaphragm upwards
From the 32nd week of the pregnancy, the fundus of the enlarged uterus is pushing the respiratory diaphragm upwards. Thus, the lungs have reduced space for expansion consequently reducing the oxygen supply.

9. Which of the following findings in a woman would be consistent with a pregnancy of two months duration?
A. Weight gain of 6-10 lbs. and presence of striae gravidarum
B. Fullness of the breast and urinary frequency
C. Braxton Hicks contractions and quickening
D. Increased respiratory rate and ballottement

Answer: (B) Fullness of the breast and urinary frequency
Fullness of the breast is due to the increased amount of progesterone in pregnancy. The urinary frequency is caused by the compression of the urinary bladder by the gravid uterus which is still within the pelvic cavity during the first trimester.

10. Which of the following is a positive sign of pregnancy?
A. Fetal movement felt by mother
B. Enlargement of the uterus
C. (+) pregnancy test
D. (+) ultrasound

Answer: (D) (+) ultrasound
A positive ultrasound will definitely confirm that a woman is pregnant since the fetus in utero is directly visualized.

11. What event occurring in the second trimester helps the expectant mother to accept the pregnancy?
A. Lightening
B. Ballotment
C. Pseudocyesis
D. Quickening

Answer: (D) Quickening
Quickening is the first fetal movement felt by the mother makes the woman realize that she is truly pregnant. In early pregnancy, the fetus is moving but too weak to be felt by the mother. In the 18th-20th week of gestation, the fetal movements become stronger thus the mother already feels the movements.

12. Shoes with low, broad heels, plus a good posture will prevent which prenatal discomfort?
A. Backache
B. Vertigo
C. Leg cramps
D. Nausea

Answer: (A) Backache
Backache usually occurs in the lumbar area and becomes more problematic as the uterus enlarges. The pregnant woman in her third trimester usually assumes a lordotic posture to maintain balance causing an exaggeration of the lumbar curvature. Low broad heels provide the pregnant woman with a good support.

13. When a pregnant woman experiences leg cramps, the correct nursing intervention to relieve the muscle cramps is:
A. Allow the woman to exercise
B. Let the woman walk for a while
C. Let the woman lie down and dorsiflex the foot towards the knees
D. Ask the woman to raise her legs

Answer: (C) Let the woman lie down and dorsiflex the foot towards the knees
Leg cramps is caused by the contraction of the gastrocnimeus (leg muscle). Thus, the intervention is to stretch the muscle by dosiflexing the foot of the affected leg towards the knee.

14. From the 33rd week of gestation till full term, a healthy mother should have prenatal check up every:
A. week
B. 2 weeks
C. 3 weeks
D. 4 weeks

Answer: (A) week
In the 9th month of pregnancy the mother needs to have a weekly visit to the prenatal clinic to monitor fetal condition and to ensure that she is adequately prepared for the impending labor and delivery.

15. The expected weight gain in a normal pregnancy during the 3rd trimester is
A. 1 pound a week
B. 2 pounds a week
C. 10 lbs a month
D. 10 lbs total weight gain in the 3rd trimester

Answer: (A) 1 pound a week
During the 3rd trimester the fetus is gaining more subcutaneous fat and is growing fast in preparation for extra uterine life. Thus, one pound a week is expected.

16. In the Batholonew’s rule of 4, when the level of the fundus is midway between the umbilicus and xyphoid process the estimated age of gestation (AOG) is:
A. 5th month
B. 6th month
C. 7th month
D. 8th month

Answer: (C) 7th month
In Bartholomew’s Rule of 4, the landmarks used are the symphysis pubis, umbilicus and xyphoid process. At the level of the umbilicus, the AOG is approximately 5 months and at the level of the xyphoid process 9 months. Thus, midway between these two landmarks would be considered as 7 months AOG.

17. The following are ways of determining expected date of delivery (EDD) when the LMP is unknown EXCEPT:
A. Naegele’s rule
B. Quickening
C. Mc Donald’s rule
D. Batholomew’s rule of 4

Answer: (A) Naegele’s rule
Naegele’s Rule is determined based on the last menstrual period of the woman.

18. If the LMP is Jan. 30, the expected date of delivery (EDD) is
A. Oct. 7
B. Oct. 24
C. Nov. 7
D. Nov. 8

Answer: (C) Nov. 7
Based on the last menstrual period, the expected date of delivery is Nov. 7. The formula for the Naegele’s Rule is subtract 3 from the month and add 7 to the day.

19. Kegel’s exercise is done in pregnancy in order to:
A. Strengthen perineal muscles
B. Relieve backache
C. Strengthen abdominal muscles
D. Prevent leg varicosities and edema

Answer: (A) Strengthen perineal muscles
Kegel’s exercise is done by contracting and relaxing the muscles surrounding the vagina and anus in order to strengthen the perineal muscles

20. Pelvic rocking is an appropriate exercise in pregnancy to relieve which discomfort?
A. Leg cramps
B. Urinary frequency
C. Orthostatic hypotension
D. Backache

Answer: (D) Backache
Backache is caused by the stretching of the muscles of the lower back because of the pregnancy. Pelvic rocking is good to relieve backache.

21. The main reason for an expected increased need for iron in pregnancy is:
A. The mother may have physiologic anemia due to the increased need for red blood cell mass as well as the fetal requires about 350-400 mg of iron to grow
B. The mother may suffer anemia because of poor appetite
C. The fetus has an increased need for RBC which the mother must supply
D. The mother may have a problem of digestion because of pica

Answer: (A) The mother may have physiologic anemia due to the increased need for red blood cell mass as well as the fetal requires about 350-400 mg of iron to grow
About 400 mgs of Iron is needed by the mother in order to produce more RBC mass to be able to provide the needed increase in blood supply for the fetus. Also, about 350-400 mgs of iron is need for the normal growth of the fetus. Thus, about 750-800 mgs iron supplementation is needed by the mother to meet this additional requirement.

22. The diet that is appropriate in normal pregnancy should be high in
A. Protein, minerals and vitamins
B. Carbohydrates and vitamins
C. Proteins, carbohydrates and fats
D. Fats and minerals

Answer: (A) Protein, minerals and vitamins
In normal pregnancy there is a higher demand for protein (body building foods), vitamins (esp. vitamin A, B, C, folic acid) and minerals (esp. iron, calcium, phosphorous, zinc, iodine, magnesium) because of the need of the growing fetus.

24. Which of the following signs will require a mother to seek immediate medical attention?
A. When the first fetal movement is felt
B. No fetal movement is felt on the 6th month
C. Mild uterine contraction
D. Slight dyspnea on the last month of gestation

Answer: (B) No fetal movement is felt on the 6th month
Fetal movement is usually felt by the mother during 4.5 – 5 months. If the pregnancy is already in its 6th month and no fetal movement is felt, the pregnancy is not normal either the fetus is already dead intra-uterine or it is an H-mole.

25. You want to perform a pelvic examination on one of your pregnant clients. You prepare your client for the procedure by:
A. Asking her to void
B. Taking her vital signs and recording the readings
C. Giving the client a perineal care
D. Doing a vaginal prep

Answer: (A) Asking her to void
A pelvic examination includes abdominal palpation. If the pregnant woman has a full bladder, the manipulation may cause discomfort and accidental urination because of the pressure applied during the abdominal palpation. Also, a full bladder can impede the accuracy of the examination because the bladder (which is located in front of the uterus) can block the uterus.

26. When preparing the mother who is on her 4th month of pregnancy for abdominal ultrasound, the nurse should instruct her to:
A. Observe NPO from midnight to avoid vomiting
B. Do perineal flushing properly before the procedure
C. Drink at least 2 liters of fluid 2 hours before the procedure and not void until the procedure is done
D. Void immediately before the procedure for better visualization

Answer: (C) Drink at least 2 liters of fluid 2 hours before the procedure and not void until the procedure is done
Drinking at least 2 liters of water 2 hours before the procedure will result to a distended bladder. A full bladder is needed when doing an abdominal ultrasound to serve as a “window” for the ultrasonic sound waves to pass through and allow visualization of the uterus (located behind the urinary bladder).

27. The nursing intervention to relieve “morning sickness” in a pregnant woman is by giving
A. Dry carbohydrate food like crackers
B. Low sodium diet
C. Intravenous infusion
D. Antacid

Answer: (A) Dry carbohydrate food like crackers
Morning sickness maybe caused by hypoglycemia early in the morning thus giving carbohydrate food will help.

28. The common normal site of nidation/implantation in the uterus is
A. Upper uterine portion
B. Mid-uterine area
C. Lower uterine segment
D. Lower cervical segment

Answer: (A) Upper uterine portion
The embryo’s normal nidation site is the upper portion of the uterus. If the implantation is in the lower segment, this is an abnormal condition called placenta previa.

29. Mrs. Santos is on her 5th pregnancy and has a history of abortion in the 4th pregnancy and the first pregnancy was a twin. She is considered to be
A. G 4 P 3
B. G 5 P 3
C. G 5 P 4
D. G 4 P 4

Answer: (B) G 5 P 3
Gravida refers to the total number of pregnancies including the current one. Para refers to the number of pregnancies that have reached viability. Thus, if the woman has had one abortion, she would be considered Para 3. Twin pregnancy is counted only as 1.

30. The following are skin changes in pregnancy EXCEPT:
A. Chloasma
B. Striae gravidarum
C. Linea negra
D. Chadwick's sign

Answer: (D) Chadwick's sign
Chadwick's sign is bluish discoloration of the vaginal mucosa as a result of the increased vascularization in the area.

31. Which of the following statements is TRUE of conception?
A. Within 2-4 hours after intercourse conception is possible in a fertile woman
B. Generally, fertilization is possible 4 days after ovulation
C. Conception is possible during menstruation in a long menstrual cycle
D. To avoid conception, intercourse must be avoided 5 days before and 3 days after menstruation

Answer: (A) Within 2-4 hours after intercourse conception is possible in a fertile woman
The sperms when deposited near the cervical os will be able to reach the fallopian tubes within 4 hours. If the woman has just ovulated (within 24hours after the rupture of the graafian follicle), fertilization is possible.

32. Which of the following are the functions of amniotic fluid? 1.Cushions the fetus from abdominal trauma 2.Serves as the fluid for the fetus 3.Maintains the internal temperature 4.Facilitates fetal movement
A. 1 & 3
B. 1, 3, 4
C. 1, 2, 3
D. All of the above

Answer: (D) All of the above
All the four functions enumerated are true of amniotic fluid.

33. You are performing abdominal exam on a 9th month pregnant woman. While lying supine, she felt breathless, had pallor, tachycardia, and cold clammy skin. The correct assessment of the woman’s condition is that she is
A. Experiencing the beginning of labor
B. Having supine hypotension
C. Having sudden elevation of BP
D. Going into shock

Answer: (B) Having supine hypotension
Supine hypotension is characterized by breathlessness, pallor, tachycardia and cold clammy skin. This is due to the compression of the abdominal aorta by the gravid uterus when the woman is on a supine position.

34. Smoking is contraindicated in pregnancy because
A. Nicotine causes vasodilation of the mother’s blood vessels
B. Carbon monoxide binds with the hemoglobin of the mother reducing available hemoglobin for the fetus
C. The smoke will make the fetus and the mother feel dizzy
D. Nicotine will cause vasoconstriction of the fetal blood vessels

Answer: (B) Carbon monoxide binds with the hemoglobin of the mother reducing available hemoglobin for the fetus
Carbon monoxide is one of the substances found in cigarette smoke. This substance diminishes the ability of the hemoglobin to bind with oxygen thus reducing the amount of oxygenated blood reaching the fetus.

35. Which of the following is the most likely effect on the fetus if the woman is severely anemic during pregnancy?
A. Large for gestational age (LGA) fetus
B. Hemorrhage
C. Small for gestational age (SGA) baby
D. Erythroblastosis fetalis

Answer: (C) Small for gestational age (SGA) baby
Anemia is a condition where there is a reduced amount of hemoglobin. Hemoglobin is needed to supply the fetus with adequate oxygen. Oxygen is needed for normal growth and development of the fetus.

36. Which of the following signs and symptoms will most likely make the nurse suspect that the patient is having hydatidiform mole?
A. Slight bleeding
B. Passage of clear vesicular mass per vagina
C. Absence of fetal heart beat
D. Enlargement of the uterus

Answer: (B) Passage of clear vesicular mass per vagina
Hydatidiform mole (H-mole) is characterized by the degeneration of the chorionic villi wherein the villi becomes vesicle-like. These vesicle-like substances when expelled per vagina and is a definite sign that the woman has H-mole.

37. Upon assessment the nurse found the following: fundus at 2 fingerbreadths above the umbilicus, last menstrual period (LMP) 5 months ago, fetal heart beat (FHB) not appreciated. Which of the following is the most possible diagnosis of this condition?
A. Hydatidiform mole
B. Missed abortion
C. Pelvic inflammatory disease
D. Ectopic pregnancy

Answer: (A) Hydatidiform mole
Hydatidiform mole begins as a pregnancy but early in the development of the embryo degeneration occurs. The proliferation of the vesicle-like substances is rapid causing the uterus to enlarge bigger than the expected size based on ages of gestation (AOG). In the situation given, the pregnancy is only 5 months but the size of the uterus is already above the umbilicus which is compatible with 7 months AOG. Also, no fetal heart beat is appreciated because the pregnancy degenerated thus there is no appreciable fetal heart beat.

38. When a pregnant woman goes into a convulsive seizure, the MOST immediate action of the nurse to ensure safety of the patient is:
A. Apply restraint so that the patient will not fall out of bed
B. Put a mouth gag so that the patient will not bite her tongue and the tongue will not fall back
C. Position the mother on her side to allow the secretions to drain from her mouth and prevent aspiration
D. Check if the woman is also having a precipitate labor

Answer: (C) Position the mother on her side to allow the secretions to drain from her mouth and prevent aspiration
Positioning the mother on her side will allow the secretions that may accumulate in her mouth to drain by gravity thus preventing aspiration pneumonia. Putting a mouth gag is not safe since during the convulsive seizure the jaw will immediately lock. The mother may go into labor also during the seizure but the immediate concern of the nurse is the safety of the baby. After the seizure, check the perineum for signs of precipitate labor.

39. A gravido-cardiac mother is advised to observe bedrest primarily to
A. Allow the fetus to achieve normal intrauterine growth
B. Minimize oxygen consumption which can aggravate the condition of the compromised heart of the mother
C. Prevent perinatal infection
D. Reduce incidence of premature labor

Answer: (B) Minimize oxygen consumption which can aggravate the condition of the compromised heart of the mother
Activity of the mother will require more oxygen consumption. Since the heart of a gravido-cardiac is compromised, there is a need to put a mother on bedrest to reduce the need for oxygen.

40. A pregnant mother is admitted to the hospital with the chief complaint of profuse vaginal bleeding, AOG 36 wks, not in labor. The nurse must always consider which of the following precautions:
A. The internal exam is done only at the delivery under strict asepsis with a double set-up
B. The preferred manner of delivering the baby is vaginal
C. An emergency delivery set for vaginal delivery must be made ready before examining the patient
D. Internal exam must be done following routine procedure

Answer: (A) The internal exam is done only at the delivery under strict asepsis with a double set-up
Painless vaginal bleeding during the third trimester maybe a sign of placenta praevia. If internal examination is done in this kind of condition, this can lead to even more bleeding and may require immediate delivery of the baby by cesarean section. If the bleeding is due to soft tissue injury in the birth canal, immediate vaginal delivery may still be possible so the set up for vaginal delivery will be used. A double set-up means there is a set up for cesarean section and a set-up for vaginal delivery to accommodate immediately the necessary type of delivery needed. In both cases, strict asepsis must be observed.

41. Which of the following signs will distinguish threatened abortion from imminent abortion?
A. Severity of bleeding
B. Dilation of the cervix
C. Nature and location of pain
D. Presence of uterine contraction

Answer: (B) Dilation of the cervix
In imminent abortion, the pregnancy will definitely be terminated because the cervix is already open unlike in threatened abortion where the cervix is still closed.

42. The nursing measure to relieve fetal distress due to maternal supine hypotension is:
A. Place the mother on semi-fowler’s position
B. Put the mother on left side lying position
C. Place mother on a knee chest position
D. Any of the above

Answer: (B) Put the mother on left side lying position
When a pregnant woman lies on supine position, the weight of the gravid uterus would be compressing on the vena cava against the vertebrae obstructing blood flow from the lower extremities. This causes a decrease in blood return to the heart and consequently immediate decreased cardiac output and hypotension. Hence, putting the mother on side lying will relieve the pressure exerted by the gravid uterus on the vena cava.

43. To prevent preterm labor from progressing, drugs are usually prescribed to halt the labor. The drugs commonly given are:
A. Magnesium sulfate and terbutaline
B. Prostaglandin and oxytocin
C. Progesterone and estrogen
D. Dexamethasone and prostaglandin

Answer: (A) Magnesium sulfate and terbutaline
Magnesium sulfate acts as a CNS depressant as well as a smooth muscle relaxant. Terbutaline is a drug that inhibits the uterine smooth muscles from contracting. On the other hand, oxytocin and prostaglandin stimulates contraction of smooth muscles.

44. In placenta praevia marginalis, the placenta is found at the:
A. Internal cervical os partly covering the opening
B. External cervical os slightly covering the opening
C. Lower segment of the uterus with the edges near the internal cervical os
D. Lower portion of the uterus completely covering the cervix

Answer: (C) Lower segment of the uterus with the edges near the internal cervical os
Placenta marginalis is a type of placenta previa wherein the placenta is implanted at the lower segment of the uterus thus the edges of the placenta are touching the internal cervical opening/os. The normal site of placental implantation is the upper portion of the uterus.

45. In which of the following conditions can the causative agent pass through the placenta and affect the fetus in utero?
A. Gonorrhea
B. Rubella
C. Candidiasis
D. moniliasis

Answer: (B) Rubella
Rubella is caused by a virus and viruses have low molecular weight thus can pass through the placental barrier. Gonorrhea, candidiasis and moniliasis are conditions that can affect the fetus as it passes through the vaginal canal during the delivery process.

46. Which of the following can lead to infertility in adult males?
A. German measles
B. Orchitis
C. Chicken pox
D. Rubella

Answer: (B) Orchitis
Orchitis is a complication that may accompany mumps in adult males. This condition is characterized by unilateral inflammation of one of the testes which can lead to atrophy of the affected testis. About 20-30% of males who gets mumps after puberty may develop this complication.

47. Papanicolaou smear is usually done to determine cancer of
A. Cervix
B. Ovaries
C. Fallopian tubes
D. Breast

Answer: (A) Cervix
Papanicolaou (Paps) smear is done to detect cervical cancer. It can’t detect cancer in ovaries and fallopian tubes because these organs are outside of the uterus and the abnormal cells from these organs will not be detected from a smear done on the cervix.

48. Which of the following causes of infertility in the female is primarily psychological in origin?
A. Vaginismus
B. Dyspareunia
C. Endometriosis
D. Impotence

Answer: (A) Vaginismus
Vaginismus is primarily psychological in origin. Endometriosis is a condition that is caused by organic abnormalities. Dyspareunia is usually caused by infection, endometriosis or hormonal changes in menopause although may sometimes be psychological in origin.

49. Before giving a repeat dose of magnesium sulfate to a pre-eclamptic patient, the nurse should assess the patient’s condition. Which of the following conditions will require the nurse to temporarily suspend a repeat dose of magnesium sulfate?
A. 100 cc. urine output in 4 hours
B. Knee jerk reflex is (+) 2
C. Serum magnesium level is 10mEg/L.
D. Respiratory rate of 16/min

Answer: (A) 100 cc. urine output in 4 hours
The minimum urine output expected for a repeat dose of MgSO4 is 30 cc/hr. If in 4 hours the urine output is only 100 cc this is low and can lead to poor excretion of Magnesium with a possible cumulative effect, which can be dangerous to the mother.

50. Which of the following is TRUE in Rh incompatibility?
A. The condition can occur if the mother is Rh(+) and the fetus is Rh(-)
B. Every pregnancy of an Rh(-) mother will result to erythroblastosis fetalis
C. On the first pregnancy of the Rh(-) mother, the fetus will not be affected
D. RhoGam is given only during the first pregnancy to prevent incompatibility

Answer: (C) On the first pregnancy of the Rh(-) mother, the fetus will not be affected
On the first pregnancy, the mother still has no contact with Rh(+) blood thus it has not antibodies against Rh(+). After the first pregnancy, even if terminated into an abortion, there is already the possibility of mixing of maternal and fetal blood so this can trigger the maternal blood to produce antibodies against Rh(+) blood. The fetus takes it’s blood type usually form the father.

Principles of Pre and Postoperative Care

noreply@blogger.com (GINO) — Mon, 14 Sep 2009 15:31:53 PDT

Admission for surgery can be planned or as an emergency. Planned surgery means that the patient has been waiting on a list, possibly for some time. The anticipated outcome of the surgery is expected to be good as the surgery is likely to relieve unpleasant or uncomfortable symptoms, or determine their cause. There will have been an opportunity for the patient to make psychological preparations and to begin to adjust to the probable outcome, and therefore he or she may be eager to get on with the process. Health care staff will have the opportunity to prepare the patient to be in the best condition for surgery, thus reducing potential problems. Emergency surgery does not allow the patient to make these preliminary adjustments, and the patient may be feeling so ill that they cannot anticipate what the outcome may be, so will have to adjust to the situation after surgery.

Whatever route patients follow for surgery, the principles for safe preparation and recovery are the same. Time is the major limitation, since patients who attend for planned day surgery have less opportunity to get to know the staff caring for them, and emergency admissions will not have had the opportunity to be in optimal health.

Pre-admission clinic

A visit to a pre-admission clinic about 10 to 14 days before an operation provides the opportunity to undertake a thorough pre-operative assessment prior to admission (Torrance and Serginson 1997). These clinics reduce unnecessary time in hospital waiting for surgery and allow familiarization with the forthcoming procedure so reducing anxiety and preparing for speedy recovery.

Torrance and Serginson (1997) summarize the aim of pre-admission clinics as being to:
● minimize cancellations and maximize the use of beds and theatre space
● improve admission and assessment procedures
● improve discharge planning
● offer full and thorough patient education prior to surgery.

The physical condition of the patient is assessed, and any outstanding investigations – such as a full blood count (FBC), electrocardiogram
(ECG), blood cross-matching or lung function tests, or the gathering of other essential medical and social information – are carried out. For an elderly patient or one with complex care needs, this provides the opportunity to assess the degree of support that they will require on discharge from hospital, and begin the process of discharge planning.

The proposed surgical procedure can be discussed and the patient is able to ask questions of the nursing and medical staff. Written information about the operation and expected plan of care may be given to the patient to take away and consider at leisure. This enables the patient to understand treatment options more fully and informed consent can be given.

Any specific preparation prior to surgery can be discussed with the patient such as:
● reducing cigarette intake
● planning weight loss
● stopping the contraceptive pill and taking alternative contraceptive precautions
● skin and hygiene preparation
● bowel preparation.

Performing Postural Drainage

noreply@blogger.com (GINO) — Mon, 14 Sep 2009 15:23:08 PDT

OVERVIEW
● To use the principles of gravity to assist in bronchial drainage whenever excessive fluid or mucus in the bronchi is not being removed by normal ciliary action and cough.
● There are 18 positions to facilitate drainage, each corresponding with one of the 18 segments of the lungs.
● The purpose of the various positions is to drain each segment toward the larger airways.
● This procedure is usually indicated in people with
• Excessive bronchial secretions who have difficulty clearing secretions, with sputum production greater than 25 to 30 mL per day.
• Evidence or suggestion of retained secretions in the presence of an artificial airway.
• Lobar atelectasis caused by or suspected of being caused by mucus plugging.
● Loosens airway secretions.
● Uses gravity to drain and remove excessive secretions.
● Decreases accumulation of secretions in unconscious or weakened patients.

PREPARATION
● Positions are determined by areas of involved lung, which are assessed by chest radiograph, percussion, palpation, and auscultation.
● Chosen position is maintained for 5 to 15 minutes, although variations can be made if patient has trouble assuming various positions.
● Usually done 2 to 4 times per day.
Special Considerations
• Aerosolized bronchodilators and hydration therapy are frequently administered before postural drainage.
• It is important to remember to perform this procedure 1 hour before meals or 1 to 3 hours after meals.
• Remember that the frequency and choice of positions depend on the location of retained secretions and patient tolerance to dependent positions.
• The patient with chest trauma, hemoptysis, heart disease, or head injury should not be placed into Trendelenburg’s position.

RELEVANT NURSING DIAGNOSES
● Impaired gas exchange related to excessive secretions

EQUIPMENT/SUPPLIES
Hospital bed or tilt board to place patient in Trendelenburg’s position (pillows, blocks, or books can also be used to help position patients)
Tissues
Container for sputum
Mouthwash and emesis basin

IMPLEMENTATION
➧Wash hands.
Reduces transmission of microorganisms.
➧ Organize equipment.
Enhances efficiency and patient safety.
➧ Explain procedure to patient and family.
Careful explanation reduces the patient’s and family’s anxiety and facilitates
cooperation.
➧ Administer bronchodilators, expectorants, or warm liquids if ordered.
Loosens and liquefies secretions and facilitates drainage.
➧ Encourage patient to void.
Prevents interruption of therapy.
➧ Loosen any tight clothing and auscultate breath sounds.
Allows assessment of pulmonary to perform therapy in the correct anatomical
place and assesses breath sounds prior to procedure.
➧ Position patient to drain upper lung segments/lobes:
● Sitting upright in bed or chair—targets right and left chest.
Drains anterior right and left apical segments.
● Leaning forward in sitting position—targets back.
Drains posterior right and left apical segments.
● Lying flat on back—targets right and left chest.
Drains anterior segments.
● Lying on abdomen, tilted to right or left side—targets right or left back.
Drains posterior segments.
➧ Position patient to drain middle lobe:
● Lying on back, tilted to left side in Trendelenburg’s position— targets right chest.
Drains middle posterior lobe.
● Lying on abdomen, tilted to left side with hips elevated—targets right back.
Drains middle posterior lobe.
➧ Position patient to drain basal/lower lobes:
● Lying in Trendelenburg’s position on back—targets right and left chest.
Drains anterior basal lobes.
● Lying in Trendelenburg’s position on abdomen—targets right and
left back
Drains posterior basal lobes.
● On right or left side in Trendelenburg’s position—targets back.
Drains lateral basal lobes.
● Lying on abdomen—targets right
➧ Maintain patient in position until chest percussion and vibration are ncompleted (approximately 5 minutes).
Loosens secretions in target area and facilitates removal.
➧ Assist patient into position for coughing or for suctioning of trachea.
Removes secretions from lungs that accumulate in the trachea.
➧ Auscultate chest areas for breath sounds.
If breath sounds are clear, secretions are cleared; however, if crackles are present, secretions may not be cleared, and nurse may need to repeat process.
➧ Continue until identified target areas have been drained.
Completes drainage of congested lung fields.
➧ Auscultate breath sounds, and assist patient with mouth care.
Assesses breath sounds after procedure, removes residual secretions from oral cavity, and freshens mouth.
➧ Position patient in bed with head of bed elevated 45 degrees or more.
Facilitates lung expansion and deep breathing.
➧ Turn patient to side with pillow at back.
Facilitates movement of secretions.
➧ Raise side rails, and place call light within reach.
Facilitates patient safety and communication with nurse.
➧Wash hands.
Reduces transmission of infection.

Review 101: Topic: Substance Abuse, Eating Disorders, Impulse Control Disorders.

noreply@blogger.com (GINO) — Sat, 29 Aug 2009 17:04:54 PDT

1. An unemployed woman, age 24, seeks help because she feels depressed and abandoned and doesn't know what to do with her life. She says she has quit her last five jobs because her coworkers didn't like her and didn't train her adequately. Last week, her boyfriend broke up with her after she drove his car into a tree after an argument. The client's initial diagnosis is borderline personality disorder. Which nursing observations support this diagnosis?

A. Flat affect, social withdrawal, and unusual dress
B. Suspiciousness, hypervigilance, and emotional coldness
C. Lack of self-esteem, strong dependency needs, and impulsive behavior
D. Insensitivity to others, sexual acting out, and violence

Rationale: Borderline personality disorder is characterized by lack of self-esteem, strong dependency needs, and impulsive behavior. Instability in interpersonal relationships, mood, and poor self-image also is common. Typically, the client can't tolerate being alone and expresses feelings of emptiness or boredom. Flat affect, social withdrawal, and unusual dress are characteristic of schizoid personality disorder. Suspiciousness, hypervigilance, and emotional coldness are seen in paranoid personality disorders. In antisocial personality disorder, clients are usually insensitive to others and act out sexually; they may also be violent

2.In a toddler, which of the following injuries is most likely the result of child abuse?

A. A hematoma on the occipital region of the head
B. A 1-inch forehead laceration
C. Several small, dime-sized circular burns on the child's back
D. A small isolated bruise on the right lower extremity

Rationale: Small circular burns on a child's back are no accident and may be from cigarettes. Toddlers are injury prone because of their developmental stage, and falls are frequent because of their unsteady gait; head injuries aren't uncommon. A small area of ecchymosis isn't suspicious in this age-group.

3. A client is admitted to the emergency department after being found unconscious. Her blood pressure is 82/50 mm Hg. She is 5′ 4" (1.6 m) tall, weighs 79 lb (35.8 kg), and appears dehydrated and emaciated. After regaining consciousness, she reports that she has had trouble eating lately and can't remember what she ate in the last 24 hours. She also states that she has had amenorrhea for the past year. She is convinced she is fat and refuses food. The nurse suspects that she has:

A. bulimia nervosa.
B. anorexia nervosa.
C. depression.
D. schizophrenia.

Rationale: Anorexia nervosa is an eating disorder characterized by self-imposed starvation with subsequent emaciation, nutritional deficiencies, and atrophic and metabolic changes. Typically, the client is hypotensive and dehydrated. Depending on the severity of the disorder, anorexic clients are at risk for circulatory collapse (indicated by hypotension), dehydration, and death. Bulimia nervosa is an eating disorder characterized by binge eating followed by self-induced vomiting. Although depression may be accompanied by weight loss, it isn't characterized by a body image disturbance or the intense fear of obesity seen in anorexia nervosa. Schizophrenia may cause bizarre eating patterns, but it rarely causes the full syndrome of anorexia nervosa.

4. A 15-year-old girl with anorexia has been admitted to a mental health unit. She refuses to eat. Which of the following statements is the best response from the nurse?

A. "You don't have to eat. It's your choice."
B. "I hope you'll eat your food by mouth. Tube feedings and I.V. lines can be uncomfortable."
C. "Why do you think you're fat? You're underweight. Here — look in the mirror."
D. "You really look terrible at this weight. I hope you'll eat."

Rationale: Clients with anorexia can refuse food to the point of cardiac damage. Tube feedings and I.V. infusions are ordered to prevent such damage. The nurse is informing her of her treatment options. Option A doesn't tell the client about the consequences of choosing not to eat. Telling clients that they are too thin won't change their self-image.

5. A client with a history of substance abuse has been attending Alcoholics Anonymous meetings regularly in the psychiatric unit. One afternoon, the client tells the nurse, "I'm not going to those meetings anymore. I'm not like the rest of those people. I'm not a drunk. "What is the most appropriate response?

A. "If you aren't an alcoholic, why do you keep drinking and ending up in the hospital?"
B. "It's your decision. If you don't want to go, you don't have to."
C. "You seem upset about the meetings."
D. "You have to go to the meetings. It's part of your treatment plan."

Rationale: The substance abuser uses the substance to cope with feelings and may deny the abuse. Asking if the client is upset about the meetings encourages the client to identify and deal with feelings instead of covering them up. Arguing with the client about the substance abuse (option A) or insisting that the client attend the meetings (option D) wouldn't help the client identify resistance to treatment. Option B isn't therapeutic behavior because it plays down the importance of attending meetings.

6. A client is admitted to the inpatient adolescent unit after being arrested for attempting to sell cocaine to an undercover police officer. The nurse plans to write a behavioral contract. To best promote compliance, the contract should be written:

A. abstractly.
B. by the client alone.
C. jointly by the client and nurse.
D. jointly by the physician and nurse.

Rationale: A contract written jointly by the client and nurse most successfully promotes cooperation and consistent behavior. The most effective contract — and the type least likely to allow for manipulation and misinterpretation — states the behavioral terms as concretely as possible. A contract written solely by the client may not be agreeable to staff members; one written by the physician and nurse may not be agreeable to the client.

7. During which phase of alcoholism is loss of control and physiologic dependence evident?

A. Prealcoholic phase
B. Early alcoholic phase
C. Crucial phase
D. Chronic phase

Rationale: The crucial phase is marked by physical dependence. The prealcoholic phase is characterized by drinking to medicate feelings and for relief from stress. The early phase is characterized by sneaking drinks, blackouts, rapidly gulping drinks, and preoccupation with alcohol. The chronic phase is characterized by emotional and physical deterioration.

8. Which of the following is important when restraining a violent client?

A. Have three staff members present, one for each side of the body and one for the head.
B. Always tie restraints to side rails.
C. Have an organized, efficient team approach after the decision is made to restrain the client.
D. Secure restraints to the gurney with knots to prevent escape.

Rationale: Emergency department personnel should use an organized, team approach when restraining violent clients so that no one is injured in the process. The leader, located at the client's head, should take charge; four staff members are required to hold and restrain the limbs. For safety reasons, restraints should be fastened to the bed frame instead of the side rails. For quick release, loops should be used instead of knots

9. A client who's actively hallucinating is brought to the hospital by friends. They say that the client used either lysergic acid diethylamide (LSD) or angel dust (phencyclidine [PCP]) at a concert. Which of the following common assessment findings indicates that the client may have ingested PCP?

A. Dilated pupils
B. Nystagmus
C. Paranoia
D. Altered mood

Rationale: Phencyclidine is an anesthetic with severe psychological effects. It blocks the reuptake of dopamine and directly affects the midbrain and thalamus. Nystagmus and ataxia are common physical findings of PCP use. Dilated pupils are evidence of LSD ingestion. Paranoia and altered mood occur with both PCP and LSD ingestion.

10. A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. Her history includes anorexia nervosa and a 20-lb (9.1-kg) weight loss in the last month. She is 5′ 7" (1.7 m) tall and weighs 80 lb (36.3 kg). Which nursing intervention takes highest priority?

A. Initiating caloric and nutritional therapy as ordered
B. Instituting behavioral modification therapy as ordered
C. Addressing the client's low self-esteem
D. Regularly monitoring vital signs and weight

Rationale: The client with anorexia nervosa is at risk for death from self-starvation. Therefore, initiating caloric and nutritional therapy takes highest priority. Behavioral modification (in which client privileges depend on weight gain) and psychoanalysis (which addresses the client's low self-esteem, guilt, anxiety, and feelings of hopelessness and depression) are important aspects of care but are secondary to stabilizing the client's physical condition. Monitoring vital signs and weight is important in evaluating nutritional therapy but doesn't take precedence over providing adequate caloric intake to ensure survival

11. A client tells the nurse that he is having suicidal thoughts every day. In conferring with the treatment team, the nurse should make which of the following recommendations?

A. A no-suicide contract
B. Weekly outpatient therapy
C. A second psychiatric opinion
D. Intensive inpatient treatment

Rationale: Inpatient care is the best intervention for a client who is thinking about suicide every day. Implementing a no-suicide contract is an important strategy, but this client requires additional care. Weekly therapy wouldn't provide the intensity of care that this case warrants. Obtaining a second opinion would take time; this client requires immediate intervention.

12. Which of the following etiologic factors predispose a client to Tourette syndrome?

A. No known etiology
B. Abnormalities in brain neurotransmitters, structural changes in basal ganglia and caudate nucleus, and genetics
C. Abnormalities in the structure and function of the ventricles
D. Environmental factors and birth-related trauma

Rationale: The etiology of Tourette syndrome includes genetics, abnormalities in neurotransmission, and structural changes in the basal ganglia and caudate nucleus. The ventricles in the brain, environmental factors, and birth trauma aren't involved.

13. A client is admitted for detoxification after a cocaine overdose. The client tells the nurse that he frequently uses cocaine but he can control his use if he chooses. Which coping mechanism is he using?

A. Withdrawal
B. Logical thinking
C. Repression
D. Denial

Rationale: Denial is an unconscious defense mechanism in which emotional conflict and anxiety are avoided by refusing to acknowledge feelings, desires, impulses, or external facts that are consciously intolerable. Withdrawal is a common response to stress, characterized by apathy. Logical thinking IS the ability to think rationally and make responsible decisions, which would lead the client to admitting the problem and seeking help. Repression is suppressing past events from the consciousness because of guilty association.

14. An 16-year-old boy is admitted to the facility after acting out his aggressions inappropriately at school. Predisposing factors to the expression of aggression include:

A. violence on television.
B. passive parents.
C. an internal locus of control.
D. a single-parent family

Rationale: Violence on television has been correlated with an increase in aggressive behavior. Passive parents contribute to acting-out behaviors but not specifically to violence. An internal locus of control leads to a positive sense of self-esteem and isn't related to violence or aggression. There is no direct correlation between single-parent families and violence.

15. A client is brought to the emergency department after being beaten by her husband, a prominent attorney. The nurse caring for this client understands that:

A. open boundaries are common in violent families.
B. violence usually results from a power struggle.
C. domestic violence and abuse span all socioeconomic classes.
D. violent behavior is a genetic trait passed from one generation to the next.

Rationale: Domestic violence and abuse affect all socioeconomic classes. Closed boundaries and an imbalance of power, with one member having control over the others, are common in violent families. Although violent behavior may be passed from one generation to the next, it's a learned behavior, not a genetic trait.

16. On discharge after treatment for alcoholism, a client plans to take disulfiram (Antabuse) as prescribed. When teaching the client about this drug, the nurse emphasizes the need to:

A. avoid all products containing alcohol.
B. adhere to concomitant vitamin B therapy.
C. return for monthly blood drug level monitoring.
D. limit alcohol consumption to a moderate level.

Rationale: To avoid severe adverse effects, the client taking disulfiram must strictly avoid alcohol and all products that contain alcohol. Vitamin B therapy and blood monitoring aren't necessary during disulfiram therapy.

17. During a private conversation, a client with borderline personality disorder asks the nurse to keep his secret and then displays multiple, self-inflicted, superficial lacerations on the forearms. What is the nurse's best response?

A. "That's it! You're on suicide precautions."
B. "I'm going to tell your physician. Do you want to tell me why you did that?"
C. "Tell me what type of instrument you used. I'm concerned about infection."
D. "The team needs to know when something important occurs in treatment. I need to tell the others, but let's talk about it first."

Rationale: This response informs the client of the nurse's planned actions and allows time to discuss the client's actions. Options A and B put the client on the defensive and may lead to a power struggle. Option C ignores the psychological implications of the client's actions.

18. The nurse is providing care for a client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with:

A. barbiturates.
B. amphetamines.
C. methadone.
D. benzodiazepines.

Rationale: Methadone is used to detoxify opiate users because it binds with opioid receptors at many sites in the central nervous system but doesn't have the same deleterious effects as other opiates, such as cocaine, heroin, and morphine. Barbiturates, amphetamines, and benzodiazepines are highly addictive and would require detoxification treatment.

19. The nurse is caring for a client who she believes has been abusing opiates. Assessment findings in a client abusing opiates such as morphine include:

A. dilated pupils and slurred speech.
B. rapid speech and agitation.
C. dilated pupils and agitation.
D. euphoria and constricted pupils.

Rationale: Assessment findings in a client abusing opiates include agitation, slurred speech, euphoria, and constricted pupils.

20. Which of the following signs should the nurse expect in a client with known amphetamine overdose?

A. Hypotension
B. Tachycardia
C. Hot, dry skin
D. Constricted pupils

Rationale: Amphetamines are central nervous system stimulants. They cause sympathetic stimulation, including hypertension, tachycardia, vasoconstriction, and hyperthermia. Hot, dry skin is seen with anticholinergic agents such as jimsonweed. Pupils will be dilated, not constricted.

21. A client is admitted to the psychiatric unit with a diagnosis of alcohol intoxication and suspected alcohol dependence. Other assessment findings include an enlarged liver, jaundice, lethargy, and rambling, incoherent speech. No other information about the client is available. After the nurse completes the initial assessment, what is the first priority?

A. Instituting seizure precautions, obtaining frequent vital signs, and recording fluid intake and output
B. Checking the client's medical records for health history information
C. Attempting to contact the client's family to obtain more information about the client
D. Restricting fluids and leaving the client alone to "sleep off" the episode

Rationale: A nurse who lacks adequate information to determine which level of care a client requires must take all possible precautions to ensure the client's physical safety and prevent complications. To do otherwise could place the client at risk for potential complications. After taking all possible precautions, the nurse can begin seeking health history information and, as needed, modify the plan of care. Fluids are typically increased unless contraindicated by a preexisting medical condition.

22. Which nursing action is best when trying to diffuse a client's impending violent behavior?

A. Helping the client identify and express feelings of anxiety and anger
B. Involving the client in a quiet activity to divert attention
C. Leaving the client alone until the client can talk about feelings
D. Placing the client in seclusion

Rationale: In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statements as "What happened to get you this angry?" may help the client verbalize feelings rather than act on them. Close interaction with the client in a quiet activity may place the nurse at risk for injury should the client suddenly become violent. An agitated and potentially violent client shouldn't be left alone or unsupervised because the danger of the client acting out is too great. The client should be placed in seclusion only if other interventions fail or the client requests this. Unlocked seclusion can be helpful for some clients because it reduces environmental stimulation and provides a feeling of security.

23. The nurse is working with a client who abuses alcohol. Which of the following facts should the nurse communicate to the client?

A. Abstinence is the basis for successful treatment.
B. Attendance at Alcoholics Anonymous meetings every day will cure alcoholism.
C. For treatment to be successful, family members must participate.
D. An occasional social drink is acceptable behavior for the alcoholic

Rationale: The foundation of any treatment for alcoholism is abstinence. Attendance at Alcoholics Anonymous is helpful to some individuals to maintain strict abstinence. Participation in treatment by the family is beneficial to both the client and the family but isn't essential. Abstinence requires refraining from social drinking.

24. Which psychosocial influence has been causally related to the development of aggressive behavior and conduct disorder?

A. An overbearing mother
B. Rejection by peers
C. A history of schizophrenia in the family
D. Low socioeconomic status

Rationale: Studies indicate that children who are rejected by their peers are more likely to behave aggressively. Aggression and conduct disorder are represented in all socioeconomic groups. Schizophrenia and an overbearing mother haven't been associated with aggression or conduct disorder

25. In group therapy, a client who has used I.V. heroin every day for the past 14 years says, "I don't have a drug problem. I can quit whenever I want. I've done it before." Which defense mechanism is the client using?

A. Denial
B. Obsession
C. Compensation
D. Rationalization

Rationale: A client who states that he or she doesn't have a drug problem and can quit using drugs at any time — despite evidence to the contrary — is denying the drug addiction. Obsession isn't a defense mechanism. In compensation, the client emphasizes positive attributes to compensate for negative ones. In rationalization, the client justifies behaviors by faulty logic.

26. A client with a history of cocaine addiction is admitted to the coronary care unit for evaluation of substernal chest pain. The electrocardiogram (ECG) shows a 1-mm ST-segment elevation the anteroseptal leads and T-wave inversion in leads V3 to V5. Considering the client's history of drug abuse, the nurse expects the physician to prescribe:

A. lidocaine (Xylocaine).
B. procainamide (Pronestyl).
C. nitroglycerin (Nitro-Bid IV).
D. epinephrine.

Rationale: The elevated ST segments in this client's ECG indicate myocardial ischemia. To reverse this problem, the physician is most likely to prescribe an infusion of nitroglycerin to dilate the coronary arteries. Lidocaine and procainamide are cardiac drugs that may be indicated for this client at some point but aren't used for coronary artery dilation. If a cocaine user experiences ventricular fibrillation or asystole, the physician may prescribe epinephrine. However, this drug must be used with caution because cocaine may potentiate its adrenergic effects.

27. A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. The nurse conducts a health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa?

A. "I like the way I look. I just need to keep my weight down because I'm a cheerleader."
B. "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends."
C. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls."
D. "I do diet around my periods; otherwise, I just get so bloated."

Rationale: Low self-esteem is the highest risk factor for anorexia nervosa. Constant dieting to get down to a "desirable weight" is characteristic of the disorder. Feeling inadequate when compared to peers indicates poor self-esteem. Most clients with anorexia nervosa don't like the way they look, and their self-perception may be distorted. A girl with cachexia may perceive herself to be overweight when she looks in the mirror. Preferring fast food over healthy food is common in this age-group. Because of the absence of body fat necessary for proper hormone production, amenorrhea is common in a client with anorexia nervosa.

28. Which is the drug of choice for treating Tourette syndrome?

A. fluoxetine (Prozac)
B. fluvoxamine (Luvox)
C. haloperidol (Haldol)
D. paroxetine (Paxil)

Rationale: Haloperidol is the drug of choice for treating Tourette syndrome. Prozac, Luvox, and Paxil are antidepressants and aren't used to treat Tourette syndrome

29. The client tells the nurse he was involved in a car accident while he was intoxicated. What would be the most therapeutic response from the nurse?

A. "Why didn't you get someone else to drive you?"
B. "Tell me how you feel about the accident."
C. "You should know better than to drink and drive."
D. "I recommend that you attend an Alcoholics Anonymous meeting."

Rationale: An open-ended statement or question is the most therapeutic response. It encourages the widest range of client responses, makes the client an active participant in the conversation, and shows the client that the nurse is interested in his feelings. Asking the client why he drove while intoxicated can make him feel defensive and intimidated. A judgmental approach isn't therapeutic. By giving advice, the nurse suggests that the client isn't capable of making decisions, thus fostering dependency.

30. A client voluntarily admits himself to the substance abuse unit. He confesses that he drinks 1 qt or more of vodka each day and uses cocaine occasionally. Later that afternoon, he begins to show signs of alcohol withdrawal. What are some early signs of this condition?

A. Vomiting, diarrhea, and bradycardia
B. Dehydration, temperature above 101° F (38.3° C), and pruritus
C. Hypertension, diaphoresis, and seizures
D. Diaphoresis, tremors, and nervousness

Rationale: Alcohol withdrawal syndrome includes alcohol withdrawal, alcoholic hallucinosis, and alcohol withdrawal delirium (formerly delirium tremens). Signs of alcohol withdrawal include diaphoresis, tremors, nervousness, nausea, vomiting, malaise, increased blood pressure and pulse rate, sleep disturbance, and irritability. Although diarrhea may be an early sign of alcohol withdrawal, tachycardia — not bradycardia — is associated with alcohol withdrawal. Dehydration and an elevated temperature may be expected, but a temperature above 101° F indicates an infection rather than alcohol withdrawal. Pruritus rarely occurs in alcohol withdrawal. If withdrawal symptoms remain untreated, seizures may arise later.

31. When monitoring a client recently admitted for treatment of cocaine addiction, the nurse notes sudden increases in the arterial blood pressure and heart rate. To correct these problems, the nurse expects the physician to prescribe:

A. norepinephrine (Levophed) and lidocaine (Xylocaine).
B. nifedipine (Procardia) and lidocaine.
C. nitroglycerin (Nitro-Bid IV) and esmolol (Brevibloc).
D. nifedipine and esmolol

Rationale: This client requires a vasodilator, such as nifedipine, to treat hypertension, and a beta-adrenergic blocker, such as esmolol, to reduce the heart rate. Lidocaine, an antiarrhythmic, isn't indicated because the client doesn't have an arrhythmia. Although nitroglycerin may be used to treat coronary vasospasm, it isn't the drug of choice in hypertension.

32. A client experiencing alcohol withdrawal is upset about going through detoxification. Which of the following goals is a priority?

A. The client will commit to a drug-free lifestyle.
B. The client will work with the nurse to remain safe.
C. The client will drink plenty of fluids daily.
D. The client will make a personal inventory of strengths

Rationale: The priority goal in alcohol withdrawal is maintaining the client's safety. Committing to a drug-free lifestyle, drinking plenty of fluids, and identifying personal strengths are important goals, but ensuring the client's safety is the nurse's top priority.

33. A client is admitted to a psychiatric facility by court order for evaluation for antisocial personality disorder. This client has a long history of initiating fights and abusing animals and recently was arrested for setting a neighbor's dog on fire. When evaluating this client for the potential for violence, the nurse should assess for which behavioral clues?

A. A rigid posture, restlessness, and glaring
B. Depression and physical withdrawal
C. Silence and noncompliance
D. Hypervigilance and talk of past violent acts

Rationale: Behavioral clues that suggest the potential for violence include a rigid posture, restlessness, glaring, a change in usual behavior, clenched hands, overtly aggressive actions, physical withdrawal, noncompliance, overreaction, hostile threats, recent alcohol ingestion or drug use, talk of past violent acts, inability to express feelings, repetitive demands and complaints, argumentativeness, profanity, disorientation, inability to focus attention, hallucinations or delusions, paranoid ideas or suspicions, and somatic complaints. Violent clients rarely exhibit depression, silence, or hypervigilance.

34. A client is brought to the psychiatric clinic by family members, who tell the admitting nurse that the client repeatedly drives while intoxicated despite their pleas to stop. During an interview with the nurse, which statement by the client most strongly supports a diagnosis of psychoactive substance abuse?

A. "I'm not addicted to alcohol. In fact, I can drink more than I used to without being affected."
B. "I only spend half of my paycheck at the bar."
C. "I just drink to relax after work."
D. "I know I've been arrested three times for drinking and driving, but the police are just trying to hassle me."

Rationale: According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, diagnostic criteria for psychoactive substance abuse include a maladaptive pattern of such use, indicated either by continued use despite knowledge of having a persistent or recurrent social, occupational, psychological, or physical problem caused or exacerbated by substance abuse or recurrent use in dangerous situations (for example, while driving). For this client, psychoactive substance dependence must be ruled out; criteria for this disorder include a need for increasing amounts of the substance to achieve intoxication (option A), increased time and money spent on the substance (option B), inability to fulfill role obligations (option C), and typical withdrawal symptoms.

35. A client with borderline personality disorder is admitted to the psychiatric unit. Initial nursing assessment reveals that the client's wrists are scratched from a recent suicide attempt. Based on this finding, the nurse should formulate a nursing diagnosis of:

A. Ineffective individual coping related to feelings of guilt.
B. Situational low self-esteem related to feelings of loss of control.
C. Risk for violence: Self-directed related to impulsive mutilating acts.
D. Risk for violence: Directed toward others related to verbal threats.

Rationale: The predominant behavioral characteristic of the client with borderline personality disorder is impulsiveness, especially of a physically self-destructive sort. The observation that the client has scratched wrists doesn't substantiate the other options.

36. A client recently admitted to the hospital with sharp, substernal chest pain suddenly complains of palpitations. The nurse notes a rise in the client's arterial blood pressure and a heart rate of 144 beats/minute. On further questioning, the client admits to having used cocaine recently after previously denying use of the drug. The nurse concludes that the client is at high risk for which complication of cocaine use?

A. Coronary artery spasm
B. Bradyarrhythmias
C. Neurobehavioral deficits
D. Panic disorder

Rationale: Cocaine use may cause such cardiac complications as coronary artery spasm, myocardial infarction, dilated cardiomyopathy, acute heart failure, endocarditis, and sudden death. Cocaine blocks reuptake of norepinephrine, epinephrine, and dopamine, causing an excess of these neurotransmitters at postsynaptic receptor sites. Consequently, the drug is more likely to cause tachyarrhythmias than bradyarrhythmias. Although neurobehavioral deficits are common in neonates born to cocaine users, they are rare in adults. As craving for the drug increases, a person who's addicted to cocaine typically experiences euphoria followed by depression, not panic disorder.

37. A client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink 6 hours before admission. Based on this response, the nurse should expect early withdrawal symptoms to:

A. begin after 7 days.
B. not occur at all because the time period for their occurrence has passed.
C. begin anytime within the next 1 to 2 days.
D. begin within 2 to 7 days.

Rationale: Acute withdrawal symptoms from alcohol may begin 6 hours after the client has stopped drinking and peak 1 to 2 days later. Delirium tremens may occur 2 to 4 days — even up to 7 days — after the last drink.

38. The nurse is assigned to care for a client with anorexia nervosa. Initially, which nursing intervention is most appropriate for this client?

A. Providing one-on-one supervision during meals and for 1 hour afterward
B. Letting the client eat with other clients to create a normal mealtime atmosphere
C. Trying to persuade the client to eat and thus restore nutritional balance
D. Giving the client as much time to eat as desired

Rationale: Because the client with anorexia nervosa may discard food or induce vomiting in the bathroom, the nurse should provide one-on-one supervision during meals and for 1 hour afterward. Option B wouldn't be therapeutic because other clients may urge the client to eat and give attention for not eating. Option C would reinforce control issues, which are central to this client's underlying psychological problem. Instead of giving the client unlimited time to eat, as in option D, the nurse should set limits and let the client know what is expected.

39. A client begins to experience alcoholic hallucinosis. What is the best nursing intervention at this time?

A. Keeping the client restrained in bed
B. Checking the client's blood pressure every 15 minutes and offering juices
C. Providing a quiet environment and administering medication as needed and prescribed
D. Restraining the client and measuring blood pressure every 30 minutes

Rationale: Manifestations of alcoholic hallucinosis are best treated by providing a quiet environment to reduce stimulation and administering prescribed central nervous system depressants in dosages that control symptoms without causing oversedation. Although bed rest is indicated, restraints are unnecessary unless the client poses a danger to himself or others. Also, restraints may increase agitation and make the client feel trapped and helpless when hallucinating. Offering juice is appropriate, but measuring blood pressure every 15 minutes would interrupt the client's rest. To avoid overstimulating the client, the nurse should check blood pressure every 2 hours.

40. Which assessment finding is most consistent with early alcohol withdrawal?

A. Heart rate of 120 to 140 beats/minute
B. Heart rate of 50 to 60 beats/minute
C. Blood pressure of 100/70 mm Hg
D. Blood pressure of 140/80 mm Hg

Rationale: Tachycardia, a heart rate of 120 to 140 beats/minute, is a common sign of alcohol withdrawal. Blood pressure may be labile throughout withdrawal, fluctuating at different stages. Hypertension typically occurs in early withdrawal. Hypotension, although rare during the early withdrawal stages, may occur in later stages. Hypotension is associated with cardiovascular collapse and most commonly occurs in clients who don't receive treatment. The nurse should monitor the client's vital signs carefully throughout the entire alcohol withdrawal process.

41. Which client is at highest risk for suicide?

A. One who appears depressed, frequently thinks of dying, and gives away all personal possessions
B. One who plans a violent death and has the means readily available
C. One who tells others that he or she might do something if life doesn't get better soon
D. One who talks about wanting to die

Rationale: The client at highest risk for suicide is one who plans a violent death (for example, by gunshot, jumping off a bridge, or hanging), has a specific plan (for example, after the spouse leaves for work), and has the means readily available (for example, a rifle hidden in the garage). A client who gives away possessions, thinks about death, or talks about wanting to die or attempting suicide is considered at a lower risk for suicide because this behavior typically serves to alert others that the client is contemplating suicide and wishes to be helped.

42. Which of the following medical conditions is commonly found in clients with bulimia nervosa?

A. Allergies
B. Cancer
C. Diabetes mellitus
D. Hepatitis A

Rationale: Bulimia nervosa can lead to many complications, including diabetes, heart disease, and hypertension. The eating disorder isn't typically associated with allergies, cancer, or hepatitis A.

43. A high school student is referred to the school nurse for suspected substance abuse. Following the nurse's assessment and interventions, what would be the most desirable outcome?

A. The student discusses conflicts over drug use.
B. The student accepts a referral to a substance abuse counselor.
C. The student agrees to inform his parents of the problem.
D. The student reports increased comfort with making choices.

Rationale: All of the outcomes stated are desirable; however, the best outcome is that the student would agree to seek the assistance of a professional substance abuse counselor.

44. A client who reportedly consumes 1 qt of vodka daily is admitted for alcohol detoxification. To try to prevent alcohol withdrawal symptoms, the physician is most likely to prescribe which drug?

A. clozapine (Clozaril)
B. thiothixene (Navane)
C. lorazepam (Ativan)
D. lithium carbonate (Eskalith)

Rationale: The best choice for preventing or treating alcohol withdrawal symptoms is lorazepam, a benzodiazepine. Clozapine and thiothixene are antipsychotic agents, and lithium carbonate is an antimanic agent; these drugs aren't used to manage alcohol withdrawal syndrome.

45. A client is being treated for alcoholism. After a family meeting, the client's spouse asks the nurse about ways to help the family deal with the effects of alcoholism. The nurse should suggest that the family join which organization?

A. Al-Anon
B. Make Today Count
C. Emotions Anonymous
D. Alcoholics Anonymous

Rationale: Al-Anon is an organization that assists family members to share common experiences and increase their understanding of alcoholism. Make Today Count is a support group for people with life-threatening or chronic illnesses. Emotions Anonymous is a support group for people experiencing depression, anxiety, or similar conditions. Alcoholics Anonymous is an organization that helps alcoholics recover by using a twelve-step program.

46. A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client's physical health, the nurse should plan to:

A. severely restrict the client's physical activities.
B. weigh the client daily, after the evening meal.
C. monitor vital signs, serum electrolyte levels, and acid-base balance.
D. instruct the client to keep an accurate record of food and fluid intake.

Rationale: An anorexic client who requires hospitalization is in poor physical condition from starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client's vital signs, serum electrolyte level, and acid base balance is crucial. Option A may worsen anxiety. Option B is incorrect because a weight obtained after breakfast is more accurate than one obtained after the evening meal. Option D would reward the client with attention for not eating and reinforce the control issues that are central to the underlying psychological problem; also, the client may record food and fluid intake inaccurately.

47. A young man is remanded by the courts for psychiatric treatment. His police record, which dates to his early teenage years, includes delinquency, running away, auto theft, and vandalism. He dropped out of school at age 16 and has been living on his own since then. His history suggests maladaptive coping, which is associated with:

A. antisocial personality disorder.
B. borderline personality disorder.
C. obsessive-compulsive personality disorder.
D. narcissistic personality disorder.

Rationale: The client's history of delinquency, running away from home, vandalism, and dropping out of school are characteristic of antisocial personality disorder. This maladaptive coping pattern is manifested by a disregard for societal norms of behavior and an inability to relate meaningfully to others. In borderline personality disorder, the client exhibits mood instability, poor self-image, identity disturbance, and labile affect. Obsessive-compulsive personality disorder is characterized by a preoccupation with impulses and thoughts that the client realizes are senseless but can't control. Narcissistic personality disorder is marked by a pattern of self-involvement, grandiosity, and demand for constant attention.

48. A husband and wife seek emergency crisis intervention because he slapped her repeatedly the night before. The husband indicates that his childhood was marred by an abusive relationship with his father. When intervening with this couple, the nurse knows they are at risk for repeated violence because the husband:

A. has only moderate impulse control.
B. denies feelings of jealousy or possessiveness.
C. has learned violence as an acceptable behavior.
D. feels secure in his relationship with his wife.

Rationale: Family violence usually is a learned behavior, and violence typically leads to further violence, putting this couple at risk. Repeated slapping may indicate poor, not moderate, impulse control. Violent people commonly are jealous and possessive and feel insecure in their relationships.

49. A client whose husband just left her has a recurrence of anorexia nervosa. The nurse caring for her realizes that this exacerbation of anorexia nervosa results from the client's effort to:

A. manipulate her husband.
B. gain control of one part of her life.
C. commit suicide.
D. live up to her mother's expectations.

Rationale: By refusing to eat, a client with anorexia nervosa is unconsciously attempting to gain control over the only part of her life she feels she can control. This eating disorder doesn't represent an attempt to manipulate others or live up to their expectations (although anorexia nervosa has a high incidence in families that emphasize achievement). The client isn't attempting to commit suicide through starvation; rather, by refusing to eat, she is expressing feelings of despair, worthlessness, and hopelessness.

50. A client has approached the nurse asking for advice on how to deal with his alcohol addiction. The nurse should tell the client that the only effective treatment for alcoholism is:

A. psychotherapy.
B. total abstinence.
C. Alcoholics Anonymous (AA).
D. aversion therapy.

Rationale: Total abstinence is the only effective treatment for alcoholism. Psychotherapy, attendance at AA meetings, and aversion therapy are all adjunctive therapies that can support the client in his efforts to abstain.

Review Your Medical Surgical Nursing

noreply@blogger.com (GINO) — Sat, 29 Aug 2009 17:05:14 PDT

1. Which of the following arteries primarily feeds the anterior wall of the heart?
a. Circumflex artery
b. Internal mammary artery
c. Left anterior descending artery
d. Right coronary artery

The left anterior descending artery is the primary source of blood for the anterior wall of the heart. The circumflex artery supplies the lateral wall, the internal mammary artery supplies the mammary, and the right coronary artery supplies the inferior wall of the heart.

2. When do coronary arteries primarily receive blood flow?
a. During inspiration
b. During diastole
c. During expiration
d. During systole

Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is supplied during diastole. Breathing patterns are irrelevant to blood flow

3. Which of the following illnesses is the leading cause of death in the US?
a. Cancer
b. Coronary artery disease
c. Liver failure
d. Renal failure

Coronary artery disease accounts for over 50% of all deaths in the US. Cancer accounts for approximately 20%. Liver failure and renal failure account for less than 10% of all deaths in the US.

4. Which of the following conditions most commonly results in CAD?
a. Atherosclerosis
b. DM
c. MI
d. Renal failure

Atherosclerosis, or plaque formation, is the leading cause of CAD. DM is a risk factor for CAD but isn't the most common cause. Renal failure doesn't cause CAD, but the two conditions are related. Myocardial infarction is commonly a result of CAD.

5. Atherosclerosis impedes coronary blood flow by which of the following mechanisms?
a. Plaques obstruct the vein
b. Plaques obstruct the artery
c. Blood clots form outside the vessel wall
d. Hardened vessels dilate to allow the blood to flow through

Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atherosclerosis is a direct result of plaque formation in the artery. Hardened vessels can't dilate properly and, therefore, constrict blood flow.

6. Which of the following risk factors for coronary artery disease cannot be corrected?
a. Cigarette smoking
b. DM
c. Heredity
d. HPN

Because "heredity" refers to our genetic makeup, it can't be changed. Cigarette smoking cessation is a lifestyle change that involves behavior modification. Diabetes mellitus is a risk factor that can be controlled with diet, exercise, and medication. Altering one's diet, exercise, and medication can correct hypertension.

7. Exceeding which of the following serum cholesterol levels significantly increases the risk of coronary artery disease?
a. 100 mg/dl
b. 150 mg/dl
c. 175 mg/dl
d. 200 mg/dl

Cholesterol levels above 200 mg/dl are considered excessive. They require dietary restriction and perhaps medication. Exercise also helps reduce cholesterol levels. The other levels listed are all below the nationally accepted levels for cholesterol and carry a lesser risk for CAD.

8. Which of the following actions is the first priority care for a client exhibiting signs and symptoms of coronary artery disease?
a. Decrease anxiety
b. Enhance myocardial oxygenation
c. Administer sublignual nitroglycerin
d. Educate the client about his symptoms

Enhancing mocardial oxygenation is always the first priority when a client exhibits signs and symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. Sublingual nitorglycerin is administered to treat acute angina, but its administration isn't the first priority. Although educating the client and decreasing anxiety are important in care delivery, nether are priorities when a client is compromised.

9. Medical treatment of coronary artery disease includes which of the following procedures?
a. Cardiac catheterization
b. Coronary artery bypass surgery
c. Oral medication administration
d. Percutaneous transluminal coronary angioplasty

Oral medication administration is a noninvasive, medical treatment for coronary artery disease. Cardiac catheterization isn't a treatment but a diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical treatments.

10. Prolonged occlusion of the right coronary artery produces an infarction in which of he following areas of the heart?
a. Anterior
b. Apical
c. Inferior
d. Lateral

The right coronary artery supplies the right ventricle, or the inferior portion of the heart. Therefore, prolonged occlusion could produce an infarction in that area. The right coronary artery doesn't supply the anterior portion ( left ventricle ), lateral portion ( some of the left ventricle and the left atrium ), or the apical portion ( left ventricle ) of the heart.

11. Which of the following is the most common symptom of myocardial infarction?
a. Chest pain
b. Dyspnea
c. Edema
d. Palpitations

The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Edema is a later sign of heart failure, often seen after an MI. Palpitations may result from reduced cardiac output, producing arrhythmias.

12. Which of the following landmarks is the corect one for obtaining an apical pulse?
a. Left intercostal space, midaxillary line
b. Left fifth intercostal space, midclavicular line
c. Left second intercostal space, midclavicular line
d. Left seventh intercostal space, midclavicular line

The correct landmark for obtaining an apical pulse is the left intercostal space in the midclavicular line. This is the point of maximum impulse and the location of the left ventricular apex. The left second intercostal space in the midclavicular line is where the pulmonic sounds are auscultated. Normally, heart sounds aren't heard in the midaxillary line or the seventh intercostal space in the midclavicular line.

13. Which of the following systems is the most likely origin of pain the client describes as knifelike chest pain that increases in intensity with inspiration?
a. Cardiac
b. Gastrointestinal
c. Musculoskeletal
d. Pulmonary

Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only increase with movement. Cardiac and GI pains don't change with respiration.

14. A murmur is heard at the second left intercostal space along the left sternal border.
Which valve area is this?
a. Aortic
b. Mitral
c. Pulmonic
d. Tricuspid

Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum. Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line. Tricuspid valve abnormalities are heard at the third and fourth intercostal spaces along the sternal border.

15. Which of the following blood tests is most indicative of cardiac damage?
a. Lactate dehydrogenase
b. Complete blood count
c. Troponin I
d. Creatine kinase

Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I levels aren't detectable in people without cardiac injury. Lactate dehydrogenase is present in almost all body tissues and not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes. Because CK levles may rise with skeletal muscle injury, CK isoenzymes are required to detect cardiac injury.

16. What is the primary reason for administering morphine to a client with myocardial infarction?
a. To sedate the client
b. To decrease the client's pain
c. To decrease the client's anxiety
d. To decrease oxygen demand on the client's heart

Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain and anxiety while causing sedation, but isn't primarily given for those reasons.

17. Which of the followng conditions is most commonly responsible for myocardial infarction?
a. Aneurysm
b. Heart failure
c. Coronary artery thrombosis
d. Renal failure

Coronary artery thrombosis causes occlusion of the artery, leading to myocardial death. An aneurysm is an outpouching of a vessel and doesn't cause an MI. Renal failure can be associated with MI but isn't a direct cause. Heart failure is usually the result of an MI.

18. What supplemental medication is most frequently ordered in conjuction with furosemide (Lasix)?
a. Chloride
b. Digoxin
c. Potassium
d. Sodium

Supplemental potassium is given with furosemide because of the potassium loss that occurs as a result of this diuretic. Chloride and sodium aren’t loss during diuresis. Digoxin acts to increase contractility but isn’t given routinely with furosemide.

19. After myocardial infarction, serum glucose levels and free fatty acids are both increase. What type of physiologic changes are these?
a. Electrophysiologic
b. Hematologic
c. Mechanical
d. Metabolic

Both glucose and fatty acids are metabolites whose levels increase after a myocardial infarction. Mechanical changes are those that affect the pumping action of the heart, and electro physiologic changes affect conduction. Hematologic changes would affect the blood.

20. Which of the following complications is indicated by a third heart sound (S3)?
a. Ventricular dilation
b. Systemic hypertension
c. Aortic valve malfunction
d. Increased atrial contractions

Rapid filling of the ventricles causes vasodilation that is auscultated as S3. Increased atrial contraction or systemic hypertension can result is a fourth heart sound. Aortic valve malfunction is heard as a murmur.

21. After an anterior wall
myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs?

a. Left-sided heart failure
b. Pulmonic valve malfunction
c. Right-sided heart failure
d. Tricuspid valve malfunction

The left ventricle is responsible for the most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn’t function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. Pulmonic and tricuspid valve malfunction causes right-sided heart failure.

22. Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage?

a. Cardiac catheterization
b. Cardiac enzymes
c. Echocardiogram
d. Electrocardiogram

The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. Cardiac enzymes are used to diagnose MI but can’t determine the location. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately.

23. What is the first intervention for a client experiencing myocardial infarction?
a. Administer morphine
b. Administer oxygen
c. Administer sublingual nitroglycerin
d. Obtain an electrocardiogram

Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage. Morphine and sublingual nitroglycerin are also used to treat MI, but they’re more commonly administered after the oxygen. An ECG is the most common diagnostic tool used to evaluate MI.

24. What is the most appropriate nursing response to a myocardial infarction client who is fearful of dying?
a. "Tell me about your feeling right now."
b. "When the doctor arrives, everything will be fine."
c. "This is a bad situation, but you'll feel better soon."
d. "Please be assured we're doing everything we can to make you feel better."

Validation of the client’s feelings is the most appropriate response. It gives the client a feeling of comfort and safety. The other three responses give the client false hope. No one can determine if a client experiencing MI will feel or get better and therefore, these responses are inappropriate.

25. Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation?
a. Beta-adrenergic blockers
b. Calcium channel blockers
c. Narcotics
d. Nitrates

Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen demand, promote vasodilation, and decreased anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload).

26. What is the most common complication of a myocardial infarction?
a. Cardiogenic shock
b. Heart failure
c. Arrhythmias
d. Pericarditis

Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. cardiogenic shock, another complication of MI, is defined as the end stage of left ventricular dysfunction. The condition occurs in approximately 15% of clients with MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results from a bacterial of viral infection but may occur after MI.

27. With which of the following disorders is jugular vein distention most prominent?
a. Abdominal aortic aneurysm
b. Heart failure
c. Myocardial infarction
d. Pneumothorax

Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump. Jugular vein distention isn’t a symptom of abdominal aortic aneurysm or pneumothorax. An MI, if severe enough, can progress to heart failure; however, in and of itself, an MI doesn’t cause jugular vein distention.

28. What position should the nurse place the head of the bed in to obtain the most accurate reading of jugular vein distention?
a. High-fowler's
b. Raised 10 degrees
c. Raised 30 degrees
d. Supine position

Jugular venous pressure is measured with a centimeter ruler to obtain the vertical distance between the sternal angle and the point of highest pulsation with the head of the bed inclined between 15 and 30 degrees. Inclined pressure can’t be seen when the client is supine or when the head of the bed is raised 10 degrees because the point that marks the pressure level is above the jaw (therefore, not visible). In high Fowler’s position, the veins would be barely discernible above the clavicle.

29. Which of the following parameters should be checked before administering digoxin?
a. Apical pulse
b. Blood pressure
c. Radial pulse
d. Respiratory rate

An apical pulse is essential or accurately assessing the client’s heart rate before administering digoxin. The apical pulse is the most accurate point in the body. Blood pressure is usually only affected if the heart rate is too low, in which case the nurse would withhold digoxin. The radial pulse can be affected by cardiac and vascular disease and therefore, won’t always accurately depict the heart rate. Digoxin has no effect on respiratory function.

30. Toxicity from which of the following medications may cause a client to see a green halo around lights?
a. Digoxin
b. Furosemide
c. Metoprolol
d. Enalapril

One of the most common signs of digoxin toxicity is the visual disturbance known as the green halo sign. The other medications aren’t associated with such an effect.

31. Which ofthe following symptoms is most commonly associated with left-sided heart failure?
a. Crackles
b. Arrhythmias
c. Hepatic engorgement
d. Hypotension

Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary system. Arrhythmias can be associated with both right and left-sided heart failure. Left-sided heart failure causes hypertension secondary to an increased workload on the system.

32. In which of the following disorders would the nurse expect to assess sacral eddema in bedridden client?

a. DM
b. Pulmonary emboli
c. Renal failure
d. Right-sided heart failure

The most accurate area on the body to assed dependent edema in a bedridden client is the sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure. Diabetes mellitus, pulmonary emboli, and renal disease aren’t directly linked to sacral edema.

33. Which of the following symptoms might a client with right-sided heart failure exhibit?
a. Adequate urine output
b. Polyuria
c. Oliguria
d. Polydipsia

Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria. Adequate urine output, polyuria, and polydipsia aren’t associated with right-sided heart failure.

34. Which of the following classes of medications maximizes cardiac performance in clients with heat failure by increasing ventricular contractility?
a. Beta-adrenergic blockers
b. Calcium channel blockers
c. Diuretics
d. Inotropic agents

Inotropic agents are administered to increase the force of the heart’s contractions, thereby increasing ventricular contractility and ultimately increasing cardiac output. Beta-adrenergic blockers and calcium channel blockers decrease the heart rate and ultimately decrease the workload of the heart. Diuretics are administered to decrease the overall vascular volume, also decreasing the workload of the heart.

35. Stimulation of the sympathetic nervous system produces which of the following responses?
a. Bradycardia
b. Tachycardia
c. Hypotension
d. Decreased myocardial contractility

Stimulation of the sympathetic nervous system causes tachycardia and increased contractility. The other symptoms listed are related to the parasympathetic nervous system, which is responsible for slowing the heart rate.

36. Which of the following conditions is most closely associated with weight gain, nausea, and a decrease in urine output?
a. Angina pectoris
b. Cardiomyopathy
c. Left-sided heart failure
d. Right-sided heart failure

Weight gain, nausea, and a decrease in urine output are secondary effects of right-sided heart failure. Cardiomyopathy is usually identified as a symptom of left-sided heart failure. Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. Angina pectoris doesn’t cause weight gain, nausea, or a decrease in urine output.

37. What is the most common cause of abdominal aortic aneurysm?
a. Atherosclerosis
b. DM
c. HPN
d. Syphilis

Atherosclerosis accounts for 75% of all abdominal aortic aneurysms. Plaques build up on the wall of the vessel and weaken it, causing an aneurysm. Although the other conditions are related to the development of an aneurysm, none is a direct cause.

38. In which of the following areas is an abdominal aortic aneurysm most commonly located?
a. Distal to the iliac arteries
b. Distal to the renal arteries
c. Adjacent to the aortic branch
d. Proximal to the renal arteries

The portion of the aorta distal to the renal arteries is more prone to an aneurysm because the vessel isn’t surrounded by stable structures, unlike the proximal portion of the aorta. Distal to the iliac arteries, the vessel is again surrounded by stable vasculature, making this an uncommon site for an aneurysm. There is no area adjacent to the aortic arch, which bends into the thoracic (descending) aorta.

39. A pulsating abdominal mass usually indicates which of the following conditions?
a. Abdominal aortic aneurysm
b. Enlarged spleen
c. Gastic distention
d. Gastritis

The presence of a pulsating mass in the abdomen is an abnormal finding, usually indicating an outpouching in a weakened vessel, as in abdominal aortic aneurysm. The finding, however, can be normal on a thin person. Neither an enlarged spleen, gastritis, nor gastic distention cause pulsation.

40. What is the most common symptom in a client with abdominal aortic aneurysm?
a. Abdominal pain
b. Diaphoresis
c. Headache
d. Upper back pain

Abdominal pain in a client with an abdominal aortic aneurysm results from the disruption of normal circulation in the abdominal region. Lower back pain, not upper, is a common symptom, usually signifying expansion and impending rupture of the aneurysm. Headache and diaphoresis aren’t associated with abdominal aortic aneurysm.

41. Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?
a. Abdominal pain
b. Absent pedal pulses
c. Angina
d. Lower back pain

Lower back pain results from expansion of the aneurysm. The expansion applies pressure in the abdominal cavity, and the pain is referred to the lower back. Abdominal pain is most common symptom resulting from impaired circulation. Absent pedal pulses are a sign of no circulation and would occur after a ruptured aneurysm or in peripheral vascular disease. Angina is associated with atherosclerosis of the coronary arteries.

42. What is the definitive test used to diagnose an abdominal aortic aneurysm?
a. Abdominal X-ray
b. Arteriogram
c. CT scan
d. Ultrasound

An arteriogram accurately and directly depicts the vasculature; therefore, it clearly delineates the vessels and any abnormalities. An abdominal aneurysm would only be visible on an X-ray if it were calcified. CT scan and ultrasound don’t give a direct view of the vessels and don’t yield as accurate a diagnosis as the arteriogram.

43. Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client?
a. HPN
b. Aneurysm rupture
c. Cardiac arrythmias
d. Diminished pedal pulses

Rupture of the aneurysm is a life-threatening emergency and is of the greatest concern for the nurse caring for this type of client. Hypertension should be avoided and controlled because it can cause the weakened vessel to rupture. Diminished pedal pulses, a sign of poor circulation to the lower extremities, are associated with an aneurysm but isn’t life threatening. Cardiac arrhythmias aren’t directly linked to an aneurysm.

44. Which of the following blood vessel layers may be damaged in a client with an aneurysm?
a. Externa
b. Interna
c. Media
d. Interna and Media

The factor common to all types of aneurysms is a damaged media. The media has more smooth muscle and less elastic fibers, so it’s more capable of vasoconstriction and vasodilation. The interna and externa are generally no damaged in an aneurysm.

45. When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated?
a. Right upper quadrant
b. Directly over the umbilicus
c. Middle lower abdomen to the left of the midline
d. Midline lower abdomen to the right of the midline

The aorta lies directly left of the umbilicus; therefore, any other region is inappropriate for palpation.

46. Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms?
a. DM
b. HPN
c. PVD
d. Syphilis

Continuous pressure on the vessel walls from hypertension causes the walls to weaken and an aneurysm to occur. Atherosclerotic changes can occur with peripheral vascular diseases and are linked to aneurysms, but the link isn’t as strong as it is with hypertension. Only 1% of clients with syphilis experience an aneurysm. Diabetes mellitus doesn’t have direct link to aneurysm.

47. Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client?
a. Bruit b. Crackles c. Dullness d. Friction rubs
A bruit, a vascular sound resembling heart murmur, suggests partial arterial occlusion. Crackles are indicative of fluid in the lungs. Dullness is heard over solid organs, such as the liver. Friction rubs indicate inflammation of the peritoneal surface.

48. Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?
a. Lower back pain, increased BP, decreased RBC, increased WBC
b. Severe lower back pain, decreased BP, decreased RBC, increased WBC
c. Severe lower back pain, decreased BP, decreased RBC, decreased WBC
d. Intermittent lower back pain, decreased BP, decreased RBC, increased WBC

Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal cavity. When rupture occurs, the pain is constant because it can’t be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldn’t increase. For the same reason, the RBC count is decreased – not increase. The WBC count increases as cells migrate to the site of injury.

49. Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the perineal area?
a. Hernia
b. Stage 1 pressure ulcer
c. Retroperitoneal rupture at the repair site
d. Rapid expansion of the aneurysm

Blood collects in the retroperitoneal space and is exhibited as a hematoma in the perineal area. This rupture is most commonly caused by leakage at the repair site. A hernia doesn’t cause vascular disturbances, nor does a pressure ulcer. Because no bleeding occurs with rapid expansion of the aneurysm, a hematoma won’t form.

50. Which hereditary disease is most closely linked to aneurysm?
a. Cystic fibrosis
b. Lupus erythematosus
c. Marfan's syndrome
d. Myocardial infarction

Marfan’s syndrome results in the degeneration of the elastic fibers of the aortic media. Therefore, clients with the syndrome are more likely to develop an aortic aneurysm. Although cystic fibrosis is hereditary, it hasn’t been linked to aneurysms. Lupus erythematosus isn’t hereditary. Myocardial infarction is neither hereditary nor a disease.

51. Which of the following treatments is the definitive one for a ruptured aneurysm?
a. Antihypertensive medication administration
b. Aortogram
c. Beta-adrenergic blocker administration
d. Surgical intervention

When the vessel ruptures, surgery is the only intervention that can repair it. Administration of antihypertensive medications and beta-adrenergic blockers can help control hypertension, reducing the risk of rupture. An aortogram is a diagnostic tool used to detect an aneurysm.

52. Which of the following heart muscle diseases is unrelated to other cardiovascular disease?
a. Cardiomyopathy
b. Coronary artery disease
c. Myocardial infarction
d. Pericardial Effusion

Cardiomyopathy isn’t usually related to an underlying heart disease such as atherosclerosis. The etiology in most cases is unknown. Coronary artery disease and myocardial infarction are directly related to atherosclerosis. Pericardial effusion is the escape of fluid into the pericardial sac, a condition associated with pericarditis and advanced heart failure.

53. Which of the following types of cardiomyopathy can be associated with childbirth?
a. Dilated
b. Hypertrophic
c. Myocarditis
d. Restrictive

Although the cause isn’t entirely known, cardiac dilation and heart failure may develop during the last month of pregnancy of the first few months after birth. The condition may result from a preexisting cardiomyopathy not apparent prior to pregnancy. Hypertrophic cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency. Myocarditis isn’t specifically associated with childbirth. Restrictive cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually myocardial.

54. Septal involvement occurs in which type of cardiomyopathy?
a. Congestive
b. Dilated
c. Hypertrophic
d. Restrictive

In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum – not the ventricle chambers – is apparent. This abnormality isn’t seen in other types of cardiomyopathy.

55. Which of the following recurring conditions most commonly occurs in clients with cardiomyopathy?
a. Heart failure
b. DM
c. MI
d. Pericardial effusion

Because the structure and function of the heart muscle is affected, heart failure most commonly occurs in clients with cardiomyopathy. Myocardial infarction results from prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries. Pericardial effusion is most predominant in clients with percarditis. Diabetes mellitus is unrelated to cardiomyopathy.

56. What is the term used to describe an enlargement of the heart muscle?
a. Cardiomegaly
b. Cardiomyopathy
c. Myocarditis
d. Pericarditis

Cardiomegaly denotes an enlarged heart muscle. Cardiomyopathy is a heart muscle disease of unknown origin. Myocarditis refers to inflammation of heart muscle. Pericarditis is an inflammation of the pericardium, the sac surrounding the heart.

57. Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the following conditions?
a. Pericarditis
b. Hypertension
c. Obliterative
d. Restricitive

These are the classic symptoms of heart failure. Pericarditis is exhibited by a feeling of fullness in the chest and auscultation of a pericardial friction rub. Hypertension is usually exhibited by headaches, visual disturbances and a flushed face. Myocardial infarction causes heart failure but isn’t related to these symptoms.

58. Which of the following types of cardiomyopathy does not affect cardiac output?
a. Dilated b. Hypertrophic c. Restrictive d. Obliterative

Cardiac output isn’t affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged. Dilated cardiomyopathy, and restrictive cardomyopathy all decrease cardiac output.

59. Which of the following cardiac conditions does a fourth heart sound (S4) indicate?
a. Dilated aorta
b. Normally functioning heart
c. Decreased myocardial contractility
d. Failure of the ventricle to eject all the blood during systole

An S4 occurs as a result of increased resistance to ventricular filling adterl atrial contraction. This increased resistance is related to decrease compliance of the ventricle. A dilated aorta doesn’t cause an extra heart sound, though it does cause a murmur. Decreased myocardial contractility is heard as a third heart sound. An s4 isn’t heard in a normally functioning heart.

60. Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy?
a. Antihypertensive
b. Beta-adrenergic blockers
c. Calcium channel blockers
d. Nitrates

By decreasing the heart rate and contractility, beta-adrenergic blockers improve myocardial filling and cardiac output, which are primary goals in the treatment of cardiomyopathy. Antihypertensives aren’t usually indicated because they would decrease cardiac output in clients who are often already hypotensive. Calcium channel blockers are sometimes used for the same reasons as beta-adrenergic blockers; however, they aren’t as effective as beta-adrenergic blockers and cause increase hypotension. Nitrates aren’t’ used because of their dilating effects, which would further compromise the myocardium.

Result of the June 2009 Nursing Board Exam

noreply@blogger.com (GINO) — Sat, 29 Aug 2009 17:09:34 PDT

A total of 32,617 out of 77,901 passed the Nurse Licensure Examination with a national passing rate of 41.87%.

A student from Verallo Memorial Foundation top the June 2009 Nursing Board Exam in the person of Golda Manto Yap with an average of 86.60%. She is a mother of three and nursing was her second course. Currently she is working as a call center agent.

2. Ronie Rose Capati Arevalo, Adamson University — 86.40%

3. Michelle Alejandro Barberan, Arellano University-Manila — 86.20%

4. Caroline May Rellosa Chamen, Philippine College of Health & Sciences — 86.00%
Clarissa Leonor Tible Escober, Naga College Foundation — 86.00%

5. Marco Magtulis Dometita, University of Santo Tomas — 85.80%
Margaret Cheung Encarnacion, University of Santo Tomas — 85.80%
Marc Bago-Od Marzan, University of Santo Tomas — 85.80%
Lalaine Lim Perlas, Our Lady of Fatima University-Valenzuela — 85.80%
Debbie Rose Uy Tanengsy, Velez College — 85.80%

6. Lisa Angelica Vela Evangelista, University of Santo Tomas — 85.60%

7. Adrian Patrick Patawaran Calimag, University of Santo Tomas — 85.20%
Jed Asiaii Mariano Dimaisip, University of the Philippines-Manila — 85.20%
Aaron Miranda Esporlas, University of Santo Tomas — 85.20%

8. Mary Joy Sarreal Crisostomo, University of Santo Tomas — 85.00%
David John Gabriel Egbalic Cristobal, University of Santo Tomas — 85.00%
Libby Joy Recinto Evangelista, University of Santo Tomas — 85.00%
Ma Paula Rhove Rivera Ortega, University of the Philippines-Manila — 85.00%
Andrew Chua Tiu, Velez College — 85.00%
Ginelle Marie Galarpe Visaya, University of Santo Tomas — 85.00%

9. Helene Marie Mejorada Calderon, University of Santo Tomas — 84.80%
Abigail Ann Borromeo Candelario, University of Santo Tomas — 84.80%
Jan Benzon Tan Chan, University of Santo Tomas — 84.80%
Anna Melissa Señga Lo, University of Santo Tomas — 84.80%
Jernedell Geishar Tabugara Mabiling, Western Mindanao State University — 84.80%
Von Vener Palicpic Miguel, Perpetual Help College of Manila — 84.80%
Johanna Thomas Yu, University of Santo Tomas — 84.80%

10. Angela Carmela Fernandez Agbay, University of Santo Tomas — 84.60%
Pheelyp Edward Cruz Aytona, University of Santo Tomas — 84.60%
Julienne Katrina Bulaon Beltran, University of Santo Tomas — 84.60%
Maria Rosario Angala Brillante, University of Santo Tomas — 84.60%
Jasper Quintana Castillo, University of Santo Tomas — 84.60%
Diane Rachelle Cruz Crisostomo, Centro Escolar University-Malolos — 84.60%
Jose Mari Niño Leonor Cuarto, University of Santo Tomas — 84.60%
Salvador Isidro Buban Destura, Immaculate Conception College-Albay — 84.60%
Abigail Joanna Uy Doluntap, University of Santo Tomas — 84.60%
Rove Ann Tonolete Enguerra, Trinity University of Asia (Trinity-QC) — 84.60%
Jana Flores Fragante, University of Santo Tomas — 84.60%
Jan Igor Temple Galinato, Mindanao State University-Marawi City — 84.60%
Divina Viktoria Pobre La Torre, University of Santo Tomas — 84.60%
Vanessarose Delavin Lim, Far Eastern University-Manila — 84.60%
Rachel Rañola Milante, University of Santo Tomas — 84.60%
Loraine Ab-Abaen Payangdo, Benguet State University-La Trinidad — 84.60%
Kristine Arcilla Ramos, Catanduanes State Colleges-Virac — 84.60%
Robert Joe Isip Sagum, Far Eastern University-Manila — 84.60%
Ingrid Buela San Juan, University of the Philippines-Manila — 84.60%
Christelle Miracle-An Quizon Santiago, University of Santo Tomas — 84.60%
Jian Laurice Ramos Sicat, Angeles University Foundation — 84.60%
Miriem Paulle Beltran Soriano, Saint Louis University — 84.60%
Teddy Jr Chan Untalasco, Lorma College — 84.60%

TO FACILITATE viewing of the nurse exam results, the results have been broken down into separate files organized alphabetically by the surnames of the successful examinees. Click on a letter below to view the corresponding file.

A1
A2
B1
B2
C1
C2
D1
D2
E
F
G1
G2
H
I
J
K
L1
L2
M1
M2
N
O
P1
P2
Q
R1
R2
S1
S2
T1
T2
U
V
W
Y
Z

Congratulations to new Registered Nurses.

June 2009 Nursing Board Exam Result

noreply@blogger.com (GINO) — Sat, 29 Aug 2009 17:09:18 PDT

The June 209 Nursing Board Exam Result will be released anytime this week. Rumors spread that the result will be out at the night of June 24, but unfortunately it was not released. Speculations said that only 44% made it in passing the June 2009 Nursing Board Examination. That's a huge percentage compare to the past Nursing Licensure Examinations.

Results of the June 2009 Nursing Board Exam will be posted in this site. Keep posted to see if your name is one of the lucky examiner who made it in passing the June 2009 Nursing Board Exam.

Congratulations to the new Registered Nurses!

Techniques in Manual HAndling of Children

noreply@blogger.com (GINO) — Sat, 29 Aug 2009 17:05:37 PDT

Moving and handling infants, children and young people is an integral part of nursing practice, and competent handling is an essential component of holistic care – but the nurse needs to be acutely aware of the risk of manual handling.

The risk of musculoskeletal damage and injury must be considered by all who work in the clinical environment, irrespective of the activity being undertaken. Twenty-four per cent of NHS staff regularly experience back pain, and one in four nurses will have taken time off work at some time with a back injury sustained at work (DH, 2004).

The need to look after one’s back is paramount, and this has been addressed through training, the introduction of medical aids to assist with manual handling, safe-handling policies and campaigns to promote safe working practices. Safe-handling policies often state that nurses should not lift at all (RCN, 2002). This does not fully reflect the needs of the infant and child in hospital.

Height-adjustable cots are not readily available. Parents often accompany their child to hospital and a bed for the parent alongside the child’s bed or cot often restricts access for the nurse to perform nursing care, particularly at night-time when he or she is trying not to disturb the parent or child.

When working with infants and children, much time is spent working at the level of the child and holding infants and children. This is either to perform nursing care such as feeding or medication administration or to comfort them. In these circumstances, the ‘no lifting’ principle advocated by the guidelines needs careful consideration. This type of moving and handling is often referred to as therapeutic handling since it is necessary in order to be able to deliver patient care. It would seem terribly cruel to leave an unaccompanied child crying in a cot when a cuddle would pacify them. Education, having height adjustable beds and cots and individual ‘child specific’ risk assessment forms will enable the practitioner to determine appropriate safeguards whether in hospital, community or home environments.

Before undertaking the activity of moving and handling, you need to understand the musculoskeletal system and how this functions. Safe-handling practice can be defined as an ergonomic approach to handling people, encouraging independence where possible and the appropriate use of equipment while promoting independence (Brown-Wilson, 2001).

The Importance of Play Among Children

noreply@blogger.com (GINO) — Sat, 29 Aug 2009 17:05:51 PDT

Play has been referred to as one of the ‘most important aspects of a child’s life’ (Wong et al., 1999, p. 1171).This chapter will explain the rationale behind this statement, and how the student can contribute to this vital aspect of a child’s world. It is intended that by the end of the chapter the student will have gained a greater understanding of the relationship between play and cognitive, social, psychological and emotional development. Chapter 3 of this text also addresses the important issue of play, from a different but complementary perspective.

Bruce (1996, p. 1) describes play as a ‘reservoir full of water.The deeper the reservoir, the more water can be stored in it, and used during times of drought.’ This time of drought referred to by Bruce could reflect those instances in a child’s life when he or she may experience distress due to illness, injury or any other times of physical or emotional trauma. As a result of reading this chapter and working through its scenarios, it is anticipated that you will feel more confident in using play as a form of communication during therapeutic interventions, as a resource that can be used in preparing children for clinical procedures and as a form of distraction therapy.

Developing skills of assessment is an essential prerequisite for those involved in the care of children. Observing how a child plays and interacts can offer valuable information in relation to their condition and relationship experiences (Wong et al., 1999). Developing an understanding of the purpose of play, and what can be expected in relation to engaging in play at various developmental stages, provides the reader with an opportunity to contribute to the multidisciplinary team and assist with appropriate care planning for individual children.

Before examining play in relation to child development and the importance of ensuring that all children are offered the opportunity for play, the immense benefits will be considered. Bruce (1996, p. 3) suggests that play helps children to become ‘whole people’, who are ‘physically healthy, co-ordinated, mentally healthy, manage feelings and ideas and co-ordinate ideas’. If children are permitted to use play during childhood, they can continue to use the resource to live full lives contributing to the mental and physical well-being of others, becoming creative, sensitive and imaginative adults who have secure relationships with others. Bax et al. (1990) remind us that the significance of play to a child’s life is not a new phenomenon. Aristotle believed that it was the highest form of human activity; this belief reinforces the need to be able to promote and provide play wherever children are cared for.

The exploration of the importance of play will begin with an understanding of its relationship with physical and cognitive development and what can be expected of children when engaging in play. Cognitive development is discussed in the next section of this chapter.

Caring for Children and Families. Edited by I. Peate and L.Whiting © 2006 John Wiley & Sons Ltd

Principles of Moving and Handling of Children

noreply@blogger.com (GINO) — Sat, 29 Aug 2009 17:06:04 PDT

Adherence to the principles of moving and handling are paramount if we are to ensure the safety of the patient, their family members, our colleagues and ourselves. You must adhere to your Trust’s policy on manual handling. The key principles of safe moving and handling infants, children and young people are as follows.
1. Do not lift if at all possible.
2. If a child needs to be moved, appropriate equipment should be utilized where necessary. It is important to communicate the procedure to the child and family beforehand. The child and family need to be involved in discussions and their preferences identified.
3. Encourage the child to help as much as they possibly can themselves; ultimately, this may avoid the need for manual handling. It is important that the child feels that they are not being transported from one place to another with little or no say. For example, a child on bed rest might be able to do a bridge when they require a bedpan or having their clothes changed. If transferring a child from a bed to a chair, they may well be able to edge their way to the side of the bed, thus completing the first part of the process, or a sliding sheet may be placed beneath them to help them move more independently.
Any independence that can be encouraged is important as it will increase the child’s feelings of security, well-being and self-esteem.
4. Do not try to perform other tasks while lifting or handling a child.
5. There is no such thing as a quick lift or a ‘simple assist’.
6. Many children are too heavy to be lifted and equipment is required.
7. If lifting cannot be avoided, the risk needs to be assessed. Refer to the child’s care plan. Identify handling hazards and regularly review this care plan.
8. Consider the task, individual, load, environment and equipment before progressing with handling the child, ensuring the correct skills are possessed by all those involved in the handling process.

Handling Hazardous and Infectious Materials

noreply@blogger.com (GINO) — Sat, 29 Aug 2009 17:06:17 PDT

• A hazardous material is a material capable of causing a harmful physical or health effect. Hazardous wastes can be liquids, solids, contained gases, or sludges.
• Resource Conservation and Recovery Act (RCRA) identifies a hazardous waste as one that exhibits at least one of the four characteristics—ignitability, corrosivity, reactivity, or toxicity.
• Federal, state, and local agencies oversee the handling of hazardous materials to protect the public from harm.

HANDLING AND STORAGE
• Hazardous materials need to be stored correctly to prevent spills and uncontrolled reactions, and to minimize employee exposure.
• Three principles form the basis of the plan for safe handling of hazardous materials:
—minimize exposure to harmful materials through product substitution and keeping limited quantities on hand.
—assume all chemicals are hazardous and handle accordingly.
—use proper control measures, such as, written policies and procedures, education, and protective equipment.
• Hazardous materials need to be stored based on their compatibility and not necessarily in the alphabetical order.
Substances need to be stored in their original containers.
• To decrease individual exposure to hazardous materials, common engineering controls, such as, local exhaust and general ventilation can be used. Other protective items that could be employed are safety glasses, gloves, and/or hearing protection.
• Development of a plan for safe handling of the hazardous or infectious material needs to include five elements.
—Element one requires maintenance of a current hazardous- waste inventory listing, which should include the full chemical name, storage location, quantities, and information regarding the hazard.

—Element two speaks of the labeling of all containers.
—Element three addresses maintaining a Material Safety Data Sheet(s).
—Element four plans for employee education and training.
—Element five provides for regular review and updating of the plan.

Biological Agents
• Agents of concern are highly pathogenic bacteria and viruses.
• The Center for Disease Control (CDC) has classified specific agents as category A, B, or C.
—Category A agents are the most dangerous (anthrax, botulism, plague, smallpox, tularemia, viral hemorrhagic fever viruses, etc.). These agents are given the highest priority in disaster planning as they pose the most potential threat to the public.
—Category B agents are the second most dangerous agents (brucellosis, salmonella, melioidosis, psittacosis, Q fever, typhus fever, viral encephalitis, etc.).
—Category C represents “emerging” agents (Nipah fever, Hantavirus, etc.).
• Client history and physical condition are key tools in assessing the client’s exposure to a biological agent, when making a diagnosis.
• Principles of infection control, beginning with universal precautions, are essential to managing the client.
Radiation
• Radiation is “energy emitted by atoms that are unstable.”
• Radioactive contamination is the “presence of radiation emitting substances in a place where it is not desired.”
• Radiological incident is when people or the environment is exposed to radiation or radioactivity through accident or misuse. The exposure may lead to death but more commonly, exposure only requires decontamination and monitoring of the client.
• Nurses need to limit the time spent with radioactive clients, to remain at a distance whenever possible, and to wear protective devices

Standards of Care for Geriatric Unit

noreply@blogger.com (GINO) — Sat, 29 Aug 2009 17:08:59 PDT

All nursing personnel within the geriatric unit should adhere to the set standards of care in rendering quality and effective care to the patients.

The following are the standards of care:

1.Necessary forms needed for admission should be checked, as well as consent forms should be secured before any patient to undergo any procedures. Patients or their significant others should be oriented and be well explained about the treatment that they can receive, about certain procedures and the like.
2.Privacy should at all times be observed in performing any procedures to the patient regardless of gender, political affiliations, race and religion.
3.Appropriate and timely care should be given to every patient and care should be in holistic approach. Every problem or any inquisitions of patients and their significant others should be addressed and dealt with aptly.
4.All personnel should be skilled in operating the health facilities and equipment within the unit it should be readily available when needed, assist for patient’s fast recovery.
5.Unit’s environment should be conducive and well modified for patient’s fast recuperation:
Patient’s safety must be observed always.
Provision of peaceful and stress free environment must be maintained.
All personnel should strictly observe infection control in rendering care to every patient; this is to prevent putting each patient to further risk.
All personnel should strictly adhere to the proper waste segregation policy.

Preventive Nursing Interventions for Urinary Retention

noreply@blogger.com (GINO) — Sat, 29 Aug 2009 17:08:41 PDT

The major sign of urinary retention is the absence of voided urine. A distended bladder differentiates retention from oliguria or anuria. The distended bladder can be palpated above the level of the symphysis pubis. Percussion of a full bladder elicits a “Kettle drum” sound. Conversely, percussion of an abdomen distended by intestinal gas produces a hollow sound.

The alert patient who has a distended bladder will complain of increasing discomfort and pain. He may be restless, anxious, diaphoretic, and hypertension. (Normotension follows catheterization.)

The overdistended bladder may expel enough urine to relieve the pressure within it temporarily. The patient with a distended bladder who voids frequently in small amounts has retention with overflow.

Preventive Nursing Interventions

1.identify patient’s at risk; consider age, type of surgery, route of anesthesia, and fluid status.
2.avoid making the patient anxious as this may contribute to his inability to void.
3.assist the patient to ambulate as soon as possible after surgery, unless contraindicated.

1.turn the water on so that the patient can hear it. This may work via the power of suggestion and also obliterates the sound of urination. The latter may be very important to the patient if he has a roommate.
2.pour warm water over the perineum or have the patient sit in a warm bath. These interventions may appeal to the power of suggestion as well as facilitate muscle relaxation.
3.lightly stoke the inner aspect of the thigh or apply ice to the inner thigh. Theses actions may stimulate trigger points, thus initiating the micturition reflex.
4.assist the patient to a normal voiding position, unless contraindicated. For example, help a male patient to stand and assist a female patient either to a bedpan placed on a chair next to the bed or to the bedroom.
5.if possible leave the patient alone when he urinates. Many people are unable to urinate in someone’s presence.
6.if the patient can sit up or stand to void, having him lean forward or push on the abdomen with his arms or hands may facilitate voiding. These actions increase the intra-abdominal pressure.
7.maintain a positive attitude, that is, that the patient will void. Do not threaten the patient with catheterization as the resulting increased anxiety does nothing to facilitate spontaneous voiding.

Genitourinary Complication Postoperatively

noreply@blogger.com (GINO) — Sat, 29 Aug 2009 17:08:23 PDT

Urinary output during the first 24 hours after surgery is normally less than the 1200 ml to 1500 ml of urine that an adequately hydrated adult with normally functioning kidneys produces. The first voiding after surgery is usually about 200 ml and surgical diuresis occurs on the second or third postoperative day.

For at least the first 24 to 48 hours after surgery the body retains fluid as part of its response to stressors inherent in the perioperative period. While increase catecholamine production results in an increase in the blood supply to the brain, heart, and skeletal muscles, it causes a decreased supply to the kidney. Additionally, increased production of antidiuretic hormone and corticoids leads to retention of sodium and water, with a resulting increased intravascular volume. Similarly, increased aldosterone activity causes increased retention of sodium and water. These physiologic responses all contribute to decreased urine production.

Other factors also contribute to decreased urine production. These include the patient’s preoperative hydration status, intraoperative events, and the effect of various preoperative medications. Preoperative dehydration, loss of body fluids during surgery, and an increased insensible body fluid loss all contribute to decreased urine production

Medications administered throughout the perioperative period affect renal blood flow and the production of antidiuretic hormone. General anesthetics cause a marked decrease in renal blood flow. There is a decrease in glomerular filtration rate and urine volume and an increase in osmolality. Other perioperative medications such as morphine sulfate, meperidine hydrochloride (Demerol), and Innovar decrease the glomerular filtration rate usualla as a function of decreased renal blood flow secondary to decreased blood pressure. Regional anesthesia (spinal or epidural) causes minimal changes in glomerular filtration rate or renal blood flow as long as hypotension is prevented or treated with fluids.

While decreased urine production is normal the first 24 hours to 48 hours after surgery other events are not. Postoperative complications involving the genitourinary system include urinary retention and urinary tract infection.

Pain Relief techniques After Surgery

noreply@blogger.com (GINO) — Sat, 29 Aug 2009 17:08:05 PDT

The vast majority of patients experience pain after surgery. Postoperative pain can be frightening and can adversely affect a patient’s recovery. It not only causes discomfort and anxiety, but also contributes to the development of pulmonary complications.

Preoperatively the nurse explains the interventions that will be used to relieve the pain. She also describes the sensations that the patient may experience and the measures that will be used to minimize distressing and painful situations. The nurse instructs the patient to ask for pain medication when he needs it and not to wait until the pain becomes severe. The nurse advises the patient to intercept the pain and not to endure it. The patient suffers less, is less anxious, and is more in control of his discomfort. As an important reminder, research has found that nurses tend to undermedicate postoperative patients.

If an electronic pain control device or epidural narcotics will be used, the nurse explains them. Additionally, she demonstrates and asks for return demonstration of noninvasive techniques such as destruction and relaxation.

Preoperatively the nurse assesses the patient’s pain experience. She explores his experience with pain and ascertains the amount of discomfort he expects postoperatively. She asks him to describe the pain he experienced with previous surgeries and the pain relief techniques that were effective. If the patient has not had previous surgery, the nurse asks him how he copes with a headache and backache.

The nurse also assesses the type of anxiety to which the patient is prone. Trait anxiety is a personality characteristic that increases the fear of generally threatening experiences. Based in the patient’s social, cultural and religious background, trait anxiety stems from complex psychological factors.

State anxiety is a transient emotional response to a specific threatening experience. While normally not afraid, the patient is now fearful because of a current event such as impending surgery.

The patient with high levels of trait anxiety may need more pain medication postoperatively. Whilr postoperative pain is not greater, its emotional impact is.

How to Select the CorrectTherapeutic Communication Answers

noreply@blogger.com (GINO) — Sat, 29 Aug 2009 17:07:20 PDT

A. Read all the answers choices and visualize yourself saying them to the patient.
B. Eliminate the following:

Authoritarian Answers: those which tell the patient what to do without regard to the patient’s desires or feelings.
Examples:
1.Insisting that the patient follow unit rules
2.Insisting that the patient do what you command immediately
Close-ended questions: those that can be answered with the words “yes” or “no”, or another monosyllabic response. Close ended questions discourage the client from sharing thoughts and feelings
Examples:
1.Are you feeling guilty about what happened?
2.How many children do you have?

“Why” questions: ones that seek reasons or justifications. Why questions imply disapproval of the patient who may become defensive. A why question can come in many forms and need not always begin with “why”. Any response that puts the patient on the defensive is non-therapeutic.
Examples:
1.What makes you think that?
2.Why do you feel this way?

“Let’s explore questions”: you are not being tested as regards your ability to be a “junior psychiatrist”. It isn’t the nurse’s role to delve into the reasons why the patient is feeling a particular way. The patient must be allowed to verbalize the fact that he/she is sad, angry, fearful, or overwhelmed.
Examples:
1.Let’s talk about why you didn’t take your medication.
2.don’t worry. Your doctors will do everything necessary for your call.

“Nurse-focused answers: the focus should be on the patient. Eliminate these answers no matter how emphatic they may sound.
Examples:
1.That happened to me once
2.I know from experience this is hard for you.

C. Choose the answer choices that gives correct information and reflects the patient’s feelings. Choose emphatic, reflective, informative statements.

Preparing Client for Diagnostic Testing

noreply@blogger.com (GINO) — Sat, 29 Aug 2009 17:06:53 PDT

Purpose:
To increase the reliability of the test by providing client teaching on why the test is being performed, what the client can expect during the test and the outcomes and side effects of the test. To decrease the clients anxiety about the test and associated risk

Supportive Data:
Increasing the clients knowledge, promotes cooperation, enhances the quality of the testing and decrease the time required to perform the study with an outcome of increased cost effectiveness. Proper physical preparation prevents delays.

Assessment:

1.Check to be sure the client is wearing an identification band.
2.Review the medical record for allergies and previous adverse reaction to dyes and other contrast media, a signed consent form and the recorded findings of diagnostic tests relative to the procedure.
3.Assess the presence, location and characteristics of physical and communitive limitations of preexisting conditions.
4.Monitor the client’s knowledge of why the test is being performed and what to expect during and after the testing.
5.Monitor vital signs for client scheduled for invasive testing to establish baseline data.
6.Assess client outcome measures relative to the practitioner’s preference for preprocedure preparations
7.Monitor level of hydration and weakness for clients who are NPO (nothing by mouth), especially geriatric and pediatric populations.

Repost to Practitioner:
Allergy, previous adverse reaction or suspected adverse reaction following administration of drugs.

Interventions:

1.Clarify with practitioner if regularly scheduled medications are to be administered.
2.The NPO status is determined by the type of test.
3.Administer cathartics or laxatives as denoted by the protocol, however there must be specific practitioner order to give children and infants a laxative. Instruct client who are weak, especially geriatric clients, to call for assistance to bathroom.
4.Teach relaxation techniques, such as deep breathing exercises and imagery.
5.Establish intravenous (IV) access if necessary for procedure.

Evaluation:
1.Client’s knowledge of what to expect

1.Client’s level of anxiety.
2.Client’s level of safety and comfort.
3.Monitor that someone will accompany a child to the department where the test is to be performed and remain with the child during the test if not at risk for harmful exposure.

Client teaching: Discuss the following with the client and family as appropriate to the test:
1.Reason for the test and what to expect.
2.An estimation of how long the test will take.
3.NPO (if oral medication to be taken, how much water to drink)
4.Cathartics or laxative, how much, how often
5.Sputum, cough deeply, do not clear throat
6.Urine: voided, clean catch specimen, time to collect
7.No objects (jewelry or hair clip) to obscure x-ray film
8.Barium: taste, consistency, aftereffects (stools lightly colored for 24-72 hours, can cause obstruction/impaction
9.Iodine: metallic taste, delayed allergic reaction (itching, rashes, hives, wheezing and breathing difficulties
10.Positioning during the tests
11.Positioning post test (angiography)- immobilize limb
12.Post test, encourage fluids if not contraindicated

Documentation: Record the following in the client’s medical record
1.Practitioner notification of allergies or suspected adverse reaction to the contrast media.
2.Presence, location and characteristics of symptoms.
3.Teaching and the client’s response to teaching.
4.Response to interventions (client’s outcomes)

American Cancer Society Recommendations for the Early Detection of Cancer in Asymptomatic People

noreply@blogger.com (GINO) — Sat, 29 Aug 2009 17:06:40 PDT

Cancer related check-up
Every 3 years for people aged 20-40
Every year for people aged 40 and older
Includes health and counseling, examinations for cancers of the thyroid, oral cavity, skin, lymph nodes, testes and ovaries as well as for some nonmalignant diseases

Breast
Women 40 years and older
Mammogram- annual
Clinical Breast Exam (CBE)- annual
Breast Self Exam (BSE)- monthly
Women aged 20-39
CBE- every 3 years
BSE- monthly

Colon and Rectum
Men and women aged 50 years or older should follow one of the examination schedules below:
Fecal occult blood test: every year
Flexible Sigmoidoscopy: every 5 years
Colonoscopy: every 10 years
Double contrast barium enema: every 5 to 10 years
Digital Rectal Exam: should be done at the same time as sigmoidoscopy, colonoscopy, or double contrast barium enema

Prostate
Men 50 years and older and younger men who are high risk
Prostate specific antigen (PSA) blood test: annual
Digital rectal exam: annual

Uterus
Cervix: all women who are or have been sexually active or who are 18 and older should have:
Papanicolaou’s (Pap) Test: annual; after 3 or more consecutive satisfactory examinations with normal findings, the Pap test may be performed less frequently.
Endometrium: Women high risk for cancer of the uterus should have a sample of endometrial tissue examined when menopause begins.