DavaoNurses

June 2009 NLE Result

noreply@blogger.com (NurseHarbee) — Sun, 26 Jul 2009 13:43:00 +0800

The Professional Regulation Commission (PRC) announces that 32, 617 out of 77, 901 passed the Nurse Licensure Examination given by the Board of Nursing in the cities of Manila, Baguio, Cagayan de Oro, Cebu, Davao, Iloilo, Legazpi, Lucena, Tacloban, Tuguegarao, Sulu, Pagadian and Zamboanga last June 2009.

The members of the Board of Nursing are Carmencita M. Abaquin, Chairman; Leonila A. Faire, Betty F. Merritt, Perla G. Po, Marco Antonio C. Sto.Tomas, Yolanda C. Arugay and Amelia B. Rosales, Members.

This year’s licensure examination for nurses top 1 is Golda Manto Yap, a graduate of the Felipe R. Verallo Memorial Foundation with a rating of 86.80 percent. June 2009 Nursing Board Exam Results

Performance of Davao City Nursing Schools in June 2009 NLE

noreply@blogger.com (NurseHarbee) — Sun, 26 Jul 2009 13:40:00 +0800

Davao Nursing Schools Performance

UK Student Visa Assistance with Study Connect International Services, Inc

noreply@blogger.com (NurseHarbee) — Sat, 4 Jul 2009 07:00:00 +0800

Hi fellow Nurses,

I would like to share to you this consultancy firm named STUDY CONNECT INTERNATIONAL SERVICES, they are into providing assistance for Nurses and other courses who are interested to go to other country. They offer Student Visa for United Kingdom under the LEARN and EARN PROGRAM of UK. Just in case you are in search of consultancy firms like this one below, do not hesitate to contact this firm.

INQUIRIES CLICK HERE

Study Connect International Services, Inc was founded on December 7, 2007 and registered with the SEC (Security & exchange Commission) on March 19, 2008. Since then we gained more than 600 clients and the number is still increasing from day to day proving itself true to its motto: “We Deliver What We Promise”.

UK & Canada

The company specializes in assisting students and providing professional as well as visa /immigration advice to prospective students intending to go to the United Kingdom and Canada to study. We work in co-operation with Universities, Colleges and Training Providers, who are licensed sponsors who meet the new UK immigration requirements.

The company promote these institutions, attract prospective students and help them with enrollment. The company also work with UK partners in finding study work placements for students, where this is needed.

Study Connect International Services, Inc is a small, friendly, efficient team that is committed to delivering a high level of service to both our students as well as the institutions we represent.

VISIT MY NEW SITE

noreply@blogger.com (NurseHarbee) — Sat, 4 Jul 2009 05:16:00 +0800

To all readers, viewers and visitors of this site

Me and my online buddy would like to invite you to visit our new website. The new site will have a lot of new and relevant information for the Nurses and Student Nurses.

http://nursesnotes.info/
" your online guide to the latest information in the world of nursing in the Philippines"

On this new site we aim to deliver the latest information about the current nursing trends, seminars, and trainings pertaining to the nursing profession. The moderators of this site would like to emphasize that this site is especially dedicated to all Registered Nurses, soon to be Nurses and Student nurses who are planning to work here in the country and abroad.

As of now me and my partner is still on the process of uploading files. We have gathered NEW materials, softwares, reviewers, ebooks, for both foreign and local examinations. We also have new collection of powerpoint files and ebooks for student nurses.

We would like to encourage everyone to log on and register to the site so that you will be updated via email regularly.

We are also looking for Nurses who are willing to be a part of our site as our moderators/correspondent/contributors in different location. Nurses and Student Nurses from Luzon, Visayas and Mindanao, are welcome to join and help us in sharing information about Nursing in your area. If you are interested please feel free to contact me at nurseharbee@gmail.com or you may text me at 09276335807

PLEASE DON'T FORGET TO REGISTER

http://nursesnotes.info/
" your online guide to the latest information in the world of nursing in the Philippines"

Nursing Opportunity in Australia

noreply@blogger.com (NurseHarbee) — Thu, 11 Jun 2009 08:58:00 +0800

THIS IS AN OPPORTUNITY FOR FILIPINO NURSES TO COME TO SYDNEY THRU APPLYING A TOURIST VISA

AN invitation from AUCEC (Australian Careers & Education Consulting).... I am just posting this info from them. Heto po yung invitation nila para sa atin. (If you have some questions about the process and fees, please go to their official website atwww.aucec.com.au)

We would like to invite you to join the upcoming Sydney Studytour which will run from 7-18 September 2009 in partnership with Australian Catholic University (www.acu.edu.au).

The Studytour aims specifically for Nurses, Doctors, IT, Accountants, Teachers, Engineers, Business and for others who are graduates of other courses. We also welcome participants who are students in High School or currently who are in the University, parents, friends and relatives to attend this Sydney event! This event focuses on the participants opportunities to study-work-migrate to Australia.

The Package 2-weeks Studytour includes:

- Visa assistance from AUCEC
- Rydges Hotel Accommodations
- Buffet Breakfast and Dinner @ Rydges Hotel North Sydney
- Career sessions
- Appointment with our Migration Agent & AUCEC Consultants
- A Seminar on issues such as the following will be discussed:

1. How Nurses, Doctors and other professionals can apply thru Intl Student Visa to migrate Australia

2. How nurses can still become an Australian registered nurse even though they are not a board passer or do not have a work experience at all

3. How a Registered Nurse who does not have an IELTS of 7.0 can still become an Australian registered nurse

4. Why is it better for current High School / University students to continue their studies in Australia instead of completing it in their home country?

5. How other graduates who has a Bachelor of Science degrees can enter to study Nursing in Australia

6. How you can include on your application your spouse, partner in Australia

7. How an Intl Student (including his/her partner/spouse) can legally work in Australia

8. How you can still enter a Universitiy even not meeting an IELTS requirement score

9. How you can take a Masteral course in Australia that is different from your Bachelor's degree

- Assistance in applying directly for your Intl Student Visa application or to the Nursing Board while in Australia

- Assistance in applying to enter the Bachelor and Masteral Courses

- Sydney City Sightseeing

- Visits to potential employment sites such as Hospitals, Aged Care Facilities, Government Dept, Commercial Business etc.

- Barbeque with ACU Students

- Certificate of Participation

Since tourist visa normally is up to 3 months, AUCEC would like to open your opportunity to maximise your stay in Australia by acquiring an Australian course and training that will be beneficial to your nursing career and future employment opportunities in Australia and other Western countries.

We have negotiated a group special rates with Rydges Hotel in North Sydney and Campbelltown (for more info seewww.rydges.com) who is our official accommodation provider for all partipants for this event.

AUCEC can assist you with your tourist visa application and liasie with the Australian Embassy in your behalf to enable you to attend this event

Should you need to confirm this event with immigrations, please do not hesitate to contact:

Daniela Bellomo

International Event Coordinator Network (IECN) –

National Office Specialist Entry Section, Education and Tourism Branch

Department of Immigration and Citizenship

Telephone Nos:

1300 550 684 (within Australia)

+61 1300 550 684 (international)

www.immi.gov.au/visitors/event-organisers-participants/index.htm

Upon your payment for registration, we will send you AUCEC & ACU invitation letters to support you when lodging your visa application at the Australian visa office overseas nearest to your current place of residence.

AUCEC will also act as your authorized agent when you lodge your application and will liaise in your behalf to immigrations should any issues arise in regards to this event. Please be advise that your application will still be subject to Australian Embassy requirements and guidelines.

For any information in regards to the Studytour at the Australian Catholic University, please contact:

Michelle Willoughby

International Programs Manager

Australian Catholic University Limited ABN 15 050 192 660

CRICOS: 0004G, 00112C, 00873F, 00885B

40 Edward Street

PO Box 968

North Sydney NSW 2059

Telephone: (02) 9739 2325

Michelle.Willoughby@acu.edu.au

www.acu.edu.au

As a Tourist visa applicant, you would normally have a 3 months allowed maximum stay in Australia and you can study legally as well during this time.

Certificate III in Aged Care Work at Active Working Solutions at Campbelltown Private Hospital
After the 2 weeks attendance to Studytour we are also offering the participants to also attend Active Working Solutions (www.activeworkingsolutions.com.au) in Campbelltown Private Hospital for the 10 - weeks study and training of Certificate III in Aged Care Work.

Participants from the Studytour who are also enrolled to study Certificate III in Aged Care Work will get their study modules emailed while in their home country immediately. Once the Studytour ends, all participants who are enrolled for the course will be transported to Rydges Hotel Campbelltown, the closest accommodation provider to Campbelltown Private Hospital.

The benefit for you: This is a must have or mandatory course for applicants who are nurses or would like to work in a nursing environment and who are planning of returning to Australia under an Intl Student Visa to apply to work immediately to any nursing facilities/ organizations asap.

If not, this is a great skill to have in your resume when you apply for work in your home country or to any other country.

For any information in regards to the 10 weeks study and training at Active Working Solutions at the Campbelltown Private Hospital after the 2 weeks Studytour, please contact:

Jacquie Castro

NSW Vocational Training Manager

Active Working Solutions/Recovre

National Head Office

PO Box 854, Campbelltown NSW 2560

Office Tel: 1300 132 990

Fax: 1300 132 991

Email: jcastro@activeworkingsolutions.com.au

This event is supported by The American Chamber of Commerce in Australia, see http://www.amcham.com.au/vpLink.aspx?ID=18000

If you have any queries in regards the Studytour, please contact directly via email at info@aucec.com.au or charmaine@aucec.com.au or call Mobile (+61) 405 660 878.

You can also visit their website for more information. www.aucec.com.au

LIMITED SEAT ONLY!

Please don't forget to indicate that you are referred by DavaoNurses Site. (para maging isang group tayo na magtulungan kung meron man problema).

Thanks!!!

Requiremenr for Nurse Volunteer Program @ Ospital ng Maynila

noreply@blogger.com (NurseHarbee) — Wed, 10 Jun 2009 21:31:00 +0800

The volunteer program is good for 2 Months and its free. A Nurse volunteer is required to complete 320 contact hours before being issued a certificate.

Here are the documents that you need to submit

Letter of Intent, address it to

Fidel C. Chua, MD

Hospital Director

Ospital ng Maynila

Thru: Mrs. Asuncion C. Balisado, RN

Chief Nurse

2. Photocopy of you PRC ID

3. Photocopy of the following

- Transcript of Record

- BSN Diploma

- Summary of Related Learning Experience

- Board Certificate / Board Rating

- Certificates ( Trainings and Seminars )

Goodluck Fellow Nurses

Attention: PHILIPPINE AIRFORCE HIRED NURSES

noreply@blogger.com (NurseHarbee) — Wed, 10 Jun 2009 17:58:00 +0800

Please be informed that we have an additional requirements:

1. Chest Xray

2. Drug Test Results

3. Medical Certificate

We may secure these at any hospitals and/or diagnostic centers (they don't have a list of accredited institutions). We can submit them on our contract signing day, June 12. Call time is at 6am, please come wearing white tshirt and pants (didn't say if 'maong' or anything). For more details, please contact PAF @ Directorate for Civilian Personnel Affairs (DCPA) A-1, Headquarters Philippine Air Force at nos. 854-6701 local 6701, or 6621

CHN Test Drill (Answers and Rationale)

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 15:58:00 +0800

SITUATION : Epidemiology and Vital statistics is a very important tool that a nurse could use in controlling the spread of disease in the community and at the same time, surveying the impact of the disease on the population and prevent it’s future occurrence.

1. It is concerned with the study of factors that influence the occurrence and distribution of diseases, defects, disability or death which occurs in groups or aggregation of individuals.

A. Epidemiology
B. Demographics
C. Vital Statistics
D. Health Statistics

2. Which of the following is the backbone in disease prevention?

A. Epidemiology
B. Demographics
C. Vital Statistics
D. Health Statistics

3. Which of the following type of research could show how community expectations can result in the actual provision of services?

A. Basic Research
B. Operational Research
C. Action Research
D. Applied Research

4. An outbreak of measles has been reported in Community A. As a nurse, which of the following is your first action for an Epidemiological investigation?

A. Classify if the outbreak of measles is epidemic or just sporadic
B. Report the incidence into the RHU
C. Determine the first day when the outbreak occurred
D. Identify if it is the disease which it is reported to be

5. After the epidemiological investigation produced final conclusions, which of the following is your initial step in your operational procedure during disease outbreak?

A. Coordinate personnel from Municipal to the National level
B. Collect pertinent laboratory specimen to confirm disease causation
C. Immunize nearby communities with Measles
D. Educate the community in future prevention of similar outbreaks

6. The main concern of a public health nurse is the prevention of disease, prolonging of life and promoting physical health and efficiency through which of the following?

A. Use of epidemiological tools and vital health statistics
B. Determine the spread and occurrence of the disease
C. Political empowerment and Socio Economic Assistance
D. Organized Community Efforts

7. In order to control a disease effectively, which of the following must first be known?

1. The conditions surrounding its occurrence
2. Factors that do not favor its development
3. The condition that do not surround its occurrence
4. Factors that favors its development

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

8. All of the following are uses of epidemiology except:

A. To study the history of health population and the rise and fall of disease
B. To diagnose the health of the community and the condition of the people
C. To provide summary data on health service delivery
D. To identify groups needing special attention

9. Before reporting the fact of presence of an epidemic, which of the following is of most importance to determine?

A. Are the facts complete?
B. Is the disease real?
C. Is the disease tangible?
D. Is it epidemic or endemic?

10. An unknown epidemic has just been reported in Barangay Dekbudekbu. People said that affected person demonstrates hemorrhagic type of fever. You are designated now to plan for epidemiological investigation. Arrange the sequence of events in accordance with the correct outline plan for epidemiological investigation.

1. Report the presence of dengue
2. Summarize data and conclude the final picture of epidemic
3. Relate the occurrence to the population group, facilities, food supply and carriers
4. Determine if the disease is factual or real
5. Determine any unusual prevalence of the disease and its nature; is it epidemic, sporadic, endemic or pandemic?
6. Determine onset and the geographical limitation of the disease.

A. 4,1,3,5,2,6
B. 4,1,5,6,3,2
C. 5,4,6,2,1,3
D. 5,4,6,1,2,3
E. 1,2,3,4,5,6

11. In the occurrence of SARS and other pandemics, which of the following is the most vital role of a nurse in epidemiology?

A. Health promotion
B. Disease prevention
C. Surveillance
D. Casefinding

12. Measles outbreak has been reported in Barangay Bahay Toro, After conducting an epidemiological investigation you have confirmed that the outbreak is factual. You are tasked to lead a team of medical workers for operational procedure in disease outbreak. Arrange the correct sequence of events that you must do to effectively contain the disease

1. Create a final report and recommendation
2. Perform nasopharyngeal swabbing to infected individuals
3. Perform mass measles immunization to vulnerable groups
4. Perform an environmental sanitation survey on the immediate environment
5. Organize your team and Coordinate the personnels
6. Educate the community on disease transmission

A. 1,2,3,4,5,6
B. 6,5,4,3,2,1
C. 5,6,4,2,3,1
D. 5,2,3,4,6,1

13. All of the following are function of Nurse Budek in epidemiology except

A. Laboratory Diagnosis
B. Surveillance of disease occurrence
C. Follow up cases and contacts
D. Refer cases to hospitals if necessary
E. Isolate cases of communicable disease

14. All of the following are performed in team organization except

A. Orientation and demonstration of methodology to be employed
B. Area assignments of team members
C. Check team’s equipments and paraphernalia
D. Active case finding and Surveillance

15. Which of the following is the final output of data reporting in epidemiological operational procedure?

A. Recommendation
B. Evaluation
C. Final Report
D. Preliminary report

16. The office in charge with registering vital facts in the Philippines is none other than the

A. PCSO
B PAGCOR
C. DOH
D. NSO

17. The following are possible sources of Data except:

A. Experience
B. Census
C. Surveys
D. Research

18. This refers to systematic study of vital events such as births, illnesses, marriages, divorces and deaths

A. Epidemiology
B. Demographics
C. Vital Statistics
D. Health Statistics

19. In case of clerical errors in your birth certificate, Where should you go to have it corrected?

A. NSO
B. Court of Appeals
C. Municipal Trial Court
D. Local Civil Registrar

20. Acasia just gave birth to Lestat, A healthy baby boy. Who are going to report the birth of Baby Lestat?

A. Nurse
B. Midwife
C. OB Gyne
D. Birth Attendant

21. In reporting the birth of Baby Lestat, where will he be registered?

A. At the Local Civil Registrar
B. In the National Statistics Office
C. In the City Health Department
D. In the Field Health Services and Information System Main Office

22. Deejay, The birth attendant noticed that Lestat has low set of ears, Micrognathia, Microcephaly and a typical cat like cry. What should Deejay do?

A. Bring Lestat immediately to the nearest hospital
B. Ask his assistant to call the nearby pediatrician
C. Bring Lestat to the nearest pediatric clinic
D. Call a Taxi and together with Acasia, Bring Lestat to the nearest hospital

23. Deejay would suspect which disorder?

A. Trisomy 21
B. Turners Syndrome
C. Cri Du Chat
D. Klinefelters Syndrome

24. Deejay could expect which of the following congenital anomaly that would accompany this disorder?

A. AVSD
B. PDA
C. TOF
D. TOGV

26. Which presidential decree orders reporting of births within 30 days after its occurrence?

A. 651
B. 541
C. 996
D. 825

25. These rates are referred to the total living population, It must be presumed that the total population was exposed to the risk of occurrence of the event.

A. Rate
B. Ratio
C. Crude/General Rates
D. Specific Rate

26. These are used to describe the relationship between two numerical quantities or measures of events without taking particular considerations to the time or place.

A. Rate
B. Ratios
C. Crude/General Rate
D. Specific Rate

27. This is the most sensitive index in determining the general health condition of a community since it reflects the changes in the environment and medical conditions of a community

A. Crude death rate
B. Infant mortality rate
C. Maternal mortality rate
D. Fetal death rate

28. According to the WHO, which of the following is the most frequent cause of death in children underfive worldwide in the 2003 WHO Survey?

A. Neonatal
B. Pneumonia
C. Diarrhea
D. HIV/AIDS

29. In the Philippines, what is the most common cause of death of infants according to the latest survey?

A. Pneumonia
B. Diarrhea
C. Other perinatal condition
D. Respiratory condition of fetus and newborn

30. The major cause of mortality from 1999 up to 2002 in the Philippines are

A. Diseases of the heart
B. Diseases of the vascular system
C. Pneumonias
D. Tuberculosis

31. Alicia, a 9 year old child asked you “ What is the common cause of death in my age group here in the Philippines? “ The nurse is correct if he will answer

A. Pneumonia is the top leading cause of death in children age 5 to 9
B. Malignant neoplasm if common in your age group
C. Probability wise, You might die due to accidents
D. Diseases of the respiratory system is the most common cause of death in children

32. In children 1 to 4 years old, which is the most common cause of death?

A. Diarrhea
B. Accidents
C. Pneumonia
D. Diseases of the heart

33. Working in the community as a PHN for almost 10 years, Aida knew the fluctuation in vital statistics. She knew that the most common cause of morbidity among the Filipinos is

A. Diseases of the heart
B. Diarrhea
C. Pneumonia
D. Vascular system diseases

34. Nurse Aida also knew that most maternal deaths are caused by

A. Hemorrhage
B. Other Complications related to pregnancy occurring in the course of labor, delivery and puerperium
C. Hypertension complicating pregnancy, childbirth and puerperium
D. Abortion

SITUATION : Barangay PinoyBSN has the following data in year 2006

1. July 1 population : 254,316
2. Livebirths : 2,289
3. Deaths from maternal cause : 15
4. Death from CVD : 3,029
5. Deaths under 1 year of age : 23
6. Fetal deaths : 8
7. Deaths under 28 days : 8
8. Death due to rabies : 45
9. Registered cases of rabies : 45
10. People with pneumonia : 79
11. People exposed with pneumonia : 2,593
12. Total number of deaths from all causes : 10,998

The following questions refer to these data

35. What is the crude birth rate of Barangay PinoyBSN?

A. 90/100,000
B. 9/100
C. 90/1000
D. 9/1000

36. What is the cause specific death rate from cardiovascular diseases?

A. 27/100
B. 1191/100,000
C. 27/100,000
D. 1.1/1000

37. What is the Maternal Mortality rate of this barangay?

A. 6.55/1000
B. 5.89/1000
C. 1.36/1000
D. 3.67/1000

38. What is the fetal death rate?

A. 3.49/1000
B. 10.04/1000
C. 3.14/1000
D. 3.14/100,000

39. What is the attack rate of pneumonia?

A. 3.04/1000
B. 7.18/1000
C. 32.82/100
D. 3.04/100

40. Determine the Case fatality ratio of rabies in this Barangay

A. 1/100
B. 100%
C. 1%
D. 100/1000

41. The following are all functions of the nurse in vital statistics, which of the following is not?

A. Consolidate Data
B. Collects Data
C. Analyze Data
D. Tabulate Data

42. The following are Notifiable diseases that needs to have a tally sheet in data reporting, Which one is not?

A. Hypertension
B. Bronchiolitis
C. Chemical Poisoning
D. Accidents

43. Which of the following requires reporting within 24 hours?

A. Neonatal tetanus
B. Measles
C. Hypertension
D. Tetanus

44. Which Act declared that all communicable disease be reported to the nearest health station?

A. 1082
B. 1891
C. 3573
D. 6675

45. In the RHU Team, Which professional is directly responsible in caring a sick person who is homebound?

A. Midwife
B. Nurse
C. BHW
D. Physician

46. During epidemics, which of the following epidemiological function will you have to perform first?

A. Teaching the community on disease prevention
B. Assessment on suspected cases
C. Monitor the condition of people affected
D. Determining the source and nature of the epidemic

47. Which of the following is a POINT SOURCE epidemic?

A. Dengue H.F
B. Malaria
C. Contaminated Water Source
D. Tuberculosis

48. All but one is a characteristic of a point source epidemic, which one is not?

A. The spread of the disease is caused by a common vehicle
B. The disease is usually caused by contaminated food
C. There is a gradual increase of cases
D. Epidemic is usually sudden

49. The only Microorganism monitored in cases of contaminated water is

A. Vibrio Cholera
B. Escherichia Coli
C. Entamoeba Histolytica
D. Coliform Test

50. Dengue increase in number during June, July and August. This pattern is called

A. Epidemic
B. Endemic
C. Cyclical
D. Secular

SITUATION : Field health services and information system provides summary data on health service delivery and selected program from the barangay level up to the national level. As a nurse, you should know the process on how these information became processed and consolidated.

51. All of the following are objectives of FHSIS Except

A. To complete the clinical picture of chronic disease and describe their natural history
B. To provide standardized, facility level data base which can be accessed for more in depth studies
C. To minimize recording and reporting burden allowing more time for patient care and promotive activities
D. To ensure that data reported are useful and accurate and are disseminated in a timely and easy to use fashion

52. What is the fundamental block or foundation of the field health service information system?

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

53. What is the primary advantage of having a target client list?

A. Nurses need not to go back to FTR to monitor treatment and services to beneficiaries thus saving time and effort
B. Help monitor service rendered to clients in general
C. Facilitate monitoring and supervision of services
D. Facilitates easier reporting

54. Which of the following is used to monitor particular groups that are qualified as eligible to a certain program of the DOH?

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

55. In using the tally sheet, what is the recommended frequency in tallying activities and services?

A. Daily
B. Weekly
C. Monthly
D. Quarterly

56. When is the counting of the tally sheet done?

A. At the end of the day
B. At the end of the week
C. At the end of the month
D. At the end of the year

57. Target client list will be transmitted to the next facility in the form of

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

58. All but one of the following are eligible target client list

A. Leprosy cases
B. TB cases
C. Prenatal care
D. Diarrhea cases

59. This is the only mechanism through which data are routinely transmitted from once facility to another

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

60. FHSIS/Q-3 Or the report for environmental health activities is prepared how frequently?

A. Daily
B. Weekly
C. Quarterly
D. Yearly

61. Nurse Budek is preparing the reporting form for weekly notifiable diseases. He knew that he will code the report form as

A. FHSIS/E-1
B. FHSIS/E-2
C. FHSIS/E-3
D. FHSIS/M-1

62. In preparing the maternal death report, which of the following correctly codes this occurrence?

A. FHSIS/E-1
B. FHSIS/E-2
C. FHSIS/E-3
D. FHSIS/M-1

63. Where should Nurse Budek bring the reporting forms if he is in the BHU Facility?

A. Rural health office
B. FHSIS Main office
C. Provincial health office
D. Regional health office

64. After bringing the reporting forms in the right facility for processing, Nurse Budek knew that the output reports are solely produced by what office?

A. Rural health office
B. FHSIS Main office
C. Provincial health office
D. Regional health office

65. Mang Raul entered the health center complaining of fatigue and frequent syncope. You assessed Mang Raul and found out that he is severely malnourished and anemic. What record should you get first to document these findings?

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

66. The information about Mang Raul’s address, full name, age, symptoms and diagnosis is recorded in

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

67. Another entry is to be made for Mang Raul because he is in the target client’s list, In what TCL should Mang Raul’s entry be documented?

A. TCL Eligible Population
B. TCL Family Planning
C. TCL Nutrition
D. TCL Pre Natal

68. The nurse uses the FHSIS Record system incorrectly when she found out that

A. She go to the individual or FTR for entry confirmation in the Tally/Report Summary
B. She refer to other sources for completing monthly and quarterly reports
C. She records diarrhea in the Tally sheet/Report form with a code FHSIS/M-1
D. She records a Child who have frequent diarrhea in TCL : Under Five

69. The BHS Is the lowest level of reporting unit in FHSIS. A BHS can be considered a reporting unit if all of the following are met except

A. It renders service to 3 barangays
B. There is a midwife the regularly renders service to the area
C. The BHS Have no mother BHS
D. It should be a satellite BHS

70. Data submitted to the PHO is processed using what type of technology?

A. Internet
B. Microcomputer
C. Supercomputer
D. Server Interlink Connections

SITUATION : Community organizing is a process by which people, health services and agencies of the community are brought together to act and solve their own problems.

71. Mang ambo approaches you for counseling. You are an effective counselor if you

A. Give good advice to Mang Ambo
B. Identify Mang Ambo’s problems
C. Convince Mang Ambo to follow your advice
D. Help Mang Ambo identify his problems

72. As a newly appointed PHN instructed to organize Barangay Baritan, Which of the following is your initial step in organizing the community for initial action?

A. Study the Barangay Health statistics and records
B. Make a courtesy call to the Barangay Captain
C. Meet with the Barangay Captain to make plans
D. Make a courtesy call to the Municipal Mayor

73. Preparatory phase is the first phase in organizing the community. Which of the following is the initial step in the preparatory phase?

A. Area selection
B. Community profiling
C. Entry in the community
D. Integration with the people

74. the most important factor in determining the proper area for community organizing is that this area should

A. Be already adopted by another organization
B. Be able to finance the projects
C. Have problems and needs assistance
D. Have people with expertise to be developed as leaders

75. Which of the following dwelling place should the Nurse choose when integrating with the people?

A. A simple house in the border of Barangay Baritan and San Pablo
B. A simple house with fencing and gate located in the center of Barangay Baritan
C. A modest dwelling place where people will not hesitate to enter
D. A modest dwelling place where people will not hesitate to enter located in the center of the community

76. In choosing a leader in the community during the Organizational phase, Which among these people will you choose?

A. Miguel Zobel, 50 years old, Rich and Famous
B. Rustom, 27 years old, Actor
C. Mang Ambo, 70, Willing to work for the desired change
D. Ricky, 30 years old, Influential and Willing to work for the desired change

77. Which type of leadership style should the leaders of the community practice?

A. Autocratic
B. Democratic
C. Laissez Faire
D. Consultative

78. Setting up Committee on Education and Training is in what phase of COPAR?

A. Preparatory
B. Organizational
C. Education and Training
D. Intersectoral Collaboration
E. Phase out

79. Community diagnosis is done to come up with a profile of local health situation that will serve as basis of health programs and services. This is done in what phase of COPAR?

A. Preparatory
B. Organizational
C. Education and Training
D. Intersectoral Collaboration
E. Phase out

80. The people named the community health workers based on the collective decision in accordance with the set criteria. Before they can be trained by the Nurse, The Nurse must first

A. Make a lesson plan
B. Set learning goals and objective
C. Assess their learning needs
D. Review materials needed for training

81. Nurse Budek wrote a letter to PCSO asking them for assistance in their feeding programs for the community’s nutrition and health projects. PCSO then approved the request and gave Budek 50,000 Pesos and a truckload of rice, fruits and vegetables. Which phase of COPAR did Budek utilized?

A. Preparatory
B. Organizational
C. Education and Training
D. Intersectoral Collaboration
E. Phase out

82. Ideally, How many years should the Nurse stay in the community before he can phase out and be assured of a Self Reliant community?

A. 5 years
B. 10 years
C. 1 year
D. 6 months

83. Major discussion in community organization are made by

A. The nurse
B. The leaders of each committee
C. The entire group
D. Collaborating Agencies

84. The nurse should know that Organizational plan best succeeds when

1. People sees its values
2. People think its antagonistic professionally
3. It is incompatible with their personal beliefs
4. It is compatible with their personal beliefs

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

85. Nurse Budek made a proposal that people should turn their backyard into small farming lots to plant vegetables and fruits. He specified that the objective is to save money in buying vegetables and fruits that tend to have a fluctuating and cyclical price. Which step in Community organizing process did he utilized?

A. Fact finding
B. Determination of needs
C. Program formation
D. Education and Interpretation

86. One of the critical steps in COPAR is becoming one with the people and understanding their culture and lifestyle. Which critical step in COPAR will the Nurse try to immerse himself in the community?

A. Integration
B. Social Mobilization
C. Ground Work
D. Mobilization

87. The Actual exercise of people power occurs during when?

A. Integration
B. Social Mobilization
C. Ground Work
D. Mobilization

88. Which steps in COPAR trains indigenous and informal leaders?

A. Ground Work
B. Mobilization
C. Core Group formation
D. Integration

89. As a PHN, One of your role is to organize the community. Nurse Budek knows that the purposes of community organizing are

1. Move the community to act on their own problems
2. Make people aware of their own problems
3. Enable the nurse to solve the community problems
4. Offer people means of solving their own problems

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

90. This is considered the first act of integrating with the people. This gives an in depth participation in community health problems and needs.

A. Residing in the area of assignment
B. Listing down the name of person to contact for courtesy call
C. Gathering initial information about the community
D. Preparing Agenda for the first meeting

SITUATION : Health education is the process whereby knowledge, attitude and practice of people are changed to improve individual, family and community health.

91. Which of the following is the correct sequence in health education?

1. Information
2. Communication
3. Education

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

92. The health status of the people is greatly affected and determined by which of the following?

A. Behavioral factors
B. Socioeconomic factors
C. Political factors
D. Psychological factors

93. Nurse Budek is conducting a health teaching to Agnesia, 50 year old breast cancer survivor needing rehabilitative measures. He knows that health education is effective when

A. Agnesia recites the procedure and instructions perfectly
B. Agnesia’s behavior and outlook in life was changed positively
C. Agnesia gave feedback to Budek saying that she understood the instruction
D. Agnesia requested a written instruction from Budek

94. Which of the following is true about health education?

A. It helps people attain their health through the nurse’s sole efforts
B. It should not be flexible
C. It is a fast and mushroom like process
D. It is a slow and continuous process

95. Which of the following factors least influence the learning readiness of an adult learner?

A. The individuals stage of development
B. Ability to concentrate on information to be learned
C. The individual’s psychosocial adaptation to his illness
D. The internal impulses that drive the person to take action

96. Which of the following is the most important condition for diabetic patients to learn how to control their diet?

A. Use of pamphlets and other materials during instructions
B. Motivation to be symptom free
C. Ability of the patient to understand teaching instruction
D. Language used by the nurse

97. An important skill that a primigravida has to acquire is the ability to bathe her newborn baby and clean her breast if she decides to breastfeed her baby, Which of the following learning domain will you classify the above goals?

A. Psychomotor
B. Cognitive
C. Affective
D. Attitudinal

98. When you prepare your teaching plan for a group of hypertensive patients, you first formulate your learning objectives. Which of the following steps in the nursing process corresponds to the writing of the learning objectives?

A. Planning
B. Implementing
C. Evaluation
C. Assessment

99. Rose, 50 years old and newly diagnosed diabetic patient must learn how to inject insulin. Which of the following physical attribute is not in anyway related to her ability to administer insulin?

A. Strength
B. Coordination
C. Dexterity
D. Muscle Built

100. Appearance and disposition of clients are best observed initially during which of the following situation?

A. Taking V/S
B. Interview
C. Implementation of the initial care
D. Actual Physical examination

CHN Test Drill

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 15:56:00 +0800

SITUATION : Epidemiology and Vital statistics is a very important tool that a nurse could use in controlling the spread of disease in the community and at the same time, surveying the impact of the disease on the population and prevent it’s future occurrence.

1. It is concerned with the study of factors that influence the occurrence and distribution of diseases, defects, disability or death which occurs in groups or aggregation of individuals.

A. Epidemiology
B. Demographics
C. Vital Statistics
D. Health Statistics

2. Which of the following is the backbone in disease prevention?

A. Epidemiology
B. Demographics
C. Vital Statistics
D. Health Statistics

3. Which of the following type of research could show how community expectations can result in the actual provision of services?

A. Basic Research
B. Operational Research
C. Action Research
D. Applied Research

4. An outbreak of measles has been reported in Community A. As a nurse, which of the following is your first action for an Epidemiological investigation?

A. Classify if the outbreak of measles is epidemic or just sporadic
B. Report the incidence into the RHU
C. Determine the first day when the outbreak occurred
D. Identify if it is the disease which it is reported to be

5. After the epidemiological investigation produced final conclusions, which of the following is your initial step in your operational procedure during disease outbreak?

A. Coordinate personnel from Municipal to the National level
B. Collect pertinent laboratory specimen to confirm disease causation
C. Immunize nearby communities with Measles
D. Educate the community in future prevention of similar outbreaks

6. The main concern of a public health nurse is the prevention of disease, prolonging of life and promoting physical health and efficiency through which of the following?

A. Use of epidemiological tools and vital health statistics
B. Determine the spread and occurrence of the disease
C. Political empowerment and Socio Economic Assistance
D. Organized Community Efforts

7. In order to control a disease effectively, which of the following must first be known?

1. The conditions surrounding its occurrence
2. Factors that do not favor its development
3. The condition that do not surround its occurrence
4. Factors that favors its development

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

8. All of the following are uses of epidemiology except:

A. To study the history of health population and the rise and fall of disease
B. To diagnose the health of the community and the condition of the people
C. To provide summary data on health service delivery
D. To identify groups needing special attention

9. Before reporting the fact of presence of an epidemic, which of the following is of most importance to determine?

A. Are the facts complete?
B. Is the disease real?
C. Is the disease tangible?
D. Is it epidemic or endemic?

10. An unknown epidemic has just been reported in Barangay Dekbudekbu. People said that affected person demonstrates hemorrhagic type of fever. You are designated now to plan for epidemiological investigation. Arrange the sequence of events in accordance with the correct outline plan for epidemiological investigation.

1. Report the presence of dengue
2. Summarize data and conclude the final picture of epidemic
3. Relate the occurrence to the population group, facilities, food supply and carriers
4. Determine if the disease is factual or real
5. Determine any unusual prevalence of the disease and its nature; is it epidemic, sporadic, endemic or pandemic?
6. Determine onset and the geographical limitation of the disease.

A. 4,1,3,5,2,6
B. 4,1,5,6,3,2
C. 5,4,6,2,1,3
D. 5,4,6,1,2,3
E. 1,2,3,4,5,6

11. In the occurrence of SARS and other pandemics, which of the following is the most vital role of a nurse in epidemiology?

A. Health promotion
B. Disease prevention
C. Surveillance
D. Casefinding

12. Measles outbreak has been reported in Barangay Bahay Toro, After conducting an epidemiological investigation you have confirmed that the outbreak is factual. You are tasked to lead a team of medical workers for operational procedure in disease outbreak. Arrange the correct sequence of events that you must do to effectively contain the disease

1. Create a final report and recommendation
2. Perform nasopharyngeal swabbing to infected individuals
3. Perform mass measles immunization to vulnerable groups
4. Perform an environmental sanitation survey on the immediate environment
5. Organize your team and Coordinate the personnels
6. Educate the community on disease transmission

A. 1,2,3,4,5,6
B. 6,5,4,3,2,1
C. 5,6,4,2,3,1
D. 5,2,3,4,6,1

13. All of the following are function of Nurse Budek in epidemiology except

A. Laboratory Diagnosis
B. Surveillance of disease occurrence
C. Follow up cases and contacts
D. Refer cases to hospitals if necessary
E. Isolate cases of communicable disease

14. All of the following are performed in team organization except

A. Orientation and demonstration of methodology to be employed
B. Area assignments of team members
C. Check team’s equipments and paraphernalia
D. Active case finding and Surveillance

15. Which of the following is the final output of data reporting in epidemiological operational procedure?

A. Recommendation
B. Evaluation
C. Final Report
D. Preliminary report

16. The office in charge with registering vital facts in the Philippines is none other than the

A. PCSO
B PAGCOR
C. DOH
D. NSO

17. The following are possible sources of Data except:

A. Experience
B. Census
C. Surveys
D. Research

18. This refers to systematic study of vital events such as births, illnesses, marriages, divorces and deaths

A. Epidemiology
B. Demographics
C. Vital Statistics
D. Health Statistics

19. In case of clerical errors in your birth certificate, Where should you go to have it corrected?

A. NSO
B. Court of Appeals
C. Municipal Trial Court
D. Local Civil Registrar

20. Acasia just gave birth to Lestat, A healthy baby boy. Who are going to report the birth of Baby Lestat?

A. Nurse
B. Midwife
C. OB Gyne
D. Birth Attendant

21. In reporting the birth of Baby Lestat, where will he be registered?

A. At the Local Civil Registrar
B. In the National Statistics Office
C. In the City Health Department
D. In the Field Health Services and Information System Main Office

22. Deejay, The birth attendant noticed that Lestat has low set of ears, Micrognathia, Microcephaly and a typical cat like cry. What should Deejay do?

A. Bring Lestat immediately to the nearest hospital
B. Ask his assistant to call the nearby pediatrician
C. Bring Lestat to the nearest pediatric clinic
D. Call a Taxi and together with Acasia, Bring Lestat to the nearest hospital

23. Deejay would suspect which disorder?

A. Trisomy 21
B. Turners Syndrome
C. Cri Du Chat
D. Klinefelters Syndrome

24. Deejay could expect which of the following congenital anomaly that would accompany this disorder?

A. AVSD
B. PDA
C. TOF
D. TOGV

26. Which presidential decree orders reporting of births within 30 days after its occurrence?

A. 651
B. 541
C. 996
D. 825

25. These rates are referred to the total living population, It must be presumed that the total population was exposed to the risk of occurrence of the event.

A. Rate
B. Ratio
C. Crude/General Rates
D. Specific Rate

26. These are used to describe the relationship between two numerical quantities or measures of events without taking particular considerations to the time or place.

A. Rate
B. Ratios
C. Crude/General Rate
D. Specific Rate

27. This is the most sensitive index in determining the general health condition of a community since it reflects the changes in the environment and medical conditions of a community

A. Crude death rate
B. Infant mortality rate
C. Maternal mortality rate
D. Fetal death rate

28. According to the WHO, which of the following is the most frequent cause of death in children underfive worldwide in the 2003 WHO Survey?

A. Neonatal
B. Pneumonia
C. Diarrhea
D. HIV/AIDS

29. In the Philippines, what is the most common cause of death of infants according to the latest survey?

A. Pneumonia
B. Diarrhea
C. Other perinatal condition
D. Respiratory condition of fetus and newborn

30. The major cause of mortality from 1999 up to 2002 in the Philippines are

A. Diseases of the heart
B. Diseases of the vascular system
C. Pneumonias
D. Tuberculosis

31. Alicia, a 9 year old child asked you “ What is the common cause of death in my age group here in the Philippines? “ The nurse is correct if he will answer

A. Pneumonia is the top leading cause of death in children age 5 to 9
B. Malignant neoplasm if common in your age group
C. Probability wise, You might die due to accidents
D. Diseases of the respiratory system is the most common cause of death in children

32. In children 1 to 4 years old, which is the most common cause of death?

A. Diarrhea
B. Accidents
C. Pneumonia
D. Diseases of the heart

33. Working in the community as a PHN for almost 10 years, Aida knew the fluctuation in vital statistics. She knew that the most common cause of morbidity among the Filipinos is

A. Diseases of the heart
B. Diarrhea
C. Pneumonia
D. Vascular system diseases

34. Nurse Aida also knew that most maternal deaths are caused by

A. Hemorrhage
B. Other Complications related to pregnancy occurring in the course of labor, delivery and puerperium
C. Hypertension complicating pregnancy, childbirth and puerperium
D. Abortion

SITUATION : Barangay PinoyBSN has the following data in year 2006

1. July 1 population : 254,316
2. Livebirths : 2,289
3. Deaths from maternal cause : 15
4. Death from CVD : 3,029
5. Deaths under 1 year of age : 23
6. Fetal deaths : 8
7. Deaths under 28 days : 8
8. Death due to rabies : 45
9. Registered cases of rabies : 45
10. People with pneumonia : 79
11. People exposed with pneumonia : 2,593
12. Total number of deaths from all causes : 10,998

The following questions refer to these data

35. What is the crude birth rate of Barangay PinoyBSN?

A. 90/100,000
B. 9/100
C. 90/1000
D. 9/1000

36. What is the cause specific death rate from cardiovascular diseases?

A. 27/100
B. 1191/100,000
C. 27/100,000
D. 1.1/1000

37. What is the Maternal Mortality rate of this barangay?

A. 6.55/1000
B. 5.89/1000
C. 1.36/1000
D. 3.67/1000

38. What is the fetal death rate?

A. 3.49/1000
B. 10.04/1000
C. 3.14/1000
D. 3.14/100,000

39. What is the attack rate of pneumonia?

A. 3.04/1000
B. 7.18/1000
C. 32.82/100
D. 3.04/100

40. Determine the Case fatality ratio of rabies in this Barangay

A. 1/100
B. 100%
C. 1%
D. 100/1000

41. The following are all functions of the nurse in vital statistics, which of the following is not?

A. Consolidate Data
B. Collects Data
C. Analyze Data
D. Tabulate Data

42. The following are Notifiable diseases that needs to have a tally sheet in data reporting, Which one is not?

A. Hypertension
B. Bronchiolitis
C. Chemical Poisoning
D. Accidents

43. Which of the following requires reporting within 24 hours?

A. Neonatal tetanus
B. Measles
C. Hypertension
D. Tetanus

44. Which Act declared that all communicable disease be reported to the nearest health station?

A. 1082
B. 1891
C. 3573
D. 6675

45. In the RHU Team, Which professional is directly responsible in caring a sick person who is homebound?

A. Midwife
B. Nurse
C. BHW
D. Physician

46. During epidemics, which of the following epidemiological function will you have to perform first?

A. Teaching the community on disease prevention
B. Assessment on suspected cases
C. Monitor the condition of people affected
D. Determining the source and nature of the epidemic

47. Which of the following is a POINT SOURCE epidemic?

A. Dengue H.F
B. Malaria
C. Contaminated Water Source
D. Tuberculosis

48. All but one is a characteristic of a point source epidemic, which one is not?

A. The spread of the disease is caused by a common vehicle
B. The disease is usually caused by contaminated food
C. There is a gradual increase of cases
D. Epidemic is usually sudden

49. The only Microorganism monitored in cases of contaminated water is

A. Vibrio Cholera
B. Escherichia Coli
C. Entamoeba Histolytica
D. Coliform Test

50. Dengue increase in number during June, July and August. This pattern is called

A. Epidemic
B. Endemic
C. Cyclical
D. Secular

SITUATION : Field health services and information system provides summary data on health service delivery and selected program from the barangay level up to the national level. As a nurse, you should know the process on how these information became processed and consolidated.

51. All of the following are objectives of FHSIS Except

A. To complete the clinical picture of chronic disease and describe their natural history
B. To provide standardized, facility level data base which can be accessed for more in depth studies
C. To minimize recording and reporting burden allowing more time for patient care and promotive activities
D. To ensure that data reported are useful and accurate and are disseminated in a timely and easy to use fashion

52. What is the fundamental block or foundation of the field health service information system?

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

53. What is the primary advantage of having a target client list?

A. Nurses need not to go back to FTR to monitor treatment and services to beneficiaries thus saving time and effort
B. Help monitor service rendered to clients in general
C. Facilitate monitoring and supervision of services
D. Facilitates easier reporting

54. Which of the following is used to monitor particular groups that are qualified as eligible to a certain program of the DOH?

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

55. In using the tally sheet, what is the recommended frequency in tallying activities and services?

A. Daily
B. Weekly
C. Monthly
D. Quarterly

56. When is the counting of the tally sheet done?

A. At the end of the day
B. At the end of the week
C. At the end of the month
D. At the end of the year

57. Target client list will be transmitted to the next facility in the form of

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

58. All but one of the following are eligible target client list

A. Leprosy cases
B. TB cases
C. Prenatal care
D. Diarrhea cases

59. This is the only mechanism through which data are routinely transmitted from once facility to another

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

60. FHSIS/Q-3 Or the report for environmental health activities is prepared how frequently?

A. Daily
B. Weekly
C. Quarterly
D. Yearly

61. Nurse Budek is preparing the reporting form for weekly notifiable diseases. He knew that he will code the report form as

A. FHSIS/E-1
B. FHSIS/E-2
C. FHSIS/E-3
D. FHSIS/M-1

62. In preparing the maternal death report, which of the following correctly codes this occurrence?

A. FHSIS/E-1
B. FHSIS/E-2
C. FHSIS/E-3
D. FHSIS/M-1

63. Where should Nurse Budek bring the reporting forms if he is in the BHU Facility?

A. Rural health office
B. FHSIS Main office
C. Provincial health office
D. Regional health office

64. After bringing the reporting forms in the right facility for processing, Nurse Budek knew that the output reports are solely produced by what office?

A. Rural health office
B. FHSIS Main office
C. Provincial health office
D. Regional health office

65. Mang Raul entered the health center complaining of fatigue and frequent syncope. You assessed Mang Raul and found out that he is severely malnourished and anemic. What record should you get first to document these findings?

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

66. The information about Mang Raul’s address, full name, age, symptoms and diagnosis is recorded in

A. Family treatment record
B. Target Client list
C. Reporting forms
D. Output record

67. Another entry is to be made for Mang Raul because he is in the target client’s list, In what TCL should Mang Raul’s entry be documented?

A. TCL Eligible Population
B. TCL Family Planning
C. TCL Nutrition
D. TCL Pre Natal

68. The nurse uses the FHSIS Record system incorrectly when she found out that

A. She go to the individual or FTR for entry confirmation in the Tally/Report Summary
B. She refer to other sources for completing monthly and quarterly reports
C. She records diarrhea in the Tally sheet/Report form with a code FHSIS/M-1
D. She records a Child who have frequent diarrhea in TCL : Under Five

69. The BHS Is the lowest level of reporting unit in FHSIS. A BHS can be considered a reporting unit if all of the following are met except

A. It renders service to 3 barangays
B. There is a midwife the regularly renders service to the area
C. The BHS Have no mother BHS
D. It should be a satellite BHS

70. Data submitted to the PHO is processed using what type of technology?

A. Internet
B. Microcomputer
C. Supercomputer
D. Server Interlink Connections

SITUATION : Community organizing is a process by which people, health services and agencies of the community are brought together to act and solve their own problems.

71. Mang ambo approaches you for counseling. You are an effective counselor if you

A. Give good advice to Mang Ambo
B. Identify Mang Ambo’s problems
C. Convince Mang Ambo to follow your advice
D. Help Mang Ambo identify his problems

72. As a newly appointed PHN instructed to organize Barangay Baritan, Which of the following is your initial step in organizing the community for initial action?

A. Study the Barangay Health statistics and records
B. Make a courtesy call to the Barangay Captain
C. Meet with the Barangay Captain to make plans
D. Make a courtesy call to the Municipal Mayor

73. Preparatory phase is the first phase in organizing the community. Which of the following is the initial step in the preparatory phase?

A. Area selection
B. Community profiling
C. Entry in the community
D. Integration with the people

74. the most important factor in determining the proper area for community organizing is that this area should

A. Be already adopted by another organization
B. Be able to finance the projects
C. Have problems and needs assistance
D. Have people with expertise to be developed as leaders

75. Which of the following dwelling place should the Nurse choose when integrating with the people?

A. A simple house in the border of Barangay Baritan and San Pablo
B. A simple house with fencing and gate located in the center of Barangay Baritan
C. A modest dwelling place where people will not hesitate to enter
D. A modest dwelling place where people will not hesitate to enter located in the center of the community

76. In choosing a leader in the community during the Organizational phase, Which among these people will you choose?

A. Miguel Zobel, 50 years old, Rich and Famous
B. Rustom, 27 years old, Actor
C. Mang Ambo, 70, Willing to work for the desired change
D. Ricky, 30 years old, Influential and Willing to work for the desired change

77. Which type of leadership style should the leaders of the community practice?

A. Autocratic
B. Democratic
C. Laissez Faire
D. Consultative

78. Setting up Committee on Education and Training is in what phase of COPAR?

A. Preparatory
B. Organizational
C. Education and Training
D. Intersectoral Collaboration
E. Phase out

79. Community diagnosis is done to come up with a profile of local health situation that will serve as basis of health programs and services. This is done in what phase of COPAR?

A. Preparatory
B. Organizational
C. Education and Training
D. Intersectoral Collaboration
E. Phase out

80. The people named the community health workers based on the collective decision in accordance with the set criteria. Before they can be trained by the Nurse, The Nurse must first

A. Make a lesson plan
B. Set learning goals and objective
C. Assess their learning needs
D. Review materials needed for training

81. Nurse Budek wrote a letter to PCSO asking them for assistance in their feeding programs for the community’s nutrition and health projects. PCSO then approved the request and gave Budek 50,000 Pesos and a truckload of rice, fruits and vegetables. Which phase of COPAR did Budek utilized?

A. Preparatory
B. Organizational
C. Education and Training
D. Intersectoral Collaboration
E. Phase out

82. Ideally, How many years should the Nurse stay in the community before he can phase out and be assured of a Self Reliant community?

A. 5 years
B. 10 years
C. 1 year
D. 6 months

83. Major discussion in community organization are made by

A. The nurse
B. The leaders of each committee
C. The entire group
D. Collaborating Agencies

84. The nurse should know that Organizational plan best succeeds when

1. People sees its values
2. People think its antagonistic professionally
3. It is incompatible with their personal beliefs
4. It is compatible with their personal beliefs

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

85. Nurse Budek made a proposal that people should turn their backyard into small farming lots to plant vegetables and fruits. He specified that the objective is to save money in buying vegetables and fruits that tend to have a fluctuating and cyclical price. Which step in Community organizing process did he utilized?

A. Fact finding
B. Determination of needs
C. Program formation
D. Education and Interpretation

86. One of the critical steps in COPAR is becoming one with the people and understanding their culture and lifestyle. Which critical step in COPAR will the Nurse try to immerse himself in the community?

A. Integration
B. Social Mobilization
C. Ground Work
D. Mobilization

87. The Actual exercise of people power occurs during when?

A. Integration
B. Social Mobilization
C. Ground Work
D. Mobilization

88. Which steps in COPAR trains indigenous and informal leaders?

A. Ground Work
B. Mobilization
C. Core Group formation
D. Integration

89. As a PHN, One of your role is to organize the community. Nurse Budek knows that the purposes of community organizing are

1. Move the community to act on their own problems
2. Make people aware of their own problems
3. Enable the nurse to solve the community problems
4. Offer people means of solving their own problems

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

90. This is considered the first act of integrating with the people. This gives an in depth participation in community health problems and needs.

A. Residing in the area of assignment
B. Listing down the name of person to contact for courtesy call
C. Gathering initial information about the community
D. Preparing Agenda for the first meeting

SITUATION : Health education is the process whereby knowledge, attitude and practice of people are changed to improve individual, family and community health.

91. Which of the following is the correct sequence in health education?

1. Information
2. Communication
3. Education

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

92. The health status of the people is greatly affected and determined by which of the following?

A. Behavioral factors
B. Socioeconomic factors
C. Political factors
D. Psychological factors

93. Nurse Budek is conducting a health teaching to Agnesia, 50 year old breast cancer survivor needing rehabilitative measures. He knows that health education is effective when

A. Agnesia recites the procedure and instructions perfectly
B. Agnesia’s behavior and outlook in life was changed positively
C. Agnesia gave feedback to Budek saying that she understood the instruction
D. Agnesia requested a written instruction from Budek

94. Which of the following is true about health education?

A. It helps people attain their health through the nurse’s sole efforts
B. It should not be flexible
C. It is a fast and mushroom like process
D. It is a slow and continuous process

95. Which of the following factors least influence the learning readiness of an adult learner?

A. The individuals stage of development
B. Ability to concentrate on information to be learned
C. The individual’s psychosocial adaptation to his illness
D. The internal impulses that drive the person to take action

96. Which of the following is the most important condition for diabetic patients to learn how to control their diet?

A. Use of pamphlets and other materials during instructions
B. Motivation to be symptom free
C. Ability of the patient to understand teaching instruction
D. Language used by the nurse

97. An important skill that a primigravida has to acquire is the ability to bathe her newborn baby and clean her breast if she decides to breastfeed her baby, Which of the following learning domain will you classify the above goals?

A. Psychomotor
B. Cognitive
C. Affective
D. Attitudinal

98. When you prepare your teaching plan for a group of hypertensive patients, you first formulate your learning objectives. Which of the following steps in the nursing process corresponds to the writing of the learning objectives?

A. Planning
B. Implementing
C. Evaluation
C. Assessment

99. Rose, 50 years old and newly diagnosed diabetic patient must learn how to inject insulin. Which of the following physical attribute is not in anyway related to her ability to administer insulin?

A. Strength
B. Coordination
C. Dexterity
D. Muscle Built

100. Appearance and disposition of clients are best observed initially during which of the following situation?

A. Taking V/S
B. Interview
C. Implementation of the initial care
D. Actual Physical examination

ANSWERS and RATIONALE

Funda Test Drill II ( Answers and Rationale)

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 15:52:00 +0800

1. The four major concepts in nursing theory are the

A. Person, Environment, Nurse, Health
B. Nurse, Person, Environment, Cure
C. Promotive, Preventive, Curative, Rehabilitative
D. Person, Environment, Nursing, Health

* This is an actual board exam question and is a common board question. Theorist always describes The nursing profession by first defining what is NURSING, followed by the PERSON, ENVIRONMENT and HEALTH CONCEPT. The most popular theory was perhaps Nightingale’s. She defined nursing as the utilization of the persons environment to assist him towards recovery. She defined the person as somebody who has a reparative capabilities mediated and enhanced by factors in his environment. She describes the environment as something that would facilitate the person’s reparative process and identified different factors like sanitation, noise, etc. that affects a person’s reparative state.

2. The act of utilizing the environment of the patient to assist him in his recovery is theorized by

A. Nightingale
B. Benner
C. Swanson
D. King

* Florence nightingale do not believe in the germ theory, and perhaps this was her biggest mistake. Yet, her theory was the first in nursing. She believed that manipulation of environment that includes appropriate noise, nutrition, hygiene, light, comfort, sanitation etc. could provide the client’s body the nurturance it needs for repair and recovery.

3. For her, Nursing is a theoretical system of knowledge that prescribes a process of analysis and action related to care of the ill person

A. King
B. Henderson
C. Roy
D. Leininger

* Remember the word “ THEOROYTICAL “ For Callista Roy, Nursing is a theoretical body of knowledge that prescribes analysis and action to care for an ill person. She introduced the ADAPTATION MODEL and viewed person as a BIOSPSYCHOSOCIAL BEING. She believed that by adaptation, Man can maintain homeostasis.

4. According to her, Nursing is a helping or assistive profession to persons who are wholly or partly dependent or when those who are supposedly caring for them are no longer able to give care.

A. Henderson
B. Orem
C. Swanson
D. Neuman

* In self care deficit theory, Nursing is defined as A helping or assistive profession to person who are wholly or partly dependent or when people who are to give care to them are no longer available. Self care, are the activities that a person do for himself to maintain health, life and well being.

5. Nursing is a unique profession, Concerned with all the variables affecting an individual’s response to stressors, which are intra, inter and extra personal in nature.

A. Neuman
B. Johnson
C. Watson
D. Parse

* Neuman divided stressors as either intra, inter and extra personal in nature. She said that NURSING is concerned with eliminating these stressors to obtain a maximum level of wellness. The nurse helps the client through PRIMARY, SECONDARY AND TERTIARY prevention modes. Please do not confuse this with LEAVELL and CLARK’S level of prevention.

6. The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health that he would perform unaided if he has the necessary strength, will and knowledge, and do this in such a way as to help him gain independence as rapidly as possible.

A. Henderson
B. Abdellah
C. Levin
D. Peplau

* This was an actual board question. Remember this definition and associate it with Virginia Henderson. Henderson also describes the NATURE OF NURSING theory. She identified 14 basic needs of the client. She describes nursing roles as SUBSTITUTIVE : Doing everything for the client, SUPPLEMENTARY : Helping the client and COMPLEMENTARY : Working with the client. Breathing normally, Eliminating waste, Eating and drinking adquately, Worship and Play are some of the basic needs according to her.

7. Caring is the essence and central unifying, a dominant domain that distinguishes nursing from other health disciplines. Care is an essential human need.

A. Benner
B. Watson
C. Leininger
D. Swanson

* There are many theorist that describes nursing as CARE. The most popular was JEAN WATSON'S Human Caring Model. But this question pertains to Leininger's definition of caring. CUD I LIE IN GER? [ Could I Lie In There ] Is the Mnemonics I am using not to get confused. C stands for CENTRAL , U stands for UNIFYING, D stands for DOMINANT DOMAIN. I emphasize on this matter due to feedback on the last June 2006 batch about a question about CARING.

8. Caring involves 5 processes, KNOWING, BEING WITH, DOING FOR, ENABLING and MAINTAINING BELIEF.

A. Benner
B. Watson
C. Leininger
D. Swanson

* Caring according to Swanson involves 5 processes. Knowing means understanding the client. Being with emphasizes the Physical presence of the nurse for the patient. Doing for means doing things for the patient when he is incapable of doing it for himself. Enabling means helping client transcend maturational and developmental stressors in life while Maintaining belief is the ability of the Nurse to inculcate meaning to these events.

9. Caring is healing, it is communicated through the consciousness of the nurse to the individual being cared for. It allows access to higher human spirit.

A. Benner
B. Watson
C. Leininger
D. Swanson

* The deepest and spiritual definition of Caring came from Jean watson. For her, Caring expands the limits of openess and allows access to higher human spirit.

10. Caring means that person, events, projects and things matter to people. It reveals stress and coping options. Caring creates responsibility. It is an inherent feature of nursing practice. It helps the nurse assist clients to recover in the face of the illness.

A. Benner
B. Watson
C. Leininger
D. Swanson

* I think of CARE BEAR to facilitate retainment of BENNER. As in, Care Benner. For her, Caring means being CONNECTED or making things matter to people. Caring according to Benner give meaning to illness and re establish connection.

11. Which of the following is NOT TRUE about profession according to Marie Jahoda?

A. A profession is an organization of an occupational group based on the application of special knowledge
B. It serves specific interest of a group
C. It is altruistic
D. Quality of work is of greater importance than the rewards

* Believe it or not, you should know the definition of profession according to Jahoda because it is asked in the Local boards. A profession should serve the WHOLE COMMUNITY and not just a specific intrest of a group. Everything else, are correct.

12. Which of the following is NOT an attribute of a professional?

A. Concerned with quantity
B. Self directed
C. Committed to spirit of inquiry
D. Independent

* A professional is concerned with QUALITY and not QUANTITY. In nursing, We have methods of quality assurance and control to evaluate the effectiveness of nursing care. Nurses, are never concerned with QUANTITY of care provided.

13. The most unique characteristic of nursing as a profession is

A. Education
B. Theory
C. Caring
D. Autonomy

* Caring and caring alone, is the most unique quality of the Nursing Profession. It is the one the delineate Nursing from other professions.

14. This is the distinctive individual qualities that differentiate a person to another

A. Philosophy
B. Personality
C. Charm
D. Character

* Personality are qualities that make us different from each other. These are impressions that we made, or the footprints that we leave behind. This is the result of the integration of one's talents, behavior, appearance, mood, character, morals and impulses into one harmonious whole. Philosophy is the basic truth that fuel our soul and give our life a purpose, it shapes the facets of a person's character. Charm is to attract other people to be a change agent. Character is our moral values and belief that guides our actions in life.

15. Refers to the moral values and beliefs that are used as guides to personal behavior and actions

A. Philosophy
B. Personality
C. Charm
D. Character

* Refer to number 14

16. As a nurse manager, which of the following best describes this function?

A. Initiate modification on client’s lifestyle
B. Protect client’s right
C. Coordinates the activities of other members of the health team in managing patient care
D. Provide in service education programs, Use accurate nursing audit, formulate philosophy and vision of the institution

* A refers to being a change agent. B is a role of a patient advocate. C is a case manager while D basically summarized functions of a nurse manager. If you haven't read Lydia Venzon's Book : NURSING MANAGEMENT TOWARDS QUALITY CARE, I suggest reading it in advance for your management subjects in the graduate school. Formulating philosophy and vision is in PLANNING. Nursing Audit is in CONTROLLING, In service education programs are included in DIRECTING. These are the processes of Nursing Management, I just forgot to add ORGANIZING which includes formulating an organizational structure and plans, Staffing and developing qualifications and job descriptions.

17. What best describes nurses as a care provider?

A. Determine client’s need
B. Provide direct nursing care
C. Help client recognize and cope with stressful psychological situation
D. Works in combined effort with all those involved in patient’s care

* You can never provide nursing care if you don't know what are the needs of the client. How can you provide an effective postural drainage if you do not know where is the bulk of the client's secretion. Therefore, the best description of a care provider is the accurate and prompt determination of the client's need to be able to render an appropriate nursing care.

18. The nurse questions a doctors order of Morphine sulfate 50 mg, IM for a client with pancreatitis. Which role best fit that statement?

A. Change agent
B. Client advocate
C. Case manager
D. Collaborator

* As a client's advocate, Nurses are to protect the client's right and promotes what is best for the client. Knowing that Morphine causes spasm of the sphincter of Oddi and will lead to further increase in the client's pain, The nurse knew that the best treatment option for the client was not provided and intervene to provide the best possible care.

19. These are nursing intervention that requires knowledge, skills and expertise of multiple health professionals.

A. Dependent
B. Independent
C. Interdependent
D. Intradependent

* Interdependent functions are those that needs expertise and skills of multiple health professionals. Example is when A child was diagnosed with nephrotic syndrome and the doctor ordered a high protein diet, Budek then work together with the dietician about the age appropriate high protein foods that can be given to the child, Including the preparation to entice the child into eating the food. NOTE : It is still debated if the diet in NS is low, moderate or high protein, In the U.S, Protein is never restricted and can be taken in moderate amount. As far as the local examination is concerned, answer LOW PROTEIN HIGH CALORIC DIET.

20. What type of patient care model is the most common for student nurses and private duty nurses?

A. Total patient care
B. Team nursing
C. Primary Nursing
D. Case management

* This is also known as case nursing. It is a method of nursing care wherein, one nurse is assigned to one patient for the delivery of total care. These are the method use by Nursing students, Private duty nurses and those in critical or isolation units.

21. This is the best patient care model when there are many nurses but few patients.

A. Functional nursing
B. Team nursing
C. Primary nursing
D. Total patient care

* Total patient care works best if there are many nurses but few patients.

22. This patient care model works best when there are plenty of patient but few nurses

A. Functional nursing
B. Team nursing
C. Primary nursing
D. Total patient care

* Functional nursing is task oriented, One nurse is assigned on a particular task leading to task expertise and efficiency. The nurse will work fast because the procedures are repetitive leading to task mastery. This care is not recommended as this leads fragmented nursing care.

23. RN assumes 24 hour responsibility for the client to maintain continuity of care across shifts, days or visits.

A. Functional nursing
B. Team nursing
C. Primary nursing
D. Total patient care

* Your keyword in Primary nursing is the 24 hours. This does not necessarily means the nurse is awake for 24 hours, She can have a SECONDARY NURSES that will take care of the patient in shifts where she is not arround.

24. Who developed the first theory of nursing?

A. Hammurabi
B. Alexander
C. Fabiola
D. Nightingale

* Refer to question # 2. Hammurabi is the king of babylon that introduces the LEX TALIONES law, If you kill me, you should be killed... If you rob me, You should be robbed, An eye for an eye and a tooth for a tooth. Alexander the great was the son of King Philip II and is from macedonia but he ruled Greece including Persia and Egypt. He is known to use a hammer to pierce a dying soldier's medulla towards speedy death when he thinks that the soldier will die anyway, just to relieve their suffering. Fabiola was a beautiful roman matron who converted her house into a hospital.

25. She introduces the NATURE OF NURSING MODEL.

A. Henderson
B. Nightingale
C. Parse
D. Orlando

* Refer to question # 6.

26. She described the four conservation principle.

A. Levin
B. Leininger
C. Orlando
D. Parse

* Myra Levin described the 4 Conservation principles which are concerned with the Unity and Integrity of an individual. These are ENERGY : Our output to facilitate meeting of our needs. STRUCTURAL INTEGRITY : We mus maintain the integrity of our organs, tissues and systems to be able to function and prevent harmful agents entering our body. PERSONAL INTEGRITY : These refers to our self esteem, self worth, self concept, identify and personality. SOCIAL INTEGRITY : Reflects our societal roles to our society, community, family, friends and fellow individuals.

27. Proposed the HEALTH CARE SYSTEM MODEL.

A. Henderson
B. Orem
C. Parse
D. Neuman

* Betty Neuman asserted that nursing is a unique profession and is concerned with all the variables affecting the individual's response to stressors. These are INTRA or within ourselves, EXTRA or outside the individual, INTER means between two or more people. She proposed the HEALTH CARE SYSTEM MODEL which states that by PRIMARY, SECONDARY and TERTIARY prevention, The nurse can help the client maintain stability against these stressors.

28. Conceptualized the BEHAVIORAL SYSTEM MODEL

A. Orem
B. Johnson
C. Henderson
D. Parse

* According to Dorothy Johnson, Each person is a behavioral system that is composed of 7 subsystems. Man adjust or adapt to stressors by a using a LEARNED PATTERN OF RESPONSE. Man uses his behavior to meet the demands of the environment, and is able to modified his behavior to support these demands.

29. Developed the CLINICAL NURSING – A HELPING ART MODEL

A. Swanson
B. Hall
C. Weidenbach
D. Zderad

* Just remember ERNESTINE WEIDENBACHLINICAL.

30. Developed the ROLE MODELING and MODELING theory

A. Erickson,Tomlin,Swain
B. Neuman
C. Newman
D. Benner and Wrubel

31. Proposed the GRAND THEORY OF NURSING AS CARING

A. Erickson, Tomlin, Swain
B. Peterson,Zderad
C. Bnner,Wrubel
D. Boykin,Schoenhofer

* This theory was called GRAND THEORY because boykin and schoenofer thinks that ALL MAN ARE CARING, And that nursing is a response to this unique call. According to them, CARING IS A MORAL IMPERATIVE, meaning, ALL PEOPLE will tend to help a man who fell down the stairs even if he is not trained to do so.

32. Postulated the INTERPERSONAL ASPECT OF NURSING

A. Travelbee
B. Swanson
C. Zderad
D. Peplau

* Travelbee's theory was referred to as INTERPERSONAL theory because she postulated that NURSING is to assist the individual and all people that affects this individual to cope with illness, recover and FIND MEANING to this experience. For her, Nursing is a HUMAN TO HUMAN relationship that is formed during illness. To her, an individual is a UNIQUE and irreplaceable being in continuous process of becoming, evolving and changing. PLEASE do remember, that it is PARSE who postulated the theory of HUMAN BECOMING and not TRAVELBEE, for I read books that say it was TRAVELBEE and not PARSE.

33. He proposed the theory of morality that is based on MUTUAL TRUST

A. Freud
B. Erikson
C. Kohlberg
D. Peters

* Kohlber states that relationships are based on mutual trust. He postulated the levels of morality development. At the first stage called the PREMORAL or preconventional, A child do things and label them as BAD or GOOD depending on the PUNISHMENT or REWARD they get. They have no concept of justice, fairness and equity, for them, If I punch this kid and mom gets mad, thats WRONG. But if I dance and sing, mama smiles and give me a new toy, then I am doing something good. In the Conventional level, The individual actuates his act based on the response of the people around him. He will follow the rules, regulations, laws and morality the society upholds. If the law states that I should not resuscitate this man with a DNR order, then I would not. However, in the Post conventional level or the AUTONOMOUS level, the individual still follows the rules but can make a rule or bend part of these rules according to his own MORALITY. He can change the rules if he thinks that it is needed to be changed. Example is that, A nurse still continue resuscitating the client even if the client has a DNR order because he believes that the client can still recover and his mission is to save lives, not watch patients die.

34. He proposed the theory of morality based on PRINCIPLES

A. Freud
B. Erikson
C. Kohlberg
D. Peters

* Remember PETERS for PRINCIPLES. P is to P. He believes that morality has 3 components : EMOTION or how one feels, JUDGEMENT or how one reason and BEHAVIOR or how one actuates his EMOTION and JUDGEMENT. He believes that MORALITY evolves with the development of PRINCPLES or the person's vitrue and traits. He also believes in AUTOMATICITY of virtues or he calls HABIT, like kindness, charity, honesty, sincerity and thirft which are innate to a person and therfore, will be performed automatically.

35. Freud postulated that child adopts parental standards and traits through

A. Imitation
B. Introjection
C. Identification
D. Regression

* A child, according to Freud adopts parental standards, traits, habits and norms through identication. A good example is the corned beef commercial " WALK LIKE A MAN, TALK LIKE A MAN " Where the child identifies with his father by wearing the same clothes and doing the same thing.

36. According to them, Morality is measured of how people treat human being and that a moral child strives to be kind and just

A. Zderad and Peterson
B. Benner and Wrubel
C. Fowler and Westerhoff
D. Schulman and Mekler

* According to Schulman and Mekler, there are 2 components that makes an action MORAL : The intention should be good and the Act must be just. A good example is ROBIN HOOD, His intention is GOOD but the act is UNJUST, which makes his action IMMORAL.

37. Postulated that FAITH is the way of behaving. He developed four theories of faith and development based on his experience.

A. Giligan
B. Westerhoff
C. Fowler
D. Freud

* There are only 2 theorist of FAITH that might be asked in the board examinations. Fowler and Westerhoff. What differs them is that, FAITH of fowler is defined abstractly, Fowler defines faith as a FORCE that gives a meaning to a person's life while Westerhoff defines faith as a behavior that continuously develops through time.

38. He described the development of faith. He suggested that faith is a spiritual dimension that gives meaning to a persons life. Faith according to him, is a relational phenomenon.

A. Giligan
B. Westerhoff
C. Fowler
D. Freud

* Refer to # 37

39. Established in 1906 by the Baptist foreign mission society of America. Miss rose nicolet, was it’s first superintendent.

A. St. Paul Hospital School of nursing
B. Iloilo Mission Hospital School of nursing
C. Philippine General Hospital School of nursing
D. St. Luke’s Hospital School of nursing

40. Anastacia Giron-Tupas was the first Filipino nurse to occupy the position of chief nurse in this hospital.

A. St. Paul Hospital
B. Iloilo Mission Hospital
C. Philippine General Hospital
D. St. Luke’s Hospital

41. She was the daughter of Hungarian kings, who feed 300-900 people everyday in their gate, builds hospitals, and care of the poor and sick herself.

A. Elizabeth
B. Catherine
C. Nightingale
D. Sairey Gamp

* Saint Elizabeth of Hungary was a daughter of a King and is the patron saint of nurses. She build hospitals and feed hungry people everyday using the kingdom's money. She is a princess, but devoted her life in feeding the hungry and serving the sick.

42. She dies of yellow fever in her search for truth to prove that yellow fever is carried by a mosquitoes.

A. Clara louise Maas
B. Pearl Tucker
C. Isabel Hampton Robb
D. Caroline Hampton Robb

* Clara Louise Maas sacrificed her life in research of YELLOW FEVER. People during her time do not believe that yellow fever was brought by mosquitoes. To prove that they are wrong, She allowed herself to be bitten by the vector and after days, She died.

43. He was called the father of sanitation.

A. Abraham
B. Hippocrates
C. Moses
D. Willam Halstead

44. The country where SHUSHURUTU originated

A. China
B. Egypt
C. India
D. Babylonia

45. They put girls clothes on male infants to drive evil forces away

A. Chinese
B. Egyptian
C. Indian
D. Babylonian

* Chinese believes that male newborns are demon magnets. To fool those demons, they put female clothes to their male newborn.

46. In what period of nursing does people believe in TREPHINING to drive evil forces away?

A. Dark period
B. Intuitive period
C. Contemporary period
D. Educative period

* Egyptians believe that a sick person is someone with an evil force or demon that is inside their heads. To release these evil spirits, They would tend to drill holes on the patient's skull and it is called TREPHINING.

47. This period ended when Pastor Fliedner, build Kaiserwerth institute for the training of Deaconesses

A. Apprentice period
B. Dark period
C. Contemporary period
D. Educative period

* What dilineates apprentice period among others is that, it ENDED when formal schools were established. During the apprentice period, There is no formal educational institution for nurses. Most of them receive training inside the convent or church. Some of them are trained just for the purpose of nursing the wounded soldiers. But almost all of them are influenced by the christian faith to serve and nurse the sick. When Fliedner build the first formal school for nurses, It marked the end of the APPRENTICESHIP period.

48. Period of nursing where religious Christian orders emerged to take care of the sick

A. Apprentice period
B. Dark period
C. Contemporary period
D. Educative period

* Apprentice period is marked by the emergence of religious orders the are devoted to religious life and the practice of nursing.

49. Founded the second order of St. Francis of Assisi

A. St. Catherine
B. St. Anne
C. St. Clare
D. St. Elizabeth

* The poor clares, is the second order of St. Francis of assisi. The first order was founded by St. Francis himself. St. Catherine of Siena was the first lady with the lamp. St. Anne is the mother of mama mary. St. Elizabeth is the patron saint of Nursing.

50. This period marked the religious upheaval of Luther, Who questions the Christian faith.

A. Apprentice period
B. Dark period
C. Contemporary period
D. Educative period

* Protestantism emerged with Martin Luther questions the Pope and Christianity. This started the Dark period of nursing when the christian faith was smeared by controversies. These leads to closure of some hospital and schools run by the church. Nursing became the work of prostitutes, slaves, mother and least desirable of women.

51. According to the Biopsychosocial and spiritual theory of Sister Callista Roy, Man, As a SOCIAL being is

A. Like all other men
B. Like some other men
C. Like no other men
D. Like men

* According to ROY, Man as a social being is like some other man. As a spiritual being and Biologic being, Man are all alike. As a psychologic being, No man thinks alike. This basically summarized her BIOPSYHOSOCIAL theory which is included in our licensure exam coverage.

52. She conceptualized that man, as an Open system is in constant interaction and transaction with a changing environment.

A. Roy
B. Levin
C. Neuman
D. Newman

* OPEN system theory is ROY. As an open system, man continuously allows input from the environment. Example is when you tell me Im good looking, I will be happy the entire day, Because I am an open system and continuously interact and transact with my environment. A close system is best exemplified by a CANDLE. When you cover the candle with a glass, it will die because it will eventually use all the oxygen it needs inside the glass for combustion. A closed system do not allow inputs and output in its environment.

53. In a CLOSED system, which of the following is true?

A. Affected by matter
B. A sole island in vast ocean
C. Allows input
D. Constantly affected by matter, energy, information

54. Who postulated the WHOLISTIC concept that the totality is greater than sum of its parts?

A. Roy
B. Rogers
C. Henderson
D. Johnson

* The wholistic theory by Martha Rogers states that MAN is greater than the sum of all its parts and that his dignity and worth will not be lessen even if one of this part is missing. A good example is ANNE BOLEYN, The mother of Queen Elizabeth and the wife of King Henry VIII. She was beheaded because Henry wants to mary another wife and that his divorce was not approved by the pope. Outraged, He insisted on the separation of the Church and State and divorce Anne himself by making everyone believe that Anne is having an affair to another man. Anne was beheaded while her lips is still saying a prayer. Even without her head, People still gave respect to her diseased body and a separate head. She was still remembered as Anne boleyn, Mother of Elizabeth who lead england to their GOLDEN AGE.

55. She theorized that man is composed of sub and supra systems. Subsystems are cells, tissues, organs and systems while the suprasystems are family, society and community.

A. Roy
B. Rogers
C. Henderson
D. Johnson

* According to Martha Rogers, Man is composed of 2 systems : SUB which includes cells, tissues, organs and system and SUPRA which includes our famly, community and society. She stated that when any of these systems are affected, it will affect the entire individual.

56. Which of the following is not true about the human needs?

A. Certain needs are common to all people
B. Needs should be followed exactly in accordance with their hierarchy
C. Needs are stimulated by internal factors
D. Needs are stimulated by external factors

* Needs can be deferred. I can urinate later as not to miss the part of the movie's climax. I can save my money that are supposedly for my lunch to watch my idols in concert. The physiologic needs can be meet later for some other needs and need not be strictly followed according to their hierarchy.

57. Which of the following is TRUE about the human needs?

A. May not be deferred
B. Are not interrelated
C. Met in exact and rigid way
D. Priorities are alterable

* Refer to question # 56.

58. According to Maslow, which of the following is NOT TRUE about a self actualized person?

A. Understands poetry, music, philosophy, science etc.
B. Desires privacy, autonomous
C. Follows the decision of the majority, uphold justice and truth
D. Problem centered

* A,B and D are all qualities of a self actualized person. A self actualized person do not follow the decision of majority but is self directed and can make decisions contrary to a popular opinion.

59. According to Maslow, which of the following is TRUE about a self actualized person?

A. Makes decision contrary to public opinion
B. Do not predict events
C. Self centered
D. Maximum degree of self conflict

* Refer to question # 58.

60. This is the essence of mental health

A. Self awareness
B. Self actualization
C. Self esteem
D. Self worth

* The peak of maslow's hierarchy is the essence of mental health.

61. Florence nightingale is born in

A. Germany
B. Britain
C. France
D. Italy

* Florence Nightingale was born in Florence, Italy, May 12, 1820. Studied in Germany and Practiced in England.

62. Which is unlikely of Florence Nightingale?

A. Born May 12, 1840
B. Built St. Thomas school of nursing when she was 40 years old
C. Notes in nursing
D. Notes in hospital

63. What country did Florence Nightingale train in nursing?

A. Belgium
B. US
C. Germany
D. England

64. Which of the following is recognized for developing the concept of HIGH LEVEL WELLNESS?

A. Erikson
B. Madaw
C. Peplau
D. Dunn

* According to Dunn, High level wellness is the ability of an individual to maximize his full potential with the limitations imposed by his environment. According to him, An individual can be healthy or ill in both favorable and unfavorable environment.

65. One of the expectations is for nurses to join professional association primarily because of

A. Promotes advancement and professional growth among its members
B. Works for raising funds for nurse’s benefit
C. Facilitate and establishes acquaintances
D. Assist them and securing jobs abroad

66. Founder of the PNA

A. Julita Sotejo
B. Anastacia Giron Tupas
C. Eufemia Octaviano
D. Anesia Dionisio

67. Which of the following provides that nurses must be a member of a national nurse organization?

A. R.A 877
B. 1981 Code of ethics approved by the house of delegates and the PNA
C. Board resolution No. 1955 Promulgated by the BON
D. RA 7164

* This is an old board resolution. The new Board resolution is No. 220 series of 2004 also known as the Nursing Code Of ethics which states that [ SECTION 17, A ] A nurse should be a member of an accredited professional organization which is the PNA.

68. Which of the following best describes the action of a nurse who documents her nursing diagnosis?

A. She documents it and charts it whenever necessary
B. She can be accused of malpractice
C. She does it regularly as an important responsibility
D. She charts it only when the patient is acutely ill

69. Which of the following does not govern nursing practice?

A. RA 7164
B. RA 9173
C. BON Res. Code Of Ethics
D. BON Res. Scope of Nursing Practice

* 7164 is an old law. This is the 1991 Nursing Law which was repealed by the newer 9173.

70. A nurse who is maintaining a private clinic in the community renders service on maternal and child health among the neighborhood for a fee is:

A. Primary care nurse
B. Independent nurse practitioner
C. Nurse-Midwife
D. Nurse specialist

71. When was the PNA founded?

A. September 22, 1922
B. September 02, 1920
C. October 21, 1922
D. September 02, 1922

* According to the official PNA website, they are founded September 02, 1922.

72. Who was the first president of the PNA ?

A. Anastacia Giron-Tupas
B. Loreto Tupas
C. Rosario Montenegro
D. Ricarda Mendoza

* Anastacia Giron Tupas founded the FNA, the former name of the PNA but the first President was Rosario Montenegro.

73. Defines health as the ability to maintain internal milieu. Illness according to him/her/them is the failure to maintain internal environment.

A. Cannon
B. Bernard
C. Leddy and Pepper
D. Roy

* According to Bernard, Health is the ability to maintain and Internal Milieu and Illness is the failure to maintain the internal environment.

74. Postulated that health is a state and process of being and becoming an integrated and whole person.

A. Cannon
B. Bernard
C. Dunn
D. Roy

* According to ROY, Health is a state and process of becoming a WHOLE AND INTEGRATED Person.

75. What regulates HOMEOSTASIS according to the theory of Walter Cannon?

A. Positive feedback
B. Negative feedback
C. Buffer system
D. Various mechanisms

* The theory of Health as the ability to maintain homeostasis was postulated by Walter Cannon. According to him, There are certain FEEDBACK Mechanism that regulates our Homeostasis. A good example is that when we overuse our arm, it will produce pain. PAIN is a negative feedback that signals us that our arm needs a rest.

76. Stated that health is WELLNESS. A termed define by the culture or an individual.

A. Roy
B. Henderson
C. Rogers
D. King

* Martha Rogers states that HEALTH is synonymous with WELLNESS and that HEALTH and WELLNESS is subjective depending on the definition of one's culture.

77. Defined health as a dynamic state in the life cycle, and Illness as interference in the life cycle.

A. Roy
B. Henderson
C. Rogers
D. King

* Emogene King states that health is a state in the life cycle and Illness is any interference on this cycle. I enjoyed the Movie LION KING and like what Mufasa said that they are all part of the CIRCLE OF LIFE, or the Life cycle.

78. She defined health as the soundness and wholness of developed human structure and bodily mental functioning.

A. Orem
B. Henderson
C. Neuman
D. Clark

* Orem defined health as the SOUNDNESS and WHOLENESS of developed human structure and of bodily and mental functioning.

79. According to her, Wellness is a condition in which all parts and subparts of an individual are in harmony with the whole system.

A. Orem
B. Henderson
C. Neuman
D. Johnson

* Neuman believe that man is composed of subparts and when this subparts are in harmony with the whole system, Wellness results. Please do not confuse this with the SUB and SUPRA systems of martha rogers.

80. Postulated that health is reflected by the organization, interaction, interdependence and integration of the subsystem of the behavioral system.

A. Orem
B. Henderson
C. Neuman
D. Johnson

* Once you see the phrase BEHAVIORAL SYSTEM, answer Dorothy Johnson.

81. According to them, Well being is a subjective perception of BALANCE, HARMONY and VITALITY

A. Leavell and Clark
B. Peterson and Zderad
C. Benner and Wruber
D. Leddy and Pepper

* According to Leddy and Pepper, Wellness is subjective and depends on an individuals perception of balance, harmony and vitality. Leavell and Clark postulared the ecologic model of health and illness or the AGENT-HOST-ENVIRONMENT model. Peterson and Zderad developed the HUMANISTIC NURSING PRACTICE theory while Benner and Wruber postulate the PRIMACY OF CARING MODEL.

82. He describes the WELLNESS-ILLNESS Continuum as interaction of the environment with well being and illness.

A. Cannon
B. Bernard
C. Dunn
D. Clark

83. An integrated method of functioning that is oriented towards maximizing one’s potential within the limitation of the environment.

A. Well being
B. Health
C. Low level Wellness
D. High level Wellness

84. What kind of illness precursor, according to DUNN is cigarette smoking?

A. Heredity
B. Social
C. Behavioral
D. Environmental

* Behavioral precursors includes smoking, alcoholism, high fat intake and other lifestyle choices. Environmental factors involved poor sanitation and over crowding. Heridity includes congenital and diseases acquired through the genes. There are no social precursors according to DUNN.

85. According to DUNN, Overcrowding is what type of illness precursor?

A. Heredity
B. Social
C. Behavioral
D. Environmental

86. Health belief model was formulated in 1975 by who?

A. Becker
B. Smith
C. Dunn
D. Leavell and Clark

* According to Becker, The belief of an individual greatly affects his behavior. If a man believes that he is susceptible to an illness, He will alter his behavior in order to prevent its occurence. For example, If a man thinks that diabetes is acquired through high intake of sugar and simple carbohydrates, then he will limit the intake of foods rich in these components.

87. In health belief model, Individual perception matters. Which of the following is highly UNLIKELY to influence preventive behavior?

A. Perceived susceptibility to an illness
B. Perceived seriousness of an illness
C. Perceived threat of an illness
D. Perceived curability of an illness

* If a man think he is susceptibe to a certain disease, thinks that the disease is serious and it is a threat to his life and functions, he will use preventive behaviors to avoid the occurence of this threat.

88. Which of the following is not a PERCEIVED BARRIER in preventive action?

A. Difficulty adhering to the lifestyle
B. Economic factors
C. Accessibility of health care facilities
D. Increase adherence to medical therapies

* Perceived barriers are those factors that affects the individual's health preventive actions. Both A and B can affect the individual's ability to prevent the occurence of diseases. C and D are called Preventive Health Behaviors which enhances the individual's preventive capabilities.

89. Conceptualizes that health is a condition of actualization or realization of person’s potential. Avers that the highest aspiration of people is fulfillment and complete development actualization.

A. Clinical Model
B. Role performance Model
C. Adaptive Model
D. Eudaemonistic Model

* Smith formulated 5 models of health. Clinical model simply states that when people experience sign and symptoms, they would think that they are unhealthy therefore, Health is the absence of clinical sign and symptoms of a disease. Role performance model states that when a person does his role and activities without deficits, he is healthy and the inability to perform usual roles means that the person is ill. Adaptive Model states that if a person adapts well with his environment, he is healthy and maladaptation equates illness. Eudaemonistic Model of health according to smith is the actualization of a person's fullest potential. If a person functions optimally and develop self actualization, then, no doubt that person is healthy.

90. Views people as physiologic system and Absence of sign and symptoms equates health.

A. Clinical Model
B. Role performance Model
C. Adaptive Model
D. Eudaemonistic Model

* Refer to question # 89.

91. Knowledge about the disease and prior contact with it is what type of VARIABLE according to the health belief model?

A. Demographic
B. Sociopsychologic
C. Structural
D. Cues to action

* Modifying variables in Becker's health belief model includes DEMOGRAPHIC : Age, sex, race etc. SOCIOPSYCHOLOGIC : Social and Peer influence. STRUCTURAL : Knowledge about the disease and prior contact with it and CUES TO ACTION : Which are the sign and symptoms of the disease or advice from friends, mass media and others that forces or makes the individual seek help.

92. It includes internal and external factors that leads the individual to seek help

A. Demographic
B. Sociopsychologic
C. Structural
D. Cues to action

* Refer to question # 92.

93. Influence from peers and social pressure is included in what variable of HBM?

A. Demographic
B. Sociopsychologic
C. Structural
D. Cues to action

* Refer to question # 92.

94. Age, Sex, Race etc. is included in what variable of HBM?

A. Demographic
B. Sociopsychologic
C. Structural
D. Cues to action

* Refer to question # 92.

95. According to Leavell and Clark’s ecologic model, All of this are factors that affects health and illness except

A. Reservoir
B. Agent
C. Environment
D. Host

* According to L&C's Ecologic model, there are 3 factors that affect health and illness. These are the AGENT or the factor the leads to illness, either a bacteria or an event in life. HOST are persons that may or may not be affected by these agents. ENVIRONMENT are factors external to the host that may or may not predispose him to the AGENT.

96. Is a multi dimensional model developed by PENDER that describes the nature of persons as they interact within the environment to pursue health

A. Ecologic Model
B. Health Belief Model
C. Health Promotion Model
D. Health Prevention Model

* Pender developed the concept of HEALTH PROMOTION MODEL which postulated that an individual engages in health promotion activities to increase well being and attain self actualization. These includes exercise, immunization, healthy lifestyle, good food, self responsibility and all other factors that minimize if not totally eradicate risks and threats of health.

97. Defined by Pender as all activities directed toward increasing the level of well being and self actualization.

A. Health prevention
B. Health promotion
C. Health teaching
D. Self actualization

* Refer to question # 96.

98. Defined as an alteration in normal function resulting in reduction of capacities and shortening of life span.

A. Illness
B. Disease
C. Health
D. Wellness

* Disease are alteration in body functions resulting in reduction of capabilities or shortening of life span.

99. Personal state in which a person feels unhealthy

A. Illness
B. Disease
C. Health
D. Wellness

* Illness is something PERSONAL. Unlike disease, Illness are personal state in which person feels unhealthy. An old person might think he is ILL but in fact, he is not due, to diminishing functions and capabilities, people might think they are ILL. Disease however, is something with tangible basis like lab results, X ray films or clinical sign and symptoms.

100. According to her, Caring is defined as a nurturant way of responding to a valued client towards whom the nurse feels a sense of commitment and responsibility.

A. Benner
B. Watson
C. Leininger
D. Swanson

* This is Jean Watson's definition of Nursing as caring. This was asked word per word last June 06' NLE. Benner defines caring as something that matters to people. She postulated the responsibility created by Caring in nursing. She was also responsible for the PRIMACY OF CARING MODEL. Leininger defind the 4 conservation principle while Swanson introduced the 5 processes of caring.

Funda drill Test II

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 15:51:00 +0800

1. The four major concepts in nursing theory are the

A. Person, Environment, Nurse, Health
B. Nurse, Person, Environment, Cure
C. Promotive, Preventive, Curative, Rehabilitative
D. Person, Environment, Nursing, Health

2. The act of utilizing the environment of the patient to assist him in his recovery is theorized by

A. Nightingale
B. Benner
C. Swanson
D. King

3. For her, Nursing is a theoretical system of knowledge that prescribes a process of analysis and action related to care of the ill person

A. King
B. Henderson
C. Roy
D. Leininger

4. According to her, Nursing is a helping or assistive profession to persons who are wholly or partly dependent or when those who are supposedly caring for them are no longer able to give care.

A. Henderson
B. Orem
C. Swanson
D. Neuman

5. Nursing is a unique profession, Concerned with all the variables affecting an individual’s response to stressors, which are intra, inter and extra personal in nature.

A. Neuman
B. Johnson
C. Watson
D. Parse

6. The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health that he would perform unaided if he has the necessary strength, will and knowledge, and do this in such a way as to help him gain independence as rapidly as possible.

A. Henderson
B. Abdellah
C. Levin
D. Peplau

7. Caring is the essence and central unifying, a dominant domain that distinguishes nursing from other health disciplines. Care is an essential human need.

A. Benner
B. Watson
C. Leininger
D. Swanson

8. Caring involves 5 processes, KNOWING, BEING WITH, DOING FOR, ENABLING and MAINTAINING BELIEF.

A. Benner
B. Watson
C. Leininger
D. Swanson

9. Caring is healing, it is communicated through the consciousness of the nurse to the individual being cared for. It allows access to higher human spirit.

A. Benner
B. Watson
C. Leininger
D. Swanson

10. Caring means that person, events, projects and things matter to people. It reveals stress and coping options. Caring creates responsibility. It is an inherent feature of nursing practice. It helps the nurse assist clients to recover in the face of the illness.

A. Benner
B. Watson
C. Leininger
D. Swanson

11. Which of the following is NOT TRUE about profession according to Marie Jahoda?

A. A profession is an organization of an occupational group based on the application of special knowledge
B. It serves specific interest of a group
C. It is altruistic
D. Quality of work is of greater importance than the rewards

12. Which of the following is NOT an attribute of a professional?

A. Concerned with quantity
B. Self directed
C. Committed to spirit of inquiry
D. Independent

13. The most unique characteristic of nursing as a profession is

A. Education
B. Theory
C. Caring
D. Autonomy

14. This is the distinctive individual qualities that differentiate a person to another

A. Philosophy
B. Personality
C. Charm
D. Character

15. Refers to the moral values and beliefs that are used as guides to personal behavior and actions

A. Philosophy
B. Personality
C. Charm
D. Character

16. As a nurse manager, which of the following best describes this function?

A. Initiate modification on client’s lifestyle
B. Protect client’s right
C. Coordinates the activities of other members of the health team in managing patient care
D. Provide in service education programs, Use accurate nursing audit, formulate philosophy and vision of the institution.

17. What best describes nurses as a care provider?

A. Determine client’s need
B. Provide direct nursing care
C. Help client recognize and cope with stressful psychological situation
D. Works in combined effort with all those involved in patient’s care

18. The nurse questions a doctors order of Morphine sulfate 50 mg, IM for a client with pancreatitis. Which role best fit that statement?

A. Change agent
B. Client advocate
C. Case manager
D. Collaborator

19. These are nursing intervention that requires knowledge, skills and expertise of multiple health professionals.

A. Dependent
B. Independent
C. Interdependent
D. Intradependent
20. What type of patient care model is the most common for student nurses and private duty nurses?

A. Total patient care
B. Team nursing
C. Primary Nursing
D. Case management

21. This is the best patient care model when there are many nurses but few patients.

A. Functional nursing
B. Team nursing
C. Primary nursing
D. Total patient care

22. This patient care model works best when there are plenty of patient but few nurses

A. Functional nursing
B. Team nursing
C. Primary nursing
D. Total patient care

23. RN assumes 24 hour responsibility for the client to maintain continuity of care across shifts, days or visits.

A. Functional nursing
B. Team nursing
C. Primary nursing
D. Total patient care

24. Who developed the first theory of nursing?

A. Hammurabi
B. Alexander
C. Fabiola
D. Nightingale

25. She introduces the NATURE OF NURSING MODEL.

A. Henderson
B. Nightingale
C. Parse
D. Orlando

26. She described the four conservation principle.

A. Levin
B. Leininger
C. Orlando
D. Parse

27. Proposed the HEALTH CARE SYSTEM MODEL.

A. Henderson
B. Orem
C. Parse
D. Neuman

28. Conceptualized the BEHAVIORAL SYSTEM MODEL

A. Orem
B. Johnson
C. Henderson
D. Parse

29. Developed the CLINICAL NURSING – A HELPING ART MODEL

A. Swanson
B. Hall
C. Weidenbach
D. Zderad

30. Developed the ROLE MODELING and MODELING theory

A. Erickson,Tomlin,Swain
B. Neuman
C. Newman
D. Benner and Wrubel

31. Proposed the GRAND THEORY OF NURSING AS CARING

A. Erickson, Tomlin, Swain
B. Peterson,Zderad
C. Bnner,Wrubel
D. Boykin,Schoenhofer

32. Postulated the INTERPERSONAL ASPECT OF NURSING

A. Travelbee
B. Swanson
C. Zderad
D. Peplau

33. He proposed the theory of morality that is based on MUTUAL TRUST

A. Freud
B. Erikson
C. Kohlberg
D. Peters

34. He proposed the theory of morality based on PRINCIPLES
A. Freud
B. Erikson
C. Kohlberg
D. Peters

35. Freud postulated that child adopts parental standards and traits through

A. Imitation
B. Introjection
C. Identification
D. Regression

36. According to them, Morality is measured of how people treat human being and that a moral child strives to be kind and just

A. Zderad and Peterson
B. Benner and Wrubel
C. Fowler and Westerhoff
D. Schulman and Mekler

37. Postulated that FAITH is the way of behaving. He developed four theories of faith and development based on his experience.

A. Giligan
B. Westerhoff
C. Fowler
D. Freud

38. He described the development of faith. He suggested that faith is a spiritual dimension that gives meaning to a persons life. Faith according to him, is a relational phenomenon.

A. Giligan
B. Westerhoff
C. Fowler
D. Freud

39. Established in 1906 by the Baptist foreign mission society of

America

. Miss rose nicolet, was it’s first superintendent.

A. St. Paul Hospital School of nursing
B. Iloilo Mission Hospital School of nursing
C. Philippine General Hospital School of nursing
D. St. Luke’s Hospital School of nursing

40. Anastacia Giron-Tupas was the first Filipino nurse to occupy the position of chief nurse in this hospital.

A. St. Paul Hospital
B. Iloilo Mission Hospital
C. Philippine General Hospital
D. St. Luke’s Hospital

41. She was the daughter of Hungarian kings, who feed 300-900 people everyday in their gate, builds hospitals, and care of the poor and sick herself.

A. Elizabeth
B. Catherine
C. Nightingale
D. Sairey Gamp

42. She dies of yellow fever in her search for truth to prove that yellow fever is carried by a mosquitoes.

A. Clara louise Maas
B. Pearl Tucker
C. Isabel Hampton Robb
D. Caroline Hampton Robb

43. He was called the father of sanitation.

A. Abraham
B. Hippocrates
C. Moses
D. Willam Halstead

44. The country where SHUSHURUTU originated

A. China
B. Egypt
C. India
D. Babylonia

45. They put girls clothes on male infants to drive evil forces away

A. Chinese
B. Egyptian
C. Indian
D. Babylonian

46. In what period of nursing does people believe in TREPHINING to drive evil forces away?

A. Dark period
B. Intuitive period
C. Contemporary period
D. Educative period

47. This period ended when Pastor Fliedner, build Kaiserwerth institute for the training of Deaconesses

A. Apprentice period
B. Dark period
C. Contemporary period
D. Educative period

48. Period of nursing where religious Christian orders emerged to take care of the sick

A. Apprentice period
B. Dark period
C. Contemporary period
D. Educative period

49. Founded the second order of St. Francis of Assisi

A. St. Catherine
B. St. Anne
C. St. Clare
D. St. Elizabeth

50. This period marked the religious upheaval of Luther, Who questions the Christian faith.

A. Apprentice period
B. Dark period
C. Contemporary period
D. Educative period

51. According to the Biopsychosocial and spiritual theory of Sister Callista Roy, Man, As a SOCIAL being is

A. Like all other men
B. Like some other men
C. Like no other men
D. Like men

52. She conceptualized that man, as an Open system is in constant interaction and transaction with a changing environment.

A. Roy
B. Levin
C. Neuman
D. Newman

53. In a CLOSED system, which of the following is true?

A. Affected by matter
B. A sole island in vast ocean
C. Allows input
D. Constantly affected by matter, energy, information

54. Who postulated the WHOLISTIC concept that the totality is greater than sum of its parts?

A. Roy
B. Rogers
C. Henderson
D. Johnson

55. She theorized that man is composed of sub and supra systems. Subsystems are cells, tissues, organs and systems while the suprasystems are family, society and community.

A. Roy
B. Rogers
C. Henderson
D. Johnson

56. Which of the following is not true about the human needs?

A. Certain needs are common to all people
B. Needs should be followed exactly in accordance with their hierarchy
C. Needs are stimulated by internal factors
D. Needs are stimulated by external factors

57. Which of the following is TRUE about the human needs?

A. May not be deferred
B. Are not interrelated
C. Met in exact and rigid way
D. Priorities are alterable

58. According to Maslow, which of the following is NOT TRUE about a self actualized person?

A. Understands poetry, music, philosophy, science etc.
B. Desires privacy, autonomous
C. Follows the decision of the majority, uphold justice and truth
D. Problem centered

59. According to Maslow, which of the following is TRUE about a self actualized person?

A. Makes decision contrary to public opinion
B. Do not predict events
C. Self centered
D. Maximum degree of self conflict

60. This is the essence of mental health

A. Self awareness
B. Self actualization
C. Self esteem
D. Self worth

61. Florence nightingale is born in

A. Germany
B. Britain
C. France
D. Italy

62. Which is unlikely of Florence Nightingale?

A. Born May 12, 1840
B. Built St. Thomas school of nursing when she was 40 years old
C. Notes in nursing
D. Notes in hospital

63. What country did Florence Nightingale train in nursing?

A. Belgium
B. US
C. Germany
D.

England

64. Which of the following is recognized for developing the concept of HIGH LEVEL WELLNESS?

A. Erikson
B. Madaw
C. Peplau
D. Dunn

65. One of the expectations is for nurses to join professional association primarily because of

A. Promotes advancement and professional growth among its members
B. Works for raising funds for nurse’s benefit
C. Facilitate and establishes acquaintances
D. Assist them and securing jobs abroad

66. Founder of the PNA

A. Julita Sotejo
B. Anastacia Giron Tupas
C. Eufemia Octaviano
D. Anesia Dionisio

67. Which of the following provides that nurses must be a member of a national nurse organization?

A. R.A 877
B. 1981 Code of ethics approved by the house of delegates and the PNA
C. Board resolution No. 1955 Promulgated by the BON
D. RA 7164

68. Which of the following best describes the action of a nurse who documents her nursing diagnosis?

A. She documents it and charts it whenever necessary
B. She can be accused of malpractice
C. She does it regularly as an important responsibility
D. She charts it only when the patient is acutely ill

69. Which of the following does not govern nursing practice?

A. RA 7164
B. RA 9173
C. BON Res. Code Of Ethics
D. BON Res. Scope of Nursing Practice

70. A nurse who is maintaining a private clinic in the community renders service on maternal and child health among the neighborhood for a fee is:

A. Primary care nurse
B. Independent nurse practitioner
C. Nurse-Midwife
D. Nurse specialist

71. When was the PNA founded?

A. September 22, 1922
B. September 02, 1920
C. October 21, 1922
D. September 02, 1922

72. Who was the first president of the PNA ?

A. Anastacia Giron-Tupas
B. Loreto Tupas
C. Rosario Montenegro
D. Ricarda Mendoza

73. Defines health as the ability to maintain internal milieu. Illness according to him/her/them is the failure to maintain internal environment.

A. Cannon
B. Bernard
C. Leddy and Pepper
D. Roy

74. Postulated that health is a state and process of being and becoming an integrated and whole person.

A. Cannon
B. Bernard
C. Dunn
D. Roy

75. What regulates HOMEOSTASIS according to the theory of Walter Cannon?

A. Positive feedback
B. Negative feedback
C. Buffer system
D. Various mechanisms

76. Stated that health is WELLNESS. A termed define by the culture or an individual.

A. Roy
B. Henderson
C. Rogers
D. King

77. Defined health as a dynamic state in the life cycle, and Illness as interference in the life cycle.

A. Roy
B. Henderson
C. Rogers
D. King

78. She defined health as the soundness and wholness of developed human structure and bodily mental functioning.

A. Orem
B. Henderson
C. Neuman
D. Clark

79. According to her, Wellness is a condition in which all parts and subparts of an individual are in harmony with the whole system.

A. Orem
B. Henderson
C. Neuman
D. Johnson

80. Postulated that health is reflected by the organization, interaction, interdependence and integration of the subsystem of the behavioral system.

A. Orem
B. Henderson
C. Neuman
D. Johnson

81. According to them, Well being is a subjective perception of BALANCE, HARMONY and VITALITY

A. Leavell and Clark
B. Peterson and Zderad
C. Benner and Wruber
D. Leddy and Pepper

82. He describes the WELLNESS-ILLNESS Continuum as interaction of the environment with well being and illness.

A. Cannon
B. Bernard
C. Dunn
D. Clark

83. An integrated method of functioning that is oriented towards maximizing one’s potential within the limitation of the environment.

A. Well being
B. Health
C. Low level Wellness
D. High level Wellness

84. What kind of illness precursor, according to DUNN is cigarette smoking?

A. Heredity
B. Social
C. Behavioral
D. Environmental

85. According to DUNN, Overcrowding is what type of illness precursor?

A. Heredity
B. Social
C. Behavioral
D. Environmental

86. Health belief model was formulated in 1975 by who?

A. Becker
B. Smith
C. Dunn
D. Leavell and Clark

87. In health belief model, Individual perception matters. Which of the following is highly UNLIKELY to influence preventive behavior?

A. Perceived susceptibility to an illness
B. Perceived seriousness of an illness
C. Perceived threat of an illness
D. Perceived curability of an illness

88. Which of the following is not a PERCEIVED BARRIER in preventive action?

A. Difficulty adhering to the lifestyle
B. Economic factors
C. Accessibility of health care facilities
D. Increase adherence to medical therapies

89. Conceptualizes that health is a condition of actualization or realization of person’s potential. Avers that the highest aspiration of people is fulfillment and complete development actualization.

A. Clinical Model
B. Role performance Model
C. Adaptive Model
D. Eudaemonistic Model

90. Views people as physiologic system and Absence of sign and symptoms equates health.

A. Clinical Model
B. Role performance Model
C. Adaptive Model
D. Eudaemonistic Model

91. Knowledge about the disease and prior contact with it is what type of VARIABLE according to the health belief model?

A. Demographic
B. Sociopsychologic
C. Structural
D. Cues to action

92. It includes internal and external factors that leads the individual to seek help

A. Demographic
B. Sociopsychologic
C. Structural
D. Cues to action

93. Influence from peers and social pressure is included in what variable of HBM?

A. Demographic
B. Sociopsychologic
C. Structural
D. Cues to action

94. Age, Sex, Race etc. is included in what variable of HBM?

A. Demographic
B. Sociopsychologic
C. Structural
D. Cues to action

95. According to Leavell and Clark’s ecologic model, All of this are factors that affects health and illness except

A. Reservoir
B. Agent
C. Environment
D. Host

96. Is a multi dimensional model developed by PENDER that describes the nature of persons as they interact within the environment to pursue health

A. Ecologic Model
B. Health Belief Model
C. Health Promotion Model
D. Health Prevention Model

97. Defined by Pender as all activities directed toward increasing the level of well being and self actualization.

A. Health prevention
B. Health promotion
C. Health teaching
D. Self actualization

98. Defined as an alteration in normal function resulting in reduction of capacities and shortening of life span.

A. Illness
B. Disease
C. Health
D. Wellness

99. Personal state in which a person feels unhealthy

A. Illness
B. Disease
C. Health
D. Wellness

100. According to her, Caring is defined as a nurturant way of responding to a valued client towards whom the nurse feels a sense of commitment and responsibility.

A. Benner
B. Watson
C. Leininger
D. Swanson

ANSWERS and RATIONALE

Funda Test Drill 1 ( Answers and Rationale)

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 15:47:00 +0800

2. Which of the following response is not expected to a person whose GAS is activated and the FIGHT OR FLIGHT response sets in?

A. The client will not urinate due to relaxation of the detrusor muscle
B. The client will be restless and alert
C. Clients BP will increase, there will be vasodilation
D. There will be increase glycogenolysis, Pancrease will decrease insulin secretion

* If vasodilation will occur, The BP will not increase but decrease. It is true that Blood pressure increases during SNS Stimulation due to the fact that we need more BLOOD to circulate during the FIGHT or FLIGHT Response because the oxygen demand has increased, but this is facilitated by vasoconstriction and not vasodilation. A,B and D are all correct. The liver will increase glycogenolysis or glycogen store utilization due to a heightened demand for energy. Pancrease will decrease insulin secretion because almost every aspect of digestion that is controlled by Parasympathetic nervous system is inhibited when the SNS dominates.

3. State in which a person’s physical, emotional, intellectual and social development or spiritual functioning is diminished or impaired compared with a previous experience.

A. Illness
B. Disease
C. Health
D. Wellness

* Disease is a PROVEN FACT based on a medical theory, standards, diagnosis and clinical feature while ILLNESS Is a subjective state of not feeling well based on subjective appraisal, previous experience, peer advice etc.

4. This is the first stage of illness wherein, the person starts to believe that something is wrong. Also known as the transition phase from wellness to illness.

A. Symptom Experience
B. Assumption of sick role
C. Medical care contact
D. Dependent patient role

* A favorite board question are Stages of Illness. When a person starts to believe something is wrong, that person is experiencing signs and symptoms of an illness. The patient will then ASSUME that he is sick. This is called assumption of the sick role where the patient accepts he is Ill and try to give up some activities. Since the client only ASSUMES his illness, he will try to ask someone to validate if what he is experiencing is a disease, This is now called as MEDICAL CARE CONTACT. The client seeks professional advice for validation, reassurance, clarification and explanation of the symptoms he is experiencing. client will then start his dependent patient role of receiving care from the health care providers. The last stage of Illness is the RECOVERY stage where the patient gives up the sick role and assumes the previous normal gunctions.

5. In this stage of illness, the person accepts or rejects a professionals suggestion. The person also becomes passive and may regress to an earlier stage.

A. Symptom Experience
B. Assumption of sick role
C. Medical care contact
D. Dependent patient role

* In the dependent patient role stage, Client needs professionals for help. They have a choice either to accept or reject the professional's decisions but patients are usually passive and accepting. Regression tends to occur more in this period.

6. In this stage of illness, The person learns to accept the illness.

A. Symptom Experience
B. Assumption of sick role
C. Medical care contact
D. Dependent patient role

* Acceptance of illness occurs in the Assumption of sick role phase of illness.

7. In this stage, the person tries to find answers for his illness. He wants his illness to be validated, his symptoms explained and the outcome reassured or predicted

A. Symptom Experience
B. Assumption of sick role
C. Medical care contact
D. Dependent patient role

* At this stage, The patient seeks for validation of his symptom experience. He wants to find out if what he feels are normal or not normal. He wants someone to explain why is he feeling these signs and symptoms and wants to know the probable outcome of this experience.

8. The following are true with regards to aspect of the sick role except

A. One should be held responsible for his condition
B. One is excused from his societal role
C. One is obliged to get well as soon as possible
D. One is obliged to seek competent help

* The nurse should not judge the patient and not view the patient as the cause or someone responsible for his illness. A sick client is excused from his societal roles, Oblige to get well as soon as possible and Obliged to seek competent help.

9. Refers to conditions that increases vulnerability of individual or group to illness or accident

A. Predisposing factor
B. Etiology
C. Risk factor
D. Modifiable Risks

10. Refers to the degree of resistance the potential host has against a certain pathogen

A. Susceptibility
B. Immunity
C. Virulence
D. Etiology

* Immunity is the ABSOLUTE Resistance to a pathogen considering that person has an INTACT IMMUNITY while susceptibility is the DEGREE of resistance. Degree of resistance means how well would the individual combat the pathogens and repel infection or invasion of these disease causing organisms. A susceptible person is someone who has a very low degree of resistance to combat pathogens. An Immune person is someone that can easily repel specific pathogens. However, Remember that even if a person is IMMUNE [ Vaccination ] Immunity can always be impaired in cases of chemotherapy, HIV, Burns, etc.

11. A group of symptoms that sums up or constitute a disease

A. Syndrome
B. Symptoms
C. Signs
D. Etiology

* Symptoms are individual manifestation of a certain disease. For example, In Tourette syndrome, patient will manifest TICS, but this alone is not enough to diagnose the patient as other diseases has the same tic manifestation. Syndrome means COLLECTION of these symptoms that occurs together to characterize a certain disease. Tics with coprolalia, echolalia, palilalia, choreas or other movement disorders are characteristics of TOURETTE SYNDROME.

12. A woman undergoing radiation therapy developed redness and burning of the skin around the best. This is best classified as what type of disease?

A. Neoplastic
B. Traumatic
C. Nosocomial
D. Iatrogenic

* Iatrogenic diseases refers to those that resulted from treatment of a certain disease. For example, A child frequently exposed to the X-RAY Machine develops redness and partial thickness burns over the chest area. Neoplastic are malignant diseases cause by proliferation of abnormally growing cells. Traumatic are brought about by injuries like Motor vehicular accidents. Nosocomial are infections that acquired INSIDE the hospital. Example is UTI Because of catheterization, This is commonly caused by E.Coli.

13. The classification of CANCER according to its etiology Is best described as

1. Nosocomial
2. Idiopathic
3. Neoplastic
4. Traumatic
5. Congenital
6. Degenrative

A. 5 and 2
B. 2 and 3
C. 3 and 4
D. 3 and 5

* Aside from being NEOPLASTIC, Cancer is considered as IDIOPATHIC because the cause is UNKNOWN.

14. Term to describe the reactiviation and recurrence of pronounced symptoms of a disease

A. Remission
B. Emission
C. Exacerbation
D. Sub acute

15. A type of illness characterized by periods of remission and exacerbation

A. Chronic
B. Acute
C. Sub acute
D. Sub chronic

* A good example is Multiple sclerosis that characterized by periods of remissions and exacerbation and it is a CHRONIC Disease. An acute and sub acute diseases occurs too short to manifest remissions. Chronic diseases persists longer than 6 months that is why remissions and exacerbation are observable.

16. Diseases that results from changes in the normal structure, from recognizable anatomical changes in an organ or body tissue is termed as

A. Functional
B. Occupational
C. Inorganic
D. Organic

* As the word implies, ORGANIC Diseases are those that causes a CHANGE in the structure of the organs and systems. Inorganic diseases is synonymous with FUNCTIONAL diseases wherein, There is no evident structural, anatomical or physical change in the structure of the organ or system but function is altered due to other causes, which is usually due to abnormal response of the organ to stressors. Therefore, ORGANIC BRAIN SYNDROME are anatomic and physiologic change in the BRAIN that is NON PROGRESSIVE BUT IRREVERSIBLE caused by alteration in structure of the brain and it's supporting structure which manifests different sign and symptoms of neurological, physiologic and psychologic alterations. Mental disorders manifesting symptoms of psychoses without any evident organic or structural damage are termed as INORGANIC PSYCHOSES while alteration in the organ structures that causes symptoms of bizaare pyschotic behavior is termed as ORGANIC PSYCHOSES.

17. It is the science of organism as affected by factors in their environment. It deals with the relationship between disease and geographical environment.

A. Epidemiology
B. Ecology
C. Statistics
D. Geography

* Ecology is the science that deals with the ECOSYSTEM and its effects on living things in the biosphere. It deals with diseases in relationship with the environment. Epidimiology is simply the Study of diseases and its occurence and distribution in man for the purpose of controlling and preventing diseases. This was asked during the previous boards.

18. This is the study of the patterns of health and disease. Its occurrence and distribution in man, for the purpose of control and prevention of disease.

A. Epidemiology
B. Ecology
C. Statistics
D. Geography

* Refer to number 17.

19. Refers to diseases that produced no anatomic changes but as a result from abnormal response to a stimuli.

A. Functional
B. Occupational
C. Inorganic
D. Organic

* Refer to number 16.

20. In what level of prevention according to Leavell and Clark does the nurse support the client in obtaining OPTIMAL HEALTH STATUS after a disease or injury?

A. Primary
B. Secondary
C. Tertiary
D. None of the above

* Perhaps one of the easiest concept but asked frequently in the NLE. Primary refers to preventions that aims in preventing the disease. Examples are healthy lifestyle, good nutrition, knowledge seeking behaviors etc. Secondary prevention are those that deals with early diagnostics, case finding and treatments. Examples are monthly breast self exam, Chest X-RAY, Antibiotic treatment to cure infection, Iron therapy to treat anemia etc. Tertiary prevention aims on maintaining optimum level of functioning during or after the impact of a disease that threatens to alter the normal body functioning. Examples are prosthetis fitting for an amputated leg after an accident, Self monitoring of glucose among diabetics, TPA Therapy after stroke etc.

The confusing part is between the treatment in secondary and treatment in tertiary. To best differentiate the two, A client with ANEMIA that is being treated with ferrous sulfate is considered being in the SECONDARY PREVENTION because ANEMIA once treated, will move the client on PRE ILLNESS STATE again. However, In cases of ASPIRING Therapy in cases of stroke, ASPIRING no longer cure the patient or PUT HIM IN THE PRE ILLNESS STATE. ASA therapy is done in order to prevent coagulation of the blood that can lead to thrombus formation and a another possible stroke. You might wonder why I spelled ASPIRIN as ASPIRING, Its side effect is OTOTOXICITY [ CN VIII ] that leads to TINNITUS or ringing of the ears.

21. In what level of prevention does the nurse encourage optimal health and increases person’s susceptibility to illness?

A. Primary
B. Secondary
C. Tertiary
D. None of the above

* The nurse never increases the person's susceptibility to illness but rather, LESSEN the person's susceptibility to illness.

22. Also known as HEALTH MAINTENANCE prevention.

A. Primary
B. Secondary
C. Tertiary
D. None of the above

* Secondary prevention is also known as HEALTH MAINTENANCE Prevention. Here, The person feels signs and symptoms and seeks Diagnosis and treatment in order to prevent deblitating complications. Even if the person feels healthy, We are required to MAINTAIN our health by monthly check ups, Physical examinations, Diagnostics etc.

23. PPD In occupational health nursing is what type of prevention?

A. Primary
B. Secondary
C. Tertiary
D. None of the above

* PPD or PERSONAL PROTECTIVE DEVICES are worn by the workes in a hazardous environment to protect them from injuries and hazards. This is considered as a PRIMARY prevention because the nurse prevents occurence of diseases and injuries.

24. BCG in community health nursing is what type of prevention?

A. Primary
B. Secondary
C. Tertiary
D. None of the above

25. A regular pap smear for woman every 3 years after establishing normal pap smear for 3 consecutive years Is advocated. What level of prevention does this belongs?

A. Primary
B. Secondary
C. Tertiary
D. None of the above

26. Self monitoring of blood glucose for diabetic clients is on what level of prevention?

A. Primary
B. Secondary
C. Tertiary
D. None of the above

27. Which is the best way to disseminate information to the public?

A. Newspaper
B. School bulletins
C. Community bill boards
D. Radio and Television

* An actual board question, The best way to disseminate information to the public is by TELEVISION followed by RADIO. This is how the DOH establish its IEC Programs other than publising posters, leaflets and brochures. An emerging new way to disseminate is through the internet.

28. Who conceptualized health as integration of parts and subparts of an individual?

A. Newman
B. Neuman
C. Watson
D. Rogers

* The supra and subsystems are theories of Martha Rogers but the parts and subparts are Betty Neuman's. She stated that HEALTH is a state where in all parts and subparts of an individual are in harmony with the whole system. Margarex Newman defined health as an EXPANDING CONSCIOUSNESS. Her name is Margaret not Margarex, I just used that to help you remember her theory of health.

29. The following are concept of health:

1. Health is a state of complete physical, mental and social wellbeing and not merely an absence of disease or infirmity.
2. Health is the ability to maintain balance
3. Health is the ability to maintain internal milieu
4. Health is integration of all parts and subparts of an individual

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

* All of the following are correct statement about health. The first one is the definition by WHO, The second one is from Walter Cannon's homeostasis theory. Third one is from Claude Bernard's concept of Health as Internal Milieu and the last one is Neuman's Theory.

30. The theorist the advocated that health is the ability to maintain dynamic equilibrium is

A. Bernard
B. Selye
C. Cannon
D. Rogers

* Walter Cannon advocated health as HOMEOSTASIS or the ability to maintain dynamic equilibrium. Hans Selye postulated Concepts about Stress and Adaptation. Bernard defined health as the ability to maintain internal milieu and Rogers defined Health as Wellness that is influenced by individual's culture.

31. Excessive alcohol intake is what type of risk factor?

A. Genetics
B. Age
C. Environment
D. Lifestyle

32. Osteoporosis and degenerative diseases like Osteoarthritis belongs to what type of risk factor?

A. Genetics
B. Age
C. Environment
D. Lifestyle

33. Also known as STERILE TECHNIQUE

A. Surgical Asepsis
B. Medical Asepsis
C. Sepsis
D. Asepsis

* Surgical Asepsis is also known as STERILE TECHNIQUE while Medical Asepsis is synonymous with CLEAN TECHNIQUE.

34. This is a person or animal, who is without signs of illness but harbors pathogen within his body and can be transferred to another

A. Host
B. Agent
C. Environment
D. Carrier

35. Refers to a person or animal, known or believed to have been exposed to a disease.

A. Carrier
B. Contact
C. Agent
D. Host

36. A substance usually intended for use on inanimate objects, that destroys pathogens but not the spores.

A. Sterilization
B. Disinfectant
C. Antiseptic
D. Autoclave

* Disinfectants are used on inanimate objects while Antiseptics are intended for use on persons and other living things. Both can kill and inhibit growth of microorganism but cannot kill their spores. That is when autoclaving or steam under pressure gets in, Autoclaving can kill almost ALL type of microoganism including their spores.

37. This is a process of removing pathogens but not their spores

A. Sterilization
B. Auto claving
C. Disinfection
D. Medical asepsis

* Both A and B are capable on killing spores. Autoclaving is a form of Sterilization. Medical Asepsis is a PRACTICE designed to minimize or reduce the transfer of pathogens, also known as your CLEAN TECHNIQUE. Disinfection is the PROCESS of removing pathogens but not their spores.

38. The third period of infectious processes characterized by development of specific signs and symptoms

A. Incubation period
B. Prodromal period
C. Illness period
D. Convalescent period

* In incubation period, The disease has been introduced to the body but no sign and symptom appear because the pathogen is not yet strong enough to cause it and may still need to multiply. The second period is called prodromal period. This is when the appearance of non specific signs and symptoms sets in, This is when the sign and symptoms starts to appear. Illness period is characterized by the appearance of specific signs and symptoms or refer tp as time with the greatest symptom experience. Acme is the PEAK of illness intensity while the convalescent period is characterized by the abatement of the disease process or it's gradual disappearance.

39. A child with measles developed fever and general weakness after being exposed to another child with rubella. In what stage of infectious process does this child belongs?

A. Incubation period
B. Prodromal period
C. Illness period
D. Convalescent period

* To be able to categorize MEASLES in the Illness period, the specific signs of Fever, Koplik's Spot and Rashes must appear. In the situation above, Only general signs and symptoms appeared and the Specific signs and symptoms is yet to appear, therefore, the illness is still in the Prodromal period. Signs and symptoms of measles during the prodromal phase are Fever, fatigue, runny nose, cough and conjunctivitis. Koplik's spot heralds the Illness period and cough is the last symptom to disappear. All of this processes take place in 10 days that is why, Measles is also known as 10 day measles.

40. A 50 year old mailman carried a mail with anthrax powder in it. A minute after exposure, he still hasn’t developed any signs and symptoms of anthrax. In what stage of infectious process does this man belongs?

A. Incubation period
B. Prodromal period
C. Illness period
D. Convalescent period

* Anthrax can have an incubation period of hours to 7 days with an average of 48 hours. Since the question stated exposure, we can now assume that the mailman is in the incubation period.

41. Considered as the WEAKEST LINK in the chain of infection that nurses can manipulate to prevent spread of infection and diseases

A. Etiologic/Infectious agent
B. Portal of Entry
C. Susceptible host
D. Mode of transmission

* Mode of transmission is the weakest link in the chain of infection. It is easily manipulated by the Nurses using the tiers of prevention, either by instituting transmission based precautions, Universal precaution or Isolation techniques.

42. Which of the following is the exact order of the infection chain?

1. Susceptible host
2. Portal of entry
3. Portal of exit
4. Etiologic agent
5. Reservoir
6. Mode of transmission

A. 1,2,3,4,5,6
B. 5,4,2,3,6,1
C. 4,5,3,6,2,1
D. 6,5,4,3,2,1

* Chain of infection starts with the SOURCE : The etiologic agent itself. It will first proliferate on a RESERVOIR and will need a PORTAL OF EXIT to be able to TRANSMIT irslef using a PORTAL OF ENTRY to a SUSCEPTIBLE HOST. A simple way to understand the process is by looking at the lives of a young queen ant that is starting to build her colony. Imagine the QUEEN ANT as a SOURCE or the ETIOLOGIC AGENT. She first need to build a COLONY, OR the RESERVOIR where she will start to lay the first eggs to be able to produce her worker ants and soldier ants to be able to defend and sustain the new colony. They need to EXIT [PORTAL OF EXIT] their colony and crawl [MODE OF TRANSMISSION] in search of foods by ENTERING / INVADING [PORTAL OF ENTRY] our HOUSE [SUSCEPTIBLE HOST]. By imagining the Ant's life cycle, we can easily arrange the chain of infection.

43. Markee, A 15 year old high school student asked you. What is the mode of transmission of Lyme disease. You correctly answered him that Lyme disease is transmitted via

A. Direct contact transmission
B. Vehicle borne transmission
C. Air borne transmission
D. Vector borne transmission

* Lyme disease is caused by Borrelia Burdorferi and is transmitted by a TICK BITE.

44. The ability of the infectious agent to cause a disease primarily depends on all of the following except

A. Pathogenicity
B. Virulence
C. Invasiveness
D. Non Specificity

* To be able to cause a disease, A pathogen should have a TARGET ORGAN/S. The pathogen should be specific to these organs to cause an infection. Mycobacterium Avium is NON SPECIFIC to human organs and therefore, not infective to humans but deadly to birds. An immunocompromised individual, specially AIDS Patient, could be infected with these NON SPECIFIC diseases due to impaired immune system.

45. Contact transmission of infectious organism in the hospital is usually cause by

A. Urinary catheterization
B. Spread from patient to patient
C. Spread by cross contamination via hands of caregiver
D. Cause by unclean instruments used by doctors and nurses

* The hands of the caregiver like nurses, is the main cause of cross contamination in hospital setting. That is why HANDWASHING is the single most important procedure to prevent the occurence of cross contamination and nosocomial infection. D refers to Nosocomial infection and UTI is the most common noscomial infection in the hospital caused by urinary catheterization. E.Coli seems to be the major cause of this incident. B best fits Cross Contamination, It is the spread of microogranisms from patient o patient.

46. Transmission occurs when an infected person sneezes, coughs or laugh that is usually projected at a distance of 3 feet.

A. Droplet transmission
B. Airborne transmission
C. Vehicle transmission
D. Vector borne transmission

47. Considered as the first line of defense of the body against infection

A. Skin
B. WBC
C. Leukocytes
D. Immunization

* Remember that intact skin and mucus membrane is our first line of defense against infection.

48. All of the following contributes to host susceptibility except

A. Creed
B. Immunization
C. Current medication being taken
D. Color of the skin

* Creed, Faith or religious belief do not affect person's susceptibility to illness. Medication like corticosteroids could supress a person's immune system that will lead to increase susceptibility. Color of the skin could affect person's susceptibility to certain skin diseases. A dark skinned person has lower risk of skin cancer than a fair skinned person. Fair skinned person also has a higher risk for cholecystitis and cholelithiasis.

49. Graciel has been injected TT5, her last dosed for tetanus toxoid immunization. Graciel asked you, what type of immunity is TT Injections? You correctly answer her by saying Tetanus toxoid immunization is a/an

A. Natural active immunity
B. Natural passive immunity
C. Artificial active immunity
D. Artificial passive immunity

* TT1 ti TT2 are considered the primary dose, while TT3 to TT5 are the booster dose. A woman with completed immunization of DPT need not receive TT1 and TT2. Tetanus toxoid is the actual toxin produce by clostridium tetani but on its WEAK and INACTIVATED form. It is Artificial because it did not occur in the course of actual illness or infection, it is Active because what has been passed is an actual toxin and not a ready made immunoglobulin.

50. Agatha, was hacked and slashed by a psychotic man while she was crossing the railway. She suffered multiple injuries and was injected Tetanus toxoid Immunoglobulin. Agatha asked you, What immunity does TTIg provides? You best answered her by saying TTIg provides

A. Natural active immunity
B. Natural passive immunity
C. Artificial active immunity
D. Artificial passive immunity

* In this scenario, Agatha was already wounded and has injuries. Giving the toxin [TT Vaccine] itself would not help Agatha because it will take time before the immune system produce antitoxin. What agatha needs now is a ready made anti toxin in the form of ATS or TTIg. This is artificial, because the body of agatha did not produce it. It is passive because her immune system is not stimulated but rather, a ready made Immune globulin is given to immediately supress the invasion.

51. This is the single most important procedure that prevents cross contamination and infection

A. Cleaning
B. Disinfecting
C. Sterilizing
D. Handwashing

* When you see the word HANDWASHING as one of the options, 90% Chance it is the correct answer in the local board. Or should I say, 100% because I have yet to see question from 1988 to 2005 board questions that has option HANDWASHING on it but is not the correct answer.

52. This is considered as the most important aspect of handwashing

A. Time
B. Friction
C. Water
D. Soap

* The most important aspect of handwashing is FRICTION. The rest, will just enhance friction. The use of soap lowers the surface tension thereby increasing the effectiveness of friction. Water helps remove transient bacteria by working with soap to create the lather that reduces surface tension. Time is of essence but friction is the most essential aspect of handwashing.

53. In handwashing by medical asepsis, Hands are held ….

A. Above the elbow, The hands must always be above the waist
B. Above the elbow, The hands are cleaner than the elbow
C. Below the elbow, Medical asepsis do not require hands to be above the waist
D. Below the elbow, Hands are dirtier than the lower arms

* Hands are held BELOW the elbow in medical asepsis in contrast with surgical asepsis, wherein, nurses are required to keep the hands above the waist. The rationale is because in medical asepsis, Hands are considered dirtier than the elbow and therefore, to limit contamination of the lower arm, The hands should always be below the elbow.

54. The suggested time per hand on handwashing using the time method is

A. 5 to 10 seconds each hand
B. 10 to 15 seconds each hand
C. 15 to 30 seconds each hand
D. 30 to 60 seconds each hand

* Each hands requires atleast 15 to 30 seconds of handwashing to effectively remove transient microorganisms.

55. The minimum time in washing each hand should never be below

A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 30 seconds

* According to Kozier, The minimum time required for watching each hands is 10 seconds and should not be lower than that. The recommended time, again, is 15 to 30 seconds.

56. How many ml of liquid soap is recommended for handwashing procedure?

A. 1-2 ml
B. 2-3 ml
C. 2-4 ml
D. 5-10 ml

* If a liquid soap is to be used, 1 tsp [ 5ml ] of liquid soap is recommended for handwashing procedure.

57. Which of the following is not true about sterilization, cleaning and disinfection?

A. Equipment with small lumen are easier to clean
B. Sterilization is the complete destruction of all viable microorganism including spores
C. Some organism are easily destroyed, while other, with coagulated protein requires longer time
D. The number of organism is directly proportional to the length of time required for sterilization

* Equipments with LARGE LUMEN are easier to clean than those with small lumen. B C and D are all correct.

58. Karlita asked you, How long should she boil her glass baby bottle in water? You correctly answered her by saying

A. The minimum time for boiling articles is 5 minutes
B. Boil the glass baby bottler and other articles for atleast 10 minutes
C. For boiling to be effective, a minimum of 15 minutes is required
D. It doesn’t matter how long you boil the articles, as long as the water reached 100 degree Celsius

* Boiling is the most common and least expensive method of sterilization used in home. For it to be effective, you should boil articles for atleast 15 minutes.

59. This type of disinfection is best done in sterilizing drugs, foods and other things that are required to be sterilized before taken in by the human body

A. Boiling Water
B. Gas sterilization
C. Steam under pressure
D. Radiation

* Imagine foods and drugs that are being sterilized by a boiling water, ethylene oxide gas and autoclave or steam under pressure, They will be inactivated by these methods. Ethylene oxide gas used in gas sterlization is TOXIC to humans. Boiling the food will alter its consistency and nutrients. Autoclaving the food is never performed. Radiation using microwave oven or Ionizing radiation penetrates to foods and drugs thus, sterilizing them.

60. A TB patient was discharged in the hospital. A UV Lamp was placed in the room where he stayed for a week. What type of disinfection is this?

A. Concurrent disinfection
B. Terminal disinfection
C. Regular disinfection
D. Routine disinfection

* Terminal disinfection refers to practices to remove pathogens that stayed in the belongings or immediate environemnt of an infected client who has been discharged. An example would be Killing airborne TB Bacilli using UV Light. Concurrent disinfection refers to ongoing efforts implented during the client's stay to remove or limit pathogens in his supplies, belongings, immediate environment in order to control the spread of the disease. An example is cleaning the bedside commode of a client with radium implant on her cervix with a bleach disinfectant after each voiding.

61. Which of the following is not true in implementing medical asepsis

A. Wash hand before and after patient contact
B. Keep soiled linens from touching the clothings
C. Shake the linens to remove dust
D. Practice good hygiene

* NEVER shake the linens. Once soiled, fold it inwards clean surface out. Shaking the linen will further spread pathogens that has been harbored by the fabric.

62. Which of the following is true about autoclaving or steam under pressure?

A. All kinds of microorganism and their spores are destroyed by autoclave machine
B. The autoclaved instruments can be used for 1 month considering the bags are still intact
C. The instruments are put into unlocked position, on their hinge, during the autoclave
D. Autoclaving different kinds of metals at one time is advisable

* Only C is correct. Metals with locks, like clamps and scissors should be UNLOCKED in order to minimize stiffening caused by autoclave to the hinges of these metals. NOT ALL microorganism are destroyed by autoclaving. There are recently discovered microorganism that is invulnarable to extreme heat. Autoclaved instruments are to be used within 2 weeks. Only the same type of metals should be autoclaved as this will alteration in plating of these metals.

63. Which of the following is true about masks?

A. Mask should only cover the nose
B. Mask functions better if they are wet with alcohol
C. Masks can provide durable protection even when worn for a long time and after each and every patient care
D. N95 Mask or particulate masks can filter organism as mall as 1 micromillimeter

* only D is correct. Mask should cover both nose and mouth. Masks will not function optimally when wet. Masks should be worn not greater than 4 hours, as it will lose effectiveness after 4 hours. N95 mask or particulate mask can filter organism as small as 1 micromillimeter.

64. Where should you put a wet adult diaper?

A. Green trashcan
B. Black trashcan
C. Orange trashcan
D. Yellow trashcan

* Infectious waste like blood and blood products, wet diapers and dressings are thrown in yellow trashcans.

65. Needles, scalpels, broken glass and lancets are considered as injurious wastes. As a nurse, it is correct to put them at disposal via a/an

A. Puncture proof container
B. Reused PET Bottles
C. Black trashcan
D. Yellow trashcan with a tag “INJURIOUS WASTES”

* Needles, scalpels and other sharps are to be disposed in a puncture proof container.

66. Miranda Priestly, An executive of RAMP magazine, was diagnosed with cancer of the cervix. You noticed that the radioactive internal implant protrudes to her vagina where supposedly, it should be in her cervix. What should be your initial action?

A. Using a long forceps, Push it back towards the cervix then call the physician
B. Wear gloves, remove it gently and place it on a lead container
C. Using a long forceps, Remove it and place it on a lead container
D. Call the physician, You are not allowed to touch, re insert or remove it

* A dislodged radioactive cervical implant in brachytherapy are to be picked by a LONG FORCEP and stored in a LEAD CONTAINER in order to prevent damage on the client's normal tissue. Calling the physician is the second most appropriate action among the choices. A nurse should never attempt to put it back nor, touch it with her bare hands.

67. After leech therapy, Where should you put the leeches?

A. In specially marked BIO HAZARD Containers
B. Yellow trashcan
C. Black trashcan
D. Leeches are brought back to the culture room, they are not thrown away for they are reusable

* Leeches, in leech therapy or LEECH PHLEBOTOMY are to be disposed on a BIO HAZARD container. They are never re used as this could cause transfer of infection. These leeches are hospital grown and not the usual leeches found in swamps.

68. Which of the following should the nurse AVOID doing in preventing spread of infection?

A. Recapping the needle before disposal to prevent injuries
B. Never pointing a needle towards a body part
C. Using only Standard precaution to AIDS Patients
D. Do not give fresh and uncooked fruits and vegetables to Mr. Gatchie, with Neutropenia

* Never recap needles. They are directly disposed in a puncture proof container after used. Recapping the needles could cause injury to the nurse and spread of infection. B C and D are all appropriate. Standard precaution is sufficient for an HIV patient. A client with neutropenia are not given fresh and uncooked fruits and vegetables for even the non infective organisms found in these foods could cause severe infection on an immunocompromised patients.

69. Where should you put Mr. Alejar, with Category II TB?

A. In a room with positive air pressure and atleast 3 air exchanges an hour
B. In a room with positive air pressure and atleast 6 air exchanges an hour
C. In a room with negative air pressure and atleast 3 air exchanges an hour
D. In a room with negative air pressure and atleast 6 air exchanges an hour

* TB patients should have a private room with negative air pressure and atleast 6 to 12 air exhanges per hour. Negative pressure room will prevent air inside the room from escaping. Air exchanges are necessary since the client's room do not allow air to get out of the room.

70. A client has been diagnosed with RUBELLA. What precaution is used for this patient?

A. Standard precaution
B. Airborne precaution
C. Droplet precaution
D. Contact precaution

* Droplet precaution is sufficient on client's with RUBELLA or german measles.

71. A client has been diagnosed with MEASLES. What precaution is used for this patient?

A. Standard precaution
B. Airborne precaution
C. Droplet precaution
D. Contact precaution

* Measles is highly communicable and more contagious than Rubella, It requires airborne precaution as it is spread by small particle droplets that remains suspended in air and disperesed by air movements.

72. A client has been diagnosed with IMPETIGO. What precaution is used for this patient?

A. Standard precaution
B. Airborne precaution
C. Droplet precaution
D. Contact precaution

* Impetigo causes blisters or sores in the skin. It is generally caused by GABS or Staph Aureaus. It is spread by skin to skin contact or by scratching the lesions and touching another person's skin.

73. The nurse is to insert an NG Tube when suddenly, she accidentally dip the end of the tube in the client’s glass containing distilled drinking water which is definitely not sterile. As a nurse, what should you do?

A. Don’t mind the incident, continue to insert the NG Tube
B. Obtain a new NG Tube for the client
C. Disinfect the NG Tube before reinserting it again
D. Ask your senior nurse what to do

* The digestive tract is not sterile, and therefore, simple errors like this would not cause harm to the patient. NGT tube need not be sterile, and so is colostomy and rectal tubes. Clean technique is sufficient during NGT and colostomy care.

74. All of the following are principle of SURGICAL ASEPSIS except

A. Microorganism travels to moist surfaces faster than with dry surfaces
B. When in doubt about the sterility of an object, consider it not sterile
C. Once the skin has been sterilized, considered it sterile
D. If you can reach the object by overreaching, just move around the sterile field to pick it rather than reaching for it

* Human skin is impossible to be sterilized. It contains normal flora of microorganism. A B and D are all correct.

75. Which of the following is true in SURGICAL ASEPSIS?

A. Autoclaved linens and gowns are considered sterile for about 4 months as long as the bagging is intact
B. Surgical technique is a sole effort of each nurse
C. Sterile conscience, is the best method to enhance sterile technique
D. If a scrubbed person leaves the area of the sterile field, He/she must do handwashing and gloving again, but the gown need not be changed.

* Sterile conscience, or the moral imperative of a nurse to be honest in practicing sterile technique, is the best method to enhance sterile technique. Autoclaved linens are considered sterile only within 2 weeks even if the bagging is intact. Surgical technique is a team effort of each nurse. If a scrubbed person leave the sterile field and area, he must do the process all over again.

76. In putting sterile gloves, Which should be gloved first?

A. The dominant hand
B. The non dominant hand
C. The left hand
D. No specific order, Its up to the nurse for her own convenience

* Gloves are put on the non dominant hands first and then, the dominant hand. The rationale is simply because humans tend to use the dominant hand first before the non dominant hand. Out of 10 humans that will put on their sterile gloves, 8 of them will put the gloves on their non dominant hands first.

77. As the scrubbed nurse, when should you apply the goggles, shoe cap and mask prior to the operation?

A. Immediately after entering the sterile field
B. After surgical hand scrub
C. Before surgical hand scrub
D. Before entering the sterile field

* The nurse should put his goggles, cap and mask prior to washing the hands. If he wash his hands prior to putting all these equipments, he must wash his hands again as these equipments are said to be UNSTERILE.

78. Which of the following should the nurse do when applying gloves prior to a surgical procedure?

A. Slipping gloved hand with all fingers when picking up the second glove
B. Grasping the first glove by inserting four fingers, with thumbs up underneath the cuff
C. Putting the gloves into the dominant hand first
D. Adjust only the fitting of the gloves after both gloves are on

* The nurse should only adjust fitting of the gloves when they are both on the hands. Not doing so will break the sterile technique. Only 4 gingers are slipped when picking up the second gloves. You cannot slip all of your fingers as the cuff is limited and the thumb would not be able to enter the cuff. The first glove is grasp by simply picking it up with the first 2 fingers and a thumb in a pinching motion. Gloves are put on the non dominant hands first.

79. Which gloves should you remove first?

A. The glove of the non dominant hand
B. The glove of the dominant hand
C. The glove of the left hand
D. Order in removing the gloves Is unnecessary

* Gloves are worn in the non dominant hand first, and is removed also from the non dominant hand first. Rationale is simply because in 10 people removing gloves, 8 of them will use the dominant hand first and remove the gloves of the non dominant hand.

80. Before a surgical procedure, Give the sequence on applying the protective items listed below

1. Eye wear or goggles
2. Cap
3. Mask
4. Gloves
5. Gown

A. 3,2,1,5,4
B. 3,2,1,4,5
C. 2,3,1,5,4
D. 2,3,1,4,5

* The nurse should use CaMEy Hand and Body Lotion in moisturizing his hand before surgical procedure and after handwashing. Ca stands for CAP, M stands for MASK, Ey stands for eye goggles. The nurse will do handwashing and then [HAND], Don the gloves first and wear the Gown [BODY]. I created this mnemonic and I advise you use it because you can never forget Camey hand and body lotion. [ Yes, I know it is spelled as CAMAY ]]

81. In removing protective devices, which should be the exact sequence?

1. Eye wear or goggles
2. Cap
3. Mask
4. Gloves
5. Gown

A. 4,3,5,1,2
B. 2,3,1,5,4
C. 5,4,3,2,1
D. 1,2,3,4,5

* When the nurse is about to remove his protective devices, The nurse will remove the GLOVES first followed by the MASK and GOWN then, other devices like cap, shoe cover, etc. This is to prevent contamination of hair, neck and face area.

82. In pouring a plain NSS into a receptacle located in a sterile field, how high should the nurse hold the bottle above the receptacle?

A. 1 inch
B. 3 inches
C. 6 inches
D. 10 inches

* Even if you do not know the answer to this question, you can answer it correctly by imagining. If you pour the NSS into a receptacle 1 to 3 inch above it, Chances are, The mouth of the NSS bottle would dip into the receptacle as you fill it, making it contaminated. If you pour the NSS bottle into a receptacle 10 inches above it, that is too high, chances are, as you pour the NSS, most will spill out because the force will be too much for the buoyant force to handle. It will also be difficult to pour something precisely into a receptacle as the height increases between the receptacle and the bottle. 6 inches is the correct answer. It is not to low nor too high.

83. The tip of the sterile forceps is considered sterile. It is used to manipulate the objects in the sterile field using the non sterile hands. How should the nurse hold a sterile forceps?

A. The tip should always be lower than the handle
B. The tip should always be above the handle
C. The handle and the tip should be at the same level
D. The handle should point downward and the tip, always upward

* A sterile forcep is usually dipped into a disinfectant or germicidal solution. Imagine, if the tip is HIGHER than the handle, the solution will go into the handle and into your hands and as you use the forcep, you will eventually lower its tip making the solution in your hand go BACK into the tip thus contaminating the sterile area of the forcep. To prevent this, the tip should always be lower than the handle. In situation questions like this, IMAGINATION is very important.

84. The nurse enters the room of the client on airborne precaution due to tuberculosis. Which of the following are appropriate actions by the nurse?

1. She wears mask, covering the nose and mouth
2. She washes her hands before and after removing gloves, after suctioning the client’s secretion
3. She removes gloves and hands before leaving the client’s room
4. She discards contaminated suction catheter tip in trashcan found in the clients room

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

* All soiled equipments use in an infectious client are disposed INSIDE the client's room to prevent contamination outside the client's room. The nurse is correct in using Mask the covers both nose and mouth. Hands are washed before and after removing the gloves and before and after you enter the client's room. Gloves and contaminated suction tip are thrown in trashcan found in the clients room.

85. When performing surgical hand scrub, which of the following nursing action is required to prevent contamination?

1. Keep fingernail short, clean and with nail polish
2. Open faucet with knee or foot control
3. Keep hands above the elbow when washing and rinsing
4. Wear cap, mask, shoe cover after you scrubbed

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

* Cap, mask and shoe cover are worn BEFORE scrubbing.

86. When removing gloves, which of the following is an inappropriate nursing action?

A. Wash gloved hand first
B. Peel off gloves inside out
C. Use glove to glove skin to skin technique
D. Remove mask and gown before removing gloves

* Gloves are the dirtiest protective item nurses are wearing and therefore, the first to be removed to prevent spread of microorganism as you remove the mask and gown.

87. Which of the following is TRUE in the concept of stress?

A. Stress is not always present in diseases and illnesses
B. Stress are only psychological and manifests psychological symptoms
C. All stressors evoke common adaptive response
D. Hemostasis refers to the dynamic state of equilibrium

* All stressors evoke common adaptive response. A psychologic fear like nightmare and a real fear or real perceive threat evokes common manifestation like tachycardia, tachypnea, sweating, increase muscle tension etc. ALL diseases and illness causes stress. Stress can be both REAL or IMAGINARY. Hemostasis refers to the ARREST of blood flowing abnormally through a damage vessel. Homeostasis is the one that refers to dynamic state of equilibrium according to Walter Cannon.

88. According to this theorist, in his modern stress theory, Stress is the non specific response of the body to any demand made upon it.

A. Hans Selye
B. Walter Cannon
C. Claude Bernard
D. Martha Rogers

* Hans Selye is the only theorist who proposed an intriguing theory about stress that has been widely used and accepted by professionals today. He conceptualized two types of human response to stress, The GAS or general adaptation syndrome which is characterized by stages of ALARM, RESISTANCE and EXHAUSTION. The Local adaptation syndrome controls stress through a particular body part. Example is when you have been wounded in your finger, it will produce PAIN to let you know that you should protect that particular damaged area, it will also produce inflammation to limit and control the spread of injury and facilitate healing process. Another example is when you are frequently lifting heavy objects, eventually, you arm, back and leg muscles hypertorphies to adapt to the stress of heavy lifting.

89. Which of the following is NOT TRUE with regards to the concept of Modern Stress Theory?

A. Stress is not a nervous energy
B. Man, whenever he encounters stresses, always adapts to it
C. Stress is not always something to be avoided
D. Stress does not always lead to distress

* Man, do not always adapt to stress. Sometimes, stress can lead to exhaustion and eventually, death. A,C and D are all correct.

90. Which of the following is TRUE with regards to the concept of Modern Stress Theory?

A. Stress is essential
B. Man does not encounter stress if he is asleep
C. A single stress can cause a disease
D. Stress always leads to distress

* Stress is ESSENTIAL. No man can live normally without stress. It is essential because it is evoked by the body's normal pattern of response and leads to a favorable adaptive mechanism that are utilized in the future when more stressors are encountered by the body. Man can encounter stress even while asleep, example is nightmare. Disease are multifactorial, No diseases are caused by a single stressors. Stress are sometimes favorable and are not always a cause for distress. An example of favorable stress is when a carpenter meets the demand and stress of everyday work. He then develops calluses on the hand to lessen the pressure of the hammer against the tissues of his hand. He also develop larger muscle and more dense bones in the arm, thus, a stress will lead to adaptations to decrease that particular stress.

91. Which of the following is TRUE in the stage of alarm of general adaptation syndrome?

A. Results from the prolonged exposure to stress
B. Levels or resistance is increased
C. Characterized by adaptation
D. Death can ensue

* Death can ensue as early as the stage of alarm. Exhaustion results to a prolonged exposure to stress. Resistance is when the levels of resistance increases and characterized by being able to adapt.

92. The stage of GAS where the adaptation mechanism begins

A. Stage of Alarm
B. Stage of Resistance
C. Stage of Homeostasis
D. Stage of Exhaustion

* Adaptation mechanisms begin in the stage of alarm. This is when the adaptive mechanism are mobilized. When someone shouts SUNOG!!! your heart will begin to beat faster, you vessels constricted and bp increased.

93. Stage of GAS Characterized by adaptation

A. Stage of Alarm
B. Stage of Resistance
C. Stage of Homeostasis
D. Stage of Exhaustion

94. Stage of GAS wherein, the Level of resistance are decreased

A. Stage of Alarm
B. Stage of Resistance
C. Stage of Homeostasis
D. Stage of Exhaustion

* Resistance are decreased in the stage of alarm. Resistance is absent in the stage of exhaustion. Resistance is increased in the stage of resistance.

95. Where in stages of GAS does a person moves back into HOMEOSTASIS?

A. Stage of Alarm
B. Stage of Resistance
C. Stage of Homeostasis
D. Stage of Exhaustion

96. Stage of GAS that results from prolonged exposure to stress. Here, death will ensue unless extra adaptive mechanisms are utilized

A. Stage of Alarm
B. Stage of Resistance
C. Stage of Homeostasis
D. Stage of Exhaustion

97. All but one is a characteristic of adaptive response

A. This is an attempt to maintain homeostasis
B. There is a totality of response
C. Adaptive response is immediately mobilized, doesn’t require time
D. Response varies from person to person

* Aside from having limits that leads to exhaustion. Adaptive response requires time for it to act. It requires energy, physical and psychological taxes that needs time for our body to mobilize and utilize.

98. Andy, a newly hired nurse, starts to learn the new technology and electronic devices at the hospital. Which of the following mode of adaptation is Andy experiencing?

A. Biologic/Physiologic adaptive mode
B. Psychologic adaptive mode
C. Sociocultural adaptive mode
D. Technological adaptive mode

99. Andy is not yet fluent in French, but he works in Quebec where majority speaks French. He is starting to learn the language of the people. What type of adaptation is Andy experiencing?

A. Biologic/Physiologic adaptive mode
B. Psychologic adaptive mode
C. Sociocultural adaptive mode
D. Technological adaptive mode

* Sociocultural adaptive modes include language, communication, dressing, acting and socializing in line with the social and cultural standard of the people around the adapting individual.

100. Andy made an error and his senior nurse issued a written warning. Andy arrived in his house mad and kicked the door hard to shut it off. What adaptation mode is this?

A. Biologic/Physiologic adaptive mode
B. Psychologic adaptive mode
C. Sociocultural adaptive mode
D. Technological adaptive mode

* Andy uses a defense mechanism called DISPLACEMENT. All DMs are categorized as PSYCHOLOGIC ADAPTIVE RESPONSE to stressors.

Funda drill Test 1

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 15:44:00 +0800

1. When the General adaptation syndrome is activated, FLIGHT OR FIGHT response sets in. Sympathetic nervous system releases norepinephrine while the adrenal medulla secretes epinephrine. Which of the following is true with regards to that statement?

A. Pupils will constrict
B. Client will be lethargic
C. Lungs will bronchodilate
D. Gastric motility will increase

2. Which of the following response is not expected to a person whose GAS is activated and the FIGHT OR FLIGHT response sets in?

A. The client will not urinate due to relaxation of the detrusor muscle
B. The client will be restless and alert
C. Clients BP will increase, there will be vasodilation
D. There will be increase glycogenolysis, Pancrease will decrease insulin secretion

3. State in which a person’s physical, emotional, intellectual and social development or spiritual functioning is diminished or impaired compared with a previous experience.

A. Illness
B. Disease
C. Health
D. Wellness

4. This is the first stage of illness wherein, the person starts to believe that something is wrong. Also known as the transition phase from wellness to illness.

A. Symptom Experience
B. Assumption of sick role
C. Medical care contact
D. Dependent patient role

5. In this stage of illness, the person accepts or rejects a professionals suggestion. The person also becomes passive and may regress to an earlier stage.

A. Symptom Experience
B. Assumption of sick role
C. Medical care contact
D. Dependent patient role

6. In this stage of illness, The person learns to accept the illness.

A. Symptom Experience
B. Assumption of sick role
C. Medical care contact
D. Dependent patient role

7. In this stage, the person tries to find answers for his illness. He wants his illness to be validated, his symptoms explained and the outcome reassured or predicted

A. Symptom Experience
B. Assumption of sick role
C. Medical care contact
D. Dependent patient role

8. The following are true with regards to aspect of the sick role except

A. One should be held responsible for his condition
B. One is excused from his societal role
C. One is obliged to get well as soon as possible
D. One is obliged to seek competent help

9. Refers to conditions that increases vulnerability of individual or group to illness or accident

A. Predisposing factor
B. Etiology
C. Risk factor
D. Modifiable Risks

10. Refers to the degree of resistance the potential host has against a certain pathogen

A. Susceptibility
B. Immunity
C. Virulence
D. Etiology

11. A group of symptoms that sums up or constitute a disease

A. Syndrome
B. Symptoms
C. Signs
D. Etiology

12. A woman undergoing radiation therapy developed redness and burning of the skin around the best. This is best classified as what type of disease?

A. Neoplastic
B. Traumatic
C. Nosocomial
D. Iatrogenic

13. The classification of CANCER according to its etiology Is best described as

1. Nosocomial
2. Idiopathic
3. Neoplastic
4. Traumatic
5. Congenital
6. Degenrative

A. 5 and 2
B. 2 and 3
C. 3 and 4
D. 3 and 5

14. Term to describe the reactiviation and recurrence of pronounced symptoms of a disease

A. Remission
B. Emission
C. Exacerbation
D. Sub acute

15. A type of illness characterized by periods of remission and exacerbation

A. Chronic
B. Acute
C. Sub acute
D. Sub chronic

16. Diseases that results from changes in the normal structure, from recognizable anatomical changes in an organ or body tissue is termed as

A. Functional
B. Occupational
C. Inorganic
D. Organic

17. It is the science of organism as affected by factors in their environment. It deals with the relationship between disease and geographical environment.

A. Epidemiology
B. Ecology
C. Statistics
D. Geography

18. This is the study of the patterns of health and disease. Its occurrence and distribution in man, for the purpose of control and prevention of disease.

A. Epidemiology
B. Ecology
C. Statistics
D. Geography

19. Refers to diseases that produced no anatomic changes but as a result from abnormal response to a stimuli.

A. Functional
B. Occupational
C. Inorganic
D. Organic

20. In what level of prevention according to Leavell and Clark does the nurse support the client in obtaining OPTIMAL HEALTH STATUS after a disease or injury?

A. Primary
B. Secondary
C. Tertiary
D. None of the above

21. In what level of prevention does the nurse encourage optimal health and increases person’s susceptibility to illness?

A. Primary
B. Secondary
C. Tertiary
D. None of the above

22. Also known as HEALTH MAINTENANCE prevention.

A. Primary
B. Secondary
C. Tertiary
D. None of the above

23. PPD In occupational health nursing is what type of prevention?

A. Primary
B. Secondary
C. Tertiary
D. None of the above

24. BCG in community health nursing is what type of prevention?

A. Primary
B. Secondary
C. Tertiary
D. None of the above

25. A regular pap smear for woman every 3 years after establishing normal pap smear for 3 consecutive years Is advocated. What level of prevention does this belongs?

A. Primary
B. Secondary
C. Tertiary
D. None of the above

26. Self monitoring of blood glucose for diabetic clients is on what level of prevention?

A. Primary
B. Secondary
C. Tertiary
D. None of the above

27. Which is the best way to disseminate information to the public?

A. Newspaper
B. School bulletins
C. Community bill boards
D. Radio and Television

28. Who conceptualized health as integration of parts and subparts of an individual?

A. Newman
B. Neuman
C. Watson
D. Rogers

29. The following are concept of health:

1. Health is a state of complete physical, mental and social wellbeing and not merely an absence of disease or infirmity.
2. Health is the ability to maintain balance
3. Health is the ability to maintain internal milieu
4. Health is integration of all parts and subparts of an individual

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

30. The theorist the advocated that health is the ability to maintain dynamic equilibrium is

A. Bernard
B. Selye
C. Cannon
D. Rogers

31. Excessive alcohol intake is what type of risk factor?

A. Genetics
B. Age
C. Environment
D. Lifestyle

32. Osteoporosis and degenerative diseases like Osteoarthritis belongs to what type of risk factor?

A. Genetics
B. Age
C. Environment
D. Lifestyle

33. Also known as STERILE TECHNIQUE

A. Surgical Asepsis
B. Medical Asepsis
C. Sepsis
D. Asepsis

34. This is a person or animal, who is without signs of illness but harbors pathogen within his body and can be transferred to another

A. Host
B. Agent
C. Environment
D. Carrier

35. Refers to a person or animal, known or believed to have been exposed to a disease.

A. Carrier
B. Contact
C. Agent
D. Host

36. A substance usually intended for use on inanimate objects, that destroys pathogens but not the spores.

A. Sterilization
B. Disinfectant
C. Antiseptic
D. Autoclave

37. This is a process of removing pathogens but not their spores

A. Sterilization
B. Auto claving
C. Disinfection
D. Medical asepsis

38. The third period of infectious processes characterized by development of specific signs and symptoms

A. Incubation period
B. Prodromal period
C. Illness period
D. Convalescent period

39. A child with measles developed fever and general weakness after being exposed to another child with rubella. In what stage of infectious process does this child belongs?

A. Incubation period
B. Prodromal period
C. Illness period
D. Convalescent period

40. A 50 year old mailman carried a mail with anthrax powder in it. A minute after exposure, he still hasn’t developed any signs and symptoms of anthrax. In what stage of infectious process does this man belongs?

A. Incubation period
B. Prodromal period
C. Illness period
D. Convalescent period

41. Considered as the WEAKEST LINK in the chain of infection that nurses can manipulate to prevent spread of infection and diseases

A. Etiologic/Infectious agent
B. Portal of Entry
C. Susceptible host
D. Mode of transmission

42. Which of the following is the exact order of the infection chain?

1. Susceptible host
2. Portal of entry
3. Portal of exit
4. Etiologic agent
5. Reservoir
6. Mode of transmission

A. 1,2,3,4,5,6
B. 5,4,2,3,6,1
C. 4,5,3,6,2,1
D. 6,5,4,3,2,1

43. Markee, A 15 year old high school student asked you. What is the mode of transmission of Lyme disease. You correctly answered him that Lyme disease is transmitted via

A. Direct contact transmission
B. Vehicle borne transmission
C. Air borne transmission
D. Vector borne transmission

44. The ability of the infectious agent to cause a disease primarily depends on all of the following except

A. Pathogenicity
B. Virulence
C. Invasiveness
D. Non Specificity

45. Contact transmission of infectious organism in the hospital is usually cause by

A. Urinary catheterization
B. Spread from patient to patient
C. Spread by cross contamination via hands of caregiver
D. Cause by unclean instruments used by doctors and nurses

46. Transmission occurs when an infected person sneezes, coughs or laugh that is usually projected at a distance of 3 feet.

A. Droplet transmission
B. Airborne transmission
C. Vehicle transmission
D. Vector borne transmission

47. Considered as the first line of defense of the body against infection

A. Skin
B. WBC
C. Leukocytes
D. Immunization

48. All of the following contributes to host susceptibility except

A. Creed
B. Immunization
C. Current medication being taken
D. Color of the skin

49. Graciel has been injected TT5, her last dosed for tetanus toxoid immunization. Graciel asked you, what type of immunity is TT Injections? You correctly answer her by saying Tetanus toxoid immunization is a/an

A. Natural active immunity
B. Natural passive immunity
C. Artificial active immunity
D. Artificial passive immunity

50. Agatha, was hacked and slashed by a psychotic man while she was crossing the railway. She suffered multiple injuries and was injected Tetanus toxoid Immunoglobulin. Agatha asked you, What immunity does TTIg provides? You best answered her by saying TTIg provides

A. Natural active immunity
B. Natural passive immunity
C. Artificial active immunity
D. Artificial passive immunity

51. This is the single most important procedure that prevents cross contamination and infection

A. Cleaning
B. Disinfecting
C. Sterilizing
D. Handwashing

52. This is considered as the most important aspect of handwashing

A. Time
B. Friction
C. Water
D. Soap

53. In handwashing by medical asepsis, Hands are held ….

A. Above the elbow, The hands must always be above the waist
B. Above the elbow, The hands are cleaner than the elbow
C. Below the elbow, Medical asepsis do not require hands to be above the waist
D. Below the elbow, Hands are dirtier than the lower arms

54. The suggested time per hand on handwashing using the time method is

A. 5 to 10 seconds each hand
B. 10 to 15 seconds each hand
C. 15 to 30 seconds each hand
D. 30 to 60 seconds each hand

55. The minimum time in washing each hand should never be below

A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 30 seconds

56. How many ml of liquid soap is recommended for handwashing procedure?

A. 1-2 ml
B. 2-3 ml
C. 2-4 ml
D. 5-10 ml

57. Which of the following is not true about sterilization, cleaning and disinfection?

A. Equipment with small lumen are easier to clean
B. Sterilization is the complete destruction of all viable microorganism including spores
C. Some organism are easily destroyed, while other, with coagulated protein requires longer time
D. The number of organism is directly proportional to the length of time required for sterilization

58. Karlita asked you, How long should she boil her glass baby bottle in water? You correctly answered her by saying

A. The minimum time for boiling articles is 5 minutes
B. Boil the glass baby bottler and other articles for atleast 10 minutes
C. For boiling to be effective, a minimum of 15 minutes is required
D. It doesn’t matter how long you boil the articles, as long as the water reached 100 degree Celsius

59. This type of disinfection is best done in sterilizing drugs, foods and other things that are required to be sterilized before taken in by the human body

A. Boiling Water
B. Gas sterilization
C. Steam under pressure
D. Radiation

60. A TB patient was discharged in the hospital. A UV Lamp was placed in the room where he stayed for a week. What type of disinfection is this?

A. Concurrent disinfection
B. Terminal disinfection
C. Regular disinfection
D. Routine disinfection

61. Which of the following is not true in implementing medical asepsis

A. Wash hand before and after patient contact
B. Keep soiled linens from touching the clothings
C. Shake the linens to remove dust
D. Practice good hygiene

62. Which of the following is true about autoclaving or steam under pressure?

A. All kinds of microorganism and their spores are destroyed by autoclave machine
B. The autoclaved instruments can be used for 1 month considering the bags are still intact
C. The instruments are put into unlocked position, on their hinge, during the autoclave
D. Autoclaving different kinds of metals at one time is advisable

63. Which of the following is true about masks?

A. Mask should only cover the nose
B. Mask functions better if they are wet with alcohol
C. Masks can provide durable protection even when worn for a long time and after each and every patient care
D. N95 Mask or particulate masks can filter organism as mall as 1 micromillimeter

64. Where should you put a wet adult diaper?

A. Green trashcan
B. Black trashcan
C. Orange trashcan
D. Yellow trashcan

65. Needles, scalpels, broken glass and lancets are considered as injurious wastes. As a nurse, it is correct to put them at disposal via a/an

A. Puncture proof container
B. Reused PET Bottles
C. Black trashcan
D. Yellow trashcan with a tag “INJURIOUS WASTES”

66. Miranda Priestly, An executive of RAMP magazine, was diagnosed with cancer of the cervix. You noticed that the radioactive internal implant protrudes to her vagina where supposedly, it should be in her cervix. What should be your initial action?

A. Using a long forceps, Push it back towards the cervix then call the physician
B. Wear gloves, remove it gently and place it on a lead container
C. Using a long forceps, Remove it and place it on a lead container
D. Call the physician, You are not allowed to touch, re insert or remove it

67. After leech therapy, Where should you put the leeches?

A. In specially marked BIO HAZARD Containers
B. Yellow trashcan
C. Black trashcan
D. Leeches are brought back to the culture room, they are not thrown away for they are reusable

68. Which of the following should the nurse AVOID doing in preventing spread of infection?

A. Recapping the needle before disposal to prevent injuries
B. Never pointing a needle towards a body part
C. Using only Standard precaution to AIDS Patients
D. Do not give fresh and uncooked fruits and vegetables to Mr. Gatchie, with Neutropenia

69. Where should you put Mr. Alejar, with Category II TB?

A. In a room with positive air pressure and atleast 3 air exchanges an hour
B. In a room with positive air pressure and atleast 6 air exchanges an hour
C. In a room with negative air pressure and atleast 3 air exchanges an hour
D. In a room with negative air pressure and atleast 6 air exchanges an hour

70. A client has been diagnosed with RUBELLA. What precaution is used for this patient?

A. Standard precaution
B. Airborne precaution
C. Droplet precaution
D. Contact precaution

71. A client has been diagnosed with MEASLES. What precaution is used for this patient?

A. Standard precaution
B. Airborne precaution
C. Droplet precaution
D. Contact precaution

72. A client has been diagnosed with IMPETIGO. What precaution is used for this patient?

A. Standard precaution
B. Airborne precaution
C. Droplet precaution
D. Contact precaution

73. The nurse is to insert an NG Tube when suddenly, she accidentally dip the end of the tube in the client’s glass containing distilled drinking water which is definitely not sterile. As a nurse, what should you do?

A. Don’t mind the incident, continue to insert the NG Tube
B. Obtain a new NG Tube for the client
C. Disinfect the NG Tube before reinserting it again
D. Ask your senior nurse what to do

74. All of the following are principle of SURGICAL ASEPSIS except

A. Microorganism travels to moist surfaces faster than with dry surfaces
B. When in doubt about the sterility of an object, consider it not sterile
C. Once the skin has been sterilized, considered it sterile
D. If you can reach the object by overreaching, just move around the sterile field to pick it rather than reaching for it

75. Which of the following is true in SURGICAL ASEPSIS?

A. Autoclaved linens and gowns are considered sterile for about 4 months as long as the bagging is intact
B. Surgical technique is a sole effort of each nurse
C. Sterile conscience, is the best method to enhance sterile technique
D. If a scrubbed person leaves the area of the sterile field, He/she must do handwashing and gloving again, but the gown need not be changed.

76. In putting sterile gloves, Which should be gloved first?

A. The dominant hand
B. The non dominant hand
C. The left hand
D. No specific order, Its up to the nurse for her own convenience

77. As the scrubbed nurse, when should you apply the goggles, shoe cap and mask prior to the operation?

A. Immediately after entering the sterile field
B. After surgical hand scrub
C. Before surgical hand scrub
D. Before entering the sterile field

78. Which of the following should the nurse do when applying gloves prior to a surgical procedure?

A. Slipping gloved hand with all fingers when picking up the second glove
B. Grasping the first glove by inserting four fingers, with thumbs up underneath the cuff
C. Putting the gloves into the dominant hand first
D. Adjust only the fitting of the gloves after both gloves are on

79. Which gloves should you remove first?

A. The glove of the non dominant hand
B. The glove of the dominant hand
C. The glove of the left hand
D. Order in removing the gloves Is unnecessary

80. Before a surgical procedure, Give the sequence on applying the protective items listed below

1. Eye wear or goggles
2. Cap
3. Mask
4. Gloves
5. Gown

A. 3,2,1,5,4
B. 3,2,1,4,5
C. 2,3,1,5,4
D. 2,3,1,4,5

81. In removing protective devices, which should be the exact sequence?

1. Eye wear or goggles
2. Cap
3. Mask
4. Gloves
5. Gown

A. 4,3,5,1,2
B. 2,3,1,5,4
C. 5,4,3,2,1
D. 1,2,3,4,5

82. In pouring a plain NSS into a receptacle located in a sterile field, how high should the nurse hold the bottle above the receptacle?

A. 1 inch
B. 3 inches
C. 6 inches
D. 10 inches

83. The tip of the sterile forceps is considered sterile. It is used to manipulate the objects in the sterile field using the non sterile hands. How should the nurse hold a sterile forceps?

A. The tip should always be lower than the handle
B. The tip should always be above the handle
C. The handle and the tip should be at the same level
D. The handle should point downward and the tip, always upward

84. The nurse enters the room of the client on airborne precaution due to tuberculosis. Which of the following are appropriate actions by the nurse?

1. She wears mask, covering the nose and mouth
2. She washes her hands before and after removing gloves, after suctioning the client’s secretion
3. She removes gloves and hands before leaving the client’s room
4. She discards contaminated suction catheter tip in trashcan found in the clients room

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

85. When performing surgical hand scrub, which of the following nursing action is required to prevent contamination?

1. Keep fingernail short, clean and with nail polish
2. Open faucet with knee or foot control
3. Keep hands above the elbow when washing and rinsing
4. Wear cap, mask, shoe cover after you scrubbed

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

86. When removing gloves, which of the following is an inappropriate nursing action?

A. Wash gloved hand first
B. Peel off gloves inside out
C. Use glove to glove skin to skin technique
D. Remove mask and gown before removing gloves

87. Which of the following is TRUE in the concept of stress?

A. Stress is not always present in diseases and illnesses
B. Stress are only psychological and manifests psychological symptoms
C. All stressors evoke common adaptive response
D. Hemostasis refers to the dynamic state of equilibrium

88. According to this theorist, in his modern stress theory, Stress is the non specific response of the body to any demand made upon it.

A. Hans Selye
B. Walter Cannon
C. Claude Bernard
D. Martha Rogers

89. Which of the following is NOT TRUE with regards to the concept of Modern Stress Theory?

A. Stress is not a nervous energy
B. Man, whenever he encounters stresses, always adapts to it
C. Stress is not always something to be avoided
D. Stress does not always lead to distress

90. Which of the following is TRUE with regards to the concept of Modern Stress Theory?

A. Stress is essential
B. Man does not encounter stress if he is asleep
C. A single stress can cause a disease
D. Stress always leads to distress

91. Which of the following is TRUE in the stage of alarm of general adaptation syndrome?

A. Results from the prolonged exposure to stress
B. Levels or resistance is increased
C. Characterized by adaptation
D. Death can ensue

92. The stage of GAS where the adaptation mechanism begins

A. Stage of Alarm
B. Stage of Resistance
C. Stage of Homeostasis
D. Stage of Exhaustion

93. Stage of GAS Characterized by adaptation

A. Stage of Alarm
B. Stage of Resistance
C. Stage of Homeostasis
D. Stage of Exhaustion

94. Stage of GAS wherein, the Level of resistance are decreased

A. Stage of Alarm
B. Stage of Resistance
C. Stage of Homeostasis
D. Stage of Exhaustion

95. Where in stages of GAS does a person moves back into HOMEOSTASIS?

A. Stage of Alarm
B. Stage of Resistance
C. Stage of Homeostasis
D. Stage of Exhaustion

96. Stage of GAS that results from prolonged exposure to stress. Here, death will ensue unless extra adaptive mechanisms are utilized

A. Stage of Alarm
B. Stage of Resistance
C. Stage of Homeostasis
D. Stage of Exhaustion

97. All but one is a characteristic of adaptive response

A. This is an attempt to maintain homeostasis
B. There is a totality of response
C. Adaptive response is immediately mobilized, doesn’t require time
D. Response varies from person to person

98. Andy, a newly hired nurse, starts to learn the new technology and electronic devices at the hospital. Which of the following mode of adaptation is Andy experiencing?

A. Biologic/Physiologic adaptive mode
B. Psychologic adaptive mode
C. Sociocultural adaptive mode
D. Technological adaptive mode

99. Andy is not yet fluent in French, but he works in Quebec where majority speaks French. He is starting to learn the language of the people. What type of adaptation is Andy experiencing?

A. Biologic/Physiologic adaptive mode
B. Psychologic adaptive mode
C. Sociocultural adaptive mode
D. Technological adaptive mode

100. Andy made an error and his senior nurse issued a written warning. Andy arrived in his house mad and kicked the door hard to shut it off. What adaptation mode is this?

A. Biologic/Physiologic adaptive mode
B. Psychologic adaptive mode
C. Sociocultural adaptive mode
D. Technological adaptive mode

Answers and Rationale

MCN drill Test 1 (Answers and Rationale)

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 15:40:00 +0800

SITUATION : [ND89] Aling Julia, a 32 year old fish vendor from baranggay matahimik came to see you at the prenatal clinic. She brought with her all her three children. Maye, 1 year 6 months; Joy, 3 and Dan, 7 years old. She mentioned that she stopped taking oral contraceptives several months ago and now suspects she is pregnant. She cannot remember her LMP.

1. Which of the following would be useful in calculating Aling Julia's EDC? [3]

A. Appearance of linea negra
B. First FHT by fetoscope
C. Increase pulse rate
D. Presence of edema

* The answer of some people is A because they say linea negra appears at 2nd trimester. Appearance of Linea negra is not the same with all women. Some will have it as early as first trimester while other on the 2nd trimester. It is very subjective and non normative.

However, First FHT by fetoscope is UNIVERSAL and it is arbitrarily accepted that it starts at the 4th month of gestation. Therefore, If I heard the First FHT by fetoscope, I can say that Aling Julia's EDC is at 4th month and the EDC will be around 5 months from now.Pulse rate and Edema will never suggest the estimated date of confinement nor age of gestation.

2. Which hormone is necessary for a positive pregnancy test? [1]

A. Progesterone
B. HCG
C. Estrogen
D. Placental Lactogen

* HCG is responsible for positive pregnancy test. But it is NOT a positive sign of pregnancy. Only PROBABLE. Purpose of HCG is to maintain the secretion of progestrone by the corpus luteum. It will deteriorate by 2nd trimester as the placenta resumes its funciton. HCG is also use to stimulate descend of the testes in case of cryptorchidism or undescended testes. HCG peaks at 10 weeks then decline for the rest of the pregnancy. Non pregnant females will have less than 5 mIU/ml and can reach up to 100,000 mIU/ml in pregnant women. By the way, undescended testes repair is done when the child is 1 year old according to Lippinncots, the doctor will try to wait baka kasi bumaba pa before they do surgery.

3. With this pregnancy, Aling Julia is a [1]

A. P3 G3
B. Primigravida
C. P3 G4
D. P0 G3

* She has 3 children, so para 3. Since she is pregnant, this is her 4th gravida. Remember that even if the pregancy is beyond the age of viability [ >7 months ] consider it as PARA and not GRAVIDA as long as the baby is still inside the uterus. A common error of the old nurses in a puericulture center where I dutied in is that they count the child inside the mother's womb as GRAVIDA when it is greater than 7 months! [ kawawang nanay,

mali

na ang home based mothers record mo ] I tried to correct it but they still INSISTED. I read pillitteri thinking that I might be wrong nakakahiya naman... but I was right.

4. In explaining the development of her baby, you identified in chronological order of growth of the fetus as it occurs in pregnancy as [1]

A. Ovum, embryo, zygote, fetus, infant
B. Zygote, ovum, embryo, fetus, infant
C. Ovum, zygote, embryo, fetus, infant
D. Zygote, ovum, fetus, embryo, infant

* The Ovum is the egg cell from the mother, the sperm will fertilize it to form a zygote. This usually happens in the AMPULLA or the distal third of the fallopian tube. Hyalorunidase is secreted by the sperm to dissolve the outer memberane of the ovum. The zygote now containes 46 chromosomes. 23 from each germ cell. The zygote is now termed as an embryo once it has been implanted. Implantation takes 3-4 days. When the embryo reach 8th weeks, it is now termed as a FETUS until it has been delivered and then, neonate then infant.

5. Aling Julia states she is happy to be pregnant. Which behavior is elicited by her during your assessment that would lead you to think she is stressed? [3]

A. She told you about her drunk husband
B. She states she has very meager income from selling
C. She laughs at every advise you give even when its not funny
D. She has difficulty following instructions

* Stressed is manifested in different ways and one of them, is difficulty following instructions. Telling you that her husband is drunk and has meager income from selling is not enough for you to conclude she is stressed. Assessment is always based on factual and specific manifestations. A diagnosis is made from either ACTUAL or POTENTIAL/RISK problems. A and B are both potential problems, but not actual like D. C is automatically eliminated first because laughing is not indicative of stress.

6. When teaching Aling Julia about her pregnancy, you should include personal common discomforts. Which of the following is an indication for prompt professional supervision? [2]

A. Constipation and hemorrhoids
B. Backache
C. Facial edema
D. frequent urination

*Facial edema is NOT NORMAL. Facial edema is one sign of MILD PRE ECLAMPSIA and prompt professional supervision is needed to lower down the client's blood pressure. Blood pressure in Mild Pre Eclampsia is around 140/90 and 160/110 in severe. Treatment involves bed rest, Magnesium sulfate, Hydralazine, Diazoxide and Diazepam [ usually a combination of Magsul + Apresoline [ Hydralazine ] ] Calcium gluconate is always at the client's bed side when magnesium toxicity occurs. It works by exchanging Calcium ions for magnesium ions. A,B and D are all physiologic change in pregnancy that do not need prompt professional supervision. Frequent urination will disappear as soon as the pressure of the uterus is released against the bladder and as soon as the client's blood volume has returned to normal. Backache is a common complaint of women with an OCCIPUT POSTERIOR presentation due to pressure on the back. Intervention includes pelvic rocking or running a tennis ball at the client's back. Constipation and hemorrhoids are relieved by increasing fluid intake and hot sitz bath.

7. Which of the following statements would be appropriate for you to include in Aling Julia's prenatal teaching plan? [1]

A. Exercise is very tiresome, it should be avoided
B. Limit your food intake
C. Smoking has no harmful effect on the growth and development of fetus
D. Avoid unnecessary fatigue, rest periods should be included in you schedule

* Exercise is not avoided in pregnancy, therfore eliminate A. Food is never limited in pregnancy. Calories are even increased by around 300 cal a day as well as vitamins and minerals. Smoking, alcohol and drug use are avoided for the rest of the pregnancy because of their harmful effects on the growth and development of the fetus. Rest period and avoiding unecessary fatigue is one of the pillars in health teaching of the pregnant client.

8. The best advise you can give to Aling Julia regarding prevention of varicosities is [3]

A. Raise the legs while in upright position and put it against the wall several times a day
B. Lay flat for most hours of the day
C. Use garters with nylon stocking
D. Wear support hose

* A thigh high stocking or a support hose WORN BEFORE GETTING UP in the morning is effective in prevention of varicosities. Stocking should have NO GARTERS because it impedes blood flow, they should be made of COTTON not nylon to allow the skin to breathe. Lying flat most of the day WILL PREVENT VARICOSITIES but will not be helpful for the client's overall health and function. Raising the legs and putting it against the wall will still create pressure in the legs.

9. In a 32 day menstrual cycle, ovulation usually occurs on the [2]

A. 14th day after menstruation
B. 18th day after menstruation
C. 20th day after menstruation
D. 24th day after menstruation

* To get the day of ovulation, A diary is made for around 6 months to determine the number of days of menstrual cycle [ from onset of mens to the next onset of mens ] and the average is taken from that cycles. 14 days are subtracted from the total days of the menstrual cycle. This signifies the ovulation day. A couple would abstain having sex 5 days before and 5 days after the ovulation day. Therefore, a 32 day cycle minus 14 days equals 18, hence... ovulation occurs at the 18th day.

10. Placenta is the organ that provides exchange of nutrients and waste products between mother and fetus. This develops by [4]

A. First month
B. Third month
C. Fifth month
D. Seventh month

* The placenta is formed at around 3 months. It is a latin word for PANCAKE because of it's appearance. It arises from the trophoblast from the chorionic villi and decidua basalis. It functions as the fetal lungs, kidney, GI tract and an endocrine organ.

11. In evaluating the weight gain of Aling Julia, you know the minimum weight gain during pregnancy is [3]

A. 2 lbs/wk
B. 5 lbs/wk
C. 7 lbs/wk
D. 10 lbs/wk

* Weight gain should be 1 to 2 lbs per week during the 2nd and 3rd trimester and 3 to 5 lbs gain during the first trimester for a total of 25-35 lbs recommended weight gain during the gravida state.

12. The more accurate method of measuring fundal height is [2]

A. Millimeter
B. Centimeter
C. Inches
D. Fingerbreadths

* Fundal height is measured in cm not mm. centimeters is the more accurate method of measuring fundic height than inches or fingerbreadths.

13. To determine fetal position using Leopold's maneuvers, the first maneuver is to [1]

A. Determine degree of cephalic flexion and engagement
B. Determine part of fetus presenting into pelvis
C. Locate the back,arms and legs
D. Determine what part of fetus is in the fundus

* Leopold's one determines what is it in the fundus. This determines whether the fetal head or breech is in the fundus. A head is round and hard. Breech is less well defined.

14. Aling julia has encouraged her husband to attend prenatal classes with her. During the prenatal class, the couple expressed fear of pain during labor and delivery. The use of touch and soothing voice often promotes comfort to the laboring patient. This physical intervention is effective because [2]

A. Pain perception is interrupted
B. Gate control fibers are open
C. It distracts the client away from the pain
D. Empathy is communicated by a caring person

* Touch and soothing voice promotes pain distraction. Instead of thinking too much of the pain in labor, The mother is diverted away from the pain sensation by the use of touch and voice. Pain perception is not interrupted, pain is still present. When gate control fibers are open, Pain is felt according to the gate control theory of pain. Although empathy is communicated by the caring person, this is not the reason why touch and voice promotes comfort to a laboring patient.

15. Which of the following could be considered as a positive sign of pregnancy ? [1]

A. Amenorrhea, nausea, vomiting
B. Frequency of urination
C. Braxton hicks contraction
D. Fetal outline by sonography

* Fetal outline by sonography or other imaging devices is considered a positive sign of pregnancy along with the presence of fetal heart rate and movement felt by a qualified examiner. All those signs with the discoverer's name on them [ chadwick, hegars, braxton hicks, goodells ] are considered probable and All the physiologic changes brought about by pregnancy like hyperpigmentation, fatgiue, uterine enlargement, nausea, vomiting, breast changes, frequent urination are considered presumptive.

Sonographic evidence of the gestational sac is not POSITIVE sign but rather, PROBABLE.

SITUATION : [FFC] Maternal and child health is the program of the department of health created to lessen the death of infants and mother in the philippines. [2]

16. What is the goal of this program?

A. Promote mother and infant health especially during the gravida stage
B. Training of local hilots
C. Direct supervision of midwives during home delivery
D. Health teaching to mother regarding proper newborn care

* The goal of the MCHN program of the DOH is the PROMOTION AND MAINTENANCE OF OPTIMUM HEALTH OF WOMAN AND THEIR NEWBORN. To achieve this goal, B,C and D are all carried out. Even without the knowledge of the MCHN goal you SHOULD answer this question correctly. Remember that GOALS are your plans or things you MUST ATTAIN while STRATEGIES are those that must be done [ ACTIONS ] to attain your goal.

Looking at B,C and D they are all ACTIONS. Only A correctly followed the definition of a goal.

17. One philosophy of the maternal and child health nursing is [1]

A. All pregnancy experiences are the same for all woman
B. Culture and religious practices have little effect on pregnancy of a woman
C. Pregnancy is a part of the life cycle but provides no meaning
D. The father is as important as the mother

* Knowing that not all individuals and pregnancy are the same for all women, you can safely eliminate letter A. Personal, culture and religious attitudes influence the meaning of pregnancy and that makes pregnancy unique for each individual. Culture and religious practice have a great impact on pregnancy, eliminate B. Pregnancy is meaningful to each individuals, not only the mother but also the father and the family and the father of the child is as important as the mother. MATERNAL AND CHILD HEALTH IS FAMILY CENTERED and thid will guide you in correctly answering D.

18. In maternal care, the PHN responsibility is [2]

A. To secure all information that would be needing in birth certificate
B. To protect the baby against tetanus neonatorum by immunizing the mother with DPT
C. To reach all pregnant woman
D. To assess nutritional status of existing children

* The sole objective of the MCHN of the DOH is to REACH ALL PREGNANT WOMEN AND GIVE SUFFICIENT CARE TO ENSURE A HEALTHY PREGNANCY AND THE BIRTH OF A FULL TERM HEALTH BABY. As not to confuse this with the GOAL of the MCHN, The OBJECTIVE should answer the GOAL, they are different. GOAL : to promote and maintain optimum health for women and their newborn HOW? OBJECTIVE : By reaching all pregnant women to give sufficient care ensuring healthy pregnancy and baby.

19. This is use when rendering prenatal care in the rural health unit. It serves as a guide in Identification of risk factors [1]

A. Underfive clinic chart
B. Home based mother's record
C. Client list of mother under prenatal care
D. Target list of woman under TT vaccination

* The HBMR is used in rendring prenatal care as guide in identifying risk factors. It contains health promotion message and information on the danger signs of pregnancy.

20. The schedule of prenatal visit in the RHU unit is [4]

A. Once from 1st up to 8th month, weekly on the 9th month
B. Twice in 1st and second trimester, weekly on third trimester
C. Once in each trimester, more frequent for those at risk
D. Frequent as possible to determine the presence of FHT each week

* Visit to the RHU should be ONCE each trimester and more frequent for those who are high risks. The visit to the BHS or health center should be ONCE for 1st to 6th months of pregnancy, TWICE for the 7th to 8th month and weekly during the 9th month. They are different and are not to be confused with.

SITUATION : Knowledge of the menstrual cycle is important in maternal health nursing. The following questions pertains to the process of menstruation

21. Menarche occurs during the pubertal period, Which of the following occurs first in the development of female sex characteristics? [2]

A. Menarche
B. Accelerated Linear Growth
C. Breast development
D. Growth of pubic hair

* Remember TAMO or THELARCHE, ADRENARCHE, MENARCHE and OVULATION. Telarche is the beginning of the breast development which is influenced by the increase in estrogen level during puberty. Adrenarche is the development of axillary and pubic hair due to androgen stimulation. Menarche is the onset of first menstruation that averagely occurs at around 12 to 13 years old. Ovulation then occurs last. However, prior to TAMO, Accelerated LINEAR GROWTH will occur first in GIRLS while WEIGHT INCREASE is the first one to occur in boys.

22. Which gland is responsible for initiating the menstrual cycle? [3]

A. Ovaries
B. APG
C. PPG
D. Hypothalamus

* Hypothalamus secretes many different hormones and one of them is the FSHRF or the FOLLICLE STIMULATING HORMONE RELEASING FACTOR. This will instruct the ANTERIOR PITUITARY GLAND to secrete FSH that will stimulate the ovary to release egg and initiate the menstrual cycle.

The PPG or the posterior pituitary only secretes two hormones : OXYTOCIN and ADH. It plays an important factor in labor as well as in the pathophysiology of diabetes insipidus.

23. The hormone that stimulates the ovaries to produce estrogen is [1]

A. GnRH
B. LH
C. LHRF
D. FSH

* FSH stimulates the ovaries to secrete estrogen. This hormone is a 3 substance compounds known as estrone [e1], estradiol [2] and estriol [3] responsible for the development of female secondary sex characteristics. It also stimulates the OOCYTES to mature. During pregnancy, Estrogen is secreted by the placenta that stimulates uterine growth to accomodate the fetus.

24. Which hormone stimulates oocyte maturation? [2]

A. GnRH
B. LH
C. LHRF
D. FSH

* Refer to #23

25. When is the serum estrogen level highest in the menstrual cycle? [4]

A. 3rd day
B. 13th day
C. 14th day
D. End of menstrual cycle

* There are only 3 days to remember in terms of hormonal heights during pregnancy. 3,13 and 14. During the 3rd day, Serum estrogen is the lowest. During the 13th day, Serum estrogen is at it's peak while progestrone is at it's lowest and this signifies that a mature oocyte is ready for release. At 14th day, Progesterone will surge and this is the reason why there is a sudden increase of temperature during the ovulation day and sudden drop during the previous day. This will not stimulate the release of the mature egg or what we call, OVULATION.

26. To correctly determine the day of ovulation, the nurse must [2]

A. Deduct 14 days at the mid of the cycle
B. Subtract two weeks at cycle's end
C. Add 7 days from mid of the cycle
D. Add 14 days from the end of the cycle

* Refer to # 9

Big thanks to marisse for the correction in this number.

27. The serum progesterone is lowest during what day of the menstrual cycle? [4]

A. 3rd day
B. 13th day
C. 14th day
D. End of menstrual cycle

* At 3rd day, The serum estrogen is at it's lowest. At the 13th day, serum estrogen is at it's peak while progesterone is at it's lowest. At the 13th day of the cycle, An available matured ovum is ready for fertilization and implantation. The slight sharp drop of temperature occurs during this time due to the very low progestrone level. The next day, 14th day, The serum progestrone sharply rises and this causes the release of the matured ovum. Temperature also rises at this point because of the sudden increase in the progestrone level.

28. How much blood is loss on the average during menstrual period? [4]

A. Half cup
B. 4 tablespoon
C. 3 ounces
D. 1/3 cup

* The average blood loss during pregnancy is 60 cc. A, half cup is equivalent to 120 cc. C, is equivalent to 90 cc while D, is equivalent to 80 cc. 1 tablespoon is equal to 15 ml. 4 tablespoon is exactly 60 cc.

29. Menstruation occurs because of which following mechanism? [2]

A. Increase level of estrogen and progesterone level
B. Degeneration of the corpus luteum
C. Increase vascularity of the endothelium
D. Surge of hormone progesterone

* Degeneration of the corpus luteum is the cause of menstruation. Menstruation occurs because of the decrease of both estrogen and progestrone. This is caused by the regression of the corpus luteum inside the ovary 8 to 10 days in absence of fertilization after an ovum was released. With the absence of progestrone, the endometrium degenerates and therefore, vascularity will decrease at approximately 25th day of the cycle which causes the external manifestation of menstruation.

30. If the menstrual cycle of a woman is 35 day cycle, she will approximately [2]

A. Ovulate on the 21st day with fertile days beginning on the 16th day to the 26th day of her cycle
B. Ovulate on the 21st day with fertile days beginning on the 16th day to the 21th day of her cycle
C. Ovulate on the 22st day with fertile days beginning on the 16th day to the 26th day of her cycle
D. Ovulate on the 22st day with fertile days beginning on the 14th day to the 30th day of her cycle

* Formula for getting the fertile days and ovulation day is : Number of days of cycle MINUS 14 [ Ovulation day ] Minus 5 Plus 5 [ Possible fertile days ].

Since the client has a 35 day cycle, we subtract 14 days to get the ovulation day which is 21. Minus 5 days is equal to [21 - 5 = 16 ] 16 , Plus 5 days [ 21 + 5 = 26 ] is equal to 26. Therefore, Client is fertile during the 16th to the 26th day of her cycle. This is the same principle and formula used in the calendar / rhythm method.

SITUATION : Wide knowledge about different diagnostic tests during pregnancy is an essential arsenal for a nurse to be successful.

31. The Biparietal diameter of a fetus is considered matured if it is atleast [4]

A. 9.8 cm
B. 8.5 cm
C. 7.5 cm
D. 6 cm

* BPD is considered matured at 8.5 cm and at term when it reaches 9.6 cm.

32. Quickening is experienced first by multigravida clients. At what week of gestation do they start to experience quickening? [4]

A. 16th
B. 20th
C. 24th
D. 28th

* Multigravid clients experience quickening at around 16 weeks or 4 months. Primigravid clients experience this 1 month later, at the 5th month or 20th week.

33. Before the start of a non stress test, The FHR is 120 BPM. The mother ate the snack and the practitioner noticed an increase from 120 BPM to 135 BPM for 15 seconds. How would you read the result? [3]

A. Abnormal
B. Non reactive
C. Reactive
D. Inconclusive, needs repeat

* Normal non stress test result is REACTIVE. Non stress test is a diagnostic procedure in which the FHR is compared with the child's movement. A normal result is an increase of 15 BPM sustained for 15 seconds at every fetal movement. The mother is told to eat a light snack during the procedure while the examiner carefully monitors the FHR. The mother will tell the examiner that she felt a movement as soon as she feels it while the examiner take note of the time and the FHR of the fetus.

34. When should the nurse expect to hear the FHR using a fetoscope? [4]

A. 2nd week
B. 8th week
C. 2nd month
D. 4th month

* The FHR is heard at about 4 months using a fetoscope. Remember the word FeFOUR to relate fetoscope to four.

35. When should the nurse expect to hear FHR using doppler Ultrasound? [4]

A. 8th week
B. 8th month
C. 2nd week
D. 4th month

* The FHR is heard as early as 8th week [ some books, 12 to 14 weeks ] using doppler ultrasound. Remember the word DOPPLE RATE, [ DOPPLER 8 ] to relate dopple ultrasound to the number 8.

36. The mother asks, What does it means if her maternal serum alpha feto protein is 35 ng/ml? The nurse should answer [4]

A. It is normal
B. It is not normal
C. 35 ng/ml indicates chromosomal abberation
D. 35 ng/ml indicates neural tube defect

* The normal maternal alpha feto protein is 38-45 ng/ml. Less 38 than this indicates CHROMOSOMAL ABBERATION [Down,Klinefelters] and more than 45 means NEURAL TUBE DEFECTS [Spina Bifida]. Remember the word CLINICAL NURSE. C for chromosomal abberation for <38>N for neural tube defect for >45. C<38>45 Clinic Nurse.

CLINIC NURSE is also an important mnemonics to differentiate COUNTER TRANSFERENCE from TRANSFERENCE. Counter transference is the special feeling of the CLINIC NURSE or CLINICIAN to the patient while transference is the development of personal feelings of the patient to the nurse.

37. Which of the following mothers needs RHOGAM? [1]

A. RH + mother who delivered an RH - fetus
B. RH - mother who delivered an RH + fetus
C. RH + mother who delivered an RH + fetus
D. RH - mother who delivered an RH - fetus

* Rhogam is given to RH - Mothers That delivers an RH + Fetus. Rhogam prevents ISOIMMUNIZATION or the development of maternal antibodies against the fetal blood due to RH incompatibility. Once the mother already develops an antibody against the fetus, Rhogam will not anymore be benificial and the mother is advised no to have anymore pregnancies. Rhogam is given within 72 hours after delivery.

38. Which family planning method is recommended by the department of health more than any other means of contraception? [4]

A. Fertility Awareness Method
B. Condom
C. Tubal Ligation
D. Abstinence

* Abstinence is never advocated as a family planning method. Though, It is probably the BEST METHOD to prevent STD and pregnancy, it is inhumane and supresses the reproductive rights of the people. It is also unrealistic. FAM is advocated by the DOH more than any other kind of contraception. It is a combination of symptothermal and billings method. CALENDAR method is the only method advocated by the catholic church.

39. How much booster dose does tetanus toxoid vaccination for pregnant women has? [4]

A. 2
B. 5
C. 3
D. 4

* TT1 and TT2 are both primary dosages. While TT3 up to TT5 represents the booster dosages.

40. Baranggay pinoybsn.tk has 70,000 population. How much nurse is needed to service this population? [4]

A. 5
B. 7
C. 50
D. 70

* For every 10,000 population , 1 nurse is needed. therefore, a population of 70,000 people needs a service of 7 nurses.

SITUATION : [ND2I246] Reproductive health is the exercise of reproductive right with responsibility. A married couple has the responsibility to reproduce and procreate.

41. Which of the following is ONE of the goals of the reproductive health concept? [3]

A. To achieve healthy sexual development and maturation
B. To prevent specific RH problem through counseling
C. Provide care, treatment and rehabilitation
D. To practice RH as a way of life of every man and woman

* EVERY ACHIEVER AVOIDS RECEIVER : Remember this mnemonics and it will guide you in differentiating which is which from the goals, visions and strategies. If a sentence begins with these words, it is automatically a GOAL. Usually, The trend in the board is that they will mix up the vision, strategies and goals to confuse you. D is the only vision of the RH program. Anything else aside from the vision and goals are more likely strategies. [ B and C ]

Strategies, even without knowing them or memorizing them can easily be seperated as they convey ACTIONS and ACTUAL INTERVENTIONS. This is universal and also applies to other DOH programs. Notice that B and C convey actions and interventions.

42. Which of the following is NOT an element of the reproductive health? [4]

A. Maternal and child health and nutrition
B. Family planning
C. Prevention and management of abortion complication
D. Healthy sexual development and nutrition

* Achieving healthy sexual development and nutrition is a GOAL of the RH. Knowledge of the elements, goals, strategies and vision of RH are important in answering this question. I removed the word ACHIEVE to let you know that it is possible for the board of nursing not to include those keywords [ although it never happened as of yet ].

43. In the international framework of RH, which one of the following is the ultimate goal? [3]

A. Women's health in reproduction
B. Attainment of optimum health
C. Achievement of women's status
D. Quality of life

* Quality of life is the ultimate goal of the RH in the international framework. Way of life is the ultimate goal of RH in the local framework.

44. Which one of the following is a determinant of RH affecting woman's ability to participate in social affairs? [3]

A. Gender issues
B. Socio-Economic condition
C. Cultural and psychosocial factors
D. Status of women

* This is an actual board question, Gender issues affects the women participation in the social affairs. Socio economic condition is the determinant for education, employment, poverty, nutrition, living condition and family environment. Status of women evolves in women's rights. Cultural and psychosocial factors refers to the norms, behaviors, orientation, values and culture. Refer to your DOH manual to read more about this.

45. In the philippine RH Framework. which major factor affects RH status? [4]

A. Women's lower level of literacy
B. Health service delivery mechanism
C. Poor living conditions lead to illness
D. Commercial sex workers are exposed to AIDS/STD.

* Health services delivery mechanism is the major factor that affect RH status. Other factors are women's behavior, Sanitation and water supply, Employment and working conditions etc.

46. Which determinant of reproductive health advocates nutrition for better health promotion and maintain a healthful life? [4]

A. Socio-Economic conditions
B. Status of women
C. Social and gender issues
D. Biological, Cultural and Psychosocial factors

* Refer to # 44

47. Which of the following is NOT a strategy of RH? [3]

A. Increase and improve contraceptive methods
B. Achieve reproductive intentions
C. Care provision focused on people with RH problems
D. Prevent specific RH problem through information dessemination

* Refer to #41

48. Which of the following is NOT a goal of RH? [3]

A. Achieve healthy sexual development and maturation
B. Avoid illness/diseases, injuries, disabilities related to sexuality and reproduction
C. Receive appropriate counseling and care of RH problems
D. Strengthen outreach activities and the referral system

* Refer to #41

49. What is the VISION of the RH? [2]

A. Attain QUALITY OF LIFE
B. Practice RH as a WAY OF LIFE
C. Prevent specific RH problem
D. Health in the hands of the filipino

* Refer to #43

SITUATION : [SORANGE19] Baby G, a 6 hours old newborn is admitted to the NICU because of low APGAR Score. His mother had a prolonged second stage of labor

50. Which of the following is the most important concept associated with all high risk newborn? [1]

A. Support the high-risk newborn's cardiopulmonary adaptation by maintaining adequate airway
B. Identify complications with early intervention in the high risk newborn to reduce morbidity and mortality
C. Assess the high risk newborn for any physical complications that will assist the parent with bonding
D. Support mother and significant others in their request toward adaptation to the high risk newborn

* The 3 major and initial and immediate needs of newborns both normal and high risks are AIR/BREATHING, CIRCULATION and TEMPERATURE. C and D are both eliminated because they do not address the immediate newborn needs. Identifying complication with early intervention is important, however, this does not address the IMMEDIATE and MOST IMPORTANT newborn needs.

51. Which of the following would the nurse expect to find in a newborn with birth asphyxia? [1]

A. Hyperoxemia
B. Acidosis
C. Hypocapnia
D. Ketosis

* Birth Asphyxia is a term used to describe the inability of an infant to maintain an adequate respiration within 1 minute after birth that leads so acidosis, hypoxia, hypoxemia and tissue anoxia. This results to Hypercapnia not Hypocapnia due to the increase in carbonic acid concentration in the fetal circulation because the carbon dioxide fails to get eliminated from the infant's lungs because of inadequate respiration. Ketosis is the presence of ketones in the body because of excessive fat metabolism. This is seen in diabetic ketoacidosis.

52. When planning and implementing care for the newborn that has been successfully resuscitated, which of the following would be important to assess? [1]

A. Muscle flaccidity
B. Hypoglycemia
C. Decreased intracranial pressure
D. Spontaneous respiration

* There is no need to assess for spontaneous respiration because OF the word SUCCESSFULLY RESUSCITATED. What is it to assess is the quality and quantity of respiration. Infants who undergone tremendous physical challenges during birth like asphyxia, prolonged labor, RDS are all high risk for developing hypoglycemia because of the severe depletion of glucose stores to sustain the demands of the body during those demanding times.

SITUATION : [P-I/46] Nurses should be aware of the different reproductive problems.

53. When is the best time to achieve pregnancy? [2]

A. Midway between periods
B. Immediately after menses end
C. 14 days before the next period is expected
D. 14 days after the beginning of the next period

* The best time to achieve pregnancy is during the ovulation period which is about 14 days before the next period is expected. A Menstrual cycle is defined as the number of days from the start of the menstruation period, up to the start of another menstrual period. To obtain the ovulation day, Subtract 14 days from the end of each cycle.

Example, The start of the menstrual flow was July 12, 2006. The next flow was experienced August 11, 2006. The length of the menstrual cycle is then 30 days [ August 11 minus July 12 ]. We then subtract 14 days from that total length of the cycle and that will give us 16 days [ 30 minus 14 ] Count 16 days from July 12, 2006 and that will give us July 28, 2006 as the day of ovulation. [ July 12 + 16 days ] This is the best time for coitus if the intention is getting pregnant, worst time if not.

54. A factor in infertility maybe related to the PH of the vaginal canal. A medication that is ordered to alter the vaginal PH is: [2]

A. Estrogen therapy
B. Sulfur insufflations
C. Lactic acid douches
D. Na HCO3 Douches

* Sperm is innately ALKALINE. Too much acidity is the only PH alteration in the vagina that can kill sperm cells. Knowing this will direct you to answering letter D. Sodium Bicarbonate douches will make the vagina less acidic because of it's alkaline property, making the vagina's environment more conducive and tolerating to the sperm cells. Estrogen therapy will not alter the PH of the vaginal canal. HRT [ Hormone replacement therapy ] is now feared by many women because of the high risk in acquiring breast, uterine and cervical cancer. Research on this was even halted because of the significant risk on the sample population. Lactic acid douches will make the vagina more acidic, further making the environment hostile to the alkaline sperm. Sulfur insufflation is a procedure used to treat vaginal infections. A tube is inserted in the vagina and sulfur is introduced to the body. The yeasts, fungi and other microorganisms that are sensitive to sulfur are all immediately killed by it on contact.

55. A diagnostic test used to evaluate fertility is the postcoital test. It is best timed [2]

A. 1 week after ovulation
B. Immediately after menses
C. Just before the next menstrual period
D. Within 1 to 2 days of presumed ovulation

* A poscoital test evaluates both ovulation detection and sperm analysis. When the woman ovulates [ by using the FAM method or commercial ovulation detection kits, woman should know she ovulates ] The couple should have coitus and then, the woman will go to the clinic within 2 to 8 hours after coitus. The woman is put on a lithotomy position. A specimen for cervical mucus is taken and examined for spinnbarkeit [ ability to stretch 15 cm before breaking ] and sperm count. Postcoital test is now considered obsolete because a single sperm and cervical mucus analysis provides more accurate data.

56. A tubal insufflation test is done to determine whether there is a tubal obstruction. Infertility caused by a defect in the tube is most often related to a [3]

A. Past infection
B. Fibroid Tumor
C. Congenital Anomaly
D. Previous injury to a tube

* PID [ Most common cause of tubal obstruction ] due to untreated gonorrhea, chlamydia or other infections that leads to chronic salphingitis often leads to scarring of the fallopian tube thereby causing tubal obstuction. This one of the common cause of infertility, the most common is Anovulation in female and low sperm count in males. A ruptured appendix, peritonitis and abdominal surgery that leads to infection and adhesion of the fallopian tube can also lead to tubal obstruction.

57. Which test is commonly used to determine the number, motility and activity of sperm is the [2]

A. Rubin test
B. Huhner test
C. Friedman test
D. Papanicolau test

* Huhner test is synonymous to postcoital test. This test evaluates the number, motility and status of the sperm cells in the cervical mucus. refer to # 55 for more information. Rubin test is a test to determine the tubal patency by introducing carbon dioxide gas via a cannula to the client's cervix. The sound is then auscultated in the client's abdomen at the point where the outer end of the fallopian tube is located, near the fimbriae. Absent of sound means that the tube is not patent. Friedman test involves a FROG to determine pregnancy that is why it is also called as FROG TEST. Papanicolaou test [Correct spelling], discovered by Dr. George Papanicolaou during the 1930's is a cytolgic examination of the epithelial lining of the cervix. It is important in diagnosis cervical cancer.

58. In the female, Evaluation of the pelvic organs of reproduction is accomplished by [2]

A. Biopsy
B. Cystoscopy
C. Culdoscopy
D. Hysterosalpingogram

* Biopsy is acquiring a sample tissue for cytological examination. Usually done in cancer grading or detecting atypical, abnormal and neoplastic cells. Cystoscopy is the visualization of the bladder using a cystoscope. This is inserted via the urethra. TURP or the transurethral resection of the prostate is frequently done via cystoscopy to remove the need for incision in resecting the enlarged prostate in BPH. Culdoscopy is the insertion of the culdoscope through the posterior vaginal wall between the rectum and uterus to visualize the douglas cul de sac. This is an important landmark because this is the lowest point in the pelvis, fluid or blood tends to collect in this place. Hysterosalpingogram is the injection of a blue dye, or any radio opaque material through the cervix under pressure. X ray is then taken to visualize the pelvic organs. This is done only after menstruation to prevent reflux of the menstrual discharge up into the fallopian tube and to prevent an accidental irradiation of the zygote. As usual, as with all other procedures that ends in GRAM, assess for iodine allergy.

59. When is the fetal weight gain greatest? [3]

A. 1st trimester
B. 2nd trimester
C. 3rd trimester
D. from 4th week up to 16th week of pregnancy

* Vital organs are formed during the first trimester, The greatest LENGTH gain occurs during the second trimester while the greatest weight gain occurs during the last trimester. This is the time when brown fats starts to be deposited in preparation for the upcoming delivery.

60. In fetal blood vessel, where is the oxygen content highest? [3]

A. Umbilical artery
B. Ductus Venosus
C. Ductus areteriosus
D. Pulmonary artery

* Ductus venosus is directly connected to the umbilical vein, Which is directly connected to the highly oxygenated placenta. This vessel supplies blood to the fetal liver. Umbilical arteries carries UNOXYGENATED BLOOD, they carry the blood away from the fetal body. Ductus arteriosus shunts the blood away from the fetal lungs, this carries an oxygenated blood but not as concentrated as the blood in the ductus venosus who have not yet service any of the fetal organ for oxygen except the liver. Knowing that the fetal lungs is not yet functional and expanded will guide you to automatically eliminate the pulmonary artery which is responsible for carrying UNOXYGENATED BLOOD away from the lungs.

61. The nurse is caring for a woman in labor. The woman is irritable, complains of nausea and vomits and has heavier show. The membranes rupture. The nurse understands that this indicates [1]

A. The woman is in transition stage of labor
B. The woman is having a complication and the doctor should be notified
C. Labor is slowing down and the woman may need oxytocin
D. The woman is emotionally distraught and needs assistance in dealing with labor

* The clue to the answer is MEMBRANES RUPTURE. Membranes, as a rule, rupture at full dilation [ 10 cm ] unless ruptured by amniotomy or ruptured at an earlier time. The last of the mucus plug from the cervix is also released during the transition phase of labor. We call that the OPERCULUM as signaled by a HEAVIER SHOW. During the transition phase, Cervix is dilated at around 8 to 10 cm and contractions reaches their peak of intensity occuring every 2 to 3 minutes with a 60 to 90 second duration.

At the transition phase, woman also experiences nausea and vomiting with intense pain. This question is LIFTED from the previous board and the question was patterned EXACTLY WORD PER WORD from pillitteri.

SITUATION : [J2I246] Katherine, a 32 year old primigravida at 39-40 weeks AOG was admitted to the labor room due to hypogastric and lumbo-sacral pains. IE revealed a fully dilated, fully effaced cervix. Station 0.

62. She is immediately transferred to the DR table. Which of the following conditions signify that delivery is near? [2]

I - A desire to defecate
II - Begins to bear down with uterine contraction
III - Perineum bulges
IV - Uterine contraction occur 2-3 minutes intervals at 50 seconds duration

A. I,II,III
B. I,II,III,IV
C. I,III,IV
D. II,III,IV

* Again, lifted word per word from Pillitteri and this is from the NLE. A is the right answer. A woman near labor experiences desire to defecate because of the pressure of the fetal head that forces the stool out from the anus. She cannot help but bear down with each of the contractions and as crowning occurs, The perineum bulges. A woman with a 50 second contraction is still at the ACTIVE PHASE labor [ 40 to 60 seconds duration, 3 to 5 minutes interval ] Women who are about to give birth experience 60-90 seconds contraction occuring at 2-3 minutes interval.

63. Artificial rupture of the membrane is done. Which of the following nursing diagnoses is the priority? [2]

A. High risk for infection related to membrane rupture
B. Potential for injury related to prolapse cord
C. Alteration in comfort related to increasing strength of uterine contraction
D. Anxiety related to unfamiliar procedure

* Nursing diagnosis is frequently ask. In any case that INFECTION was one of the choices, remove it as soon as you see it in ALL CASES during the intra and pre operative nursing care. Infection will only occur after 48 hours of operation or event. B is much more immediate and more likely to occur than A, and is much more FATAL. Prioritization and Appropriateness is the key in correctly answering this question. High risk for infection is an appropriate nursing diagnosis, but as I said, Infection will occur in much later time and not as immediate as B. Readily remove D and C because physiologic needs of the mother and fetus take precedence over comfort measures and psychosocial needs.

64. Katherine complains of severe abdominal pain and back pain during contraction. Which two of the following measures will be MOST effective in reducing pain? [4]

I - Rubbing the back with a tennis ball
II- Effleurage
III-Imagery
IV-Breathing techniques

A. II,IV
B. II,III
C. I,IV
D. I,II

* Remove B. Imagery is not used in severe pain. This is a labor pain and the mother will never try to imagine a nice and beautiful scenery with you at this point because the pain is all encompassing and severe during the transition phase of labor. Remove A and C Because breathing techniques is not a method to ELIMINATE PAIN but a method to reduce anxiety, improve pushing and prevent rapid expulsion of the fetus during crowning [ By PANTING ]

Back pain is so severe during labor in cases of Posterior presentations [ ROP,LOP,RMP,LSaP, etc... ] Mother is asked to pull her knees towards her chest and rock her back. [ As in a rocking chair ] A Tennis ball rubbed at the client's back can relieve the pain due to the pressure of the presenting part on the posterior part of the birth canal. Also, rubbing a tennis ball to the client's back OPENS THE LARGE FIBER NERVE GATE. Effleurage or a simple rotational massage on the abdomen simply relieves the client's pain by opening the large fiber nerve gate and closing the the small fiber nerve gate. [ Please read about Gate control theory by Mezack and Wall ].

65. Lumbar epidural anesthesia is administered. Which of the following nursing responsibilities should be done immediately following procedure? [1]

A. Reposition from side to side
B. Administer oxygen
C. Increase IV fluid as indicated
D. Assess for maternal hypotension

* Hypotension is one of the side effects of an epidural anesthesia. An epidural anesthesia is injected on the L3 - L4 or L4 - L5 area. The injection lies just above the dura and must not cross the dura [ spinal anesthesia crosses the dura ]. Nursing intervention revolves in assesing RR, BP and other vital signs for possible complication and side effects. There is no need to position the client from side to side, The preferred position during the transition phase of labor is LITHOTOMY. Oxygen is not specific after administration of an epidural anesthesia. IV fluid is not increased without doctor's order. AS INDICATED is different from AS ORDERED.

66. Which is NOT the drug of choice for epidural anesthesia? [4]

A. Sensorcaine
B. Xylocaine
C. Ephedrine
D. Marcaine

* A,B and D are all drugs of choice for epidural anesthesia. Ephedrine is the drug use to reverse the symptom of hypotension caused by epidural anesthesia. It is a sympathomimetic agent that causes vasoconstriction, bronchodilation [ in asthma ] and can increase the amount of energy and alertness. Ephedrine is somewhat similar to epinephrine in terms of action as well as it's adverse effects of urinary retention, tremor, hypersalivation, dyspnea, tachycardia, hypertension.

SITUATION : [SORANGE217] Alpha, a 24 year old G4P3 at full term gestation is brought to the ER after a gush of fluid passes through here vagina while doing her holiday shopping.

67. She is brought to the triage unit. The FHT is noted to be 114 bpm. Which of the following actions should the nurse do first? [2]

A. Monitor FHT ever 15 minutes
B. Administer oxygen inhalation
C. Ask the charge nurse to notify the Obstetrician
D. Place her on the left lateral position

* Remove A. A FHR of 114 bpm is 6 beats below normal. Though monitoring is continuous and appropriate, This is not your immediate action. B, Oxygen inhalation needs doctor's order and therefore, is a DEPENDENT nursing action and won't be your first option. Although administration of oxygen by the nurse is allowed when given at the lowest setting during emergency situation. C is appropriate, but should not be your IMMEDIATE action. The best action is to place the client on the LEFT LATERAL POSITION to decrease the pressure in the inferior vena cava [ by the gravid uterus ] thereby increasing venus return and giving an adequate perfusion to the fetus. Your next action is to call and notify the obstetrician. Remember to look for an independent nursing action first before trying to call the physician.

68. The nurse checks the perineum of alpha. Which of the following characteristic of the amniotic fluid would cause an alarm to the nurse? [1]

A. Greenish
B. Scantly
C. Colorless
D. Blood tinged

* A greenish amniotic fluid heralds fetal distress not unless the fetus is in breech presentation and pressure is present on the bowel. Other color that a nurse should thoroughly evaluate are : Tea colored or strong yellow color that indicates hemolytic anemia , as in RH incompatibility.

69. Alpha asks the nurse. "Why do I have to be on complete bed rest? I am not comfortable in this position." Which of the following response of the nurse is most appropriate? [3]

A. Keeping you on bed rest will prevent possible cord prolapse
B. Completed bed rest will prevent more amniotic fluid to escape
C. You need to save your energy so you will be strong enough to push later
D. Let us ask your obstetrician when she returns to check on you

* Once the membrane ruptures, as in the situation of alpha, The immediate and most appropriate nursing diagnosis is risk for injury related to cord prolapse. Keeping the client on bed rest is one of the best intervention in preventing cord prolapse. Other interventions are putting the client in a modified T position or Kneed chest position. Once the amniotic fluid escapes, It is allowed to escape. Although bed rest does saves energy, It is not the most appropriate response why bed rest is prescribed after membranes have ruptured. Not answering the client's question now will promote distrust and increase client's anxiety. It will also make the client think that the nurse is incompetent for not knowing the answer.

70. Alpha wants to know how many fetal movements per hour is normal, the correct response is [4]

A. Twice
B. Thrice
C. Four times
D. 10-12 times

* According to Sandovsky, To count for the fetal movement, Mother is put on her LEFT SIDE to decrease placental insufficiency. This is usually done after meals. The mother is asked to record the number of fetal movements per hour. A fetus moves Twice every 10 minutes and 10 to 12 times times an hour.

In SIA'S Book, She answered this question with letter B. But according to Pillitteri, A movement fewer than 5 in an hour is to be reported to the health care provider. The Board examiners uses Pillitteri as their reference and WORD PER WORD, Their question are answered directly from the Pillitteri book. 10-12 times according to Pillitteri, is the normal fetal movement per minute.

71. Upon examination by the obstetrician, he charted that Alpha is in the early stage of labor. Which of the following is true in this state? [1]

A. Self-focused
B. Effacement is 100%
C. Last for 2 hours
D. Cervical dilation 1-3 cm

* The earliest phase of labor is the first stage of labor : latent phase characterized by a cervical dilation of 0-3 cm, Mild contraction lasting for 20 to 40 seconds. This lasts approximately 6 hours in primis and 4.5 hours in multis. C is the characteristic of ACTIVE PHASE of labor, Characterized by a cervical dilation of 4-7 cm and contractions of 40 to 60 seconds. This phase lasts at around 3 hours in primis and 2 hours in multis. Effacement of 100% is a characteristic of the TRANSITION PHASE as well as being self focused.

SITUATION : Maternal and child health nursing a core concept of providing health in the community. Mastery of MCH Nursing is a quality all nurse should possess.

72. When should be the 2nd visit of a pregnant mother to the RHU? [2]

A. Before getting pregnant
B. As early in pregnancy
C. Second trimester
D. Third trimester

* Visit to the RHU are once every trimester and more frequent for those women at risk. Visit to the health center is once during the 0-6th month of pregnancy, twice during the 7th-8th month and weekly at the last trimester.

73. Which of the following is NOT a standard prenatal physical examination? [1]

A. Neck examination for goiter
B. Examination of the palms of the hands for pallor
C. Edema examination of the face hands, and lower extremeties
D. Examination of the legs for varicosities

74. Which of the following is NOT a basic prenatal service delivery done in the BHS? [2]

A. Oral / Dental check up
B. Laboratory examination
C. Treatment of diseases
D. Iron supplementation

* A is done at the RHU not in BHS.

75. How many days and how much dosage will the IRON supplementation be taken? [4]

A. 365 days / 300 mg
B. 210 days / 200 mg
C. 100 days/ 100mg
D. 50 days / 50 mg

* Iron supplementation is taken for 210 days starting at the 5th month of pregnancy up to 2nd month post partum. Dosage can range from 100 to 200 mg.

76. When should the iron supplementation starts and when should it ends? [4]

A. 5th month of pregnancy to 2nd month post partum
B. 1st month of pregnancy to 5th month post partum
C. As early in pregnancy up to 9th month of pregnancy
D. From 1st trimester up to 6 weeks post partum

* Refer to #75

77. In malaria infested area, how is chloroquine given to pregnant women? [4]

A. 300 mg / twice a month for 9 months
B. 200 mg / once a week for 5 months
C. 150 mg / twice a week for the duration of pregnancy
D. 100 mg / twice a week for the last trimester of pregnancy

* Always remember that chloroquine is given twice a week for the whole duration of pregnancy. This knowledge alone will lead you to correctly identifying letter C.

78. Which of the following mothers are qualified for home delivery? [2]

A. Pre term
B. 6th pregnancy
C. Has a history of hemorrhage last pregnancy
D. 2nd pregnancy, Has a history of 20 hours of labor last pregnancy.

* Knowing that a preterm mother is not qualified for home delivery will help you eliminate A. History of complications like bleeding, CPD, Eclampsia and diseases like TB, CVD, Anemia also nulls this qualification. A qualified woman for home delivery should only had less than 5 pregnancies. More than 5 disqualifies her from home delivery. High risk length of labor for primigravidas ls more than 24 hours and for multigravidas, it is more than 12 hours. Knowing this will allow you to choose D.

79. Which of the following is not included on the 3 Cs of delivery? [2]

A. Clean Surface
B. Clean Hands
C. Clean Equipments
D. Clean Cord

* 3 Cs of delivery are CLEAN SURFACE,HANDS AND CORD. " Kinamay ni Cordapya ang labada gamit ang Surf - Budek "

80. Which of the following is unnecessary equipment to be included in the home delivery kit? [4]

A. Boiled razor blade
B. 70% Isopropyl Alcohol
C. Flashlight
D. Rectal and oral thermometer

* Home delivery kit should contain the following : Clamps, Scissors, Blade, Antiseptic, Soap and hand brush, Bp app, Clean towel or cloth and Flashlight.

Optional equipments include : Plastic sheet, Suction bulb, Weighing scale, Ophthalmic ointment, Nail cutter, Sterile gloves, Rectal and oral thermometers.

SITUATION : [NBLUE166] Pillar is admitted to the hospital with the following signs : Contractions coming every 10 minutes, lasting 30 seconds and causing little discomfort. Intact membranes without any bloody shows. Stable vital signs. FHR = 130bpm. Examination reveals cervix is 3 cm dilated with vertex presenting at minus 1 station.

81. On the basis of the data provided above, You can conclude the pillar is in the [1]

A. In false labor
B. In the active phase of labor
C. In the latent phase of labor
D. In the transitional phase of labor

* Refer to #71

82. Pitocin drip is started on Pilar. Possible side effects of pitocin administration include all of the following except [3]

A. Diuresis
B. Hypertension
C. Water intoxication
D. Cerebral hemorrhage

* Oxytocin [ Pitocin ] is a synthetic form of hormone naturally released by the PPG. It is used to augment labor and delivery. Dosage is about 1 to 2 milli units per minute and this can be doubled until the desired contraction is met. Side effects are Water intoxication, Diuresis, Hypertonicity of the uterus, Uterine rupture, Precipitated labor, Walang kamatayang Nausea and Vomiting and Fetal bradycardia. Diuresis occurs because of water intoxication, The kidney will try to compensate to balance the fluid in the body.

NEVER give pitocin when FHR is below 120. Even without knowing anything about Pitocin, A cerebral hemorrhage is LETHAL and DAMAGE IS IRREVERSIBLE and if this is a side effect of a drug, I do not think that FDA or BFAD will approve it.

83. The normal range of FHR is approximately [3]

A. 90 to 140 bpm
B. 120 to 160 bpm
C. 100 to 140 bpm
D. 140 to 180 bpm

* A normal fetal heart rate is 120-160 bpm.

84. A negative 1 [-1] station means that [1]

A. Fetus is crowning
B. Fetus is floating
C. Fetus is engaged
D. Fetus is at the ischial spine

* At the negative station, The fetus is not yet engaged and floating. At 0 station, it means that the fetus is engaged to the ischial spine. Crowning occurs when the fetus is at the +3,+4 Station. Stations signifies distance of the presensting part below or above ischial spine. + denoted below while - denotes above. The number after the sign denotes length in cm. +1 station therefore means that the presenting part is 1 cm below the ischial spine.

85. Which of the following is characteristics of false labor [1]

A. Bloody show
B. Contraction that are regular and increase in frequency and duration
C. Contraction are felt in the back and radiates towards the abdomen
D. None of the above

* A,B and C are all charactertistics of a true labor. True labor is heralded by LIGHTENING. This makes the uterus lower and more anterior. This occrs 2 weeks prior to labor. At the morning of labor, women experiences BURST OF ENERGY because of adrenaline rush induced by the decrease progestrone secretion of the deteriorating placenta. The pain in labor is felt at the back and radiates towards the abdomen and becomes regular, increasing frequency and duration. As the cervix softens and dilates, The OPERCULUM or the mucus plug is expelled.

False labor is characterized by Irregular uterine contraction that is relieved by walking, Pain felt at the abdomen and confined there and in the groin, The cervix do not achieve dilation and Pain that is relieved by sleep and do not increase in intensity and duration.

86. Who's Theory of labor pain that states that PAIN in labor is cause by FEAR [4]

A. Bradley
B. Simpson
C. Lamaze
D. Dick-Read

* Believe it or not, this is an actual board question. Grantley Dick-Read is just one person. Usually a two name theory means two theorist. He published a book in 1933 "CHILDBIRTH WITHOUT FEAR". He believes that PAIN in labor is caused by FEAR that causes muscle tension, thereby halting the blood towards the uterus and causing decreased oxygenation which causes the PAIN.

1950s French obstetrician, Dr. Ferdinand Lamaze perhaps is the most popular theorist when it comes to labor. The theory behind Lamaze is that birth is a normal, natural and healthy event that should occur without unnecessary medical intervention. Rather than resorting to pain medication, different breathing techniques are used for each stage of labor to control pain. Fathers are assigned the role of labor coach, and are responsible for monitoring and adjusting their partner's breathing pattern throughout childbirth.

In 1965, obstetrician Robert A. Bradley, MD wrote "Husband Coached Childbirth." The Bradley method perhaps is the easiest to remember, BRAD ley necessitates the presence of the FATHER during labor. Bradley Method views birth as a natural process. This method also emphasizes the importance of actively involving fathers in the labor process. Fathers are taught ways to help ease their partner's pain during childbirth through guided relaxation and slow abdominal breathing.

James Young Simpson is an english doctor and the first to apply anesthesia during labor and child birth. He uses ETHER to alleviate labor pain. He then discovered the effects of chloroform as an anesthetic agent. Because of his works, He was recognized by Queen Victoria because the queen herself uses Simpson's chloroform in alleviating labor pain when she gave birth to prince leopold.

87. Which sign would alert the nurse that Pillar is entering the second stage of labor? [1]

A. Increase frequency and intensity of contraction
B. Perineum bulges and anal orifice dilates
C. Effacement of internal OS is 100%
D. Vulva encircles the largest diameter of presenting part

* The second stage of labor begins as the cervical internal os is 100% effaced and fully dilated. It ends after the fetus has been delivered. Crowning, as in letter B and D is too late of a sign to alert the nurse that Pillar is entering the second stage of labor. A occurs during the first stage of labor.

88. Nursing care during the second stage of labor should include [1]

A. Careful evaluation of prenatal history
B. Coach breathing, Bear down with each contraction and encourage patient.
C. Shave the perineum
D. Administer enema to the patient

* The second stage of labor begins with a full cervical dilation and effacement and finishes when the baby is fully delivered. Careful evaluation of prenatal history is done on admission and check ups and is never done in the second stage of labor. Shaving the perineum and enema are done during the first stage of labor in preparation for delivery or before labor begins when client is admitted. Enema is not a routine procedure before delivery, but can be done to prevent defecation during labor. B is appropriate during the second stage of labor when the client's contraction is at it's peak and dilation and effacement are at maximum to help client accomplish the task of giving birth.

SITUATION : [NBLUE170] Baby boy perez was delivered spontaneously following a term pregnancy. Apgar scores are 8 and 9 respectively. Routine procedures are carried out.

89. When is the APGAR Score taken? [1]

A. Immediately after birth and at 30 minutes after birth
B. At 5 minutes after birth and at 30 minutes after birth
C. At 1 minute after birth and at 5 minutes after birth
D. Immediately after birth and at 5 minutes after birth

* APGAR score taken 1 minute after birth determines the initial status of the newborn while the 5 minute assessment after birth determines how well the newborn is adjusting to the extrauterine life.

90. The best way to position a newborn during the first week of life is to lay him [3]

A. Prone with head slightly elevated
B. On his back, flat
C. On his side with his head flat on bed
D. On his back with head slightly elevated

* Sudden infant death syndrome occurs when the fetus is in prone position. Knowing this will allow you to eliminate A first. During the first week of life, The fetus has an immature cardiac sphincter and musculature for swallowing, Knowing this will let you eliminate B and D. Side lying position is the best position for a neonate during the first few weeks of life. This will decrease the risk of aspiration of secretion.

91. Baby boy perez has a large sebaceous glands on his nose, chin, and forehead. These are known as [1]

A. Milia
B. Lanugo
C. Hemangiomas
D. Mongolian spots

* Newborn sebaceous glands are sometimes unopened or plugged. They are called MILIA. They will disappear once the gland opens at around 2 weeks after delivery. They are characterized by a pinpoint white papule. Lanugo is the fine hair that covers the newborn. It disappears starting 2 weeks after birth. A premature infant has more lanugo than a post mature infant. Hemangiomas are vascular tumors of the skin. Mongolian spots are patches that are gray in color and are often found in sacrum or buttocks. They disappear as the child grows older.

92. Baby boy perez must be carefully observed for the first 24 hours for [2]

A. Respiratory distress
B. Duration of cry
C. Frequency of voiding
D. Range in body temperature

* Range in body temperature needs to be observed and carefully monitored for the first 24 hours after delivery. A newborn has an inadequate and immature temperature regulating mechanism. RDS is observed immediately after delivery, not in a continuous 24 hour observation. Once the fetus establish a normal breathing pattern it is not anymore of a concern. RDS occurs when the Surfactants are absent or insufficient. The adequacy of these surfactants is measured by the L:S ratio [ Lecithin : Spingomyelin ] An L:S ratio of 2:1 is considered, mature and adequate to sustain fetal lung expansion and ventilation. Therefore, A child born without RDS is unlikely to have RDS in 24 hours.

Another thing that is carefully observed during the first 24 hours is the meconium. Absent of meconium during the first 24 hours after birth warrants further investigation by the attending physician.

93. According to the WHO , when should the mother starts breastfeeding the infant? [4]

A. Within 30 minutes after birth
B. Within 12 hours after birth
C. Within a day after birth
D. After infant's condition stabilizes

* According to the world health organization, The mother should start breastfeeding her infant within 30 minutes after birth.

94. What is the BEST and most accurate method of measuring the medication dosage for infants and children? [3]

A. Weight
B. Height
C. Nomogram
D. Weight and Height

* A nomogram is the most accurate method for measuring medication dosage for infants and children. It estimates the body surface area by drawing a line in the first column [ child's height ] towards the third column [ child's weight ]. The point in which it crosses the middle column [ BSA ] is the child's surface area.

95. The first postpartum visit should be done by the mother within [4]

A. 24 hours
B. 3 days
C. a week
D. a month

* Mother should visit the health facility 4 weeks to 6 weeks after delivery. The first post partum visit by the birth attendant is done within 24 hours after delivery, the next visit will be at 1 week after delivery and the third visit is done 2 to 4 weeks after delivery.

96. The major cause of maternal mortality in the philippines is [3]

A. Infection
B. Hemorrhage
C. Hypertension
D. Other complications related to labor,delivery and puerperium

* Refer to the latest survey of FHSIS in the DOH website.

97. According to the WHO, what should be the composition of a commercialized Oral rehydration salt solution? [4]

A. Potassium : 1.5 g. ; Sodium Bicarbonate 2.5g ; Sodium Chloride 3.5g; Glucose 20 g.
A. Potassium : 1.5 g. ; Sodium Bicarbonate 2.5g ; Sodium Chloride 3.5g; Glucose 10 g.
A. Potassium : 2.5 g. ; Sodium Bicarbonate 3.5g ; Sodium Chloride 4.5g; Glucose 20 g.
A. Potassium : 2.5 g. ; Sodium Bicarbonate 3.5g ; Sodium Chloride 4.5g; Glucose 10 g.

* This is the WHO ORESOL formula for the commercialized ORS. Remember PA BCG Which stands for POTASSIUM [ Pa ] SODIUM BICARBONATE [ B ] SODIUM CHLORIDE [ C ] GLUCOSE [ G ]. The numbers are easy to remember because they are just increased by 1.0 g increment starting from 1.5. Glucose however is at 20 g. So the MNEMONIC is PA BCG 1.5 2.5 3.5 20. This is the mnemonic I use and it is easy to remember that way. It is original by the way.

98. In preparing ORESOL at home, The correct composition recommnded by the DOH is [4]

A. 1 glass of water, 1 pinch of salt and 2 tsp of sugar
B. 1 glass of water, 2 pinch of salt and 2 tsp of sugar
C. 1 glass of water, 3 pinch of salt and 4 tsp of sugar
D. 1 glass of water, 1 pinch of salt and 1 tsp of sugar

99. Milk code is a law that prohibits milk commercialization or artificial feeding for up to 2 years. Which law provides its legal basis? [4]

A. Senate bill 1044
B. RA 7600
C. Presidential Proclamation 147
D. EO 51

* Executive order # 51 prohibits milk commercialization or artificial feeding up to 2 years. That is why the milk commercials in the country has " BREAST MILK IS STILL BEST FOR BABIES UP TO 2 YEARS " After their presentation in accordance with EO 51. RA 7600 is the ROOMING IN / BREAST FEEDING ACT which requires the heatlh professionals to bring the baby to the mother for breastfeeding as early as possible. Senate bill # 1044 was created to implement RA 7600. Presidential Proclamation # 147 made WEDNESDAY as the national immunization day.

100. A 40 year old mother in her third trimester should avoid [4]

A. Traveling
B. Climbing
C. Smoking
D. Exercising

* Mother's are not prohibited to travel, climb or exercise. If long travels are expected, Mother should have a 30 minute rest period for every 2 hours of travel [ LIPPINCOTT ]. Climbing is a very vague term used by the board examiners though I assume they are referring to climbing a flight of stairs. Anyhow, SMOKING is detrimental for both mother and child no question about it and so is ALCOHOL. In thousands of questions I answered, it never fails that HANDWASHING, AVOID SMOKING, AVOID ALCOHOL are always the answer. It still depends on the question so THINK.

MCN drill Test 1

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 15:36:00 +0800

MS drill Test IV (Answers and Rationale)

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 13:06:00 +0800

DEGREE OF QUESTION DIFFICULTY

4 – Very hard question, 25% Chance of answering correctly
3 – Hard question, 50% Chance of answering correctly
2 – Moderately hard question, 75% of answering correctly
1 – Easy question, 99% will answer the question correctly

SITUATION : Jessa, A registered nurse, witnessed an old woman hit by a motorcycle while crossing a train railway. The old woman fell at the railway. Jessa Rushed at the scene.

1. As a registered nurse, Jessa knew that the first thing that he will do at the scene is [3]

A. Stay with the person, Encourage her to remain still and Immobilize the leg while
While waiting for the ambulance.
B. Leave the person for a few moments to call for help.
C. Reduce the fracture manually.
D. Move the person to a safer place.

* The old woman is in the middle of a train railway. It is very unsafe to immobilize here legs and remain still at the middle of a railway considering that a train might come anytime while waiting for an ambulance. Safety is the utmost importance at this point. If letter D is not among the choices and the situation is a little less dangerous, the answer will be A. Remember that in all cases of emergencies, removing the victim from the scene to a much safer place is a priority.

2. Dervid suspects a hip fracture when he noticed that the old woman’s leg is [4]

A. Lengthened, Abducted and Internally Rotated.
B. Shortened, Abducted and Externally Rotated.
C. Shortened, Adducted and Internally Rotated.
D. Shortened, Adducted and Externally Rotated.

* SADDER should be your keyword. A hip fracture will produce a SHORTENED, ADDUCTED AND EXTERNALLY ROTATED extremity. Treatment will evolve in casting the leg and putting it in a EXTENSION, NEUTRALLY POSITIONED and SLIGHT INTERNAL ROTATION. In Hip prosthesis, The nurse should maintain the client’s leg in FLEXION, EXTERNAL ROTATION and ABDUCTION to prevent the dislocation of the prosthesis from the acetabulum. Take note of the difference because I mistakenly answered the LATTER in casting a hip fracture thinking that it is similar to a the leg positioning in hip dislocation. Just imagine a patient with a cast that has his leg in ABDUCTION, EXTERNAL ROTATION AND FLEXION. It will cause flexion contractures.

3. The old woman complains of pain. John noticed that the knee is reddened, warm to touch and swollen. John interprets that this signs and symptoms are likely related to [2]

A. Infection
C. Thrombophlebitis
B. Inflammation
D. Degenerative disease

* After a trauma, Inflammation will start almost instantly. Infection occurse 24-48 hours after bone fracture and not immediately. Thrombophlebitis occurs within 4 to 7 days of hospitalization after prolonged immobilization. There is no evidence that the client has a degenerative disease and degenerative diseases will manifest in variety of ways and not after a trauma.

4. The old woman told John that she has osteoporosis; Jessa knew that all of the following factors would contribute to osteoporosis except [4]

A. Hypothyroidism
B. End stage renal disease
C. Cushing’s Disease
D. Taking Furosemide and Phenytoin.

* B,C,D all contributes to bone deminiralization except HYPOTHYROIDISM. Hyperthyroidism will contribute to bone deminiralization as well as Hyperparathyroidism due to the increase in PTH, It will cause the movement of calcium from the bone to the blood causing HYPERCALCEMIA. ESRD will cause increase in PHOPHSATE due to its poor excretion. The amount of phosphate is inversely proportional to the amount of calcium. Cushing disease promotes bone demineralization as well as medications like diuretics and anti convulsants.

5. Martha, The old woman was now Immobilized and brought to the emergency room. The X-ray shows a fractured femur and pelvis. The ER Nurse would carefully monitor Martha for which of the following sign and symptoms? [3]

A. Tachycardia and Hypotension
B. Fever and Bradycardia
C. Bradycardia and Hypertension
D. Fever and Hypertension

* hemorrhage results in severing of the vascular supply of the bone of the femur and the pelvis due to the fracture leading to bleeding causing the s/s of tachycardia and hypotension.

SITUATION: Mr. D. Rojas, An obese 35 year old MS Professor of OLFU Lagro is admitted due to pain in his weight bearing joint. The diagnosis was Osteoarthritis.

6. As a nurse, you instructed Mr. Rojas how to use a cane. Mr. Rojas has a weakness on his right leg due to self immobilization and guarding. You plan to teach Mr. Rojas to hold the cane [4]

A. On his left hand, because his right side is weak.
B. On his left hand, because of reciprocal motion.
C. On his right hand, to support the right leg.
D. On his right hand, because only his right leg is weak.

* Reciprocal motion is a very important aspect of rehabilitation. Mr. Rojas has a weakness on his right leg. If a human moves his right leg, the left arm will accompany the movement of the right leg. That is what you call RECIPROCAL MOTION which is innate, natural and required to maintain balance. Mr. Rojas has weakness in his RIGHT LEG. If we put the cane on his right arm, The client will then be left UNSUPPORTED when he use his stronger leg [LEFT LEG] and stand with his weaker leg [RIGHT LEG] due to the fact that the opposite arm must accompany the movement of the opposite leg [RIGHT ARM]. In a more easier term, Always put the cane on the opposite of the weaker side. A is not correct because the client is NOT hemiplegic and will never be correct to reason out why the cane must always be at the opposite of the weaker side, it will always be due to reciprocal motion.

7. You also told Mr. Rojas to hold the cane [4]

A. 1 Inches in front of the foot.
B. 3 Inches at the lateral side of the foot.
c. 6 Inches at the lateral side of the foot.
D. 12 Inches at the lateral side of the foot.

* Remove option A, the client will kick off the cane if it was in the front of the foot. Remove option D because that is too far and will cause the cane to poorly support the client because the side, not the tip, is touching the ground. At 3 inches, imagine how short it is and will cause a very poor supporting base. The correct answer is anywhere from 6 to 10 inches for both crutches and cane.

8. Mr. Rojas was discharged and 6 months later, he came back to the emergency room of the hospital because he suffered a mild stroke. The right side of the brain was affected. At the rehabilitative phase of your nursing care, you observe Mr. Rojas use a cane and you intervene if you see him [4]

A. Moves the cane when the right leg is moved.
B. Leans on the cane when the right leg swings through.
C. keeps the cane 6 Inches out to the side of the right foot.
D. Holds the cane on the right side.

* If the right side of the brain is affected, weakness will always be CONTRALATERAL and therefore, Mr. Rojas will have weakness on his left side. Earlier I told you that cane is held on the opposite side of the weaker side, which in this situation, will be on the RIGHT. Imagine if the client moves his RIGHT LEG together witht the RIGHT CANE, it already violated the LAW OF RECIPROCAL MOTION. Moving the right leg will require Mr. Rojas to move his left arm and not the cane, which is on his right.

SITUATION: Alfred, a 40 year old construction worker developed cough, night sweats and fever. He was brought to the nursing unit for diagnostic studies. He told the nurse he did not receive a BCG vaccine during childhood

9. The nurse performs a Mantoux Test. The nurse knows that Mantoux Test is also known as [1]

A. PPD
B. PDP
C. PDD
D. DPP

* PPD stands for purified protein derivative. It is used to check for TB exposure. All clients who had BCG need not perform this test because they will always be + .

10. The nurse would inject the solution in what route? [1]

A. IM
B. IV
C. ID
D. SC

* A Wheal is created intradermally and then it is marked and timed. reading will be done within 2 to 3 days.

11. The nurse notes that a positive result for Alfred is [2]

A. 5 mm wheal
B. 5 mm Induration
C. 10 mm Wheal
D. 10 mm Induration

* 10 mm Induration [ redness ] is considered positive for individuals with competitive immune response. Wheals are not measured, they will not anymore enlarge. A 5 mm induration is considered positive for patients with AIDS or immunocompromised.

12. The nurse told Alfred to come back after [2]

A. a week
B. 48 hours
C. 1 day
D. 4 days

* Clients are asked to comeback within 2 to 3 days for the reading.

13. Mang Alfred returns after the Mantoux Test. The test result read POSITIVE. What should be the nurse’s next action? [3]

A. Call the Physician
B. Notify the radiology dept. for CXR evaluation
C. Isolate the patient
D. Order for a sputum exam

* The nurse has no authority order the radiology department for a chest x ray evaluation nor order for a sputum exam. The client need not be isolated because Mantoux test do not determine the activeness of the disease.

14. Why is Mantoux test not routinely done in the Philippines? [2]

A. It requires a highly skilled nurse to perform a Mantoux test
B. The sputum culture is the gold standard of PTB Diagnosis and it will definitively determine the extent of the cavitary lesions
C. Chest X Ray Can diagnose the specific microorganism responsible for the lesions
D. Almost all Filipinos will test positive for Mantoux Test

* almost all filipinos tests positive for mantoux test due to the fact that BCG are required and TB exposure in the country is fullminant. All individuals vaccinated with BCG will test POSITIVE for mantoux test all their lives.

15. Mang Alfred is now a new TB patient with an active disease. What is his category according to the DOH? [1]

A. I
B. II
C. III
D. IV

* Category I patients are those with a newly diagnosed TB whose sputum culture are positive. II are for those who have relapses while III are those with negative sputum culture but positive chest x ray, or PTB Minimal.

16. How long is the duration of the maintenance phase of his treatment? [2]

A. 2 months
B. 3 months
C. 4 months
D. 5 months

* Clients in category I will have 2 months INTENSIVE and 4 months maintenance treatment.

17. Which of the following drugs is UNLIKELY given to Mang Alfred during the maintenance phase? [3]

A. Rifampicin
B. Isoniazid
C. Ethambutol
D. Pyridoxine

* Drugs given in the maintenance phase includes Rifampicin and Isoniazid. Ethambutol is given on the intensive phase along with rifampicin and isoniazid. Pyridoxine is given during Isoniazid treatment to prevent peripheral neuritis in contrast in treatment of parkinson's with levodopa, Pyridoxine or VB6 is restricted.

18. According to the DOH, the most hazardous period for development of clinical disease is during the first [4]

A. 6-12 months after
B. 3-6 months after
C. 1-2 months after
D. 2-4 weeks after

* According to the department of health, the most hazardous period for development of clinical disease is during the first 6 to 12 months.

19. This is the name of the program of the DOH to control TB in the country [2]

A. DOTS
B. National Tuberculosis Control Program
C. Short Coursed Chemotherapy
D. Expanded Program for Immunization

* National tuberculosis control program is the name of the program of the DOH to control and eradicate TB in the country. DOTS refers to the STRATEGY used by the department in treating TB patients. EPI is not a program for TB control although BCG is one of the vaccine given in this program.

20. Susceptibility for the disease [ TB ] is increased markedly in those with the following condition except [3]

A. 23 Year old athlete with diabetes insipidus
B. 23 Year old athlete taking long term Decadron therapy and anabolic steroids
C. 23 Year old athlete taking illegal drugs and abusing substances
D. Undernourished and Underweight individual who undergone gastrectomy

* Nutrition, Long term immunosupression and drug abuse are all factors that affects the resistance of an individual in acquiring communicable diseases. Other factors includes extremes of ages, poor environmental sanitation, poverty and poor living conditions. Diabetes insipidus does not, in anyway alter a persons immune response.

21. Direct sputum examination and Chest X ray of TB symptomatic is in what level of prevention? [1]

A. Primary
B. Secondary
C. Tertiary
D. Quarterly

* National board exam loves asking about level of prevention. Mastery with the primary, secondary and tertiary levels of prevention is a must. All diagnostic, case finding and treatment belongs to the secondary level of prevention.

SITUATION: Michiel, A male patient diagnosed with colon cancer was newly put in colostomy.

22. Michiel shows the BEST adaptation with the new colostomy if he shows which of the following? [2]

A. Look at the ostomy site
B. Participate with the nurse in his daily ostomy care
C. Ask for leaflets and contact numbers of ostomy support groups
D. Talk about his ostomy openly to the nurse and friends

* Actual participation conveys positive acceptance and adjustment to the altered body image. Although looking at the ostomy site also conveys acceptance and adjustment, Participating with the nurse to his daily ostomy care is the BEST adaptation a client can make during the first few days after colostomy creation.

23. The nurse plans to teach Michiel about colostomy irrigation. As the nurse prepares the materials needed, which of the following item indicates that the nurse needs further instruction? [3]

A. Plain NSS / Normal Saline
B. K-Y Jelly
C. Tap water
D. Irrigation sleeve

* The colon is not sterile, nor the stomach. Tap water is used in enema irrigation and not NSS. Although some clients would prefer a distilled, mineral or filtered water, NSS is not always necessary. KY Jelly is used as the lubricant for the irrigation tube and is inserted 3-4 inches into the colostomy pointing towards the RIGHT. Irrigation sleeve is use to direct the flow of the irrigated solution out of the stomach and into the bedpan or toilet.

24. The nurse should insert the colostomy tube for irrigation at approximately [3]

A. 1-2 inches
B. 3-4 inches
C. 6-8 inches
D. 12-18 inches

* Remember 3-4 inches. They are both used in the rectal tube and colostomy irrigation tube insertion. 1 to 2 inches is too short and may spill out the irrigant out of the stoma. Starting from 6 inches, it would be too long already and may perforate the bowel.

25. The maximum height of irrigation solution for colostomy is [3]

A. 5 inches
B. 12 inches
C. 18 inches
D. 24 inches

* If you will answer in the CGFNS and NCLEX, C will be the correct answer. According to BRUNNER AND SUDDARTHS and Saunders, The height of the colostomy irrigation bag should be hanging above the clients shoulder at around 18 inches. According to MOSBY, 12 inches should be the maximum height. According to Lippinncots, 18 inches is the maximum height. According the the board of examiners, 12 inches should be the maximum height and an 18 inches irrigant height would cause rapid flow of the irrigant towards the colostomy. Therefore, answer in the local board should only be at 12 inches.

26. Which of the following behavior of the client indicates the best initial step in learning to care for his colostomy? [1]

A. Ask to defer colostomy care to another individual
B. Promises he will begin to listen the next day
C. Agrees to look at the colostomy
D. States that colostomy care is the function of the nurse while he is in the hospital

* The client made the best initial step in learning to care for his colostomy once he looks at the site. This is the start of the client's acceptance on his altered body image. A,B and D delays learning and shows the client's disintrest regarding colostomy care.

27. While irrigating the client’s colostomy, Michiel suddenly complains of severe cramping. Initially, the nurse would [1]

A. Stop the irrigation by clamping the tube
B. Slow down the irrigation
C. Tell the client that cramping will subside and is normal
D. Notify the physician

* Stopping the irrigation will also stop the cramping and pain. During the first few days of irrigation, The client will feel pain and cramping as soon as the irirgant touches the bowel. This will start to lessen once the client got accustomed to colostomy irrigation. Slowing down the irrigation will not stop the pain. Telling the client that it is normal and will subside eventually is not acceptable when a client experiences pain. Pain is all encompasing and always a priority over anything else in most situations. Notifying the physician will not be helpful and unecessary.

28. The next day, the nurse will assess Michiel’s stoma. The nurse noticed that a prolapsed stoma is evident if she sees which of the following? [1]

A. A sunken and hidden stoma
B. A dusky and bluish stoma
C. A narrow and flattened stoma
D. Protruding stoma with swollen appearance

* A refers to a retracted stoma, B refers to a stoma that is getting a very poor blood supply. C is a description of stenosis of the stoma.

29. Michiel asked the nurse, what foods will help lessen the odor of his colostomy. The nurse best response would be [4]

A. Eat eggs
B. Eat cucumbers
C. Eat beet greens and parsley
D. Eat broccoli and spinach

* Kinchay and Pechay helps lessen the odor of the colostomy. Spinach, broccoli, Cabbage, Cucumbers, Patola or bottle gourd also help lessen the odor BUT are gas formers. Eggs are not recommended because they are known to cause unpleasant odors in patients with colostomy.

30. The nurse will start to teach Michiel about the techniques for colostomy irrigation. Which of the following should be included in the nurse’s teaching plan? [4]

A. Use 500 ml to 1,000 ml NSS
B. Suspend the irrigant 45 cm above the stoma
C. Insert the cone 4 cm in the stoma
D. If cramping occurs, slow the irrigation

* 1 inches is equal to 2.54 cm. Convert the cm if you are not familiar. 45 cm is around 17 inches which is ideal for colostomy irrigation. Any value from 12 to 18 is accepted as the colostomy irrigant height. Tap water is used as an irrigant and is infused at room temperature. 4 cm is a little bit short for the ideal 3-4 inches. If cramping occurs STOP the irrigation and continue when is subsides.

31. The nurse knew that the normal color of Michiel’s stoma should be [1]

A. Brick Red
B. Gray
C. Blue
D. Pale Pink

* The stoma should be RED in color. Pale pink are common with anemic or dehydrated patients who lost a lot of blood after an operation. Blue stoma indicated cyanosis or alteration in perfusion. Stomas are not expected to be Gray.

SITUATION: James, A 27 basketball player sustained inhalation burn that required him to have tracheostomy due to massive upper airway edema.

32. Wilma, His sister and a nurse is suctioning the tracheostomy tube of James. Which of the following, if made by Wilma indicates that she is committing an error? [2]

A. Hyperventilating James with 100% oxygen before and after suctioning
B. Instilling 3 to 5 ml normal saline to loosen up secretion
C. Applying suction during catheter withdrawal
D. Suction the client every hour

* This is unecessary. Suctioning is done on PRN basis and not every hour. A,B and C are all correct processes of suctioning a tracheostomy.

33. What size of suction catheter would Wilma use for James, who is 6 feet 5 inches in height and weighing approximately 145 lbs? [2]

A. Fr. 5
B. Fr. 10
C. Fr. 12
D. Fr. 18

* The height is given and it looks like james is a very tall individual. The maximum height of suction tube is used. fr 12-18 are used for adults while 6-8 are used in children.

34. Wilma is using a portable suction unit at home, What is the amount of suction required by James using this unit? [4]

A. 2-5 mmHg
B. 5-10 mmHg
C. 10-15 mmHg
D. 20-25 mmHg

* A is used in pediatric clients. B is for children and C is for adults. 20-25 mmHg is too much for a portable suction unit and is not recommended.

35. If a Wall unit is used, What should be the suctioning pressure required by James? [4]

A. 50-95 mmHg
B. 95-110 mmHg
C. 100-120 mmHg
D. 155-175 mmHg

* A is used in pediatric clients. B is for children and C is for adults. 155-175 mmHg is too much for a wall suction unit and is not recommended.

36. Wilma was shocked to see that the Tracheostomy was dislodged. Both the inner and outer cannulas was removed and left hanging on James’ neck. What are the 2 equipment’s at james’ bedside that could help Wilma deal with this situation? [3]

A. New set of tracheostomy tubes and Oxygen tank
B. Theophylline and Epinephrine
C. Obturator and Kelly clamp
D. Sterile saline dressing

* In an emergency like this, The first thing the nurse should do is maintaining the airway patency. With the cannunlas dislodged, The stoma will stenosed and narrows giving james an obstructed airway. The nurse would insert the kelly clamp to open the stoma and lock the clamp in place to maintain it open while she uses an obturator as to prevent further stenosis of the stoma. An obturator is a part of the NGT package included by most manufacturers to guide the physician or nurses in inserting the outer cannula.

37. Which of the following method if used by Wilma will best assure that the tracheostomy ties are not too tightly placed? [2]

A. Wilma places 2 fingers between the tie and neck
B. The tracheotomy can be pulled slightly away from the neck
C. James’ neck veins are not engorged
D. Wilma measures the tie from the nose to the tip of the earlobe and to the xiphoid process.

* Wilma should place 2 fingers underneath the tie to ensure that it is not too tight nor too loose. Letter D is the measurement for NGT insertion and is unrelated to tracheostomy.

38. Wilma knew that James have an adequate respiratory condition if she notices that [1]

A. James’ respiratory rate is 18
B. James’ Oxygen saturation is 91%
C. There are frank blood suction from the tube
D. There are moderate amount of tracheobronchial secretions

* an RR of 18 means that James is not tachypneic and has an adequate air exchange. Oxygen saturation should be more than 95%. Frank blood is not expected in the suction tube. A slight tinged of blood in the tube is acceptable and expected. Amount of secretion are not in anyway related in assessing the respiratory condition of a person and so is the amount of blood in the tube.

39. Wilma knew that the maximum time when suctioning James is [1]

A. 10 seconds
B. 20 seconds
C. 30 seconds
D. 45 seconds

* According to our reviewers and lecturers, 10 to 15 seconds is the maximum suction time. But according to almost all foreign books I read, it should only be 10 seconds at max. I prefer following Saunders,Mosby and Lippinncots when they are all united.

SITUATION : Juan Miguel Lopez Zobel Ayala de Batumbakal was diagnosed with Acute Close Angle Glaucoma. He is being seen by Nurse Jet.

40. What specific manifestation would nurse Jet see in Acute close angle glaucoma that she would not see in an open angle glaucoma? [3]

A. Loss of peripheral vision
B. Irreversible vision loss
C. There is an increase in IOP
D. Pain

* There is NO PAIN in open angle glaucoma. A,B,C are all present in both glaucomas including the low pressure glaucoma. Pain is absent because the increase in intra ocular pressure is not initiated abruptly. It is gradual and progressive and will lead to unoticed loss of peripheral vision. Pain is present in acute close angle glaucoma because there is a sudden closure or narrowing of the canal of schlemm. Therefore if you will be ask what s/s is common in both, answer IRREVERSIBLE LOSS OF PERIPHERAL VISION.

41. Nurse jet knew that Acute close angle glaucoma is caused by [3]

A. Sudden blockage of the anterior angle by the base of the iris
B. Obstruction in trabecular meshwork
C. Gradual increase of IOP
D. An abrupt rise in IOP from 8 to 15 mmHg

* Sudden blockage of the angle will cause s/s of acute angle closure glaucoma. B and C are all related to open angle glaucoma. D is insignificant, If the client bends or cough, IOP can increase from 8 to as much as 30 mmHg but then return again to normal.

42. Nurse jet performed a TONOMETRY test to Mr. Batumbakal. What does this test measures [1]

A. It measures the peripheral vision remaining on the client
B. Measures the Intra Ocular Pressure
C. Measures the Client’s Visual Acuity
D. Determines the Tone of the eye in response to the sudden increase in IOP.

* Tonometry measures the IOP. Normal range is 8 to 21 mmHg.

43. The Nurse notices that Mr. Batumbakal cannot anymore determine RED from BLUE. The nurse knew that which part of the eye is affected by this change? [3]

A. IRIS
B. PUPIL
c. RODS [RETINA]
D. CONES [RETINA]

* CONES Are responsible for COLOR VISION and DAY VISION, they are very sensitive to RED LIGHT that is why red lights are use to guide the elderly towards the bathroom when they wake up to urinate. Rods are responsible for night vision. They are sensitive to blue and green lights.

44. Nurse Jet knows that Aqueous Humor is produce where? [4]

A. In the sub arachnoid space of the meninges
B. In the Lateral ventricles
C. In the Choroids
D. In the Ciliary Body

* AH is produced in the CILIARY BODY. It is filtered by the trabecular meshwork into the canal of schlemm.

45. Nurse Jet knows that the normal IOP is [2]

A. 8-21 mmHg
B. 2-7 mmHg
c. 31-35 mmHg
D. 15-30 mmHg

46. Nurse Jet wants to measure Mr. Batumbakal’s CN II Function. What test would Nurse Jet implement to measure CN II’s Acuity? [1]

A. Slit lamp
B. Snellen’s Chart
C. Wood’s light
D. Gonioscopy

* CN II is the optic nerve. To assess its acuity, Snellen's chart is used. Slit lamp is the one you see in the usual Eye glasses shop where in, you need to look into its binocular-like holes and the optometrist is on the other side to magnify the structures of the eye to assess gross damage and structure. Woods light is a BLUE LIGHT used in dermatology. It is use to mark lesions usually caused skin infection. Gonioscopy is the angle measurement of the eye.

47. The Doctor orders pilocarpine. Nurse jet knows that the action of this drug is to [4]

A. Contract the Ciliary muscle
B. Relax the Ciliary muscle
C. Dilate the pupils
D. Decrease production of Aqueous Humor

* When the ciliary muscles contract, pupils constrict and the angle widens causing an increase AH outflow and decrease IOP. Relaxing the ciliary muscle will cause mydriasis or dilation, it is used as a pre op meds for cataract surgery and eye examination to better visualize the structures behind the iris. A and C are the same. Other drugs like betaxolol, Azetazolamide and epinephrine are the drugs used to decrease AH production.

48. The doctor orders timolol [timoptic]. Nurse jet knows that the action of this drug is [4]

A. Reduce production of CSF
B. Reduce production of Aqueous Humor
C. Constrict the pupil
D. Relaxes the Ciliary muscle

* All the eye drops the ends in OLOL decreases AH production. They are BETA BLOCKERS. Watch out for the S/S of congestive heart failure, bradycardia, hypotension and arrythmias.

49. When caring for Mr. Batumbakal, Jet teaches the client to avoid [1]

A. Watching large screen TVs
B. Bending at the waist
C. Reading books
D. Going out in the sun

* Bending at the waist increase IOP and should be avoided by patients with glaucoma. Treatment for glaucoma is usually for life. Patients are given laxatives to avoid stratining at the stool. They should avoid all activities that will lead to sudden IOP increase like bending at the waist. Clients should bend at the knees.

50. Mr. Batumbakal has undergone eye angiography using an Intravenous dye and fluoroscopy. What activity is contraindicated immediately after procedure? [4]

A. Reading newsprint
B. Lying down
C. Watching TV
D. Listening to the music

* The client had an eye angiography. Eye angiography requires the use MYDRIATICS pre-procedure. It is done by injecting an Intravenous dye and visualizes the flow of the dye throught the fluoroscopy along the vessels of the eye. This is to assess macular degeneration or neovascularizations [ proliferation of new vessels to compensate for continuous rupture and aneurysms of the existing vessels ] Mydratics usually takes 6 hours to a day to wear off. If client uses a mydratic, his pupil wil dilate making it UNABLE to focus on closer objects. Only A necessitates the constriction of the pupil to focus on a near object, which Mr.Batumbakals eye cannot perform at this time.

51. If Mr. Batumbakal is receiving pilocarpine, what drug should always be available in any case systemic toxicity occurs? [2]

A. Atropine Sulfate
B. Pindolol [Visken]
C. Naloxone Hydrochloride [Narcan]
D. Mesoridazine Besylate [Serentil]

* Atropine sulfate is use to reverse the effects of systemic toxicity of pilocarpine. Narcan is the antidote for respiratory depression caused by narcotics like morphine and demerol. Serentil is an antipsychotic.

SITUATION : Wide knowledge about the human ear, it’s parts and it’s functions will help a nurse assess and analyze changes in the adult client’s health.

52. Nurse Budek is doing a caloric testing to his patient, Aida, a 55 year old university professor who recently went into coma after being mauled by her disgruntled 3rd year nursing students whom she gave a failing mark. After instilling a warm water in the ear, Budek noticed a rotary nystagmus towards the irrigated ear. What does this means? [2]

A. Indicates a CN VIII Dysfunction
B. Abnormal
C. Normal
D. Inconclusive

* Rotary nystagmus towards the ear [ if warm ] or away from it [ if cool ] is a normal response. It indicates that the CN VIII Vestibular branch is still intact.

53. Ear drops are prescribed to an infant, The most appropriate method to administer the ear drops is [2]

A. Pull the pinna up and back and direct the solution towards the eardrum
B. Pull the pinna down and back and direct the solution onto the wall of the canal
C. Pull the pinna down and back and direct the solution towards the eardrum
D. Pull the pinna up and back and direct the solution onto the wall of the canal

* Instillation for children under age 3 is CHILD : DOWN AND BACK. Directing the solution towards the eardrum might perforate or damage the infants fragile tympanic membrane.

54. Nurse Budek is developing a plan of care for a patient with Menieres disease. What is the priority nursing intervention in the plan of care for this particular patient? [1]

A. Air, Breathing, Circulation
B. Love and Belongingness
C. Food, Diet and Nutrition
D. Safety

* Although A is priority according to maslow, it is not specific in clients with menieres disease. The client has an attack of incapacitating vertigo and client is high risk for injury due to falls. The client will perceive the environment moving due to disruption of the vestibular system of the ear's normal function.

55. After mastoidectomy, Nurse Budek should be aware that the cranial nerve that is usually damage after this procedure is [3]

A. CN I
B. CN II
C. CN VII
D. CN VI

* The facial nerve branches from the back of the ear and spread towards the mouth, cheeks, eyelids and almost all over the face. In mastoidectomy, Incision is made at the back of the ears to clear the mastoid air cells of the mastoid bone that is infected. Clients are at very high risk for CN VII injury because of this. Observation during the post op after mastoidectomy should revolve around assessing the client's CN VII integrity.

56. The physician orders the following for the client with Menieres disease. Which of the following should the nurse question? [1]

A. Dipenhydramine [Benadryl]
B. Atropine sulfate
C. Out of bed activities and ambulation
D. Diazepam [Valium]

* Clients with acute attack of Menieres are required to have bed rest with side rails up to prevent injury. During periods of incapacitating vertigo, patient's eyes will have rotary nystagmus because of the perception that the environment is moving. Patients are also observed to hold the side rails so hard because they thought they are going to fall. Benadryl is used in menieres due to its anti histamine effects. B and D are used to allay clients anxiety and apprehension.

57. Nurse Budek is giving dietary instruction to a client with Menieres disease. Which statement if made by the client indicates that the teaching has been successful? [1]

A. I will try to eat foods that are low in sodium and limit my fluid intake
B. I must drink atleast 3,000 ml of fluids per day
C. I will try to follow a 50% carbohydrate, 30% fat and 20% protein diet
D. I will not eat turnips, red meat and raddish

* Clients are advised to limite fluid and sodium intake as not to further cause accumulation of fluids in the endolymph. C is the diabetic diet. D are the foods not eaten when clients are about to have a guaiac test.

58. Peachy was rushed by his father, Steven into the hospital admission. Peachy is complaining of something buzzing into her ears. Nurse Budek assessed peachy and found out It was an insect. What should be the first thing that Nurse Budek should try to remove the insect out from peachy’s ear? [3]
A. Use a flashlight to coax the insect out of peachy’s ear
B. Instill an antibiotic ear drops
C. Irrigate the ear
D. Pick out the insect using a sterile clean forceps

* Lights can coax the insect out of the child's ear. This is the first measure employed in removing a live insect from the childs ear. Insects are not removed ALIVE, therfore, C and D are both wrong. Antibiotics has no effects since the child do not have any infection. If the insect did not come out after coaxing it with light, 2nd measure employs instillation of diluted alcohol or a mineral oil to kill the insect which is then removed using letter D.

59. Following an ear surgery, which statement if heard by Nurse Budek from the patient indicates a correct understanding of the post operative instructions? [2]

A. Activities are resumed within 5 days
B. I will make sure that I will clean my hair and face to prevent infection
C. I will use straw for drinking
D. I should avoid air travel for a while

* After ear surgery, Air travel is halted for a while. There is no need to restrict activities. The client is not allowed to shower for 7 days, Patient can clean himself using a sponge bath but avoids to shampoo or wet the face and hair. Straws are not used after ear surgery because sips increases pressure in the ear.

60. Nurse Budek will do a caloric testing to a client who sustained a blunt injury in the head. He instilled a cold water in the client’s right ear and he noticed that nystagmus occurred towards the left ear. What does this finding indicates? [2]

A. Indicating a Cranial Nerve VIII Dysfunction
B. The test should be repeated again because the result is vague
C. This is Grossly abnormal and should be reported to the neurosurgeon
D. This indicates an intact and working vestibular branch of CN VIII

* Refer to #52

61. A client with Cataract is about to undergo surgery. Nurse Budek is preparing plan of care. Which of the following nursing diagnosis is most appropriate to address the long term need of this type of patient? [1]

A. Anxiety R/T to the operation and its outcome
B. Sensory perceptual alteration R/T Lens extraction and replacement
C. Knowledge deficit R/T the pre operative and post operative self care
D. Body Image disturbance R/T the eye packing after surgery

* Patient do not have signs of anxiety, knowledge deficit or body image disturbance. The safest answer is B because before cataract surgery, client has a blurry vision that alters his sensory perception. After surgery client will be APHAKIC and again, will have an alteration in perception until the aphakic glass is available.

62. Nurse Budek is performing a WEBERS TEST. He placed the tuning fork in the patients forehead after tapping it onto his knee. The client states that the fork is louder in the LEFT EAR. Which of the following is a correct conclusion for nurse Budek to make? [4]

A. He might have a sensory hearing loss in the left ear
B. Conductive hearing loss is possible in the right ear
C. He might have a sensory hearing loss in the right hear, and/or a conductive hearing loss in the left ear.
D. He might have a conductive hearing loss in the right ear, and/or a sensory hearing loss in the left ear.

* Webers test assesses both air and bone conduction but is not decisive enough to judge which is which. When the tuning fork is tapped on the examiners knee, it is placed in the forehead or above the clients top lip. If the sound lateralizes towards the left ear, its either, the client has conductive hearing loss towards the left OR a sensory hearing loss in the right ear.

Why does conductive hearing produces a louder sound ?

Conductive hearing loss is a type of hearing loss where in, the ossicles hypertrophies, as in OTOSCLEROSIS. The stape is permanently attached to the oval window and it would not bulge causing a permanent LOUD conduction of sound using the bone because the stapes is already attached permanently into the inner ear. In a normal stape, It will not touch the oval window unless a sound is transmitted. [ refer to the ear anatomy and physiology ]

63. Aling myrna has Menieres disease. What typical dietary prescription would nurse Budek expect the doctor to prescribe? [2]

A. A low sodium , high fluid intake
B. A high calorie, high protein dietary intake
C. low fat, low sodium and high calorie intake
D. low sodium and restricted fluid intake

* Refer to # 57

SITUATION : [ From DEC 1991 NLE ] A 45 year old male construction worker was admitted to a tertiary hospital for incessant vomiting. Assessment disclosed: weak rapid pulse, acute weight loss of .5kg, furrows in his tongue, slow flattening of the skin was noted when the nurse released her pinch.

Temperature: 35.8 C , BUN Creatinine ratio : 10 : 1, He also complains for postural hypotension. There was no infection.

64. Which of the following is the appropriate nursing diagnosis? [1]

A. Fluid volume deficit R/T furrow tongue
B. Fluid volume deficit R/T uncontrolled vomiting
C. Dehydration R/T subnormal body temperature
D. Dehydration R/T incessant vomiting

65. Approximately how much fluid is lost in acute weight loss of .5kg? [1]

A. 50 ml
B. 750 ml
C. 500 ml
D. 75 ml

* 1L = 1kg

66. Postural Hypotension is [1]

A. A drop in systolic pressure less than 10 mmHg when patient changes position from lying to sitting.
B. A drop in systolic pressure greater than 10 mmHg when patient changes position from lying to sitting
C. A drop in diastolic pressure less than 10 mmHg when patient changes position from lying to sitting
D. A drop in diastolic pressure greater than 10 mmHg when patient changes position from lying to sitting

* Postural hypotension is exhibited by a drop of systolic BP when client changes position from lying to sitting or standing.

67. Which of the following measures will not help correct the patient’s condition [1]

A. Offer large amount of oral fluid intake to replace fluid lost
B. Give enteral or parenteral fluid
C. Frequent oral care
D. Give small volumes of fluid at frequent interval

* The patient will not tolerate large amount of oral fluid due to incessant vomiting.

68. After nursing intervention, you will expect the patient to have [1]

1. Maintain body temperature at 36.5 C
2. Exhibit return of BP and Pulse to normal
3. Manifest normal skin turgor of skin and tongue
4. Drinks fluids as prescribed

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

* Client need not maintain a temperature of 36.5 C. As long as the client will exhibit absence of fever or hypothermia, Nursing interventions are successfully carried out.

SITUATION: [ From JUN 2005 NLE ] A 65 year old woman was admitted for Parkinson’s Disease. The charge nurse is going to make an initial assessment.

69. Which of the following is a characteristic of a patient with advanced Parkinson’s disease? [1]

A. Disturbed vision
B. Forgetfulness
C. Mask like facial expression
D. Muscle atrophy

* Parkinson's disease does not affect the cognitive ability of a person. It is a disorder due to the depletion of the neurotransmitter dopamine which is needed for inhibitory control of muscular contractions. Client will exhibit mask like facial expression, Cog wheel rigidity, Bradykinesia, Shuffling gait etc. Muscle atrophy does not occur in parkinson's disease nor visual disturbances.

70. The onset of Parkinson’s disease is between 50-60 years old. This disorder is caused by [1]

A. Injurious chemical substances
B. Hereditary factors
C. Death of brain cells due to old age
D. Impairment of dopamine producing cells in the brain

* Dopamine producing cells in the basal ganglia mysteriously deteriorates due to unknown cause.

71. The patient was prescribed with levodopa. What is the action of this drug? [1]

A. Increase dopamine availability
B. Activates dopaminergic receptors in the basal ganglia
C. Decrease acetylcholine availability
D. Release dopamine and other catecholamine from neurological storage sites

* Levodopa is an altered form of dopamine. It is metabolized by the body and then converted into dopamine for brain's use thus increasing dopamine availability. Dopamine is not given directly because of its inability to cross the BBB.

72. You are discussing with the dietician what food to avoid with patients taking levodopa? [3]

A. Vitamin C rich food
B. Vitamin E rich food
C. Thiamine rich food
D. Vitamin B6 rich food

* Vitamin b6 or pyridoxine is avoided in patients taking levodopa because levodopa increases vitamin b6 availability leading to toxicity.

73. One day, the patient complained of difficulty in walking. Your response would be [2]

A. You will need a cane for support
B. Walk erect with eyes on horizon
C. I’ll get you a wheelchair
D. Don’t force yourself to walk

* Telling the client to walk erect neglects the clients complain of difficulty walking. Wheelchair is as much as possible not used to still enhance the client's motor function using a cane. Telling the client not to force himself walk is non therapeutic. The client wants to talk and we should help her walk using devices such as cane to provide support and prevent injuries.

SITUATION: [ From JUN 2005 NLE ] Mr. Dela Isla, a client with early Dementia exhibits thought process disturbances.

74. The nurse will assess a loss of ability in which of the following areas? [2]

A. Balance
B. Judgment
C. Speech
D. Endurance

* Perhaps this question from the JUN 2005 NLE is finding what should the nurse NOT assess because A,B and C are all affected by dementia except ENDURANCE, which is normally lost as a person ages. There will be alteration in balance because coordination and spatial ability gradually deteriorates. Judgement is also impaired as the client exhibits poor memory and concentration. Speech is severely altered. Client develops aphasia, agnosia and in at end, will lose all the ability to speak without any manifestation of motor problem.

75. Mr. Dela Isla said he cannot comprehend what the nurse was saying. He suffers from: [1]

A. Insomnia
B. Aphraxia
C. Agnosia
D. Aphasia

* This question was RECYCLED during the last 2006 NLE. Aphasia is the INABILITY to speak or understand. Aphraxia is the inability to carry out purposeful tasks. Agnosia is the inability to recognize familiar objects. Insomnia is the inability to fall asleep.

76. The nurse is aware that in communicating with an elderly client, the nurse will [1]

A. Lean and shout at the ear of the client
B. Open mouth wide while talking to the client
C. Use a low-pitched voice
D. Use a medium-pitched voice

* Talk as normally as possible. The client has dementia and is not deaf, although hearing might be impaired progressively as the client ages, the nurse should not alter his voice, shout or over enunciate the words. Client will preceive this things as belittling and direspectful.

77. As the nurse talks to the daughter of Mr. Dela Isla, which of the following statement of the daughter will require the nurse to give further teaching? [1]

A. I know the hallucinations are parts of the disease
B. I told her she is wrong and I explained to her what is right
C. I help her do some tasks he cannot do for himself
D. Ill turn off the TV when we go to another room

* Hallucinations and delusions are part of DEMENTIA and is termed as ORGANIC PSYCHOSES. The daughter needs further teaching when she try to bargain, explain, dissprove or advice a client with dementia. the client has an impaired judgement, concentration, thinking, reasoning and memory and has inability to learn that is why institutional care for clients with dementia is always required. The disease is progressive and is not preventable.

78. Which of the following is most important discharge teaching for Mr. Dela Isla [2]

A. Emergency Numbers
B. Drug Compliance
C. Relaxation technique
D. Dietary prescription

* Drug compliance is the most important teaching for Mr. Dela Isla to prevent the symptoms of psychoses and to control behavioral symptoms.

SITUATION : Knowledge of the drug PROPANTHELINE BROMIDE [Probanthine] Is necessary in treatment of various disorders.

79. What is the action of this drug? [4]

A. Increases glandular secretion for clients affected with cystic fibrosis
B. Dissolve blockage of the urinary tract due to obstruction of cystine stones
C. Reduces secretion of the glandular organ of the body
D. Stimulate peristalsis for treatment of constipation and obstruction

* Probanthine reduces glandular secretion of the different organs of the body. It is an anti-cholinergic / anti spasmodic drug and still, not approved by the FDA for treatment with various disorders. Probanthine exerts benifits for treatment of severe diaphoresis, Ulcers due to over secretion of HCl, Spasms, PANCREATITS [ Please take note ] and other conditions of over secretion.

80. What should the nurse caution the client when using this medication [4]

A. Avoid hazardous activities like driving, operating machineries etc.
B. Take the drug on empty stomach
C. Take with a full glass of water in treatment of Ulcerative colitis
D. I must take double dose if I missed the previous dose

* Like other anti cholinergics/ anti spasmodics, Probanthine causes dizziness, blurred vision and drowsiness. Patients are advised not to drive, operate heavy machineries etc. Probanthine should be taken with a full glass of water but is contraindicated with inflammatory bowel diseases like ulcerative colitis and chrons disease. Drug is taken with meals to prevent irritation of the gastric mucosa and client is advised not to take double dose in case the previous dose is missed.

81. Which of the following drugs are not compatible when taking Probanthine? [4]

A. Caffeine
B. NSAID
C. Acetaminophen
D. Alcohol

* Probanthine on its own already cause severe dizziness and drowsiness. Addition of alcohol will further depress the CNS and might lead to potentiation of the side effects of probanthine. A,B,C are not contraindicated when taking probanthine EXCEPT when the disease entity itself do not permit intake of such drugs like in Pancreatitis, NSAID is not use. Pain is controlled using probanthine and meperidine [ demerol ] in cases of acute pancreatitis.

82. What should the nurse tell clients when taking Probanthine? [4]

A. Avoid hot weathers to prevent heat strokes
B. Never swim on a chlorinated pool
C. Make sure you limit your fluid intake to 1L a day
D. Avoid cold weathers to prevent hypothermia

* Probanthine alters the ability of the body to secrete sweat. Telling the client to avoid hot weathers to prevent heat stroke is appropriate. Chlorinated pool is discouraged for patients undergoing skin radiation for skin cancer to prevent breakdown. Limiting fluid intake and avoiding cold weather are unecessary teachings.

83. Which of the following disease would Probanthine exert the much needed action for control or treatment of the disorder? [4]

A. Urinary retention
B. Peptic Ulcer Disease
C. Ulcerative Colitis
D. Glaucoma

* Probanthine is use in PUD to decrease gastric acid secretion. It is also used in Pancreatitis to rest the pancreas from over secretion of pancreatic enzyme and to prevent pain and spasm. Probanthine is contraindicated in clients with UC, Glaucoma. Since this is an anti spasmodic drug, Urinary retention will be a side effect.

SITUATION : [ From DEC 2000 NLE ] Mr. Franco, 70 years old, suddenly could not lift his spoons nor speak at breakfast. He was rushed to the hospital unconscious. His diagnosis was CVA.

84. Which of the following is the most important assessment during the acute stage of an unconscious patient like Mr. Franco? [1]

A. Level of awareness and response to pain
B. Papillary reflexes and response to sensory stimuli
C. Coherence and sense of hearing
D. Patency of airway and adequacy of respiration

* Airway is always a priority in an unconscious client. Refer to maslows hierarchy of needs for prioritization. Although this is not absolute, knowledge with pathophysiology will best lead you to the correct option.

85. Considering Mr. Franco’s conditions, which of the following is most important to include in preparing Franco’s bedside equipment? [1]

A. Hand bell and extra bed linen
B. Sandbag and trochanter rolls
C. Footboard and splint
D. Suction machine and gloves

* CVA patients has impaired swallowing ability and if not absent, depressed gag reflex. Client is at the highest risk for aspiration when eating or drinking that is why NGT is initiated early in the hospitalization. B prevent EXTERNAL ROTATION in hip or leg fracture. Footboards and splint prevents FOOTDROP seen in clients that has a severed peroneal nerve or prolonged immobilization usually due to fractures that eventually puts pressure on the peroneal nerve. A is not specific to clients with CVA.

86. What is the rationale for giving Mr. Franco frequent mouth care? [1]

A. He will be thirsty considering that he is doesn’t drink enough fluids
B. To remove dried blood when tongue is bitten during a seizure
C. The tactile stimulation during mouth care will hasten return to consciousness
D. Mouth breathing is used by comatose patient and it’ll cause oral mucosa dying and cracking.

* Client will be on NGT once comatose, A is removed first. Client with CVA MAY have seizures, but it is RARE enough that it must require a frequent mouth care, B is eliminated next. Knowing that tactile stimulation is done by touching the patient and not by peforming mouth care will lead you to letter D. Comatose patient uses the mouth to breathe predisposing himself to drying, cracking and infections.

87. One of the complications of prolonged bed rest is decubitus ulcer. Which of the following can best prevent its occurrence? [1]

A. Massage reddened areas with lotion or oils
B. Turn frequently every 2 hours
C. Use special water mattress
D. Keep skin clean and dry

* Frequent turning and positioning is the single most important nursing intervention to prevent ulcer formation. Skins are massaged but once the areas are reddened already [ CLASS I Ulcer ], It is not anymore massaged as not to prevent further breakdown. Lotions and Oils are not use in clients skin because it will further enhance skin breakdown. Water matress are used in BURN patients to limit the pressure on the skin by his own body weight. An alternating-inflatable air matress is much more compatible in periodic distribution of pressure in clients with prolong immobility. Keeping skin clean and dry is important but not as important as frequent turning and positioning.

88. If Mr. Franco’s Right side is weak, What should be the most accurate analysis by the nurse? [4]

A. Expressive aphasia is prominent on clients with right sided weakness
B. The affected lobe in the patient is the Right lobe
C. The client will have problems in judging distance and proprioception
D. Clients orientation to time and space will be much affected

* If the client's right side is weak, the affected lobe is the LEFT LOBE which is where the broca's area is located. Client will exhibit expressive aphasia, careful and slow movements and right sided weakness. Judging distance and proprioception is usually impaired in clients with RIGHT sided stroke. Telling that the clients orientation to time and space will be much affected is a blind shot analysis. This is seen on clients with severe and massive hemorrhagic stroke with recovery failure related to aneurysms producing long term and permanent coma. Mr. Franco right side is weak, not paralysed, meaning, some functions are still left intact.

SITUATION : [ From JUN 1988 NLE ] a 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis.

89. Which result of the lab test will be significant to the diagnosis? [1]

A. RBC : 4.5 TO 5 Million / cu. mm.
B. Hgb : 13 to 14 gm/dl.
C. Platelets : 250,000 to 500,000 cu.mm.
D. WBC : 12,000 to 13,000/cu.mm

* WBC increases with inflammation and infection.

90. Stat appendectomy was indicated. Pre op care would include all of the following except? [1]

A. Consent signed by the father
B. Enema STAT
C. Skin prep of the area including the pubis
D. Remove the jewelries

* Refer to ABDOMINAL ASSESSMENT : STORY TOWARDS MASTERY

91. Pre-anesthetic med of Demerol and atrophine sulfate were ordered to : [3]

A. Allay anxiety and apprehension
B. Reduce pain
C. Prevent vomiting
D. Relax abdominal muscle

* Pain is not reduced in appendicits. Clients are not given pain medication as to assess whether the appendix ruptured. A sudden relief of pain indicates the the appendix has ruptured and client will have an emergency appendectomy and prevent peritonitis. Demerol and Atropine are used to allay client's anxiety pre operatively.

92. Common anesthesia for appendectomy is [3]

A. Spinal
B. General
C. Caudal
D. Hypnosis

* Spinal anesthesia is the most common method used in appendectomy. Using this method, Only the area affected is anesthetized preventing systemic side effects of anesthetics like dizziness, hypotension and RR depression.

93. Post op care for appendectomy include the following except [1]

A. Early ambulation
B. Diet as tolerated after fully conscious
C. Nasogastric tube connect to suction
D. Deep breathing and leg exercise

* Client's peristalsis will return in 48 to 72 hours post-op therefore, Fluid and food are witheld until the bowel sounds returns. Remember that ALL PROCUDURES requiring GENERAL and SPINAL anesthesia above the nerves that supply the intestines will cause temporary paralysis of the bowel. Specially when the bowels are traumatized during the procedure, it may take longer for the intestinal peristalsis to resume.

94. Peritonitis may occur in ruptured appendix and may cause serious problems which are [2]

1. Hypovolemia, electrolyte imbalance
2. Elevated temperature, weakness and diaphoresis
3. Nausea and vomiting, rigidity of the abdominal wall
4. Pallor and eventually shock

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

* Peritonitis will cause all of the above symptoms. The peritoneum has a natural tendency to GUARD and become RIGID as to limit the infective exudate exchange inside the abdominal cavity. Hypovolemia and F&E imbalance are caused by severe nausea and vomiting in patients with peritonitis because of acute pain. As inflammation and infection spreads, fever and chills will become more apparent causing elevation in temperature, weakness and sweating. If peritonitis is left untreated, Client will become severely hypotensive leading to shock and death.

95. If after surgery the patient’s abdomen becomes distended and no bowel sounds appreciated, what would be the most suspected complication? [1]

A. Intussusception
B. Paralytic Ileus
C. Hemorrhage
D. Ruptured colon

* Paralytic Ileus is a mechanical bowel obstruction where in, the patients intestine fails to regain its motility. It is usually caused by surgery and anesthesia. Intusussusception, Appendicitis and Peritonitis also causes paralytic ileus.

96. NGT was connected to suction. In caring for the patient with NGT, the nurse must [2]

A. Irrigate the tube with saline as ordered
B. Use sterile technique in irrigating the tube
C. advance the tube every hour to avoid kinks
D. Offer some ice chips to wet lips

* NGT after appendectomy is used not to deliver nutrients but to decompress the GI tract because of the absence of peristalsis after appendectomy. The stomach and intestines are not sterile, Clean technique is sufficient during irrigation. NGT is placed and not anymore advanced as long as it already reach the stomach. Naso enteric tubes are the one that are advanced periodically until obstruction is reached in the intestine. The client still needs assessment and confirmation of the return of peristalsis before anything is given per orem. Irrigations are done to prevent obstruction in the tube.

97. When do you think the NGT tube be removed? [1]

A. When patient requests for it
B. Abdomen is soft and patient asks for water
C. Abdomen is soft and flatus has been expelled
D. B and C only

* When flatus is expelled, it means that peristalsis has returned and theres is no need for continuing the NGT.

Situation: Amanda is suffering from chronic arteriosclerosis Brain syndrome she fell while getting out of the bed one morning and was brought to the hospital, and she was diagnosed to have cerebrovascular thrombosis thus transferred to a nursing home.

98. What do you call a STROKE that manifests a bizarre behavior? [4]

A. Inorganic Stroke
B. Inorganic Psychoses
C. Organic Stroke
D. Organic Psychoses

* Organic psychoses is a broad and collective term used for psychoses and schizophrenia that has an organic cause. [ Due to Creutzfeldt jakob disease, huntington, hydrocephalus, increase ICP, dementia, stroke etc. ] Manifesting signs and symptoms like hallucination, delustions, illusion, ideas of reference etc. that is similar to schizophrenia and psychoses in absence of organic causes.

99. The main difference between chronic and organic brain syndrome is that the former [2]

A. Occurs suddenly and reversible
B. Is progressive and reversible
C. tends to be progressive and irreversible
D. Occurs suddenly and irreversible

* Chronic brain syndrome tends to be progressive and irreversible. Organic brain syndrome is acute and irreversible or reversible depending on the causative factor.

100. Which behavior results from organic psychoses? [4]

A. Memory deficit
B. Disorientation
C. Impaired Judgement
D. Inappropriate affect

* B, C and D are all behaviors that results from organic psychoses. The questions seems to ask EXCEPTION which is A. MEMORY DEFICIT. Organic psychoses is the same as the usual psychoses except that the causative factor of organic psychoses is evidently caused by a disease process of the brain or affecting the brain. Example are patients who suffer stroke suddenly experience hallucinations and delusions. Organic psychoses is simply a psychoses that has an IDENTIFIED CAUSE. Knowing this will lead you to understand that psychoses is manifested by B,C, and D but NOT MEMORY DEFICIT.

MS drill Test IV

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 12:09:00 +0800

53. Ear drops are prescribed to an infant, The most appropriate method to administer the ear drops is [2]

A. Pull the pinna up and back and direct the solution towards the eardrum
B. Pull the pinna down and back and direct the solution onto the wall of the canal
C. Pull the pinna down and back and direct the solution towards the eardrum
D. Pull the pinna up and back and direct the solution onto the wall of the canal

54. Nurse Budek is developing a plan of care for a patient with Menieres disease. What is the priority nursing intervention in the plan of care for this particular patient? [1]

A. Air, Breathing, Circulation
B. Love and Belongingness
C. Food, Diet and Nutrition
D. Safety

55. After mastoidectomy, Nurse Budek should be aware that the cranial nerve that is usually damage after this procedure is [3]

A. CN I
B. CN II
C. CN VII
D. CN VI

56. The physician orders the following for the client with Menieres disease. Which of the following should the nurse question? [1]

A. Dipenhydramine [Benadryl]
B. Atropine sulfate
C. Out of bed activities and ambulation
D. Diazepam [Valium]

57. Nurse Budek is giving dietary instruction to a client with Menieres disease. Which statement if made by the client indicates that the teaching has been successful? [1]

A. I will try to eat foods that are low in sodium and limit my fluid intake
B. I must drink atleast 3,000 ml of fluids per day
C. I will try to follow a 50% carbohydrate, 30% fat and 20% protein diet
D. I will not eat turnips, red meat and raddish

58. Peachy was rushed by his father, Steven into the hospital admission. Peachy is complaining of something buzzing into her ears. Nurse Budek assessed peachy and found out It was an insect. What should be the first thing that Nurse Budek should try to remove the insect out from peachy’s ear? [3]

A. Use a flashlight to coax the insect out of peachy’s ear
B. Instill an antibiotic ear drops
C. Irrigate the ear
D. Pick out the insect using a sterile clean forceps

59. Following an ear surgery, which statement if heard by Nurse Budek from the patient indicates a correct understanding of the post operative instructions? [2]

A. Activities are resumed within 5 days
B. I will make sure that I will clean my hair and face to prevent infection
C. I will use straw for drinking
D. I should avoid air travel for a while

60. Nurse Budek will do a caloric testing to a client who sustained a blunt injury in the head. He instilled a cold water in the client’s right ear and he noticed that nystagmus occurred towards the left ear. What does this finding indicates? [2]

A. Indicating a Cranial Nerve VIII Dysfunction
B. The test should be repeated again because the result is vague
C. This is Grossly abnormal and should be reported to the neurosurgeon
D. This indicates an intact and working vestibular branch of CN VIII

61. A client with Cataract is about to undergo surgery. Nurse Budek is preparing plan of care. Which of the following nursing diagnosis is most appropriate to address the long term need of this type of patient? [1]

A. Anxiety R/T to the operation and its outcome
B. Sensory perceptual alteration R/T Lens extraction and replacement
C. Knowledge deficit R/T the pre operative and post operative self care
D. Body Image disturbance R/T the eye packing after surgery

62. Nurse Budek is performing a WEBERS TEST. He placed the tuning fork in the patients forehead after tapping it onto his knee. The client states that the fork is louder in the LEFT EAR. Which of the following is a correct conclusion for nurse Budek to make? [4]

A. He might have a sensory hearing loss in the left ear
B. Conductive hearing loss is possible in the right ear
C. He might have a sensory hearing loss in the right hear, and/or a conductive hearing loss in the left ear.
D. He might have a conductive hearing loss in the right ear, and/or a sensory hearing loss in the left ear.

63. Aling myrna has Menieres disease. What typical dietary prescription would nurse Budek expect the doctor to prescribe? [2]

A. A low sodium , high fluid intake
B. A high calorie, high protein dietary intake
C. low fat, low sodium and high calorie intake
D. low sodium and restricted fluid intake

SITUATION : [ From DEC 1991 NLE ] A 45 year old male construction worker was admitted to a tertiary hospital for incessant vomiting. Assessment disclosed: weak rapid pulse, acute weight loss of .5kg, furrows in his tongue, slow flattening of the skin was noted when the nurse released her pinch.

Temperature: 35.8 C , BUN Creatinine ratio : 10 : 1, He also complains for postural hypotension. There was no infection.

64. Which of the following is the appropriate nursing diagnosis? [1]

A. Fluid volume deficit R/T furrow tongue
B. Fluid volume deficit R/T uncontrolled vomiting
C. Dehydration R/T subnormal body temperature
D. Dehydration R/T incessant vomiting

65. Approximately how much fluid is lost in acute weight loss of .5kg? [1]

A. 50 ml
B. 750 ml
C. 500 ml
D. 75 ml

66. Postural Hypotension is [1]

A. A drop in systolic pressure less than 10 mmHg when patient changes position from lying to sitting.
B. A drop in systolic pressure greater than 10 mmHg when patient changes position from lying to sitting
C. A drop in diastolic pressure less than 10 mmHg when patient changes position from lying to sitting
D. A drop in diastolic pressure greater than 10 mmHg when patient changes position from lying to sitting

67. Which of the following measures will not help correct the patient’s condition [1]

A. Offer large amount of oral fluid intake to replace fluid lost
B. Give enteral or parenteral fluid
C. Frequent oral care
D. Give small volumes of fluid at frequent interval

68. After nursing intervention, you will expect the patient to have [1]

1. Maintain body temperature at 36.5 C
2. Exhibit return of BP and Pulse to normal
3. Manifest normal skin turgor of skin and tongue
4. Drinks fluids as prescribed

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

SITUATION: [ From JUN 2005 NLE ] A 65 year old woman was admitted for Parkinson’s Disease. The charge nurse is going to make an initial assessment.

69. Which of the following is a characteristic of a patient with advanced Parkinson’s disease? [1]

A. Disturbed vision
B. Forgetfulness
C. Mask like facial expression
D. Muscle atrophy

70. The onset of Parkinson’s disease is between 50-60 years old. This disorder is caused by [1]

A. Injurious chemical substances
B. Hereditary factors
C. Death of brain cells due to old age
D. Impairment of dopamine producing cells in the brain

71. The patient was prescribed with levodopa. What is the action of this drug? [1]

A. Increase dopamine availability
B. Activates dopaminergic receptors in the basal ganglia
C. Decrease acetylcholine availability
D. Release dopamine and other catecholamine from neurological storage sites

72. You are discussing with the dietician what food to avoid with patients taking levodopa? [3]

A. Vitamin C rich food
B. Vitamin E rich food
C. Thiamine rich food
D. Vitamin B6 rich food

73. One day, the patient complained of difficulty in walking. Your response would be [2]

A. You will need a cane for support
B. Walk erect with eyes on horizon
C. I’ll get you a wheelchair
D. Don’t force yourself to walk

SITUATION: [ From JUN 2005 NLE ] Mr. Dela Isla, a client with early Dementia exhibits thought process disturbances.

74. The nurse will assess a loss of ability in which of the following areas? [2]

A. Balance
B. Judgment
C. Speech
D. Endurance

75. Mr. Dela Isla said he cannot comprehend what the nurse was saying. He suffers from: [1]

A. Insomnia
B. Aphraxia
C. Agnosia
D. Aphasia

76. The nurse is aware that in communicating with an elderly client, the nurse will [1]

A. Lean and shout at the ear of the client
B. Open mouth wide while talking to the client
C. Use a low-pitched voice
D. Use a medium-pitched voice

77. As the nurse talks to the daughter of Mr. Dela Isla, which of the following statement of the daughter will require the nurse to give further teaching? [1]

A. I know the hallucinations are parts of the disease
B. I told her she is wrong and I explained to her what is right
C. I help her do some tasks he cannot do for himself
D. Ill turn off the TV when we go to another room

78. Which of the following is most important discharge teaching for Mr. Dela Isla [2]

A. Emergency Numbers
B. Drug Compliance
C. Relaxation technique
D. Dietary prescription

SITUATION : Knowledge of the drug PROPANTHELINE BROMIDE [Probanthine] Is necessary in treatment of various disorders.

79. What is the action of this drug? [4]

A. Increases glandular secretion for clients affected with cystic fibrosis
B. Dissolve blockage of the urinary tract due to obstruction of cystine stones
C. Reduces secretion of the glandular organ of the body
D. Stimulate peristalsis for treatment of constipation and obstruction

80. What should the nurse caution the client when using this medication [4]

A. Avoid hazardous activities like driving, operating machineries etc.
B. Take the drug on empty stomach
C. Take with a full glass of water in treatment of Ulcerative colitis
D. I must take double dose if I missed the previous dose

81. Which of the following drugs are not compatible when taking Probanthine? [4]

A. Caffeine
B. NSAID
C. Acetaminophen
D. Alcohol

82. What should the nurse tell clients when taking Probanthine? [4]

A. Avoid hot weathers to prevent heat strokes
B. Never swim on a chlorinated pool
C. Make sure you limit your fluid intake to 1L a day
D. Avoid cold weathers to prevent hypothermia

83. Which of the following disease would Probanthine exert the much needed action for control or treatment of the disorder? [4]

A. Urinary retention
B. Peptic Ulcer Disease
C. Ulcerative Colitis
D. Glaucoma

SITUATION : [ From DEC 2000 NLE ] Mr. Franco, 70 years old, suddenly could not lift his spoons nor speak at breakfast. He was rushed to the hospital unconscious. His diagnosis was CVA.

84. Which of the following is the most important assessment during the acute stage of an unconscious patient like Mr. Franco? [1]

A. Level of awareness and response to pain
B. Papillary reflexes and response to sensory stimuli
C. Coherence and sense of hearing
D. Patency of airway and adequacy of respiration

85. Considering Mr. Franco’s conditions, which of the following is most important to include in preparing Franco’s bedside equipment? [1]

A. Hand bell and extra bed linen
B. Sandbag and trochanter rolls
C. Footboard and splint
D. Suction machine and gloves

86. What is the rationale for giving Mr. Franco frequent mouth care? [1]

A. He will be thirsty considering that he is doesn’t drink enough fluids
B. To remove dried blood when tongue is bitten during a seizure
C. The tactile stimulation during mouth care will hasten return to consciousness
D. Mouth breathing is used by comatose patient and it’ll cause oral mucosa dying and cracking.

87. One of the complications of prolonged bed rest is decubitus ulcer. Which of the following can best prevent its occurrence? [1]

A. Massage reddened areas with lotion or oils
B. Turn frequently every 2 hours
C. Use special water mattress
D. Keep skin clean and dry

88. If Mr. Franco’s Right side is weak, What should be the most accurate analysis by the nurse? [4]

A. Expressive aphasia is prominent on clients with right sided weakness
B. The affected lobe in the patient is the Right lobe
C. The client will have problems in judging distance and proprioception
D. Clients orientation to time and space will be much affected

SITUATION : [ From JUN 1988 NLE ] a 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis.

89. Which result of the lab test will be significant to the diagnosis? [1]

A. RBC : 4.5 TO 5 Million / cu. mm.
B. Hgb : 13 to 14 gm/dl.
C. Platelets : 250,000 to 500,000 cu.mm.
D. WBC : 12,000 to 13,000/cu.mm

90. Stat appendectomy was indicated. Pre op care would include all of the following except? [1]

A. Consent signed by the father
B. Enema STAT
C. Skin prep of the area including the pubis
D. Remove the jewelries

91. Pre-anesthetic med of Demerol and atrophine sulfate were ordered to : [3]

A. Allay anxiety and apprehension
B. Reduce pain
C. Prevent vomiting
D. Relax abdominal muscle

92. Common anesthesia for appendectomy is [3]

A. Spinal
B. General
C. Caudal
D. Hypnosis

93. Post op care for appendectomy include the following except [1]

A. Early ambulation
B. Diet as tolerated after fully conscious
C. Nasogastric tube connect to suction
D. Deep breathing and leg exercise

94. Peritonitis may occur in ruptured appendix and may cause serious problems which are [2]

1. Hypovolemia, electrolyte imbalance
2. Elevated temperature, weakness and diaphoresis
3. Nausea and vomiting, rigidity of the abdominal wall
4. Pallor and eventually shock

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

95. If after surgery the patient’s abdomen becomes distended and no bowel sounds appreciated, what would be the most suspected complication? [1]

A. Intussusception
B. Paralytic Ileus
C. Hemorrhage
D. Ruptured colon

96. NGT was connected to suction. In caring for the patient with NGT, the nurse must [2]

A. Irrigate the tube with saline as ordered
B. Use sterile technique in irrigating the tube
C. advance the tube every hour to avoid kinks
D. Offer some ice chips to wet lips

97. When do you think the NGT tube be removed? [1]

A. When patient requests for it
B. Abdomen is soft and patient asks for water
C. Abdomen is soft and flatus has been expelled
D. B and C only

Situation: Amanda is suffering from chronic arteriosclerosis Brain syndrome she fell while getting out of the bed one morning and was brought to the hospital, and she was diagnosed to have cerebrovascular thrombosis thus transferred to a nursing home.

98. What do you call a STROKE that manifests a bizarre behavior? [4]

A. Inorganic Stroke
B. Inorganic Psychoses
C. Organic Stroke
D. Organic Psychoses

99. The main difference between chronic and organic brain syndrome is that the former [2]

A. Occurs suddenly and reversible
B. Is progressive and reversible
C. tends to be progressive and irreversible
D. Occurs suddenly and irreversible

100. Which behavior results from organic psychoses? [4]

A. Memory deficit
B. Disorientation
C. Impaired Judgement
D. Inappropriate affect

Answer and Rationale

MS drill Test III (Answers and Rationale)

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 12:07:00 +0800

All the nursing interventions listed are important in the care of Mr. Duffy. However relief of his pain will be best achieved by increasing the O2 content of the blood to his heart, and relieving the spasm of coronary vessels.

2. During the first three days that Mr. Duffy is in the CCU, a number of diagnostic blood tests are obtained. Which of the following patterns of cardiac enzyme elevation are most common following an MI?

a. SGOT, CK, and LDH are all elevated immediately.
b. SGOT rises 4-6 hours after infarction with CK and LDH rising slowly 24 hours later.
c. CK peaks first (12-24 hours), followed by the SGOT (peaks in 24-36 hours) and then the LDH (peaks 3-4 days).
d. CK peaks first and remains elevated for 1 to 2 weeks.

Although the timing of initial elevation, peak elevation, and duration of elevation vary with sources, current literature favors option letter c.

3. On his second day in CCU Mr. Duffy suffers a life-threatening cardiac arrhythmia. Considering his diagnosis, which is the most probable arrhythmia?

a. atrial tachycardia
b. ventricular fibrillation
c. atrial fibrillation
d. heart block

Ventricular irritability is common in the early post-MI period, which predisposes the client to ventricular arrhythmias. Heart block and atrial arrhythmias may also be seen post-MI but ventricular arrhythmias are more common.

4. Mr. Duffy is placed on digitalis on discharge from the hospital. The nurse planning with him for his discharge should educate him as to the purpose and actions of his new medication. What should she or he teach Mr. Duffy to do at home to monitor his reaction to this medication?

a. take his blood pressure
b. take his radial pulse for one minute
c. check his serum potassium (K) level
d. weigh himself everyday

All options have some validity. However, option B relates best to the action of digitalis. If the pulse rate drops below 60 or is markedly irregular, the digitalis should be held and the physician consulted. Serum potassium levles should be monitored periodically in clients on digitalis and diuretics, as potassium balance is essential for prevention of arrhythmias. However the client cannot do this at home. Daily weights may make the client alert to fluid accumulation, an early sign of CHF. Blood pressure measurement is also helpful; providing the client has the right size cuff and he or she and/or significant other understand the technique and can interpret the results meaningfully.

You are speaking to an elderly group of diabetics in the OPD about eye health and the importance of visits to the ophthalmologist.

5. You decide to discuss glaucoma prevention. Which of the following diagnostic tests should these clients request from their care provider?

a. fluorescein stain
b. snellen’s test
c. tonometry
d. slit lamp

Option A is most often used to detect corneal lesions; B is a test for visual acuity using snellen’s chart; D is used to focus on layers of the cornea and lens looking for opacities and inflammation.

6. You also explain common eye changes associated with aging. One of these is presbyopia, which is:

a. Refractive error that prevents light rays from coming to a single focus on the retina.
b. Poor distant vision
c. Poor near vision
d. A gradual lessening of the power of accommodation

Option A defines astigmatism, B is myopia, and C is hyperopia

7. Some of the diabetic clients are interested in understanding what is visualized during funduscopic examination. During your discussion you describe the macular area as:

a. Head of the optic nerve, seen on the nasal side of the field, lighter in color than the retina.
b. The area of central vision, seen on the temporal side of the optic disc, which is quite avascular.
c. Area where the central retinal artery and vein appear on the retina.
d. Reddish orange in color, sometimes stippled.

Options A and C refer to the optic disc, D describes the color of the retina.

8. One of the clients has noted a raised yellow plaque on the nasal side of the conjunctiva. You explain that this is called:

a. a pinguecula, which is normal slightly raised fatty structure under the conjunctiva that may gradually increase with age.
b. Icterus, which may be due to liver disease.
c. A pterygium, which will interfere with vision.
d. Ciliary flush caused by congestion of the ciliary artery.

Correct by definition.

You are caring for Mr. Kaplan who has chronic renal failure (uremia)

9. You know that all but one of the following may eventually result in uremia. Which option is not implicated?

a. glomerular disease
b. uncontrolled hypertension
c. renal disease secondary to drugs, toxins, infections, or radiations
d. all of the above

Options A, B and C are potential causes of renal damage and eventual renal failure. Individuals can live very well with only one healthy kidney.

10. You did the initial assessment on Mr. Kaplan when he came to your unit. What classical signs and symptoms did you note?

a. fruity- smelling breath.
b. Weakness, anorexia, pruritus
c. Polyuria, polydipsia, polyphagia
d. Ruddy complexion

Weakness and anorexia are due to progressive renal damage; pruritus is secondary to presence of urea in the perspiration. Fruity smelling breath is found in diabetic ketoacidosis. Polyuria, polydipsia, polyphagia are signs of DM and early diabetic ketoacidosis. Oliguria is seen in chronic renal failure. The skin is more sallow or brown as renal failure continues.

11. Numerous drugs have been used on Mr. Kaplan in an attempt to stabilize him. Regarding his diagnosis and management of his drugs, you know that:

a. The half-life of many drugs is decreased in uremia; thus dosage may have to be increased to be effective.
b. Drug toxicity is a major concern in uremia; individualization of therapy and often a decrease in dose is essential.
c. Drug therapy is not usually affected by this diagnosis
d. Precautions should be taken with prescription drugs, but most OTC medications are safe for him to use.

Metabolic changes and alterations in excretion put the client with uremia at risk for development of toxicity to any drug. Thus alteration in drug schedule and dosage is necessary for safe care.

You are assigned to cardiac clinic to fill in for a colleague for 3 weeks. You begin by reviewing assessment of the cardiovascular system in your mind and asking yourself the following:

12. The point of maximum impulse (PMI) is an important landmark in the cardiac exam. Which statement best describes the location of the PMI in the healthy adult?

a. Base of the heart, 5th intercostal space, 7-9 cm to the left of the midsternal line.
b. Base of the heart, 7th intercostal space, 7-9 cm to the left of the midsternal line.
c. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.
d. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.

The PMI is the impulse at the apex of the heart caused by the beginning of ventricular systole. It is generally located in the 5^th left ICS, 7-9 cm from the MSL or at, or just medial to, the MCL.

13. During the physical examination of the well adult client, the health care provider auscultates the heart. When the stethoscope is placed on the 5th intercostal space along the left sternal border, which valve closure is best evaluated?

a. Tricuspid
b. Pulmonic
c. Aortic
d. Mitral

The sound created by closure of the tricuspid valve is heard at the 5^th LICS at the LSB. Pulmonic closure is best heard at the 2^nd LICS, LSB. Aortic closure is best heard at the 2^nd RICS, RSB. Mitral valve closure is best heard at the PMI landmark (apex)

14. The pulmonic component of which heart sound is best heard at the 2nd LICS at the LSB?

a. S1
b. S2
c. S3
d. S4

S1 is caused by mitral and tricuspid valve closure, S2 is caused by the aortic and pulmonic valve closure; S3 and S4 are generally considered abnormal heat sounds in adults and are best heard at the apex.

15. The coronary arteries furnish blood supply to the myocardium. Which of the following is a true statement relative to the coronary circulation?

a. the right and left coronary arteries are the first of many branches off the ascending aorta
b. blood enters the right and left coronary arteries during systole only
c. the right coronary artery forms almost a complete circle around the heart, yet supplies only the right ventricle
d. the left coronary artery has two main branches, the left anterior descending and left circumflex: both supply the left ventricle

The right and left coronary arteries are the only branches off the ascending aorta; blood enters these arteries mainly during diastole; the right coronary artery also often supplies a small portion of the left ventricle.

Sally Baker, a 40-year-old woman, is admitted to the hospital with an established diagnosis of mitral stenosis. She is scheduled for surgery to repair her mitral valve.

16. Ms. Baker has decided to have surgical correction of her stenosed valve at this time because her subjective complaints of dyspnea, hemoptysis, orthopnea, and paroxysmal nocturnal dyspnea have become unmanageable. These complaints are probably due to:

a. thickening of the pericardium
b. right heart failure
c. pulmonary hypertension
d. left ventricular hypertrophy

Pulmonary congestion secondary to left atrial hypertrophy causes these symptoms. The left ventricle does not hypertrophy in mitral stenosis; right heart failure would cause abdominal discomfort and peripheral edema; pericardial thickening does not occur.

17. On physical exam of Ms. Baker, several abnormal findings can be observed. Which of the following is not one of the usual objective findings associated with mitral stenosis?

a. low-pitched rumbling diastolic murmur, precordial thrill, and parasternal lift
b. small crepitant rales at the bases of the lungs
c. weak, irregular pulse, and peripheral and facial cyanosis in severe disease
d. chest x-ray shows left ventricular hypertrophy

Evidence of left atrial enlargement may be seen on chest x-ray and ECG. The other objective findings may be seen in chronic mitral stenosis with episodes of atrial fibrillation and right heart failure.

18. You are seeing more clients with diagnoses of mitral valve prolapse. You know those mitral valve prolapse is usually a benign cardiac condition, but may be associated with atypical chest pain. This chest pain is probably caused by:

a. ventricular ischemia
b. dysfunction of the left ventricle
c. papillary muscle ischemia and dysfunction
d. cardiac arrythmias

Ventricular ischemia does not occur with prolapsed mitral valve; options B and D are not painful conditions in themselves.

Mr. Oliver, a long term heavy smoker, is admitted to the hospital for a diagnostic workup. His possible diagnosis is cancer of the lung.

19. The most common lethal cancer in males between their fifth and seventh decades is:

a. cancer of the prostate
b. cancer of the lung
c. cancer of the pancreas
d. cancer of the bowel

The incidence of lung cancer is also rapidly rising in women.

20. Of the four basic cell types of lung cancer listed below, which is always associated with smoking?

a. adenocarcinoma
b. squamous cell carcinoma (epidermoid)
c. undifferenciated carcinoma
d. bronchoalveolar carcinoma

Textbooks of medicine and nursing classify primary pulmonary carcinoma somewhat differently. However most agree that sqaumous cell or epidermoid carcinoma is always associated with cigarette smoking.

21. Chemotherapy may be used in combination with surgery in the treatment of lung cancer. Special nursing considerations with chemotherapy include all but which of the following?

a. Helping the client deal with depression secondary to the diagnosis and its treatment
b. Explaining that the reactions to chemotherapy are minimal
c. Careful observation of the IV site of the administration of the drugs
d. Careful attention to blood count results

There ar enumerous severe reactions to chemotherapy such as stomatitis, alopecia, bone marrow depression, nausea and vomiting. Options A, B and D are important nursing considerations.

22. Which of the following operative procedures of the thorax is paired with the correct definition?

a. Pneumonectomy: removal of the entire lung
b. Wedge resection: removal of one or more lobes of a lung
c. Decortication: removal of the reibs or sections of ribs
d. Thoracoplasty: removal of fibrous membrane that develops over visceral pleura as a result of emphysema

Wedge resection is removal of part of a segment of the lung; decortication is the removal of a fibrous membrane that develops over the visceral pleura; and thoracoplasty is the removal of ribs or sections of ribs.

Mr. Liberatore, age 76, is admitted to your unit. He has a past medical history of hypertension, DM, hyperlipidemia. Recently he has had several episodes where he stops talking in midsentence and stares into space. Today the episode lasted for 15 minutes. The admission diagnosis is impending CVA.

23. The episodes Mr. Liberatore has been experiencing are probably:

a. small cerebral hemorrhages
b. TIA’s or transient ischemic attacks
c. Secondary to hypoglycemia
d. Secondary to hyperglycemia

A TIA is a temporary reduction in blood flow to the brain, manifesting itself in symptoms like those Mr. Liberatore experiences. Although hypo- and hyperglycemia can cause some drowsiness and/or disorientation, the episodes Mr. Liberatore experiences fit the pattern of TIA because of his quick recovery with no sequelae and no treatment.

24. Mr. Liberatore suffers a left sided CVA. He is right handed. The nurse should expect:

a. left-sided paralysis
b. visual loss
c. no alterations in speech
d. no impairment of bladder function

Visual field loss is a common side effect of CVA. In right-handed persons the speech center (Broca’s area) is most commonly in the left brain; because of the crossover of the motor fibers, a CVA in the left brain will produce a right-sided hemiplegia. Thus, Mr. Liberatore will probably have some speech disturbance and right-sided paralysis. Often bladder control is diminished following CVA.

25. Upper motor neuron disease may be manifested in which of the following clinical signs?

a. spastic paralysis, hyperreflexia, presence of babinski reflex
b. flaccid paralysis, hyporeflexia
c. muscle atrophy, fasciculations
d. decreased or absent voluntary movement

Options B, C and D describe lower motor neuron disease.

Julie, an 18-year-old girl, is brought into the ER by her mother with the chief complaint of sudden visual disturbance that began half an hour ago and was described as double vision and flashing lights.

26. During your assessment of Julie she tells you all visual symptoms are gone but that she now has a severe pounding headache over her left eye. You suspect Julie may have:

a. a tension headache
b. the aura and headache of migraine
c. a brain tumor
d. a conversion reaction

The warning sign or aura is associated with migraine although not everyone with migrane has an aura. Migraine is usually unilateral and described as pounding. Julie’s symptoms are most compatible with migraine.

27. You explain to Julie and her mother that migraine headaches are caused by:

a. an allergic response triggered by stress
b. dilation of cerebral arteries
c. persistent contraction of the muscles of the head, neck and face
d. increased intracranial pressure

The vascular theory best explains migraine and often diagnosis is confirmed through a trial of ergotamine, which constricts the dilated, pulsating vesels.

28. A thorough history reveals that hormonal changes associated with menstruation may have triggered Julie’s migraine attack. In investigating Julie’s history what factors would be least significant in migraine?

a. seasonal allergies
b. trigger foods such as alcohol, MSG, chocolate
c. family history of migraine
d. warning sign of onset, or aura

Sinus headache often accompanies seasonal allergies. Many factors may contribute to migraine. Usually the client comes from a family that has migrated, which may have been called “sick headache” due to accompanying nausea and vomiting. Often there is an aura. Stress, diet, hormonal changes, and fatigue may all be implicated in migraine.

29. A client with muscle contraction headache will exhibit a pattern different for Julie’s. Which of the following is more compatible with tension headache?

a. severe aching pain behind both eyes
b. headache worse when bending over
c. a bandlike burning around the neck
d. feeling of tightness bitemporally, occipitally, or in the neck

Options A and B describe sinus headache; option A may also be compatible with headache secondary to eyestrain; option B is also compatible with migraine; option C would be correct if stated a bandlike “tightness” around the head instead of “burning”

Mr. Snyder is admitted to your unit with a brain tumor. The type of tumor he has is currently unknown. You begin to think about the way brain tumors are classified.

30. Glioma is an intracranial tumor. Which of the following statements about gliomas do you know to be false?

a. 50% of all intracranial tumors are gliomas
b. gliomas are usually benign
c. they grow rapidly and often cannot be totally excised from the surrounding tissue
d. most glioma victims die within a year after diagnosis

Gliomas are malignant tumors.

31. Acoustic neuromas produce symptoms of progressive nerve deafness, tinnitus, and vertigo due to pressure and eventual destruction of:

a. CN5
b. CN7
c. CN8
d. The ossicles

CN8, the acoustic nerve or vestibulocochlear nerve, is the most commonly affected CN in acoustic neuroma although as the tumor progresses CN5 and CN7 can be affected.

32. Whether Mr Snyder’s tumor is benign or malignant, it will eventually cause increased intracranial pressure. Signs and symptoms of increasing intracranial pressure may include all of the following except:

a. headache, nausea, and vomiting
b. papilledema, dizziness, mental status changes
c. obvious motor deficits
d. increased pulse rate, drop in blood pressure

As ICP increases, the pulse rate decreases and the BP rise. However, as ICP continues to rise, vital signs may vary considerably.

33. Mr Snyder is scheduled for surgery in the morning, and you are surprised to find out that there is no order for an enema. You assess the situation and conclude that the reason for this is:

a. Mr. Snyder has had some mental changes due to the tumor and would find an enema terribly traumatic
b. Straining to evacuate the enema might increase the intracranial pressure
c. Mr. Snyder had been on clear liquids and then was NPO for several days, so an enema is not necessary
d. An oversight and you call the physician to obtain the order

Any activity that increases ICP could possibly cause brain herniation. Straining to expel an enema is one example of how the increased ICP can be further aggravated.

34. Postoperatively Mr. Snyder needs vigilant nursing care including all of the following except:

a. Keeping his head flat
b. Assessments q ½ hour of LOC, VS, papillary responses, and mental status
c. Helping him avoid straining at stool, vomiting, or coughing
d. Providing a caring, supportive atmosphere for him and his family

Postoperatively clients who have undergone craniotomy usually have their heads elevated to decrease local edema and also decrease ICP.

35. Potential postintracranial surgery problems include all but which of the following?

a. increased ICP
b. extracranial hemorrhage
c. seizures
d. leakage of cerebrospinal fluid

Hemorrhage is predominantly intracranial, although there may be some bloody drainage on external dressings. Increased ICP may result from hemorrhage or edema. CSF leakage may result in meningitis. Seizures are another postoperative concern.

Mrs. Hogan, a 43-year-old woman, is admitted to your unit for cholecystectomy.

36. You are responsible for teaching Mrs. Hogan deep breathing and coughing exercises. Why are these exercises especially important for Mrs. Hogan?

a. they prevent postoperative atelectasis and pneumonia
b. the incision in gallbladder surgery is in the subcostal area, which makes the client reluctant to take a deep breath and cough
c. because she is probably overweight and will be less willing to breathe, cough, and move postoperatively

Option A is true: the rationale for deep breathing and coughing is to prevent postoperative pulmonary complications such as pneumonia and atelectasis. However, the risk of pulmonary problems is somewhat increased in clients with biliary tract surgery because of their high abdominal incisions. Option C assumes the stereotype of the person with gallbladder disease – fair, fat and fory – which is not necessarily the case. Splinting the incision with the hands or a pillow is very helpful in controlling the pain during coughing.

37. On the morning of Mrs. Hogan’s planned cholecystectomy she awakens with a pain in her right scapular area and thinks she slept in poor position. While doing the preop check list you note that on her routine CB report her WBC is 15,000. Your responsibility at this point is:

a. to notify the surgeon at once; this is an elevated WBC indicating an inflammatory reaction
b. to record this finding in a prominent place on the preop checklist and in your preop notes
c. to call the laboratory for a STAT repeat WBC
d. none. This is not an unusual finding

A WBC count of 15,000 probably indicates acute cholecystitis, especially considering Mrs. Hogan’s new pain. The surgeon should be called as he/she may treat the acute attack medically and delay the surgery for several days, weeks, or months.

38. Mrs. Hogan is scheduled for surgery 2 days later and is to be given atropine 0.3 mg IM and Demerol 50 mg IM one hour preoperatively. Which nursing actions follow the giving of the preop medication?

a. have her void soon after receiving the medication
b. allow her family to be with her before the medication takes effect
c. bring her valuables to the nursing station
d. reinforce preop teaching

Options A, C and D should all take place prior to administration of the drugs. The family may also be involved earlier but certainly should have that time immediately after the medication is given and before it takes full effect to be with their loved ones. Good planning of nursing care can facilitate this.

39. Mrs. Hogan is transported to the recovery room following her cholecystectomy. As you continue to check her vital signs you note a continuing trend in Mrs. Hogan’s status: her BP is gradually dropping and her pulse rate is increasing. Your most appropriate nursing action is to:

a. order whole blood for Mrs. Hogan from the lab
b. increase IV fluid rate of infusion and place in trendelenburg position
c. immediately report signs of shock to the head nurse and/or surgeon and monitor VS closely
d. place in lateral sims position to facilitate breathing

These are signs of impending shock, which may be true shock or a reaction to anesthesia. Your most appropriate action is to report your findings quickly and accurately and to continue to monitor Mrs. Hogan carefully.

40. Mrs. Hogan returns to your clinical unit following discharge from the recovery room. Her vital signs are stable and her family is with her. Postoperative leg exercises should be inititated:

a. after the physician writes the order
b. after the family leaves
c. if Mrs. Hogan will not be ambulated early
d. stat

Leg exercises, deep breathing and coughing, moving, and turning should begin as soon as the client’s condition is stable. The family can be extremely helpful in encouraging the client to do them, in supporting the incision, etc. a doctor’s oreder is not necessary – this is a nursing responsibility.

41. An oropharyngeal airway may:

a. Not be used in a conscious patient.
b. Cause airway obstruction.
c. Prevent a patient from biting and occluding an ET tube.
d. Be inserted "upside down" into the mouth opening and then rotated into the proper orientation as it is advanced into the mouth.
e. All of the above.

An oropharyngeal airway should be used in an unconscious patient. In a conscious or semiconscious patient its use may cause laryngospasm or vomiting. An oropharyngeal airway that is too long may push the epiglottis into a position that obstructs the airway. It is often use with an ETT to prevent biting and occlusion. It is usually inserted upside down and then rotated into the correct orientation as it approaches full insertion.

42. Endotracheal intubation:

a. Can be attempted for up to 2 minutes before you need to stop and ventilate the patient.
b. Reduces the risk of aspiration of gastric contents.
c. Should be performed with the neck flexed forward making the chin touch the chest.
d. Should be performed after a patient is found to be not breathing and two breaths have been given but before checking for a pulse.

Letter A is wrong because an attempt should not last no longer than 30 seconds. Unless injury is suspected the neck should be slightly flexed and the head extended.. the ‘sniffing position’. After securing an airway and successfully ventilating the patient with two breaths you should then check for a pulse. If there is no pulse begin chest compressions. Intubation is part of the secondary survey ABC’s.

43. When giving bag-valve mask ventilations:

a. Rapid and forceful ventilations are desirable so that adequate ventilation will be assured
b. Effective ventilations can always be given by one person.
c. Cricoid pressure may prevent gastric inflation during ventilations.
d. Tidal volumes will always be larger than when giving mouth to pocket mask ventilations.

Cricoid pressure may prevent gastric inflation during ventilations and may also prevent regurgitation by compressing the esophagus. Letter A may cause gastric insufflation thus increasing the risk for regurgitation and aspiration. With adults breaths should be delivered slowly and steadily over 2 seconds. Effective ventilation using bag-valve mask usually requires at least two well trained rescuers. A frequent problem with bag-valve mask ventilations is the inability to provide adequate tidal volumes.

44. If breath sounds are only heard on the right side after intubation:

a. Extubate, ventilate for 30 seconds then try again.
b. The patient probably only has one lung, the right.
c. You have intubated the stomach.
d. Pull the tube back and listen again.

Most likely you have a right main stem bronchus intubation. Pulling the tube back a few centimeters may be all you need to do.

45. An esophageal obturator airway (EOA):

a. Can be inserted by any person trained in ACLS.
b. Requires visualization of the trachea before insertion.
c. Never causes regurgitation.
d. Should not be used with a conscious person, pediatric patients, or patients who have swallowed caustic substances.

EOA insertion should only be attempted by persons highly proficient in their use. Moreover, since visualization is not required the EOA may be very useful in patient’s when intubation is contraindicated or not possible. Vomiting and aspiration are possible complications of insertion and removal of an EOA.

46. During an acute myocardial infarct (MI):

a. A patient may have a normal appearing ECG.
b. Chest pain will always be present.
c. A targeted history is rarely useful in making the diagnosis of MI.
d. The chest pain is rarely described as crushing, pressing, or heavy.

Which is why a normal ECG alone cannot be relied upon to rule out an MI. Chest pain does not always accompany an MI. This is especially true of patients with diabetes. A targeted history is often crucial in making the diagnosis of acute MI. The chest pain associated with an acute MI is often described as heavy, crushing pressure, 'like an elephant sitting on my chest.'

47. The most common lethal arrhythmia in the first hour of an MI is:

a. Pulseless Ventricular Tachycardia
b. Asystole
c. Ventricular fibrillation
d. First degree heart block.

Moreover, ventricular fibrillation is 15 times more likely to occur during the first hour of an acute MI than the following twelve hours which is why it is vital to decrease the delay between onset of chest pain and arrival at a medical facility. First degree heart block is not a lethal arrhythmia.

48. Which of the following is true about verapamil?

a. It is used for wide-complex tachycardia.
b. It may cause a drop in blood pressure.
c. It is a first line drug for Pulseless Electrical Activity.
d. It is useful for treatment of severe hypotension.

Verapamil usually decreases blood pressure, which is why it is sometimes used as an antihypertensive agent. Verapamil may be lethal if given to a patient with V-tach, therefore it should not be given to a tachycardic patient with a wide complex QRS. Verapamil is a calcium channel blocker and may actually cause PEA if given too fast intravenously or if given in excessive amounts. The specific antidote for overdose from verapamil, or any other calcium channel blocker, is calcium. Verapamil may cause hypotension.

49. Atropine:

a. Is always given for a heart rate less than 60 bpm.
b. Cannot be given via ET tube.
c. Has a maximum total dosage of 0.03-0.04 mg/kg IV in the setting of cardiac arrest.
d. When given IV, should always be given slowly.

Only give atropine for symptomatic bradycardias. Many physically fit people have resting heart rates less than 60 bpm. Atropine may be given via an endotracheal tube. Administering atropine slowly may cause paradoxical bradycardia.

50. Asystole should not be "defibrillated."

a. True
b. False

Asystole is not amenable to correction by defibrillation. But there is a school of thought that holds that asystole should be treated like V-fib, i.e... defibrillate it. The thinking is that human error or equipment malfunction may result in misidentifying V-fib as asystole. Missing V-fib can have deadly consequences for the patient because V-fib is highly amenable to correction by defibrillation.

MS drill Test III

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 12:06:00 +0800

Mr. Duffy is admitted to the CCU with a diagnosis of R/O MI. He presented in the ER with a typical description of pain associated with an MI, and is now cold and clammy, pale and dyspneic. He has an IV of D5W running, and is complaining of chest pain. Oxygen therapy has not been started, and he is not on the monitor. He is frightened.

1. The nurse is aware of several important tasks that should all be done immediately in order to give Mr. Duffy the care he needs. Which of the following nursing interventions will relieve his current myocardial ischemia?

a. stool softeners, rest
b. O2 therapy, analgesia
c. Reassurance, cardiac monitoring
d. Adequate fluid intake, low-fat diet

2. During the first three days that Mr. Duffy is in the CCU, a number of diagnostic blood tests are obtained. Which of the following patterns of cardiac enzyme elevation are most common following an MI?

a. SGOT, CK, and LDH are all elevated immediately.
b. SGOT rises 4-6 hours after infarction with CK and LDH rising slowly 24 hours later.
c. CK peaks first (12-24 hours), followed by the SGOT (peaks in 24-36 hours) and then the LDH (peaks 3-4 days).
d. CK peaks first and remains elevated for 1 to 2 weeks.

3. On his second day in CCU Mr. Duffy suffers a life-threatening cardiac arrhythmia. Considering his diagnosis, which is the most probable arrhythmia?

a. atrial tachycardia
b. ventricular fibrillation
c. atrial fibrillation
d. heart block

4. Mr. Duffy is placed on digitalis on discharge from the hospital. The nurse planning with him for his discharge should educate him as to the purpose and actions of his new medication. What should she or he teach Mr. Duffy to do at home to monitor his reaction to this medication?

a. take his blood pressure
b. take his radial pulse for one minute
c. check his serum potassium (K) level
d. weigh himself everyday

You are speaking to an elderly group of diabetics in the OPD about eye health and the importance of visits to the ophthalmologist.

5. You decide to discuss glaucoma prevention. Which of the following diagnostic tests should these clients request from their care provider?

a. fluorescein stain
b. snellen’s test
c. tonometry
d. slit lamp

6. You also explain common eye changes associated with aging. One of these is presbyopia, which is:

a. Refractive error that prevents light rays from coming to a single focus on the retina.
b. Poor distant vision
c. Poor near vision
d. A gradual lessening of the power of accommodation

7. Some of the diabetic clients are interested in understanding what is visualized during funduscopic examination. During your discussion you describe the macular area as:

a. Head of the optic nerve, seen on the nasal side of the field, lighter in color than the retina.
b. The area of central vision, seen on the temporal side of the optic disc, which is quite avascular.
c. Area where the central retinal artery and vein appear on the retina.
d. Reddish orange in color, sometimes stippled.

8. One of the clients has noted a raised yellow plaque on the nasal side of the conjunctiva. You explain that this is called:

a. a pinguecula, which is normal slightly raised fatty structure under the conjunctiva that may gradually increase with age.
b. Icterus, which may be due to liver disease.
c. A pterygium, which will interfere with vision.
d. Ciliary flush caused by congestion of the ciliary artery.

You are caring for Mr. Kaplan who has chronic renal failure (uremia)

9. You know that all but one of the following may eventually result in uremia. Which option is not implicated?

a. glomerular disease
b. uncontrolled hypertension
c. renal disease secondary to drugs, toxins, infections, or radiations
d. all of the above

10. You did the initial assessment on Mr. Kaplan when he came to your unit. What classical signs and symptoms did you note?

a. fruity- smelling breath.
b. Weakness, anorexia, pruritus
c. Polyuria, polydipsia, polyphagia
d. Ruddy complexion

11. Numerous drugs have been used on Mr. Kaplan in an attempt to stabilize him. Regarding his diagnosis and management of his drugs, you know that:

a. The half-life of many drugs is decreased in uremia; thus dosage may have to be increased to be effective.
b. Drug toxicity is a major concern in uremia; individualization of therapy and often a decrease in dose is essential.
c. Drug therapy is not usually affected by this diagnosis
d. Precautions should be taken with prescription drugs, but most OTC medications are safe for him to use.

You are assigned to cardiac clinic to fill in for a colleague for 3 weeks. You begin by reviewing assessment of the cardiovascular system in your mind and asking yourself the following:

12. The point of maximum impulse (PMI) is an important landmark in the cardiac exam. Which statement best describes the location of the PMI in the healthy adult?

a. Base of the heart, 5th intercostal space, 7-9 cm to the left of the midsternal line.
b. Base of the heart, 7th intercostal space, 7-9 cm to the left of the midsternal line.
c. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.
d. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.

13. During the physical examination of the well adult client, the health care provider auscultates the heart. When the stethoscope is placed on the 5th intercostal space along the left sternal border, which valve closure is best evaluated?

a. Tricuspid
b. Pulmonic
c. Aortic
d. Mitral

14. The pulmonic component of which heart sound is best heard at the 2nd LICS at the LSB?

a. S1
b. S2
c. S3
d. S4

15. The coronary arteries furnish blood supply to the myocardium. Which of the following is a true statement relative to the coronary circulation?

a. the right and left coronary arteries are the first of many branches off the ascending aorta
b. blood enters the right and left coronary arteries during systole only
c. the right coronary artery forms almost a complete circle around the heart, yet supplies only the right ventricle
d. the left coronary artery has two main branches, the left anterior descending and left circumflex: both supply the left ventricle

Sally Baker, a 40-year-old woman, is admitted to the hospital with an established diagnosis of mitral stenosis. She is scheduled for surgery to repair her mitral valve.

16. Ms. Baker has decided to have surgical correction of her stenosed valve at this time because her subjective complaints of dyspnea, hemoptysis, orthopnea, and paroxysmal nocturnal dyspnea have become unmanageable. These complaints are probably due to:

a. thickening of the pericardium
b. right heart failure
c. pulmonary hypertension
d. left ventricular hypertrophy

17. On physical exam of Ms. Baker, several abnormal findings can be observed. Which of the following is not one of the usual objective findings associated with mitral stenosis?

a. low-pitched rumbling diastolic murmur, precordial thrill, and parasternal lift
b. small crepitant rales at the bases of the lungs
c. weak, irregular pulse, and peripheral and facial cyanosis in severe disease
d. chest x-ray shows left ventricular hypertrophy

18. You are seeing more clients with diagnoses of mitral valve prolapse. You know those mitral valve prolapse is usually a benign cardiac condition, but may be associated with atypical chest pain. This chest pain is probably caused by:

a. ventricular ischemia
b. dysfunction of the left ventricle
c. papillary muscle ischemia and dysfunction
d. cardiac arrythmias

Mr. Oliver, a long term heavy smoker, is admitted to the hospital for a diagnostic workup. His possible diagnosis is cancer of the lung.

19. The most common lethal cancer in males between their fifth and seventh decades is:

a. cancer of the prostate
b. cancer of the lung
c. cancer of the pancreas
d. cancer of the bowel

20. Of the four basic cell types of lung cancer listed below, which is always associated with smoking?

a. adenocarcinoma
b. squamous cell carcinoma (epidermoid)
c. undifferenciated carcinoma
d. bronchoalveolar carcinoma

21. Chemotherapy may be used in combination with surgery in the treatment of lung cancer. Special nursing considerations with chemotherapy include all but which of the following?

a. Helping the client deal with depression secondary to the diagnosis and its treatment
b. Explaining that the reactions to chemotherapy are minimal
c. Careful observation of the IV site of the administration of the drugs
d. Careful attention to blood count results

22. Which of the following operative procedures of the thorax is paired with the correct definition?

a. Pneumonectomy: removal of the entire lung
b. Wedge resection: removal of one or more lobes of a lung
c. Decortication: removal of the reibs or sections of ribs
d. Thoracoplasty: removal of fibrous membrane that develops over visceral pleura as a result of emphysema

Mr. Liberatore, age 76, is admitted to your unit. He has a past medical history of hypertension, DM, hyperlipidemia. Recently he has had several episodes where he stops talking in midsentence and stares into space. Today the episode lasted for 15 minutes. The admission diagnosis is impending CVA.

23. The episodes Mr. Liberatore has been experiencing are probably:

a. small cerebral hemorrhages
b. TIA’s or transient ischemic attacks
c. Secondary to hypoglycemia
d. Secondary to hyperglycemia

24. Mr. Liberatore suffers a left sided CVA. He is right handed. The nurse should expect:

a. left-sided paralysis
b. visual loss
c. no alterations in speech
d. no impairment of bladder function

25. Upper motor neuron disease may be manifested in which of the following clinical signs?

a. spastic paralysis, hyperreflexia, presence of babinski reflex
b. flaccid paralysis, hyporeflexia
c. muscle atrophy, fasciculations
d. decreased or absent voluntary movement

Julie, an 18-year-old girl, is brought into the ER by her mother with the chief complaint of sudden visual disturbance that began half an hour ago and was described as double vision and flashing lights.

26. During your assessment of Julie she tells you all visual symptoms are gone but that she now has a severe pounding headache over her left eye. You suspect Julie may have:

a. a tension headache
b. the aura and headache of migraine
c. a brain tumor
d. a conversion reaction

27. You explain to Julie and her mother that migraine headaches are caused by:

a. an allergic response triggered by stress
b. dilation of cerebral arteries
c. persistent contraction of the muscles of the head, neck and face
d. increased intracranial pressure

28. A thorough history reveals that hormonal changes associated with menstruation may have triggered Julie’s migraine attack. In investigating Julie’s history what factors would be least significant in migraine?

a. seasonal allergies
b. trigger foods such as alcohol, MSG, chocolate
c. family history of migraine
d. warning sign of onset, or aura

29. A client with muscle contraction headache will exhibit a pattern different for Julie’s. Which of the following is more compatible with tension headache?

a. severe aching pain behind both eyes
b. headache worse when bending over
c. a bandlike burning around the neck
d. feeling of tightness bitemporally, occipitally, or in the neck

Mr. Snyder is admitted to your unit with a brain tumor. The type of tumor he has is currently unknown. You begin to think about the way brain tumors are classified.

30. Glioma is an intracranial tumor. Which of the following statements about gliomas do you know to be false?

a. 50% of all intracranial tumors are gliomas
b. gliomas are usually benign
c. they grow rapidly and often cannot be totally excised from the surrounding tissue
d. most glioma victims die within a year after diagnosis

31. Acoustic neuromas produce symptoms of progressive nerve deafness, tinnitus, and vertigo due to pressure and eventual destruction of:

a. CN5
b. CN7
c. CN8
d. The ossicles

32. Whether Mr Snyder’s tumor is benign or malignant, it will eventually cause increased intracranial pressure. Signs and symptoms of increasing intracranial pressure may include all of the following except:

a. headache, nausea, and vomiting
b. papilledema, dizziness, mental status changes
c. obvious motor deficits
d. increased pulse rate, drop in blood pressure

33. Mr Snyder is scheduled for surgery in the morning, and you are surprised to find out that there is no order for an enema. You assess the situation and conclude that the reason for this is:

a. Mr. Snyder has had some mental changes due to the tumor and would find an enema terribly traumatic
b. Straining to evacuate the enema might increase the intracranial pressure
c. Mr. Snyder had been on clear liquids and then was NPO for several days, so an enema is not necessary
d. An oversight and you call the physician to obtain the order

34. Postoperatively Mr. Snyder needs vigilant nursing care including all of the following except:

a. Keeping his head flat
b. Assessments q ½ hour of LOC, VS, papillary responses, and mental status
c. Helping him avoid straining at stool, vomiting, or coughing
d. Providing a caring, supportive atmosphere for him and his family

35. Potential postintracranial surgery problems include all but which of the following?

a. increased ICP
b. extracranial hemorrhage
c. seizures
d. leakage of cerebrospinal fluid

Mrs. Hogan, a 43-year-old woman, is admitted to your unit for cholecystectomy.

36. You are responsible for teaching Mrs. Hogan deep breathing and coughing exercises. Why are these exercises especially important for Mrs. Hogan?

a. they prevent postoperative atelectasis and pneumonia
b. the incision in gallbladder surgery is in the subcostal area, which makes the client reluctant to take a deep breath and cough
c. because she is probably overweight and will be less willing to breathe, cough, and move postoperatively

37. On the morning of Mrs. Hogan’s planned cholecystectomy she awakens with a pain in her right scapular area and thinks she slept in poor position. While doing the preop check list you note that on her routine CB report her WBC is 15,000. Your responsibility at this point is:

a. to notify the surgeon at once; this is an elevated WBC indicating an inflammatory reaction
b. to record this finding in a prominent place on the preop checklist and in your preop notes
c. to call the laboratory for a STAT repeat WBC
d. none. This is not an unusual finding

38. Mrs. Hogan is scheduled for surgery 2 days later and is to be given atropine 0.3 mg IM and Demerol 50 mg IM one hour preoperatively. Which nursing actions follow the giving of the preop medication?

a. have her void soon after receiving the medication
b. allow her family to be with her before the medication takes effect
c. bring her valuables to the nursing station
d. reinforce preop teaching

39. Mrs. Hogan is transported to the recovery room following her cholecystectomy. As you continue to check her vital signs you note a continuing trend in Mrs. Hogan’s status: her BP is gradually dropping and her pulse rate is increasing. Your most appropriate nursing action is to:

a. order whole blood for Mrs. Hogan from the lab
b. increase IV fluid rate of infusion and place in trendelenburg position
c. immediately report signs of shock to the head nurse and/or surgeon and monitor VS closely
d. place in lateral sims position to facilitate breathing

40. Mrs. Hogan returns to your clinical unit following discharge from the recovery room. Her vital signs are stable and her family is with her. Postoperative leg exercises should be inititated:

a. after the physician writes the order
b. after the family leaves
c. if Mrs. Hogan will not be ambulated early
d. stat

41. An oropharyngeal airway may:

a. Not be used in a conscious patient.
b. Cause airway obstruction.
c. Prevent a patient from biting and occluding an ET tube.
d. Be inserted "upside down" into the mouth opening and then rotated into the proper orientation as it is advanced into the mouth.
e. All of the above.

42. Endotracheal intubation:

a. Can be attempted for up to 2 minutes before you need to stop and ventilate the patient.
b. Reduces the risk of aspiration of gastric contents.
c. Should be performed with the neck flexed forward making the chin touch the chest.
d. Should be performed after a patient is found to be not breathing and two breaths have been given but before checking for a pulse.

43. When giving bag-valve mask ventilations:

a. Rapid and forceful ventilations are desirable so that adequate ventilation will be assured
b. Effective ventilations can always be given by one person.
c. Cricoid pressure may prevent gastric inflation during ventilations.
d. Tidal volumes will always be larger than when giving mouth to pocket mask ventilations.

44. If breath sounds are only heard on the right side after intubation:

a. Extubate, ventilate for 30 seconds then try again.
b. The patient probably only has one lung, the right.
c. You have intubated the stomach.
d. Pull the tube back and listen again.

45. An esophageal obturator airway (EOA):

a. Can be inserted by any person trained in ACLS.
b. Requires visualization of the trachea before insertion.
c. Never causes regurgitation.
d. Should not be used with a conscious person, pediatric patients, or patients who have swallowed caustic substances.

46. During an acute myocardial infarct (MI):

a. A patient may have a normal appearing ECG.
b. Chest pain will always be present.
c. A targeted history is rarely useful in making the diagnosis of MI.
d. The chest pain is rarely described as crushing, pressing, or heavy.

47. The most common lethal arrhythmia in the first hour of an MI is:

a. Pulseless Ventricular Tachycardia
b. Asystole
c. Ventricular fibrillation
d. First degree heart block.

48. Which of the following is true about verapamil?

a. It is used for wide-complex tachycardia.
b. It may cause a drop in blood pressure.
c. It is a first line drug for Pulseless Electrical Activity.
d. It is useful for treatment of severe hypotension.

49. Atropine:

a. Is always given for a heart rate less than 60 bpm.
b. Cannot be given via ET tube.
c. Has a maximum total dosage of 0.03-0.04 mg/kg IV in the setting of cardiac arrest.
d. When given IV, should always be given slowly.

50. Asystole should not be "defibrillated."

a. True
b. False

MS drill Test II (Answers and Rationale)

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 11:15:00 +0800

1. The nursing care plan for a toddler diagnosed with Kawasaki Disease (mucocutaneous lymph node syndrome) should be based on the high risk for development of which problem?
A)Chronic vessel plaque formation
B)Pulmonary embolism
C)Occlusions at the vessel bifurcations
D)Coronary artery aneurysms

The correct answer is D: Coronary artery aneurysms
Kawasaki Disease involves all the small and medium-sized blood vessels. There is progressive inflammation of the small vessels which progresses to the medium-sized muscular arteries, potentially damaging the walls and leading to coronary artery aneurysms.

2. A nurse has just received a medication order which is not legible. Which statement best reflects assertive communication?
A)"I cannot give this medication as it is written. I have no idea of what you mean."
B)"Would you please clarify what you have written so I am sure I am reading it correctly?"
C)"I am having difficulty reading your handwriting. It would save me time if you would be more careful."
D)"Please print in the future so I do not have to spend extra time attempting to read your writing."

The correct answer is B: "Would you please clarify what you have written so I am sure I am reading it correctly?"
Assertive communication respects the rights and responsibilities of both parties. This statement is an honest expression of concern for safe practice and a request for clarification without self-depreciation. It reflects the right of the professional to give and receive information.

3. The nurse is discussing negativism with the parents of a 30 month-old child. How should the nurse tell the parents to best respond to this behavior?
A)Reprimand the child and give a 15 minute "time out"
B)Maintain a permissive attitude for this behavior
C)Use patience and a sense of humor to deal with this behavior
D)Assert authority over the child through limit setting

The correct answer is C: Use patience and a sense of humor to deal with this behavior
The nurse should help the parents see the negativism as a normal growth of autonomy in the toddler. They can best handle the negative toddler by using patience and humor.

4. An ambulatory client reports edema during the day in his feet and an ankle that disappears while sleeping at night. What is the most appropriate follow-up question for the nurse to ask?
A)"Have you had a recent heart attack?"
B)"Do you become short of breath during your normal daily activities?"
C)"How many pillows do you use at night to sleep comfortably?"
D)"Do you smoke?"

The correct answer is B: "Do you become short of breath during your normal daily activities?"

These are the symptoms of right-sided heart failure, which causes increased pressure in the systemic venous system. To equalize this pressure, the fluid shifts into the interstitial spaces causing edema. Because of gravity, the lower extremities are first affected in an ambulatory patient. This question would elicit information to confirm the nursing diagnosis of activity intolerance and fluid volume excess both associated with right-sided heart failure.

5. The nurse is planning care for a client during the acute phase of a sickle cell vaso-occlusive crisis. Which of the following actions would be most appropriate?
A)Fluid restriction 1000cc per day
B)Ambulate in hallway 4 times a day
C)Administer analgesic therapy as ordered
D)Encourage increased caloric intake

The correct answer is C: Administer analgesic therapy as ordered
The main general objectives in the treatment of a sickle cell crisis is bed rest, hydration, electrolyte replacement, analgesics for pain, blood replacement and antibiotics to treat any existing infection.

6. While working with an obese adolescent, it is important for the nurse to recognize that obesity in adolescents is most often associated with what other behavior?
A)Sexual promiscuity
B)Poor body image
C)Dropping out of school
D)Drug experimentation

The correct answer is B: Poor body image
As the adolescent gains weight, there is a lessening sense of self esteem and poor body image.

7. A nurse and client are talking about the client’s progress toward understanding his behavior under stress. This is typical of which phase in the therapeutic relationship?
A)Pre-interaction
B)Orientation
C)Working
D)Termination

The correct answer is C: Working
During the working phase alternative behaviors and techniques are explored. The nurse and the client discuss the meaning behind the behavior.

8. A nurse is eating in the hospital cafeteria when a toddler at a nearby table chokes on a piece of food and appears slightly blue. The appropriate initial action should be to
A)Begin mouth to mouth resuscitation
B)Give the child water to help in swallowing
C)Perform 5 abdominal thrusts
D)Call for the emergency response team

The correct answer is C: Perform 5 abdominal thrusts
At this age, the most effective way to clear the airway of food is to perform abdominal thrusts.

9. The emergency room nurse admits a child who experienced a seizure at school. The father comments that this is the first occurrence, and denies any family history of epilepsy. What is the best response by the nurse?
A)"Do not worry. Epilepsy can be treated with medications."
B)"The seizure may or may not mean your child has epilepsy."
C)"Since this was the first convulsion, it may not happen again."
D)"Long term treatment will prevent future seizures."

The correct answer is B: "The seizure may or may not mean your child has epilepsy."
There are many possible causes for a childhood seizure. These include fever, central nervous system conditions, trauma, metabolic alterations and idiopathic (unknown).

10. A nurse admits a 3 week-old infant to the special care nursery with a diagnosis of bronchopulmonary dysplasia. As the nurse reviews the birth history, which data would be most consistent with this diagnosis?
A)Gestational age assessment suggested growth retardation
B)Meconium was cleared from the airway at delivery
C)Phototherapy was used to treat Rh incompatibility
D)The infant received mechanical ventilation for 2 weeks

The correct answer is D: The infant received mechanical ventilation for 2 weeks
Bronchopulmonary dysplasia is an iatrogenic disease caused by therapies such as use of positive-pressure ventilation used to treat lung disease.

11. Parents of a 6 month-old breast fed baby ask the nurse about increasing the baby's diet. Which of the following should be added first?
A)Cereal
B)Eggs
C)Meat
D)Juice

The correct answer is A: Cereal
The guidelines of the American Academy of Pediatrics recommend that one new food be introduced at a time, beginning with strained cereal.

12. A victim of domestic violence states, "If I were better, I would not have been beat." Which feeling best describes what the victim may be experiencing?
A)Fear
B)Helplessness
C)Self-blame
D)Rejection

The correct answer is C: Self-blame
Domestic violence victims may be immobilized by a variety of affective responses, one being self-blame. The victim believes that a change in their behavior will cause the abuser to become nonviolent, which is a myth.

13. The nurse is assessing the mental status of a client admitted with possible organic brain disorder. Which of these questions will best assess the function of the client's recent memory?
A)"Name the year." "What season is this?" (pause for answer after each question)
B)"Subtract 7 from 100 and then subtract 7 from that." (pause for answer) "Now continue to subtract 7 from the new number."
C)"I am going to say the names of three things and I want you to repeat them after me: blue, ball, pen."
D)"What is this on my wrist?" (point to your watch) Then ask, "What is the purpose of it?"

The correct answer is C: "I am going to say the names of three things and I want you to repeat them after me: blue, ball, pen."

14. Which oxygen delivery system would the nurse apply that would provide the highest concentrations of oxygen to the client?
A) Venturi mask
B) Partial rebreather mask
C) Non-rebreather mask
D) Simple face mask

The correct answer is C: The non-rebreather mask has a one-way valve that prevents exhales air from entering the reservoir bag and one or more valves covering the air holes on the face mask itself to prevent inhalation of room air but to allow exhalation of air. When a tight seal is achieved around the mask up to 100% of oxygen is available.

15. A nurse is caring for a client who had a closed reduction of a fractured right wrist followed by the application of a fiberglass cast 12 hours ago. Which finding requires the nurse’s immediate attention?
A) Capillary refill of fingers on right hand is 3 seconds
B) Skin warm to touch and normally colored
C) Client reports prickling sensation in the right hand
D) Slight swelling of fingers of right hand

The correct answer is C: Prickling sensation is an indication of compartment syndrome and requires immediate action by the nurse. The other findings are normal for a client in this situation.

16. Included in teaching the client with tuberculosis taking INH about follow-up home care, the nurse should emphasize that a laboratory appointment for which of the following lab tests is critical?
A) Liver function
B) Kidney function
C) Blood sugar
D) Cardiac enzymes

The correct answer is A: INH can cause hepatocellular injury and hepatitis. This side effect is age-related and can be detected with regular assessment of liver enzymes, which are released into the blood from damaged liver cells.

17. Which client is at highest risk for developing a pressure ulcer?
A) 23 year-old in traction for fractured femur
B) 72 year-old with peripheral vascular disease, who is unable to walk without assistance
C) 75 year-old with left sided paresthesia and is incontinent of urine and stool
D) 30 year-old who is comatose following a ruptured aneurysm

The correct answer is C: Risk factors for pressure ulcers include: immobility, absence of sensation, decreased LOC, poor nutrition and hydration, skin moisture, incontinence, increased age, decreased immune response. This client has the greatest number of risk factors.

18. Which contraindication should the nurse assess for prior to giving a child immunization?
A) Mild cold symptoms
B) Chronic asthma
C) Depressed immune system
D) Allergy to eggs

The correct answer is C: Children who have a depressed immune system related to HIV or chemotherapy should not be given routine immunizations.

19. The nurse is caring for a 2 year-old who is being treated with chelation therapy, calcium disodium edetate, for lead poisoning. The nurse should be alert for which of the following side effects?
A) Neurotoxicity
B) Hepatomegaly
C) Nephrotoxicity
D) Ototoxicity

The correct answer is C: Nephrotoxicity is a common side effect of calcium disodium edetate, in addition to lead poisoning in general.

20. A newborn is having difficulty maintaining a temperature above 98 degrees Fahrenheit and has been placed in a warming isolette. Which action is a nursing priority?
A) Protect the eyes of the neonate from the heat lamp
B) Monitor the neonate’s temperature
C) Warm all medications and liquids before giving
D) Avoid touching the neonate with cold hands

The correct answer is B: When using a warming device the neonate’s temperature should be continuously monitored for undesired elevations. The use of heat lamps is not safe as there is no way to regulate their temperature. Warming medications and fluids is not indicated. While touching with cold hands can startle the infant it does not pose a safety risk.

21. At a senior citizens meeting a nurse talks with a client who has diabetes mellitus Type 1. Which statement by the client during the conversation is most predictive of a potential for impaired skin integrity?
A) "I give my insulin to myself in my thighs."
B) "Sometimes when I put my shoes on I don't know where my toes are."
C) "Here are my up and down glucose readings that I wrote on my calendar."
D) "If I bathe more than once a week my skin feels too dry."

The correct answer is B: Peripheral neuropathy can lead to lack of sensation in the lower extremities. Clients do not feel pressure and/or pain and are at high risk for skin impairment.

22. A 4 year-old hospitalized child begins to have a seizure while playing with hard plastic toys in the hallway. Of the following nursing actions, which one should the nurse do first?

A) Place the child in the nearest bed
B) Administer IV medication to slow down the seizure
C) Place a padded tongue blade in the child's mouth
D) Remove the child's toys from the immediate area

The correct answer is D: Nursing care for a child having a seizure includes, maintaining airway patency, ensuring safety, administering medications, and providing emotional support. Since the seizure has already started, nothing should be forced into the child''s mouth and they should not be moved. Of the choices given, first priority would be for safety.

23. The nurse is at the community center speaking with retired people. To which comment by one of the retirees during a discussion about glaucoma would the nurse give a supportive comment to reinforce correct information?

A) "I usually avoid driving at night since lights sometimes seem to make things blur."
B) "I take half of the usual dose for my sinuses to maintain my blood pressure."
C) "I have to sit at the side of the pool with the grandchildren since I can't swim with this eye problem."
D) "I take extra fiber and drink lots of water to avoid getting constipated.”

The correct answer is D: Any activity that involves straining should be avoided in clients with glaucoma. Such activities would increase intraocular pressure.

24. The nurse is teaching a parent about side effects of routine immunizations. Which of the following must be reported immediately?
A) Irritability
B) Slight edema at site
C) Local tenderness
D) Temperature of 102.5 F

The correct answer is D: An adverse reaction of a fever should be reported immediately. Other reactions that should be reported include crying for > 3 hours, seizure activity, and tender, swollen, reddened areas.

25. A client is admitted with the diagnosis of pulmonary embolism. While taking a history, the client tells the nurse he was admitted for the same thing twice before, the last time just 3 months ago. The nurse would anticipate the health care provider ordering
A) Pulmonary embolectomy
B) Vena caval interruption
C) Increasing the coumadin therapy to an INR of 3-4
D) Thrombolytic therapy

The correct answer is B: Clients with contraindications to heparin, recurrent PE or those with complications related to the medical therapy may require vena caval interruption by the placement of a filter device in the inferior vena cava. A filter can be placed transvenously to trap clots before they travel to the pulmonary circulation.

26. A woman in her third trimester complains of severe heartburn. What is appropriate teaching by the nurse to help the woman alleviate these symptoms?
A) Drink small amounts of liquids frequently
B) Eat the evening meal just before retiring
C) Take sodium bicarbonate after each meal
D) Sleep with head propped on several pillows

The correct answer is D: Heartburn is a burning sensation caused by regurgitation of gastric contents that is best relieved by sleeping position, eating small meals, and not eating before bedtime.

27. The nurse is teaching the mother of a 5 month-old about nutrition for her baby. Which statement by the mother indicates the need for further teaching?

A) "I'm going to try feeding my baby some rice cereal."
B) "When he wakes at night for a bottle, I feed him."
C) "I dip his pacifier in honey so he'll take it."
D) "I keep formula in the refrigerator for 24 hours."

The correct answer is C: Honey has been associated with infant botulism and should be avoided. Older children and adults have digestive enzymes that kill the botulism spores.

28. For a 6 year-old child hospitalized with moderate edema and mild hypertension associated with acute glomerulonephritis (AGN), which one of the following nursing interventions would be appropriate?
A) Institute seizure precautions
B) Weigh the child twice per shift
C) Encourage the child to eat protein-rich foods
D) Relieve boredom through physical activity

The correct answer is A: Institute seizure precautions
The severity of the acute phase of AGN is variable and unpredictable; therefore, a child with edema, hypertension, and gross hematuria may be subject to complications and anticipatory preparation such as seizure precautions are needed.

29. Which statement by the client with chronic obstructive lung disease indicates an understanding of the major reason for the use of occasional pursed-lip breathing?
A) "This action of my lips helps to keep my airway open."
B) "I can expel more when I pucker up my lips to breathe out."
C) "My mouth doesn't get as dry when I breathe with pursed lips."
D) "By prolonging breathing out with pursed lips the little areas in my lungs don't collapse."

The correct answer is D: "By prolonging breathing out with pursed lips my little areas in my lungs don''t collapse."
Clients with chronic obstructive pulmonary disease have difficulty exhaling fully as a result of the weak alveolar walls from the disease process . Alveolar collapse can be avoided with the use of pursed-lip breathing. This is the major reason to use it. The other options are secondary effects of purse-lip breathing.

30. A 57 year-old male client has hemoglobin of 10 mg/dl and a hematocrit of 32%. What would be the most appropriate follow-up by the home care nurse?
A) Ask the client if he has noticed any bleeding or dark stools
B) Tell the client to call 911 and go to the emergency department immediately
C) Schedule a repeat Hemoglobin and Hematocrit in 1 month
D) Tell the client to schedule an appointment with a hematologist

The correct answer is A: Ask the client if he has noticed any bleeding or dark stools
Normal hemoglobin for males is 13.0 - 18 g/100 ml. Normal hemotocrit for males is 42 - 52%. These values are below normal and indicate mild anemia. The first thing the nurse should do is ask the client if he''s noticed any bleeding or change in stools that could indicate bleeding from the GI tract.

31. Which response by the nurse would best assist the chemically impaired client to deal with issues of guilt?
A) "Addiction usually causes people to feel guilty. Don’t worry, it is a typical response due to your drinking behavior."
B) "What have you done that you feel most guilty about and what steps can you begin to take to help you lessen this guilt?"
C) "Don’t focus on your guilty feelings. These feelings will only lead you to drinking and taking drugs." D) "You’ve caused a great deal of pain to your family and close friends, so it will take time to undo all the things you’ve done."

The correct answer is B: "What have you done that you feel most guilty about and what steps can you begin to take to help you lessen this guilt?"
This response encourages the client to get in touch with their feelings and utilize problem solving steps to reduce guilt feelings.

32. An adolescent client comes to the clinic 3 weeks after the birth of her first baby. She tells the nurse she is concerned because she has not returned to her pre-pregnant weight. Which action should the nurse perform first?
A) Review the client's weight pattern over the year
B) Ask the mother to record her diet for the last 24 hours
C) Encourage her to talk about her view of herself
D) Give her several pamphlets on postpartum nutrition

The correct answer is C: Encourage her to talk about her view of herself
To an adolescent, body image is very important. The nurse must acknowledge this before assessment and teaching.

33. Which of the following measures would be appropriate for the nurse to teach the parent of a nine month-old infant about diaper dermatitis?
A) Use only cloth diapers that are rinsed in bleach
B) Do not use occlusive ointments on the rash
C) Use commercial baby wipes with each diaper change
D) Discontinue a new food that was added to the infant's diet just prior to the rash

The correct answer is D: Discontinue a new food that was added to the infant''s diet just prior to the rash
The addition of new foods to the infant''s diet may be a cause of diaper dermatitis.

34. A 16 year-old client is admitted to a psychiatric unit with a diagnosis of attempted suicide. The nurse is aware that the most frequent cause for suicide in adolescents is
A) Progressive failure to adapt
B) Feelings of anger or hostility
C) Reunion wish or fantasy
D) Feelings of alienation or isolation

The correct answer is D: Feelings of alienation or isolation
The isolation may occur gradually resulting in a loss of all meaningful social contacts. Isolation can be self imposed or can occur as a result of the inability to express feelings. At this stage of development it is important to achieve a sense of identity and peer acceptance.

35. A mother brings her 26 month-old to the well-child clinic. She expresses frustration and anger due to her child's constantly saying "no" and his refusal to follow her directions. The nurse explains this is normal for his age, as negativism is attempting to meet which developmental need?
A) Trust
B) Initiative
C) Independence
D) Self-esteem

The correct answer is C: Independence
In Erikson’s theory of development, toddlers struggle to assert independence. They often use the word “no” even when they mean yes. This stage is called autonomy versus shame and doubt.

36. Following mitral valve replacement surgery a client develops PVC’s. The health care provider orders a bolus of Lidocaine followed by a continuous Lidocaine infusion at a rate of 2 mgm/minute. The IV solution contains 2 grams of Lidocaine in 500 cc’s of D5W. The infusion pump delivers 60 microdrops/cc. What rate would deliver 4 mgm of Lidocaine/minute?
A) 60 microdrops/minute
B) 20 microdrops/minute
C) 30 microdrops/minute
D) 40 microdrops/minute

The correct answer is A: 60 microdrops/minute
2 gm=2000 mgm
2000 mgm/500 cc = 4 mgm/x cc
2000x = 2000
x= 2000/2000 = 1 cc of IV solution/minute
CC x 60 microdrops = 60 microdrops/minute

37. A couple asks the nurse about risks of several birth control methods. What is the most appropriate response by the nurse?
A) Norplant is safe and may be removed easily
B) Oral contraceptives should not be used by smokers
C) Depo-Provera is convenient with few side effects
D) The IUD gives protection from pregnancy and infection

The correct answer is B: Oral contraceptives should not be used by smokers
The use of oral contraceptives in a pregnant woman who smokes increases her risk of cardiovascular problems, such as thromboembolic disorders.

38. The nurse is caring for a client in the late stages of Amyotrophic Lateral Sclerosis (A.L.S.). Which finding would the nurse expect?
A) Confusion
B) Loss of half of visual field
C) Shallow respirations
D) Tonic-clonic seizures

The correct answer is C: Shallow respirations
A.L.S. is a chronic progressive disease that involves degeneration of the anterior horn of the spinal cord as well as the corticospinal tracts. When the intercostal muscles and diaphragm become involved, the respirations become shallow and coughing is ineffective.

39. A client experiences post partum hemorrhage eight hours after the birth of twins. Following administration of IV fluids and 500 ml of whole blood, her hemoglobin and hematocrit are within normal limits. She asks the nurse whether she should continue to breast feed the infants. Which of the following is based on sound rationale?
A) "Nursing will help contract the uterus and reduce your risk of bleeding."
B) "Breastfeeding twins will take too much energy after the hemorrhage."
C) "The blood transfusion may increase the risks to you and the babies."
D) "Lactation should be delayed until the "real milk" is secreted."

The correct answer is A: "Nursing will help contract the uterus and reduce your risk of bleeding." Stimulation of the breast during nursing releases oxytocin, which contracts the uterus. This contraction is especially important following hemorrhage.

40. A client complained of nausea, a metallic taste in her mouth, and fine hand tremors 2 hours after her first dose of lithium carbonate (Lithane). What is the nurse’s best explanation of these findings?
A) These side effects are common and should subside in a few days
B) The client is probably having an allergic reaction and should discontinue the drug
C) Taking the lithium on an empty stomach should decrease these symptoms
D) Decreasing dietary intake of sodium and fluids should minimize the side effects

The correct answer is A: These side effects are common and should subside in a few days
Nausea, metallic taste and fine hand tremors are common side effects that usually subside within days.

41. The nurse is caring for a post-surgical client at risk for developing deep vein thrombosis. Which intervention is an effective preventive measure?
A) Place pillows under the knees
B) Use elastic stockings continuously
C) Encourage range of motion and ambulation
D) Massage the legs twice daily

The correct answer is C: Encourage range of motion and ambulation
Mobility reduces the risk of deep vein thrombosis in the post-surgical client and the adult at risk.

42. The parents of a newborn male with hypospadias want their child circumcised. The best response by the nurse is to inform them that
A) Circumcision is delayed so the foreskin can be used for the surgical repair
B) This procedure is contraindicated because of the permanent defect
C) There is no medical indication for performing a circumcision on any child
D) The procedure should be performed as soon as the infant is stable

The correct answer is A: Circumcision is delayed so the foreskin can be used for the surgical repair
Even if mild hypospadias is suspected, circumcision is not done in order to save the foreskin for surgical repair, if needed.

43. The nurse is teaching parents about the treatment plan for a 2 weeks-old infant with Tetralogy of Fallot. While awaiting future surgery, the nurse instructs the parents to immediately report
A) Loss of consciousness
B) Feeding problems
C) Poor weight gain
D) Fatigue with crying

The correct answer is A: Loss of consciousness
While parents should report any of the observations, they need to call the health care provider immediately if the level of alertness changes. This indicates anoxia, which may lead to death. The structural defects associated with Tetralogy of Fallot include pulmonic stenosis, ventricular septal defect, right ventricular hypertrophy and overriding of the aorta. Surgery is often delayed, or may be performed in stages.

44. An infant weighed 7 pounds 8 ounces at birth. If growth occurs at a normal rate, what would be the expected weight at 6 months of age?
A) Double the birth weight
B) Triple the birth weight
C) Gain 6 ounces each week
D) Add 2 pounds each month

The correct answer is A: Double the birth weight
Although growth rates vary, infants normally double their birth weight by 6 months.

45. The nurse is caring for a 13 year-old following spinal fusion for scoliosis. Which of the following interventions is appropriate in the immediate post-operative period?
A) Raise the head of the bed at least 30 degrees
B) Encourage ambulation within 24 hours
C) Maintain in a flat position, logrolling as needed
D) Encourage leg contraction and relaxation after 48 hours

The correct answer is C: Maintain in a flat position, logrolling as needed
The bed should remain flat for at least the first 24 hours to prevent injury. Logrolling is the best way to turn for the client while on bed rest.

46. A client asks the nurse about including her 2 and 12 year-old sons in the care of their newborn sister. Which of the following is an appropriate initial statement by the nurse?
A) "Focus on your sons' needs during the first days at home."
B) "Tell each child what he can do to help with the baby."
C) "Suggest that your husband spend more time with the boys."
D) "Ask the children what they would like to do for the newborn."

The correct answer is A: "Focus on your sons'' needs during the first days at home."
In an expanded family, it is important for parents to reassure older children that they are loved and as important as the newborn.

47. A nurse is caring for a 2 year-old child after corrective surgery for Tetralogy of Fallot. The mother reports that the child has suddenly begun seizing. The nurse recognizes this problem is probably due to
A) A cerebral vascular accident
B) Postoperative meningitis
C) Medication reaction
D) Metabolic alkalosis

The correct answer is A: A cerebral vascular accident
Polycythemia occurs as a physiological reaction to chronic hypoxemia which commonly occurs in clients with Tetralogy of Fallot. Polycythemia and the resultant increased viscosity of the blood increase the risk of thromboembolic events. Cerebrovascular accidents may occur. Signs and symptoms include sudden paralysis, altered speech, extreme irritability or fatigue, and seizures.

48. A client with schizophrenia is receiving Haloperidol (Haldol) 5 mg t.i.d.. The client’s family is alarmed and calls the clinic when "his eyes rolled upward." The nurse recognizes this as what type of side effect?
A) Oculogyric crisis
B) Tardive dyskinesia
C) Nystagmus
D) Dysphagia

The correct answer is A: Oculogyric crisis
This refers to involuntary muscles spasm of the eye.

49. A home health nurse is at the home of a client with diabetes and arthritis. The client has difficulty drawing up insulin. It would be most appropriate for the nurse to refer the client to
A) A social worker from the local hospital
B) An occupational therapist from the community center
C) A physical therapist from the rehabilitation agency
D) Another client with diabetes mellitus and takes insulin

The correct answer is B: An occupational therapist from the community center
An occupational therapist can assist a client to improve the fine motor skills needed to prepare an insulin injection.

50. A client was admitted to the psychiatric unit after complaining to her friends and family that neighbors have bugged her home in order to hear all of her business. She remains aloof from other clients, paces the floor and believes that the hospital is a house of torture. Nursing interventions for the client should appropriately focus on efforts to
A) Convince the client that the hospital staff is trying to help
B) Help the client to enter into group recreational activities
C) Provide interactions to help the client learn to trust staff
D) Arrange the environment to limit the client’s contact with other clients

The correct answer is C: Provide interactions to help the client learn to trust staff
This establishes trust, facilitates a therapeutic alliance between staff and client.

51. A client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA). The nurse knows that a PTCA is the
A) Surgical repair of a diseased coronary artery
B) Placement of an automatic internal cardiac defibrillator
C) Procedure that compresses plaque against the wall of the diseased coronary artery to improve blood flow
D) Non-invasive radiographic examination of the heart

The correct answer is C: Procedure that compresses plaque against the wall of the diseased coronary artery to improve blood flow
PTCA is performed to improve coronary artery blood flow in a diseased artery. It is performed during a cardiac catheterization. Aorta coronary bypass Graft is the surgical procedure to repair a diseased coronary artery.

52. A newborn has been diagnosed with hypothyroidism. In discussing the condition and treatment with the family, the nurse should emphasize
A) They can expect the child will be mentally retarded
B) Administration of thyroid hormone will prevent problems
C) This rare problem is always hereditary
D) Physical growth/development will be delayed

The correct answer is B: Administration of thyroid hormone will prevent problems
Early identification and continued treatment with hormone replacement corrects this condition.

53. A priority goal of involuntary hospitalization of the severely mentally ill client is
A) Re-orientation to reality
B) Elimination of symptoms
C) Protection from harm to self or others
D) Return to independent functioning

The correct answer is C: Protection from self-harm and harm to others
Involuntary hospitalization may be required for persons considered dangerous to self or others or for individuals who are considered gravely disabled.

54. A 19 year-old client is paralyzed in a car accident. Which statement used by the client would indicate to the nurse that the client was using the mechanism of "suppression"?
A) "I don't remember anything about what happened to me."
B) "I'd rather not talk about it right now."
C) "It's the other entire guy's fault! He was going too fast."
D) "My mother is heartbroken about this."

The correct answer is A: "I don''t remember anything about what happened to me."
Suppression is willfully putting an unacceptable thought or feeling out of one’s mind. A deliberate exclusion "voluntary forgetting" is generally used to protect one’s own self esteem.

55. The nurse is caring for a woman 2 hours after a vaginal delivery. Documentation indicates that the membranes were ruptured for 36 hours prior to delivery. What are the priority nursing diagnoses at this time?
A) Altered tissue perfusion
B) Risk for fluid volume deficit
C) High risk for hemorrhage
D) Risk for infection

The correct answer is D: Risk for infection
Membranes ruptured over 24 hours prior to birth greatly increases the risk of infection to both mother and the newborn.

56. A 3 year-old had a hip spica cast applied 2 hours ago. In order to facilitate drying, the nurse should
A) Expose the cast to air and turn the child frequently
B) Use a heat lamp to reduce the drying time
C) Handle the cast with the abductor bar
D) Turn the child as little as possible

The correct answer is A: Expose the cast to air and turn the child frequently
The child should be turned every 2 hours, with surface exposed to the air.

57. A client is scheduled for an Intravenous Pyelogram (IVP). In order to prepare the client for this test, the nurse would:
A) Instruct the client to maintain a regular diet the day prior to the examination
B) Restrict the client's fluid intake 4 hours prior to the examination
C) Administer a laxative to the client the evening before the examination
D) Inform the client that only 1 x-ray of his abdomen is necessary

The correct answer is C: Administer a laxative to the client the evening before the examination
Bowel prep is important because it will allow greater visualization of the bladder and ureters.

58. Following a diagnosis of acute glomerulonephritis (AGN) in their 6 year-old child, the parent’s remark: “We just don’t know how he caught the disease!” The nurse's response is based on an understanding that
A) AGN is a streptococcal infection that involves the kidney tubules
B) The disease is easily transmissible in schools and camps
C) The illness is usually associated with chronic respiratory infections
D) It is not "caught" but is a response to a previous B-hemolytic strep infection

The correct answer is D: It is not "caught" but is a response to a previous B-hemolytic strep infection
AGN is generally accepted as an immune-complex disease in relation to an antecedent streptococcal infection of 4 to 6 weeks prior, and is considered as a noninfectious renal disease.

59. The nurse is caring for a 20 lbs (9 kg) 6 month-old with a 3 day history of diarrhea, occasional vomiting and fever. Peripheral intravenous therapy has been initiated, with 5% dextrose in 0.33% normal saline with 20 mEq of potassium per liter infusing at 35 ml/hr. Which finding should be reported to the health care provider immediately?
A) 3 episodes of vomiting in 1 hour
B) Periodic crying and irritability
C) Vigorous sucking on a pacifier
D) No measurable voiding in 4 hours

The correct answer is D: No measurable voiding in 4 hours
The concern is possible hyperkalemia, which could occur with continued potassium administration and a decrease in urinary output since potassium is excreted via the kidneys.

60. While caring for the client during the first hour after delivery, the nurse determines that the uterus is boggy and there is vaginal bleeding. What should be the nurse's first action?
A) Check vital signs
B) Massage the fundus
C) Offer a bedpan
D) Check for perineal lacerations

The correct answer is B: Massage the fundus
The nurse’s first action should be to massage the fundus until it is firm as uterine atony is the primary cause of bleeding in the first hour after delivery.

61. The nurse is assessing an infant with developmental dysplasia of the hip. Which finding would the nurse anticipate?
A) Unequal leg length
B) Limited adduction
C) Diminished femoral pulses
D) Symmetrical gluteal folds

The correct answer is A: Unequal leg length
Shortening of a leg is a sign of developmental dysplasia of the hip.

62. To prevent a valsalva maneuver in a client recovering from an acute myocardial infarction, the nurse would
A) Assist the client to use the bedside commode
B) Administer stool softeners every day as ordered
C) Administer antidysrhythmics prn as ordered
D) Maintain the client on strict bed rest

The correct answer is B: Administer stool softeners every day as ordered
Administering stool softeners every day will prevent straining on defecation which causes the Valsalva maneuver. If constipation occurs then laxatives would be necessary to prevent straining. If straining on defecation produced the valsalva maneuver and rhythm disturbances resulted then antidysrhythmics would be appropriate.

63. On admission to the psychiatric unit, the client is trembling and appears fearful. The nurse’s initial response should be to
A) Give the client orientation materials and review the unit rules and regulations
B) Introduce him/her and accompany the client to the client’s room
C) Take the client to the day room and introduce her to the other clients
D) Ask the nursing assistant to get the client’s vital signs and complete the admission search

The correct answer is B: Introduce him/herself and accompany the client to the client’s room
Anxiety is triggered by change that threatens the individual’s sense of security. In response to anxiety in clients, the nurse should remain calm, minimize stimuli, and move the client to a calmer, more secure/safe setting.

64. During the admission assessment on a client with chronic bilateral glaucoma, which statement by the client would the nurse anticipate since it is associated with this problem?
A) "I have constant blurred vision."
B) "I can't see on my left side."
C) "I have to turn my head to see my room."
D) "I have specks floating in my eyes."

The correct answer is C: "I have to turn my head to see my room."
Intraocular pressure becomes elevated which slowly produces a progressive loss of the peripheral visual field in the affected eye along with rainbow halos around lights. Intraocular pressure becomes elevated from the microscopic obstruction of the trabeculae meshwork. If left untreated or undetected blindness results in the affected eye.

65. A client with asthma has low pitched wheezes present on the final half of exhalation. One hour later the client has high pitched wheezes extending throughout exhalation. This change in assessment indicates to the nurse that the client
A) Has increased airway obstruction
B) Has improved airway obstruction
C) Needs to be suctioned
D) Exhibits hyperventilation

The correct answer is A: Has increased airway obstruction
The higher pitched a sound is, the more narrow the airway. Therefore, the obstruction has increased or worsened. With no evidence of secretions no support exists to indicate the need for suctioning.

66. Which behavioral characteristic describes the domestic abuser?
A) Alcoholic
B) Over confident
C) High tolerance for frustrations
D) Low self-esteem

The correct answer is D: Low self-esteem
Batterers are usually physically or psychologically abused as children or have had experiences of parental violence. Batterers are also manipulative, have a low self-esteem, and have a great need to exercise control or power-over partner.

67. The nurse is caring for a client with a long leg cast. During discharge teaching about appropriate exercises for the affected extremity, the nurse should recommend
A) Isometric
B) Range of motion
C) Aerobic
D) Isotonic

The correct answer is A: Isometric
The nurse should instruct the client on isometric exercises for the muscles of the casted extremity, i.e., instruct the client to alternately contract and relax muscles without moving the affected part. The client should also be instructed to do active range of motion exercises for every joint that is not immobilized at regular and frequent intervals.

68. A client is in her third month of her first pregnancy. During the interview, she tells the nurse that she has several sex partners and is unsure of the identity of the baby's father. Which of the following nursing interventions is a priority?
A) Counsel the woman to consent to HIV screening
B) Perform tests for sexually transmitted diseases
C) Discuss her high risk for cervical cancer
D) Refer the client to a family planning clinic

The correct answer is A: Counsel the woman to consent to HIV screening
The client''s behavior places her at high risk for HIV. Testing is the first step. If the woman is HIV positive, the earlier treatment begins, the better the outcome.

69. A 16 month-old child has just been admitted to the hospital. As the nurse assigned to this child enters the hospital room for the first time, the toddler runs to the mother, clings to her and begins to cry. What would be the initial action by the nurse?
A) Arrange to change client care assignments
B) Explain that this behavior is expected
C) Discuss the appropriate use of "time-out"
D) Explain that the child needs extra attention

The correct answer is B: Explain that this behavior is expected
During normal development, fear of strangers becomes prominent beginning around age 6-8 months. Such behaviors include clinging to parent, crying, and turning away from the stranger. These fears/behaviors extend into the toddler period and may persist into preschool.

70. While planning care for a 2 year-old hospitalized child, which situation would the nurse expect to most likely affect the behavior?
A) Strange bed and surroundings
B) Separation from parents
C) Presence of other toddlers
D) Unfamiliar toys and games

The correct answer is B: Separation from parents
Separation anxiety if most evident from 6 months to 30 months of age. It is the greatest stress imposed on a toddler by hospitalization. If separation is avoided, young children have a tremendous capacity to withstand other stress.

71. While explaining an illness to a 10 year-old, what should the nurse keep in mind about the cognitive development at this age?
A) They are able to make simple association of ideas
B) They are able to think logically in organizing facts
C) Interpretation of events originate from their own perspective
D) Conclusions are based on previous experiences

The correct answer is B: Think logically in organizing facts
The child in the concrete operations stage, according to Piaget, is capable of mature thought when allowed to manipulate and organize objects.

72. The nurse is has just admitted a client with severe depression. From which focus should the nurse identify a prioriy nursing diagnosis?
A) Nutrition
B) Elimination
C) Activity
D) Safety

The correct answer is D: Safety
Safety is a priority of care for the depressed client. Precautions to prevent suicide must be a part of the plan.

73. Which playroom activities should the nurse organize for a small group of 7 year-old hospitalized children?
A) Sports and games with rules
B) Finger paints and water play
C) "Dress-up" clothes and props
D) Chess and television programs

The correct answer is A: Sports and games with rules
The purpose of play for the 7 year-old is cooperation. Rules are very important. Logical reasoning and social skills are developed through play.

74. A client is discharged following hospitalization for congestive heart failure. The nurse teaching the family suggests they encourage the client to rest frequently in which of the following positions?
A) High Fowler's
B) Supine
C) Left lateral
D) Low Fowler's

The correct answer is A: High Fowler''s
Sitting in a chair or resting in a bed in high Fowler''s position decreases the cardiac workload and facilitates breathing.

75. The nurse is caring for a 10 year-old on admission to the burn unit. One assessment parameter that will indicate that the child has adequate fluid replacement is
A) Urinary output of 30 ml per hour
B) No complaints of thirst
C) Increased hematocrit
D) Good skin turgor around burn

The correct answer is A: Urinary output of 30 ml per hour
For a child of this age, this is adequate output, yet does not suggest overload.

MS drill Test II

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 11:13:00 +0800

MS drill Test 1 (Answers and Rationale)

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 11:08:00 +0800

Musculoskeletal Examination Answers

1. A client is 1 day postoperative after a total hip replacement. The client should be placed in which of the following position?

a. Supine
b. Semi Fowler's
c. Orthopneic
d. Trendelenburg

2. A client who has had a plaster of Paris cast applied to his forearm is receiving pain medication. To detect early manifestations of compartment syndrome, which of these assessments should the nurse make?

a. Observe the color of the fingers
b. Palpate the radial pulse under the cast
c. Check the cast for odor and drainage
d. Evaluate the response to analgesics

3. After a computer tomography scan with intravenous contrast medium, a client returns to the unit complaining of shortness of breath and itching. The nurse should be prepared to treat the client for:

a. An anaphylactic reaction to the dye
b. Inflammation from the extravasation of fluid during injection.
c. Fluid overload from the volume of the infusions
d. A normal reaction to the stress of the diagnostic procedure.

4. While caring for a client with a newly applied plaster of Paris cast, the nurse makes note of all the following conditions. Which assessment finding requires immedite notification of the physician?

a. Moderate pain, as reported by the client
b. Report, by client, the heat is being felt under the cast
c. Presence of slight edema of the toes of the casted foot
d. Onset of paralysis in the toes of the casted foot

5. Which of these nursing actions will best promote independence for the client in skeletal traction?

a. Instruct the client to call for an analgesic before pain becomes severe.
b. Provide an overhead trapeze for client use
c. Encourage leg exercise within the limits of traction
d. Provide skin care to prevent skin breakdown.

6. A client presents in the emergency department after falling from a roof. A fracture of the femoral neck is suspected. Which of these assessments best support this diagnosis.

a. The client reports pain in the affected leg
b. A large hematoma is visible in the affected extremity
c. The affected extremity is shortenend, adducted, and extremely rotated
d. The affected extremity is edematous.

7. The nurse is caring for a client with compound fracture of the tibia and fibula. Skeletal traction is applied. Which of these priorities should the nurse include in the care plan?

a. Order a trapeze to increase the client's ambulation
b. Maintain the client in a flat, supine position at all times.
c. Provide pin care at least every hour
d. Remove traction weights for 20 minutes every two hours.

8. To prevent foot drop in a client with Buck's traction, the nurse should:

a. Place pillows under the client's heels.
b. Tuck the sheets into the foot of the bed
c. Teach the client isometric exercises
d. Ensure proper body positioning.

9. Which nursing intervention is appropriate for a client with skeletal traction?

a. Pin care
b. Prone positioning
c. Intermittent weights
d. 5lb weight limit

10. In order for Buck's traction applied to the right leg to be effective, the client should be placed in which position?

a. Supine c. Sim's
b. Prone d. Lithotomy

11. An elderly client has sustained intertrochanteric fracture of the hip and has just returned from surgery where a nail plate was inserted for internal fixation. The client has been instructed that she should not flex her hip. The best explanation of why this movement would be harmful is:

a. It will be very painful for the client
b. The soft tissue around the site will be damaged
c. Displacement can occur with flexion
d. It will pull the hip out of alignment

12. When the client is lying supine, the nurse will prevent external rotation of the lower extremity by using a:

a. Trochanter roll by the knee
b. Sandbag to the lateral calf
c. Trochanter roll to the thigh
d. Footboard

13. A client has just returned from surgery after having his left leg amputated below the knee. Physician's orders include elevation of the foot of the bed for 24 hours. The nurse observes that the nursing assistant has placed a pillow under the client's amputated limb. The nursing action is to:

a. Leave the pillow as his stump is elevated
b. Remove the pillow and elevate the foot of the bed
c. Leave the pillow and elevate the foot of the bed
d. Check with the physician and clarify the orders

14. A client has sustained a fracture of the femur and balanced skeletal traction with a Thomas splint has been applied. To prevent pressure points from occurring around the top of the splint, the most important intervention is to:

a. Protect the skin with lotion
b. Keep the client pulled up in bed
c. Pad the top of the splint with washcloths
d. Provide a footplate in the bed

15. The major rationale for the use of acetylsalicylic acid (aspirin) in the treatment of rheumatoid arthritis is to:

a. Reduce fever
b. Reduce the inflammation of the joints
c. Assist the client's range of motion activities without pain
d. Prevent extension of the disease process

16. Following an amputation, the advantage to the client for an immediate prosthesis fitting is:

a. Ability to ambulate sooner
b. Less change of phantom limb sensation
c. Dressing changes are not necessary
d. Better fit of the prosthesis

17. One method of assessing for sign of circulatory impairment in a client with a fractured femur is to ask the client to:

a. Cough and deep breathe
b. Turn himself in bed
c. Perform biceps exercise
d. Wiggle his toes

18. The morning of the second postoperative day following hip surgery for a fractured right hip, the nurse will ambulate the client. The first intervention is to:

a. Get the client up in a chair after dangling at the bedside.
b. Use a walker for balance when getting the client out of bed
c. Have the client put minimal weight on the affected side when getting up
d. Practice getting the client out of bed by having her slightly flex her hips

19. A young client is in the hospital with his left leg in Buck's traction. The team leader asks the nurse to place a footplate on the affected side at the bottom of the bed. The purpose of this action is to:

a. Anchor the traction
b. Prevent footdrop
c. Keep the client from sliding down in bed
d. Prevent pressure areas on the foot

20. When evaluating all forms of traction, the nurse knows the direction of pull is controlled by the:

a. Client's position
b. Rope/pulley system
c. Amount of weight
d. Point of friction

21. When a client has cervical halter traction to immobilize the cervical spine counteraction is provided by:

a. Elevating the foot of the bed
b. Elevating the head of the bed
c. Application of the pelvic girdle
d. Lowering the head of the bed

22. After falling down the basement steps in his house, a client is brought to the emergency room. His physician confirms that his leg is fractured. Following application of a leg cast, the nurse will first check the client's toes for:

a. Increase in the temperature
b. Change in color
c. Edema
d. Movement

23. A 23 year old female client was in an automobile accident and is now a paraplegic. She is on an intermittent urinary catheterization program and diet as tolerated. The nurse's priority assessment should be to observe for:

a. Urinary retention
b. Bladder distention
c. Weight gain
d. Bower evacuation

24. A female client with rheumatoid arthritis has been on aspirin grain TID and prednisone 10mg BID for the last two years. The most important assessment question for the nurse to ask related to the client's drug therapy is whether she has

a. Headaches
b. Tarry stools
c. Blurred vision
d. Decreased appetite

25. A 7 year old boy with a fractured leg tells the nurse that he is bored. An appropriate intervention would be to

a. Read a story and act out the part
b. Watch a puppet show
c. Watch television
d. Listen to the radio

26. On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. Which of the following would be the nurse most likely to asses:

a. Limited motion of joints
b. Deformed joints of the hands
c. Early morning stiffness
d. Rheumatoid nodules

27. After teaching the client about risk factors for rheumatoid arthritis, which of the following, if stated by the client as a risk factor, would indicate to the nurse that the client needs additional teaching?

a. History of Epstein-Barr virus infection
b. Female gender
c. Adults between the ages 60 to 75 years
d. Positive testing for human leukocyte antigen (HLA) DR4 allele

28. When developing the teaching plan for the client with rheumatoid arthritis to promote rest, which of the following would the nurse expect to instruct the client to avoid during the rest periods?

a. Proper body alignment
b. Elevating the part
c. Prone lying positions
d. Positions of flexion

29. After teaching the client with severe rheumatoid arthritis about the newly prescribed medication methothrexate (Rheumatrex 0), which of the following statements indicates the need for further teaching?

a. "I will take my vitamins while I am on this drug"
b. "I must not drink any alcohol while I'm taking this drug"
c. I should brush my teeth after every meal"
d. "I will continue taking my birth control pills"

30. When completing the history and physical examination of a client diagnosed with osteoarthritis, which of the following would the nurse assess?

a. Anemia c. Weight loss
b. Osteoporosis d. Local joint pain

31. At which of the following times would the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation?

a. At bedtime c. Immediately after meal
b. On arising d. On an empty stomach

32. When preparing a teaching plan for the client with osteoarthritis who is taking celecoxib (Celebrex), the nurse expects to explain that the major advantage of celecoxib over diclofenac (Voltaren), is that the celecoxib is likely to produce which of the following?

a. Hepatotoxicity
b. Renal toxicity
c. Gastrointestinal bleeding
d. Nausea and vomiting

33. After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse interprets these findings as indicating which of the following?

a. A developing infection
b. Bleeding in the operative site
c. Joint dislocation
d. Glue seepage into soft tissue

34. Which of the following would the nurse assess in a client with an intracapsular hip fracture?

a. Internal rotation c. Shortening of the affected leg
b. Muscle flaccidity d. Absence of pain the fracture area

35. Which of the following would be inappropriate to include when preparing a client for magnetic resonance imaging (MRI) to evaluate a rupture disc?

a. Informing the client that the procedure is painless
b. Taking a thorough history of past surgeries
c. Checking for previous complaints of claustrophobia
d. Starting an intravenous line at keep-open rate

36. Which of the following actions would be a priority for a client who has been in the postanesthesia care unit (PACU) for 45 minutes after an above the knee amputation and develops a dime size bright red spot on the ace bondage above the amputation site?

a. Elevate the stump
b. Reinforcing the dressing
c. Calling the surgeon
d. Drawing a mark around the site

37. A client in the PACU with a left below the knee amputation complains of pain in her left big toe. Which of the following would the nurse do first?

a. Tell the client it is impossible to feel the pain
b. Show the client that the toes are not there
c. Explain to the client that the pain is real
d. Give the client the prescribed narcotic analgesic

38. The client with an above the knee amputation is to use crutches until the prosthesis is being adjusted. In which of the following exercises would the nurse instruct the client to best prepare him for using crutches?

a. Abdominal exercises
b. Isometric shoulder exercises
c. Quadriceps setting exercises
d. Triceps stretching exercises

39. The client with an above the knee amputation is to use crutches until the prosthesis is properly lifted. When teaching the client about using the crutches, the nurse instructs the client to support her weight primarily on which of the following body areas?

a. Axillae
b. Elbows
c. Upper arms
d. Hands

40. Three hours ago a client was thrown from a car into a ditch, and he is now admitted to the ED in a stable condition with vital signs within normal limits, alert and oriented with good coloring and an open fracture of the right tibia. When assessing the client, the nurse would be especially alert for signs and symptoms of which of the following?

a. Hemorrhage
b. Infection
c. Deformity
d. Shock

41. The client with a fractured tibia has been taking methocarbamol (Robaxin), when teaching the client about this drug, which of the following would the nurse include as the drug's primary effect?

a. Killing of microorganisms
b. Reduction in itching
c. Relief of muscle spasms
d. Decrease in nervousness

42. A client who has been taking carisoprodol (Soma) at home for a fractured arm is admitted with a blood pressure of 80/50 mmHg, a pulse rate of 115bpm, and respirations of 8 breaths/minute and shallow, the nurse interprets these finding as indicating which of the following?

a. Expected common side effects
b. Hypersensitivity reactions
c. Possible habituating effects
d. Hemorrhage from GI irritation

43. When admitting a client with a fractured extremity, the nurse would focus the assessment on which of the following first?

a. The area proximal to the fracture
b. The actual fracture site
c. The area distal to the fracture
d. The opposite extremity for baseline comparison

44. A client with fracture develops compartment syndrome. When caring for the client, the nurse would be alert for which of the following signs of possible organ failure?

a. Rales c. Generalized edema
b. Jaundice d. Dark, scanty urine

45. Which of the following would lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat embolus?

a. Acute respiratory distress syndrome
b. Migraine like headaches
c. Numbness in the right leg
d. Muscle spasms in the right thigh

46. The client who had an open femoral fracture was discharged to her home, where she developed, fever, night sweats, chills, restlessness and restrictive movement of the fractured leg. The nurse interprets these finding as indicating which of the following?

a. Pulmonary emboli
b. Osteomyelitis
c. Fat emboli
d. Urinary tract infection

47. When antibiotics are not producing the desired outcome for a client with osteomyelitis, the nurse interprets this as suggesting the occurrence of which of the following as most likely?

a. Formation of scar tissue interfering with absorption
b. Development of pus leading to ischemia
c. Production of bacterial growth by avascular tissue
d. Antibiotics not being instilled directly into the bone

48. Which of the following would the nurse use as the best method to assess for the development of deep vein thrombosis in a client with a spinal cord injury?

a. Homan's sign c. Tenderness
b. Pain d. Leg girth

49. The nurse is caring for the client who is going to have an arthogram using a contrast medium. Which of the following assessments by the nurse are of highest priority?

a. Allergy to iodine or shellfish
b. Ability of the client to remain still during the procedure
c. Whether the client has any remaining questions about the procedure
d. Whether the client wishes to void before the procedure

50. The client immobilized skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse formulates which of the following nursing diagnoses for this client?

a. Divertional activity deficit
b. Powerlessness
c. Self care deficit
d. Impaired physical mobility

51. The nurse is teaching the client who is to have a gallium scan about the procedure. The nurse includes which of the following items as part of the instructions?

a. The gallium will be injected intravenously 2 to 3 hours before the procedure
b. The procedure takes about 15 minutes to perform
c. The client must stand erect during the filming
d. The client should remain on bed rest for the remainder of the day after the scan

52. The nurse is assessing the casted extremity of a client. The nurse assesses for which of the following signs and symptoms indicative of infection?

a. Coolness and pallor of the extremity
b. Presence of a "hot spot" on the cast
c. Diminished distal pulse
d. Dependent edema

53. The client has Buck's extension applied to the right leg. The nurse plans which of the following interventions to prevent complications of the device?

a. Massage the skin of the right leg with lotion every 8 hours
b. Give pin care once a shift
c. Inspect the skin on the right leg at least once every 8 hours
d. Release the weights on the right leg for range of motion exercises daily

54. The nurse is giving the client with a left cast crutch walking instructions using the three point gait. The client is allowed touchdown of the affected leg. The nurse tells the client to advance the:

a. Left leg and right crutch then right leg and left crutch
b. Crutches and then both legs simultaneously
c. Crutches and the right leg then advance the left leg
d. Crutches and the left leg then advance the right leg

55. The client with right sided weakness needs to learn how to use a cane. The nurse plans to teach the client to position the cane by holding it with the:

a. Left hand and placing the cane in front of the left foot
b. Right hand and placing the cane in front of the right foot
c. Left hand and 6 inches lateral to the left foot
d. Right hand and 6 inches lateral to the left foot

56. The nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. The nurse uses a:

a. Pillow to keep the right leg abducted during turning
b. Pillow to keep the right leg adducted during turning
c. Trochanter roll to prevent external rotation while turning
d. Trochanter roll to prevent abduction while turning

57. The nurse has an order to get the client out of bed to a chair on the first postoperative day after a total knee replacement. The nurse plans to do which of the following to protect the knee joint:

a. Apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting
b. Apply an Ace wrap around the dressing and put ice on the knee while sitting
c. Lift the client to the bedside change leaving the CPM machine in place
d. Obtain a walker to minimize weight bearing by the client on the affected leg

58. The nurse is caring for the client who had an above the knee amputation 2days ago. The residual limb was wrapped with an elastic compression bandage which has come off. The nurse immediately:

a. Calls the physician
b. Rewrap the stump with an elastic compression bandage
c. Applies ice to the site
d. Applies a dry sterile dressing and elevates it on a pillow

59. The nurse has taught the client with a below the knee amputation about prosthesis and stump care. The nurse evaluates that the client states to:

a. Wear a clean nylon stump sock daily
b. Toughen the skin of the stump by rubbing it with alcohol
c. Prevent cracking of the skin of the stump by applying lotion daily
d. Using a mirror to inspect all areas of the stump each day

60. The nurse is caring for a client with a gout. Which of the following laboratory values does the nurse expect to note in the client?

a. Uric acid level of 8 mg/dl
b. Calcium level of 9 mg/dl
c. Phosphorus level of 3 mg/dl
d. Uric acid level of 5 mg/dl

MS drill Test 1

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 11:05:00 +0800

Musculoskeletal Examination

1. A client is 1 day postoperative after a total hip replacement. The client should be placed in which of the following position?

a. Supine
b. Semi Fowler's
c. Orthopneic
d. Trendelenburg

2. A client who has had a plaster of Paris cast applied to his forearm is receiving pain medication. To detect early manifestations of compartment syndrome, which of these assessments should the nurse make?

a. Observe the color of the fingers
b. Palpate the radial pulse under the cast
c. Check the cast for odor and drainage
d. Evaluate the response to analgesics

3. After a computer tomography scan with intravenous contrast medium, a client returns to the unit complaining of shortness of breath and itching. The nurse should be prepared to treat the client for:

a. An anaphylactic reaction to the dye
b. Inflammation from the extravasation of fluid during injection.
c. Fluid overload from the volume of the infusions
d. A normal reaction to the stress of the diagnostic procedure.

4. While caring for a client with a newly applied plaster of Paris cast, the nurse makes note of all the following conditions. Which assessment finding requires immedite notification of the physician?

a. Moderate pain, as reported by the client
b. Report, by client, the heat is being felt under the cast
c. Presence of slight edema of the toes of the casted foot
d. Onset of paralysis in the toes of the casted foot

5. Which of these nursing actions will best promote independence for the client in skeletal traction?

a. Instruct the client to call for an analgesic before pain becomes severe.
b. Provide an overhead trapeze for client use
c. Encourage leg exercise within the limits of traction
d. Provide skin care to prevent skin breakdown.

6. A client presents in the emergency department after falling from a roof. A fracture of the femoral neck is suspected. Which of these assessments best support this diagnosis.

a. The client reports pain in the affected leg
b. A large hematoma is visible in the affected extremity
c. The affected extremity is shortenend, adducted, and extremely rotated
d. The affected extremity is edematous.

7. The nurse is caring for a client with compound fracture of the tibia and fibula. Skeletal traction is applied. Which of these priorities should the nurse include in the care plan?

a. Order a trapeze to increase the client's ambulation
b. Maintain the client in a flat, supine position at all times.
c. Provide pin care at least every hour
d. Remove traction weights for 20 minutes every two hours.

8. To prevent foot drop in a client with Buck's traction, the nurse should:

a. Place pillows under the client's heels.
b. Tuck the sheets into the foot of the bed
c. Teach the client isometric exercises
d. Ensure proper body positioning.

9. Which nursing intervention is appropriate for a client with skeletal traction?

a. Pin care
b. Prone positioning
c. Intermittent weights
d. 5lb weight limit

10. In order for Buck's traction applied to the right leg to be effective, the client should be placed in which position?

a. Supine c. Sim's
b. Prone d. Lithotomy

11. An elderly client has sustained intertrochanteric fracture of the hip and has just returned from surgery where a nail plate was inserted for internal fixation. The client has been instructed that she should not flex her hip. The best explanation of why this movement would be harmful is:

a. It will be very painful for the client
b. The soft tissue around the site will be damaged
c. Displacement can occur with flexion
d. It will pull the hip out of alignment

12. When the client is lying supine, the nurse will prevent external rotation of the lower extremity by using a:

a. Trochanter roll by the knee
b. Sandbag to the lateral calf
c. Trochanter roll to the thigh
d. Footboard

13. A client has just returned from surgery after having his left leg amputated below the knee. Physician's orders include elevation of the foot of the bed for 24 hours. The nurse observes that the nursing assistant has placed a pillow under the client's amputated limb. The nursing action is to:

a. Leave the pillow as his stump is elevated
b. Remove the pillow and elevate the foot of the bed
c. Leave the pillow and elevate the foot of the bed
d. Check with the physician and clarify the orders

14. A client has sustained a fracture of the femur and balanced skeletal traction with a Thomas splint has been applied. To prevent pressure points from occurring around the top of the splint, the most important intervention is to:

a. Protect the skin with lotion
b. Keep the client pulled up in bed
c. Pad the top of the splint with washcloths
d. Provide a footplate in the bed

15. The major rationale for the use of acetylsalicylic acid (aspirin) in the treatment of rheumatoid arthritis is to:

a. Reduce fever
b. Reduce the inflammation of the joints
c. Assist the client's range of motion activities without pain
d. Prevent extension of the disease process

16. Following an amputation, the advantage to the client for an immediate prosthesis fitting is:

a. Ability to ambulate sooner
b. Less change of phantom limb sensation
c. Dressing changes are not necessary
d. Better fit of the prosthesis

17. One method of assessing for sign of circulatory impairment in a client with a fractured femur is to ask the client to:

a. Cough and deep breathe
b. Turn himself in bed
c. Perform biceps exercise
d. Wiggle his toes

18. The morning of the second postoperative day following hip surgery for a fractured right hip, the nurse will ambulate the client. The first intervention is to:

a. Get the client up in a chair after dangling at the bedside.
b. Use a walker for balance when getting the client out of bed
c. Have the client put minimal weight on the affected side when getting up
d. Practice getting the client out of bed by having her slightly flex her hips

19. A young client is in the hospital with his left leg in Buck's traction. The team leader asks the nurse to place a footplate on the affected side at the bottom of the bed. The purpose of this action is to:

a. Anchor the traction
b. Prevent footdrop
c. Keep the client from sliding down in bed
d. Prevent pressure areas on the foot

20. When evaluating all forms of traction, the nurse knows the direction of pull is controlled by the:

a. Client's position
b. Rope/pulley system
c. Amount of weight
d. Point of friction

21. When a client has cervical halter traction to immobilize the cervical spine counteraction is provided by:

a. Elevating the foot of the bed
b. Elevating the head of the bed
c. Application of the pelvic girdle
d. Lowering the head of the bed

22. After falling down the basement steps in his house, a client is brought to the emergency room. His physician confirms that his leg is fractured. Following application of a leg cast, the nurse will first check the client's toes for:

a. Increase in the temperature
b. Change in color
c. Edema
d. Movement

23. A 23 year old female client was in an automobile accident and is now a paraplegic. She is on an intermittent urinary catheterization program and diet as tolerated. The nurse's priority assessment should be to observe for:

a. Urinary retention
b. Bladder distention
c. Weight gain
d. Bower evacuation

24. A female client with rheumatoid arthritis has been on aspirin grain TID and prednisone 10mg BID for the last two years. The most important assessment question for the nurse to ask related to the client's drug therapy is whether she has

a. Headaches
b. Tarry stools
c. Blurred vision
d. Decreased appetite

25. A 7 year old boy with a fractured leg tells the nurse that he is bored. An appropriate intervention would be to

a. Read a story and act out the part
b. Watch a puppet show
c. Watch television
d. Listen to the radio

26. On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. Which of the following would be the nurse most likely to asses:

a. Limited motion of joints
b. Deformed joints of the hands
c. Early morning stiffness
d. Rheumatoid nodules

27. After teaching the client about risk factors for rheumatoid arthritis, which of the following, if stated by the client as a risk factor, would indicate to the nurse that the client needs additional teaching?

a. History of Epstein-Barr virus infection
b. Female gender
c. Adults between the ages 60 to 75 years
d. Positive testing for human leukocyte antigen (HLA) DR4 allele

28. When developing the teaching plan for the client with rheumatoid arthritis to promote rest, which of the following would the nurse expect to instruct the client to avoid during the rest periods?

a. Proper body alignment
b. Elevating the part
c. Prone lying positions
d. Positions of flexion

29. After teaching the client with severe rheumatoid arthritis about the newly prescribed medication methothrexate (Rheumatrex 0), which of the following statements indicates the need for further teaching?

a. "I will take my vitamins while I am on this drug"
b. "I must not drink any alcohol while I'm taking this drug"
c. I should brush my teeth after every meal"
d. "I will continue taking my birth control pills"

30. When completing the history and physical examination of a client diagnosed with osteoarthritis, which of the following would the nurse assess?

a. Anemia c. Weight loss
b. Osteoporosis d. Local joint pain

31. At which of the following times would the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation?

a. At bedtime c. Immediately after meal
b. On arising d. On an empty stomach

32. When preparing a teaching plan for the client with osteoarthritis who is taking celecoxib (Celebrex), the nurse expects to explain that the major advantage of celecoxib over diclofenac (Voltaren), is that the celecoxib is likely to produce which of the following?

a. Hepatotoxicity
b. Renal toxicity
c. Gastrointestinal bleeding
d. Nausea and vomiting

33. After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse interprets these findings as indicating which of the following?

a. A developing infection
b. Bleeding in the operative site
c. Joint dislocation
d. Glue seepage into soft tissue

34. Which of the following would the nurse assess in a client with an intracapsular hip fracture?

a. Internal rotation c. Shortening of the affected leg
b. Muscle flaccidity d. Absence of pain the fracture area

35. Which of the following would be inappropriate to include when preparing a client for magnetic resonance imaging (MRI) to evaluate a rupture disc?

a. Informing the client that the procedure is painless
b. Taking a thorough history of past surgeries
c. Checking for previous complaints of claustrophobia
d. Starting an intravenous line at keep-open rate

36. Which of the following actions would be a priority for a client who has been in the postanesthesia care unit (PACU) for 45 minutes after an above the knee amputation and develops a dime size bright red spot on the ace bondage above the amputation site?

a. Elevate the stump
b. Reinforcing the dressing
c. Calling the surgeon
d. Drawing a mark around the site

37. A client in the PACU with a left below the knee amputation complains of pain in her left big toe. Which of the following would the nurse do first?

a. Tell the client it is impossible to feel the pain
b. Show the client that the toes are not there
c. Explain to the client that the pain is real
d. Give the client the prescribed narcotic analgesic

38. The client with an above the knee amputation is to use crutches until the prosthesis is being adjusted. In which of the following exercises would the nurse instruct the client to best prepare him for using crutches?

a. Abdominal exercises
b. Isometric shoulder exercises
c. Quadriceps setting exercises
d. Triceps stretching exercises

39. The client with an above the knee amputation is to use crutches until the prosthesis is properly lifted. When teaching the client about using the crutches, the nurse instructs the client to support her weight primarily on which of the following body areas?

a. Axillae
b. Elbows
c. Upper arms
d. Hands

40. Three hours ago a client was thrown from a car into a ditch, and he is now admitted to the ED in a stable condition with vital signs within normal limits, alert and oriented with good coloring and an open fracture of the right tibia. When assessing the client, the nurse would be especially alert for signs and symptoms of which of the following?

a. Hemorrhage
b. Infection
c. Deformity
d. Shock

41. The client with a fractured tibia has been taking methocarbamol (Robaxin), when teaching the client about this drug, which of the following would the nurse include as the drug's primary effect?

a. Killing of microorganisms
b. Reduction in itching
c. Relief of muscle spasms
d. Decrease in nervousness

42. A client who has been taking carisoprodol (Soma) at home for a fractured arm is admitted with a blood pressure of 80/50 mmHg, a pulse rate of 115bpm, and respirations of 8 breaths/minute and shallow, the nurse interprets these finding as indicating which of the following?

a. Expected common side effects
b. Hypersensitivity reactions
c. Possible habituating effects
d. Hemorrhage from GI irritation

43. When admitting a client with a fractured extremity, the nurse would focus the assessment on which of the following first?

a. The area proximal to the fracture
b. The actual fracture site
c. The area distal to the fracture
d. The opposite extremity for baseline comparison

44. A client with fracture develops compartment syndrome. When caring for the client, the nurse would be alert for which of the following signs of possible organ failure?

a. Rales c. Generalized edema
b. Jaundice d. Dark, scanty urine

45. Which of the following would lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat embolus?

a. Acute respiratory distress syndrome
b. Migraine like headaches
c. Numbness in the right leg
d. Muscle spasms in the right thigh

46. The client who had an open femoral fracture was discharged to her home, where she developed, fever, night sweats, chills, restlessness and restrictive movement of the fractured leg. The nurse interprets these finding as indicating which of the following?

a. Pulmonary emboli
b. Osteomyelitis
c. Fat emboli
d. Urinary tract infection

47. When antibiotics are not producing the desired outcome for a client with osteomyelitis, the nurse interprets this as suggesting the occurrence of which of the following as most likely?

a. Formation of scar tissue interfering with absorption
b. Development of pus leading to ischemia
c. Production of bacterial growth by avascular tissue
d. Antibiotics not being instilled directly into the bone

48. Which of the following would the nurse use as the best method to assess for the development of deep vein thrombosis in a client with a spinal cord injury?

a. Homan's sign c. Tenderness
b. Pain d. Leg girth

49. The nurse is caring for the client who is going to have an arthogram using a contrast medium. Which of the following assessments by the nurse are of highest priority?

a. Allergy to iodine or shellfish
b. Ability of the client to remain still during the procedure
c. Whether the client has any remaining questions about the procedure
d. Whether the client wishes to void before the procedure

50. The client immobilized skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse formulates which of the following nursing diagnoses for this client?

a. Divertional activity deficit
b. Powerlessness
c. Self care deficit
d. Impaired physical mobility

51. The nurse is teaching the client who is to have a gallium scan about the procedure. The nurse includes which of the following items as part of the instructions?

a. The gallium will be injected intravenously 2 to 3 hours before the procedure
b. The procedure takes about 15 minutes to perform
c. The client must stand erect during the filming
d. The client should remain on bed rest for the remainder of the day after the scan

52. The nurse is assessing the casted extremity of a client. The nurse assesses for which of the following signs and symptoms indicative of infection?

a. Coolness and pallor of the extremity
b. Presence of a "hot spot" on the cast
c. Diminished distal pulse
d. Dependent edema

53. The client has Buck's extension applied to the right leg. The nurse plans which of the following interventions to prevent complications of the device?

a. Massage the skin of the right leg with lotion every 8 hours
b. Give pin care once a shift
c. Inspect the skin on the right leg at least once every 8 hours
d. Release the weights on the right leg for range of motion exercises daily

54. The nurse is giving the client with a left cast crutch walking instructions using the three point gait. The client is allowed touchdown of the affected leg. The nurse tells the client to advance the:

a. Left leg and right crutch then right leg and left crutch
b. Crutches and then both legs simultaneously
c. Crutches and the right leg then advance the left leg
d. Crutches and the left leg then advance the right leg

55. The client with right sided weakness needs to learn how to use a cane. The nurse plans to teach the client to position the cane by holding it with the:

a. Left hand and placing the cane in front of the left foot
b. Right hand and placing the cane in front of the right foot
c. Left hand and 6 inches lateral to the left foot
d. Right hand and 6 inches lateral to the left foot

56. The nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. The nurse uses a:

a. Pillow to keep the right leg abducted during turning
b. Pillow to keep the right leg adducted during turning
c. Trochanter roll to prevent external rotation while turning
d. Trochanter roll to prevent abduction while turning

57. The nurse has an order to get the client out of bed to a chair on the first postoperative day after a total knee replacement. The nurse plans to do which of the following to protect the knee joint:

a. Apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting
b. Apply an Ace wrap around the dressing and put ice on the knee while sitting
c. Lift the client to the bedside change leaving the CPM machine in place
d. Obtain a walker to minimize weight bearing by the client on the affected leg

58. The nurse is caring for the client who had an above the knee amputation 2days ago. The residual limb was wrapped with an elastic compression bandage which has come off. The nurse immediately:

a. Calls the physician
b. Rewrap the stump with an elastic compression bandage
c. Applies ice to the site
d. Applies a dry sterile dressing and elevates it on a pillow

59. The nurse has taught the client with a below the knee amputation about prosthesis and stump care. The nurse evaluates that the client states to:

a. Wear a clean nylon stump sock daily
b. Toughen the skin of the stump by rubbing it with alcohol
c. Prevent cracking of the skin of the stump by applying lotion daily
d. Using a mirror to inspect all areas of the stump each day

60. The nurse is caring for a client with a gout. Which of the following laboratory values does the nurse expect to note in the client?

a. Uric acid level of 8 mg/dl
b. Calcium level of 9 mg/dl
c. Phosphorus level of 3 mg/dl
d. Uric acid level of 5 mg/dl

ANSWERS and RATIONALE

PEDIA TEST DRILL (ANSWERS and RATIONALE)

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 10:46:00 +0800

Situation 1: Raphael, a 6 year’s old prep pupil is seen at the school clinic for growth and development monitoring (Questions 1-5)

1. Which of the following is characterized the rate of growth during this period?
a. most rapid period of growth
b. a decline in growth rate
c. growth spurt
d. slow uniform growth rate

Correct answer is letter B. During the Preschooler stage growth is very minimal. Weight gain is only 4.5lbs (2kgs) per year and Height is 3.5in (6-8cm) per year.
Review:
Most rapid growth and development- Infancy
Slow growth- Toddler hood and Preschooler
Slower growth- School age
Rapid growth- Adolescence

2. In assessing Raphael’s growth and development, the nurse is guided by principles of growth and development. Which is not included?
a. All individuals follow cephalo-caudal and proximo-distal
b. Different parts of the body grows at different rate
c. All individual follow standard growth rate
d. Rate and pattern of growth can be modified

Growth and development occurs in cephalo-caudal meaning development occurs through out the body’s axis. Example: the child must be able to lift the head before he is able to lift his chest. Proximo-distal is development that progresses from center of the body to the extremities. Example: a child first develops arm movement before fine-finger movement. Different parts of the body grows at different range because some body tissue mature faster than the other such as the neurologic tissues peaks its growth during the first years of life while the genital tissue doesn’t till puberty. Also G&D is predictable in the sequence which a child normally precedes such as motor skills and behavior. Lastly G&D can never be modified “Haller? (Pwede mo bang turuan mag basa ang Infant? Or patayuin sya bago pa nakakagapang?)

3. What type of play will be ideal for Raphael at this period?
a. Make believe
b. Hide and seek
c. Peek-a-boo
d. Building blocks

Correct answer is Letter A, make believe is most appropriate because it enhances the imitative play and imagination of the preschooler. C and D are for infants while letter A is B is recommended for schoolers because it enhances competitive play.

4. Which of the following information indicate that Raphael is normal for his age?
a. Determine own sense self
b. Develop sense of whether he can trust the world
c. Has the ability to try new things
d. Learn basic skills within his culture

The correct answer is letter C; because Erickson defines the developmental task of a preschool period is learning Initiative vs. Guilt. Children can initiate motor activities of various sorts on their own and no longer responds to or imitate the actions of other children or of their parents. Letter A and B is.. for you!!

5. Based on Kohlberg’s theory, what is the stage of moral development of Raphael?
a. Punishment-obedience
b. “good boy-Nice girl”
c. naïve instrumental orientation
d. social contact

Correct answer is letter C: According to Kohlber, a preschooler is under Pre-conventional where a child learns about instrumental purpose and exchange, that is they will something do for another if that that person does something with the child in return. Letter A is applicable for Toddlers and letter B is for a School age child.

Situation 2 Baby boy Lacson delivered at 36 weeks gestation weighs 3,400 gm and height of 59 cm (6-10)

6. Baby boy Lacson’s height is
a. Long
b. Short
c. Average
d. Too short

Correct answer is Letter A because the normal length of a newborn is 47.5-53.75 cm (19.5-21in) with an average of 50cm (Filipino standards po ito, pag kay Pilliteri nyo tinignan, 53cm for female and 54cm for male)

7. Growth and development in a child progresses in the following ways EXCEPT
a. From cognitive to psychosexual
b. From trunk to the tip of the extremities
c. From head to toe
d. From general to specific

Growth and development occurs in cephalo-caudal (head to toe), proximo-distal (trunk to tips of the extremities and general to specific, but it doesn’t occurs in cognitive to psychosexual because they can develop at the same time.

8. As described by Erikson, the major psychosexual conflict of the above situation is
a. Autonomy vs. Shame and doubt
b. Industry vs. Inferiority
c. Trust vs. mistrust
d. Initiation vs. guilt

According to Erikson, children 0-18 months are under the developmental task of Trust vs. Mistrust.

9. Which of the following is true about Mongolian Spots?
a. Disappears in about a year
b. Are linked to pathologic conditions
c. Are managed by tropical steroids
d. Are indicative of parental abuse

Mongolian spots are stale grey or bluish patches of discoloration commonly seen across the sacrum or buttocks due to accumulation of melanocytes and they disappears in 1 year. They are not linked to steroid use and pathologic conditions.

10. Signs of cold stress that the nurse must be alert when caring for a Newborn is:
a. Hypothermia
b. Decreased activity level
c. Shaking
d. Increased RR

Correct answer is letter D. Hypothermia is inaccurate cause normally, temperature of a newborn drop, Also a child under cold stress will kick and cry to increase the metabolic rate thereby increasing heat so B isn’t a good choice. A newborn doesn’t have the ability to shiver (Pag ikaw ay nag pa anak at ang beybe ay nanga-ngatog, naku itapon mo yan..di yan beybe itik yan.. hehe). So letter B and C is wrong. A newborn will increase its RR because the NB will need more oxygen because of too much activity.

Situation 3 Nursing care after delivery has an important aspect in every stages of delivery

11. After the baby is delivered, the cord was cut between two clamps using a sterile scissors and blade, then the baby is placed at the:
a. Mother’s breast
b. Mother’s side
c. Give it to the grandmother
d. Baby’s own mat or bed

Of course, place it at the mother’s breast for latch-on. (Note: for NSD breast feed ASAP while for CS delivery, breast feed after 4 hours) Lol, syempre d naman pwede sa grandma dba? Kasi naman hindi gatas ang ipapadede nyan, yogurt na sosyal. ewwww. LOL

12. The baby’s mother is RH(-). Which of the following laboratory tests will probably be ordered for the newborn?
a. Direct Coomb’s
b. Indirect Coomb’s
c. Blood culture
d. Platelet count

Coomb’s test is the test to determine if RH antibodies are present. Indirect Coomb’s is done to the mother and Direct Coomb’s is the one don’t to the baby. Blood culture and Platelet count doesn’t help detect RH antibodies.

13. Hypothermia is common in newborn because of their inability to control heat. The following would be an appropriate nursing intervention to prevent heat loss except
a. Place the crib beside the wall
b. Doing Kangaroo care
c. By using mechanical pressure
d. Drying and wrapping the baby

Placing the crib beside the wall is un-appropriate because it can provide heat loss by radiation. Doing Kangaroo care or hugging the baby, mechanical pressure or incubators and drying and wrapping the baby will help conserve heat,

14. The following conditions are caused by cold stress except
a. Hypoglycemia
b. Increase ICP
c. Metabolic acidosis
d. Cerebral palsy

Hypoglycemia may occur due to increase metabolic rate, And because of newborns are born slightly acidic, and they catabolize brownfat which will produce ketones which is an acid will cause metabolic acidosis. Also a NB with severe hypothermia is in high risk for kernicterus (too much bilirubin in the brain) can lead to Cerebral palsy. There is no connection in the increase of ICP with hypothermia.
(NOTE: pathognomonic sign of Kernicterus in adult- asterexis, or involuntary flapping of the hand.)

15. During the feto-placental circulation, the shunt between two atria is called
a. Ductus venosous
b. Foramen Magnum
c. Ductus arteriosus
d. Foramen Ovale

Foramen ovale is opening between two atria, Ductus venosus is the shunt from liver to the inferior vena cava, and your Ductus Arteriosus is the shunt from the pulmonary artery to the aorta. (hindi kasali sa feto-placental circulation ang Foramen Magnum, sa skull un!)

16. What would cause the closure of the Foramen ovale after the baby had been delivered?
a. Decreased blood flow
b. Shifting of pressures from right side to the left side of the heart
c. Increased PO2
d. Increased in oxygen saturation

During feto-placental circulation, the pressure in the heart is much higher in the right side, but once breathing/crying is established, the pressure will shift from the R to the L side, and will facilitate the closure of Foramen Ovale. (Note: that is why you should position the NB in R side lying position to increase pressure in the L side of the heart.)
Review:
Increase PO2-> closure of ductus arteriosus
Decreased bloodflow -> closure of the ductus venosus
Circulation in the lungs is initiated by -> lung expansion and pulmonary ventilation
What will sustain 1st breath-> decreased artery pressure
What will complete circulation-> cutting of the cord

17. Failure of the Foramen Ovale to close will cause what Congenital Heart Disease?
a. Total anomalous Pulmunary Artery
b. Atrial Septal defect
c. Transposition of great arteries
d. Pulmunary Stenosis

Foramen ovale is the opening between two Atria so, if its will not close Atrial Septal defect can occur.

Situation 4 Children are vulnerable to some minor health problems or injuries hence the nurse should be able to teach mothers to give appropriate home care.

18. A mother brought her child to the clinic with nose bleeding. The nurse showed the mother the most appropriate position for the child which is:
a. Sitting up
b. With low back rest
c. With moderate back rest
d. Lying semi flat

The correct position is making the child having an upright sitting position with the head slightly tilted forward. This position will minimize the amount of blood pressure in nasal vessels and keep blood moving forward not back into the nasopharynx, which will have the choking sensation and increase risk of aspiration. Choices b, c, d, are inappropriate cause they can cause blood to enter the nasopharynx.

19. A common problem in children is the inflammation of the middle ear. This is related to the malfunctioning of the:
a. Tympanic membrane
b. Eustachian tube
c. Adenoid
d. Nasopharynx

This is because children has short, horizontal Eustachian tubes. The dysfunction in the Eustachian tube enables bacterial invasion of the middle ear and obstructs drainage of secretions.

20. For acute otitis media, the treatment is prompt antibiotic therapy. Delayed treatment may result in complications of:
a. Tonsillitis
b. Eardrum Problems
c. Brain damage
d. Diabetes mellitus

One of the complication of recurring acute otitis media is risk for having Meningitis, thereby causing possible brain damage. That is why patient must follow a complete treatment regimen and follow up care. A and B are not complications of AOM, (lalo na ung D!!)

21. When assessing gross motor development in a 3 year old, which of the following activities would the nurse expect to finds?
a. Riding a tricycle
b. Hopping on one foot
c. Catching a ball
d. Skipping on alternate foot.

Answer is A, riding a tricycle is appropriate for a 3 y/o child. Hopping on one foot can be done by a 4 y/o child, as well as catching and throwing a ball over hand. Skipping can be done by a 5 y/o.

22. When assessing the weight of a 5-month old, which of the following indicates healthy growth?
a. Doubling of birth weight
b. Tripling of birth weight
c. Quadrupling of birth weight
d. Stabilizing of birth weight

During the first 6 months of life the weight from birth will be doubled and as soon as the baby reaches 1 year, its birth weight is tripled.

23. An appropriate toy for a 4 year old child is:
a. Push-pull toys
b. Card games
c. Doctor and nurse kits
d. Books and Crafts

Letter C is appropriate because it will enhance the creativity and imagination of a pre-school child. Letter B and D are inappropriate because they are too complex for a 4 y/o. Push-pull toys are recommended for infants.

24. Which of the following statements would the nurse expects a 5-year old boy to say whose pet gerbil just died
a. “The boogieman (kamatayan- the man with the scythe) got him”
b. “He’s just a bit dead”
c. “Ill be good from now own so I wont die like my gerbil”
d. “Did you hear the joke about…”

A 5 y/o views death in “degrees”, so the child most likely will say that “he is just a bit dead”. Personification of death like boogeyman or “kamatayan” occurs in ages 7 to 9 as well as denying death can if they will be good. Denying death using jokes and attributing life qualities to death occurs during age 3-5.

25. When assessing the fluid and electrolyte balance in an infant, which of the following would be important to remember?
a. Infant can concentrate urine at an adult level
b. The metabolic rate of an infant is slower than in adults
c. Infants have more intracellular water that adult do
d. Infant have greater body surface area than adults

Infants have greater body surface area than adult, increasing their risk to F&E imbalances. Also infants cant concentrate a urine at an adult level and their metabolic rate, also called water turnover, is 2 to 3 times higher than adult. Plus more fluids of the infants are at the ECF spaces not in the ICF spaces.

26. When assessing a child with aspirin overdose, which of the following will be expected?
a. Metabolic alkalosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Respiratory acidosis

Remember that Aspirin is acid (Acetylsalicylic ACID), so what do you expect? (ang taray LOL) UN NA!
Review:
Pag galling sa bibig: alkalosis (hyper-emesis)
Pag galling sap wet: acidosis (diarrhea)

27. Which of the following is not a possible systemic clinical manifestation of severe burns?
a. Growth retardation
b. Hypermetabolism
c. Sepsis
d. Blisters and edema

The question was asking for a SYSTEMIC clinical manifestation, Letters A,B and C are systemic manifestations while Blisters and Edema weren’t.

28. When assessing a family for potential child abuse risks, the nurse would observe for which of the following?
a. Periodic exposure to stress
b. Low socio-economic status
c. High level of self esteem
d. Problematic pregnancies

Answer is D, Typical factors that may be risk for Child abuse are problematic pregnancies, chronic exposure to stress not periodic, low level of self esteem not high level. Also child abuse can happen in all socio-economic status not just on low socio-economic status.

29. Which of the following is a possible indicator of Munchausen syndrome by proxy type of child abuse?
a. Bruises found at odd locations, with different stages of healing
b. STD’s and genital discharges
c. Unexplained symptoms of diarrhea, vomiting and apnea with no organic basis
d. Constant hunger and poor hygiene

Munchausen syndrome by Proxy is the fabrication or inducement of an illness by one person to another person, usually mother to child. It is characterized by symptoms such as apnea and siezures, which may be due to suffocation, drugs or poisoning, vomiting which can be induced with poisons and diarrhea with the use of laxatives. Letter A can be seen in a Physical abuse, Letter B for sexual abuse and Letter C is for Physical Neglect.

30. Which of the following is an inappropriate intervention when caring for a child with HIV?
a. Teaching family about disease transmission
b. Offering large amount of fresh fruits and vegetables
c. Encouraging child to perform at optimal level
d. Teach proper hand washing technique

A child with HIV is immunocompromised. Fresh fruits and vegetables, which may be contaminated with organisms and pesticides can be harmful, if not fatal to the child, therefore these items should be avoided.

Situation 5 Agata, 2 years old is rushed to the ER due to cyanosis precipitated by crying. Her mother observed that after playing she gets tired. She was diagnosed with Tetralogy of Fallot.

31. The goal of nursing care fro Agata is to:
a. Prevent infection
b. Promote normal growth and development
c. Decrease hypoxic spells
d. Hydrate adequately

The correct answer is letter C. Though letter B would be a good answer too, this goal is too vague and not specific. Nursing interventions will not solely promote normal G&D unless he will undergo surgical repair. So decreasing Hypoxic Spells is more SMART. (alam nyo na kung ano yun! Specific, measurable, attainable, realistic and time bounded). Letter A and D are inappropriate.
REVIEW! REVIEW! REVIEW!
Tetralogy of Fallot is a cyanotic Congenital Heart disease. Kaya sa tinawag na Tetralogy cause it has 4 anomalies;
1. VSD- ventricular septal defect
2. Pulmunary Stenosis
3. Over-riding of the Aorta- the aorta overrides both ventricles
4. Right ventricular hypertrophy

We have 14 congenital heart defects. 8 acyanotic and 6 cyanoyic.
8 Acyanotice includes: ASD, VSD, PDA, endocardial cushion defect, pulmonary stenosis, doupling of the aorta, Aortic stenosis and Coarctation of the Aorta
6 Cyanotic includes: Tetralogy of fallot, Total anomalous pulmonary artery, Transposition of the great arteries, Truncus arteriousus, Hypoplastic Left heart syndrome.
(Acyanotic causes L->R shunting while cyanotic cause R->L shunting. Para madaling matandaan lahat ng may “T” eh cyanotic OK?

32. The immediate nursing intervention for cyanosis of Agata is:
a. Call up the pediatrician
b. Place her in knee chest position
c. Administer oxygen inhalation
d. Transfer her to the PICU

The immediate intervention would be to place her on knee-chest or “squatting” position because it traps blood into the lower extremities. Though also letter C would be a good choice but the question is asking for “Immediate” so letter B is more appropriate. Letter A and D are incorrect because its normal for a child who have ToF to have hypoxic or “tets” spells so there is no need to transfer her to the NICU or to alert the Pediatrician.

33. Agata was scheduled for a palliative surgery, which creates anastomosis of the subclavian artery to the pulmonary artery. This procedure is:
a. Waterston-Cooley
b. Raskkind Procedure
c. Coronary artery bypass
d. Blalock-Taussig

Correct answer is Blalock-Taussig procedure its just a temporary or palliative surgery which creates a shunt between the aorta and pulmonary artery (oist parang ductus arteriosus) so that the blood can leave the aorta and enter the pulmonary artery and thus oxygenating the lungs and return to the left side of the heart, then to the aorta then to the body. This procedure also makes use of the subclavian vein so pulse is not palpable at the right arm.
The full repair for ToF is called the Brock procedure. Raskkind is a palliative surgery for TOGA.

34. Which of the following is not an indicator that Agata experiences separation anxiety brought about her hospitalization?
a. Friendly with the nurse
b. Prolonged loud crying, consoled only by mother
c. Occasional temper tantrums and always says NO
d. Repeatedly verbalizes desire to go home

Because toddlers views hospitalization is abandonment, separation anxiety is common. Its has 3 phases: PDD (parang c puff daddy LOL)
1. Protest 2. despair 3. detachment (or denial). Choices B, C, D are usually seen in a child with separation anxiety (usually in the protest stage).
REVIEW:
Separation anxiety begin at: 9 months
Peaks: 18 months

35. When Agata was brought to the OR, her parents where crying. What would be the most appropriate nursing diagnosis?
a. Infective family coping r/t situational crisis
b. Anxiety r/t powerlessness
c. Fear r/t uncertain prognosis
d. Anticipatory grieving r/t gravity of child’s physical status

In this item letter A and be are inappropriate response so remove them. The possible answers are C and D. Fear defined as the perceived threat (real or imagined) that is consciously recognized as danger (NANDA) is applicable in the situation but its defining characteristics are not applicable. Crying per se can not be a subjective cue to signify fear, and most of the symptoms of fear in NANDA are physiological. Anticipatory grieving on the other hand are intellectual and EMOTIONAL responses based on a potential loss. And remember that procedures like this cannot assure total recovery. So letter D is a more appropriate Nursing diagnosis.
NOTE: GANATO NA PO ANG PATTERN NG NLE, LAGING MAY HALONG THERAPUETIC COMMUNICATION AT NURSING DIAGNOSIS.

36. Which of the following respiratory condition is always considered a medical emergency?
a. Laryngeotracheobronchitis (LTB)
b. Epiglottitis
c. Asthma
d. Cystic Fibrosis

Correct answer is letter B, because acute and sever inflammation of the epiglottis can cause life threatening airway obstruction, that is why its always treated as a medical emergency. NSG intervention : Prepare tracheostomy set at bed side.
LTB, can also cause airway obstruction but its not an emergency. Asthma is also not an emergency (ung status asthmaticus ang kaylangan ng prompt treatment). CF is a chronic disease, so its not a medical emergency.
REVIEW: Medical emergency of GI: peritonitis

37. Which of the following statements by the family of a child with asthma indicates a need for additional teaching?
a. “We need to identify what things triggers his attacks”
b. “He is to use bronchodilator inhaler before steroid inhaler”
c. “We’ll make sure he avoids exercise to prevent asthma attacks”
d. “he should increase his fluid intake regularly to thin secretions”

Asthmatic children don’t have to avoid exercise. They can participate on physical activities as tolerated. Using a bronchodilator before administering steroids is correct because steroids are just anti-inflammatory and they don’t have effects on the dilation of the bronchioles. OF course letters A and B are obviously correct.

38. Which of the following would require careful monitoring in the child with ADHD who is receiving Methylphenidate (Ritalin)?
a. Dental health
b. Mouth dryness
c. Height and weight
d. Excessive appetite

Dental problems are more likely to occur in children under going TCA therapy. Mouth dryness is a expected side effects of Ritalin since it activates the SNS. Also loss of appetite is more likely to happen, not increase in appetite. The correct answer is letter C, because Ritalin can affect the child’s G&D. Intervention: medication “holidays or vacation”. (This means na.. during weekends or holidays or school vacations, where the child wont be in school, the drug can be withheld.)

Situation 6 Laura is assigned as the Team Leader during the immunization day at the RHU

39. What program for the DOH is launched at 1976 in cooperation with WHO and UNICEF to reduce morbidity and mortality among infants caused by immunizable disease?
a. Patak day
b. Immunization day on Wednesday
c. Expanded program on immunization
d. Bakuna ng kabtaan

SUS me! Dapat pa bang I-rationalize? Ang di nakakuha ng tamang sagot… hala… JOKE.. hehehe

40. One important principle of the immunization program is based on?
a. Statistical occurrence
b. Epidemiologic situation
c. Cold chain management
d. Surveillance study

Letters A, C and D are not included in the principles of EPI.
The principle of EPI are the following:
1. Its is based on epidemiological situation
2. Mass approach utilization- the whole community is to be protected rather than the individual
3. Immunization is a basic health service, and should be provided by the RHU

41. The main element of immunization program is one of the following?
a. Information, education and communication
b. Assessment and evaluation of the program
c. Research studies
d. Target setting

Correct answer is D.
The following are the elements of EPI:
• Target seting
• Cold chain logistic management
• Information, education and communication
• Assessment and evaluation of the program’s over all performance
• Surveillance, studies and research

42. What does herd immunity means?
a. Interruption of transmission
b. All to be vaccinated
c. Selected group for vaccination
d. Shorter incubation

43. Measles vaccine can be given simultaneously. What is the combined vaccine to be given to children starting at 15 months?
a. MCG
b. MMR
c. BCG
d. BBR

MMR or Measles, Mumps, Rubella is a vaccine furnished in one vial and is routinely given in one injection (Sub-Q). It can be given at 15 months but can also be given as early as 12th month.

Situation 7: Braguda brought her 5-month old daughter in the nearest RHU because her baby sleeps most of the time, with decreased appetite, has colds and fever for more than a week. The physician diagnosed pneumonia.

44. Based on this data given by Braguda, you can classify Braguda’s daughter to have:
a. Pneumonia: cough and colds
b. Severe pneumonia
c. Very severe pneumonia
d. Pneumonia moderate

For a child aging 2months up to 5 years old can be classified to have sever pneumonia when he have any of the following danger signs:
• Not able to drink
• Convulsions
• Abnormally sleepy or difficult to wake
• Stridor in calm child or
• Severe under-nutrition

45. For a 3-month old child to be classified to have Pneumonia (not severe), you would expect to find RR of:
a. 60 bpm
b. 40 bpm
c. 70 bpm
d. 50 pbm

Correct answer is letter D. A child can be classified to have Pneumonia (not severe) if:
• the young infant is less than 2 months- 60 bpm or more
• if the child is 2 months up to less than 12 months- 50 bpm or more
• if the child is 12 months to 4 y/o- 40 bpm or more

46. You asked Braguda if her baby received all vaccines under EPI. What legal basis is used in implementing the UN’s goal on Universal Child Immunization?
a. PD no. 996
b. PD no. 6
c. PD no. 46
d. RA 9173

Correct answer is letter B. Presidential Proclamation no. 6 (April 3, 1986) is the “Implementing a United Nations goal on Universal Child Immunization by 1990”. PD 996 (September 16, 1976) is “providing for compulsory basic immunization for infants and children below 8 years of age. PD no. 46 (September 16, 1992) is the “Reaffirming the commitment of the Philippines to the universal Child and Mother goal of the World Health Assembly. RA 9173 is of course the “Nursing act of 2002”

47. Braguda asks you about Vitamin A supplementation. You responded that giving Vitamin A starts when the infant reaches 6 months and the first dose is”
a. 200,000 “IU”
b. 100,000 “IU”
c. 500,000 “IU”
d. 10,000 “IU”

An infant aging 6-11 months will be given Vitamin supplementation of 100, 000 IU and for Preschoolers ages 12-83 months 200,000 “IU” will be given.

48. As part of CARI program, assessment of the child is your main responsibility. You could ask the following question to the mother except:
a. “How old is the child?”
b. “IS the child coughing? For how long?”
c. “Did the child have chest indrawing?”
d. “Did the child have fever? For how long?”

The CARI program of the DOH includes the “ASK” and “LOOK, LISTEN” as part of the assessment of the child who has suspected Pneumonia. Choices A, B and D are included in the “ASK” assessment while Chest indrawings is included in the “LOOK, LISTEN” and should not be asked to the mother.

49. A newborn’s failure to pass meconium within 24 hours after birth may indicate which of the following?
a. Aganglionic Mega colon
b. Celiac disease
c. Intussusception
d. Abdominal wall defect

Failure to pass meconium of Newborn during the first 24 hours of life may indicate Hirschsprung disease or Congenital Aganglionic Megacolon, an anomaly resulting in mechanical obstruction due to inadequate motility in an intestinal segment. B, C, and D are not associated in the failure to pass meconium of the newborn.

50. The nurse understands that a good snack for a 2 year old with a diagnosis of acute asthma would be:
a. Grapes
b. Apple slices
c. A glass of milk
d. A glass of cola

Correct answer is B, apple slices. Grapes is in appropriate because of its “balat” that can cause choking. A glass of milk is not a good snack because it’s the most common cause of Iron-deficiency anemia in children (milk contains few iron), A glass of cola is also not appropriate cause it contains complex sugar. (walang kinalaman ang asthma dahil ala naman itong diatery restricted foods na nasa choices.)

51. Which of the following immunizations would the nurse expect to administer to a child who is HIV (+) and severely immunocomromised?
a. Varicella
b. Rotavirus
c. MMR
d. IPV

IPV or Inactivated polio vaccine does not contain live micro organisms which can be harmful to an immunocompromised child. Unlike OPV, IPV is administered via IM route.

52. When assessing a newborn for developmental dysplasia of the hip, the nurse would expect to assess which of the following/
a. Symmetrical gluteal folds
b. Trendelemburg sign
c. Ortolani’s sign
d. Characteristic limp

Correct answer is Ortolani’s sign; it is the abnormal clicking sound when the hips are abducted. The sound is produced when the femoral head enters the acetabulum. Letter A is wrong because its should be “asymmetrical gluteal fold”. Letter B and C are not applicable for newborns because they are seen in older children.

53. While assessing a male neonate whose mother desires him to be circumcised, the nurse observes that the neonate’s urinary meatus appears to be located on the ventral surface of the penis. The physician is notified because the nurse would suspect which of the following?
a. Phimosis
b. Hydrocele
c. Epispadias
d. Hypospadias

Hypospadias is a c condition in which the urethral opening is located below the glans penis or anywhere along the ventral surface of the penile shaft. Epispadias, the urethral meatus is located at the dorsal surface of the penile shaft. (Para di ka malilto, I-alphabetesize mo Dorsal, (Above) eh mauuna sa Ventral (Below) , Epis mauuna sa Hypo.)

54. When teaching a group of parents about seat belt use, when would the nurse state that the child be safely restrained in a regular automobile seatbelt?
a. 30 lb and 30 in
b. 35 lb and 3 y/o
c. 40 lb and 40 in
d. 60 lb and 6 y/o

Basta tandaan ang rule of 4! 4 years old, 40 lbs and 40 in.

55. When assessing a newborn with cleft lip, the nurse would be alert which of the following will most likely be compromised?
a. Sucking ability
b. Respiratory status
c. Locomotion
d. GI function

Because of the defect, the child will be unable to form the mouth adequately arounf the nipple thereby requiring special devices to allow feeding and sucking gratification. Respiratory status may be compromised when the child is fed improperly or during post op period.
REVIEW!
Repair of cleft lip-cheiloplasty-should be done within 1-3 months- to save sucking reflex- position post-op side lying
Repair of cleft palate- Uranoplasty- should be done within 4-6 months-to preserve speech- position post-op is prone.

56. For a child with recurring nephritic syndrome, which of the following areas of potential disturbances should be a prime consideration when planning ongoing nursing care?
a. Muscle coordination
b. Sexual maturation
c. Intellectual development
d. Body image

Because of edema, associated with nephroitic syndrome, potential self concept and body image disturbance related to changes in appearance and social isolation should be considered.

HEY! NARARAMDAMAN KO NA LALABAS ULIT ANG MGA SAKIT RELATED SA NEW BORN SCREENING KAYA ARALIN NA ITO. I WILL POST A SIMPLE LECTURE DITO. (LATER…. Kasi tamad ako,,, hehehe)

57. An inborn error of metabolism that causes premature destruction of RBC?
a. G6PD
b. Hemocystinuria
c. Phenylketonuria
d. Celiac Disease

G6PD is the premature destruction of RBC when the blood is exposed to antioxidants, ASA (ano un? Aspirin), legumes and flava beans.

58. Which of the following would be a diagnostic test for Phenylketonuria which uses fresh urine mixed with ferric chloride?
a. Guthrie Test
b. Phenestix test
c. Beutler’s test
d. Coomb’s test

Phenestix test is a diagnostic test which uses a fresh urine sample (diapers) and mixed with ferric chloride. If positive, there will be a presence of green spots at the diapers. Guthrie test is another test for PKU and is the one that mostly used. The specimen used is the blood and it tests if CHON is converted to amino acid.

59. Dietary restriction in a child who has Hemocystenuria will include which of the following amino acid?
a. Lysine
b. Methionine
c. Isolensine tryptophase
d. Valine

Hemocystenuria is the elevated excretion of the amino acid hemocystiene, and there is inability to convert the amino acid methionine or cystiene. So dietary restriction of this amino acids is advised. This disease can lead to mental retardation.

60. A milk formula that you can suggest for a child with Galactosemia:
a. Lofenalac
b. Lactum
c. Neutramigen
d. Sustagen

Neutramigen is suggested for a child with Galactosemia. Lofenalac is suggested for a child with PKU.

PEDIA TEST DRILL

noreply@blogger.com (NurseHarbee) — Fri, 5 Jun 2009 10:45:00 +0800