Professional Documents
Culture Documents
A. Reduce anaphylaxis
B. Relieve hypersensitivity to allergen
C. Relieve respiratory distress due to bronchial spasm
D. Restore client’s cardiac rhythm
A. Taps the ampule at the top to allow fluid to flow to the base of the
ampule
B. Checks expiration date of the medication ampule
C. Removes needle cap of syringe and pulls plunger to expel air
D. Breaks the neck of the ampule with a gauze wrapped around it
A. Applied research
B. Qualitative research
C. Basic research
D. Quantitative research
A. Experimental design
B. Quasi-experimental design
C. Non-experimental design
D. Quantitative design
A. right of self-determination
B. right to compensation
C. right of privacy
D. right not to be harmed
11. Mario listens to Richard’s bilateral sounds and finds that congestion
is in the upper lobes of the lungs. The appropriate position to drain the
anterior and posterior apical segments of the lungs when Mario does
percussion would be:
13. When assessing Richard for chest percussion or chest vibration and
postural drainage, Mario would focus on the following EXCEPT:
A. Amount of food and fluid taken during the last meal before
treatment
B. Respiratory rate, breath sounds and location of congestion
C. Teaching the client’s relatives to perform the procedure
D. Doctor’s order regarding position restrictions and client’s tolerance
for lying flat
A. Percussion uses only one hand while vibration uses both hands
B. Percussion delivers cushioned blows to the chest with cupped palms
while vibration gently shakes secretion loose on the exhalation cycle
C. In both percussion and vibration the hands are on top of each other
and hand action is in tune with client’s breath rhythm
D. Percussion slaps the chest to loosen secretions while vibration
shakes the secretions along with the inhalation of air
16. When doing an initial assessment, the best way for you to identify
the client’s priority problem is to:
17. Upon establishing Mr. Regalado’s nursing needs, the next nursing
approach would be to:
A. Introduce the client to the ward staff to put the client and family at
ease
B. Give client and relatives a brief tour of the physical set up the unit
C. Take his vital signs for a baseline assessment
D. Establish priority needs and implement appropriate interventions
18. Mr. Regalado says he has “trouble going to sleep”. In order to plan
your nursing intervention you will:
A. Observe his sleeping patterns in the next few days
B. Ask him what he means by this statement
C. Check his physical environment to decrease noise level
D. Take his blood pressure before sleeping and upon waking up
19. Mr. Regalado’s lower extremities are swollen and shiny. He has
pitting pedal edema. When taking care of Mr. Regalado, which of the
following interventions would be the most appropriate immediate
nursing approach?
20. Mr. Regalado will be discharged from your unit within the hour.
Nursing actions when preparing a client for discharge include all
EXCEPT:
21. Considering her level of anxiety, the nurse can best assist Nancy
by:
22. Nancy blames God for her situation. She is easily provoked to
tears and wants to be left alone, refusing to eat or talk to her family. A
religious person before, she now refuses to pray or go to church
stating that God has abandoned her. The nurse understands that
Nancy is grieving for her self and is in the stage of:
A. bargaining
B. denial
C. anger
D. acceptance
23. The nurse visits Nancy and prods her to eat her food. Nancy
replies “what’s the use? My time is running out.” The nurse’s best
response would be:
A. “The doctor ordered full diet for you so that you will be strong for
surgery”
B. “I understand how you feel but you have to try for your children’s
sake”
C. “Have you told your doctor how you feel? Are you changing your
mind about your surgery?”
D. “You sound like you are giving up.”
24. The nurse feels sad about Nancy’s illness and tells her head nurse
during the end of shift endorsement that “it’s unfair for Nancy to have
cancer when she is still so young and with two kids”. The best
response of the head nurse would be:
A. Advise the nurse to “be strong and learn to control her feelings”
B. Assign the nurse to another client to avoid sympathy for the client
C. Reassure the nurse that the client has hope if she goes through all
treatments prescribed for her
D. Ask the other nurses what they feel about the patient to find out if
they share the same feelings
25. Realizing that she feels angry about Nancy’s condition, the nurse
learns that being self-aware is a conscious process that she should do
in any situation like this because:
27. Mrs. Seva also tells the nurse that she is often constipated.
Because she is aging, what physical changes predispose her to
constipation?
A. excessive exercise
B. high fiber diet
C. no regular time for defecation daily
D. prolonged use of laxatives
29. Mrs. Seva talks about fear of being incontinent due to a prior
experience of dribbling urine when laughing or sneezing and when she
has a full bladder. Your most appropriate instruction would be to:
30. Mrs. Seva asked for instructions for skin care for her mother who
has urinary incontinence and is almost always in bed. Your instruction
would focus on prevention of skin irritation and breakdown by:
31. Which of these clients has a problem with the transport of oxygen
from the lungs to the tissues:
32. You noted from the lab exams in the chart of M. Santos that he
has reduced oxygen in the blood. This condition is called:
A. Cyanosis
B. Hypoxia
C. Hypoxemia
D. Anemia
33. You will do nasopharyngeal suctioning on Mr. Abad. Your guide for
the length of insertion of the tubing for an adult would be:
34. While doing nasopharyngeal suctioning on Mr. Abad, the nurse can
avoid trauma to the area by:
A. Apply suction for at least 20-30 seconds each time to ensure that all
secretions are removed
B. Using gloves to prevent introduction of pathogens to the respiratory
system
C. Applying no suction while inserting the catheter
D. Rotating catheter as it is inserter with gentle suction
35. Myrna has difficulty breathing when on her back and must sit
upright in bed to breath effectively and comfortably. The nurse
documents this condition as:
A. Apnea
B. Orthopnea
C. Dyspnea
D. Tachypnea
Situation 8 – You are assigned to screen for hypertension. Your task is
to take blood pressure readings and you are informed about avoiding
the common mistakes in BP taking that lead to false or inaccurate
blood pressure readings.
36. When taking blood pressure reading the cuff should be:
A. deflated fully then immediately start second reading for same client
B. deflated quickly after inflating up to 180 mmHg
C. large enough to wrap around upper arm of the adult client 1 cm
above brachial artery
D. inflated to 30 mmHg above the estimated systolic BP based on
palpation of radial or bronchial artery
A. tobacco hack
B. bronchitis
C. asthma
D. cigarette smoking
38. In your health education class for clients with diabetes you teach
them the areas for control of Diabetes which include all EXCEPT
39. You teach your clients the difference between, Type I (IDDM) and
Type II (NDDM) diabetes. Which of the following is true?
A. physical activity
B. smoking
C. genetics
D. nutrition
44. The nurse applies dressing on the bleeding site. This intervention
is done to:
45. After the treatment, the client is sent home and asked to come
back for follow-up care. Your responsibilities when the client is to be
discharged include the following EXCEPT:
48. Geline tells you that she drinks black coffee frequently within the
day to “have energy and be wide awake” and she eats nothing for
breakfast and eats strictly vegetable salads for lunch and dinner to
lose weight. She has lost weight during the past two weeks. In
planning a healthy balanced diet with Geline, you will:
A. Start her off with a cleansing diet to free her body of toxins then
change to a vegetarian diet and drink plenty of fluids
B. Plan a high protein diet, low carbohydrate diet for her considering
her favorite food.
C. Instruct her to attend classes in nutrition to find food rich in
complex carbohydrates to maintain daily high energy level.
D. Discuss with her the importance of eating a variety of food from
major food groups with plenty of fluids.
49. Geline tells you that she drinks 4-5 cups of black coffee and diet
cola drinks. She also smokes up to a pack of cigarettes daily. She
confesses that she is in her 2nd month of pregnancy but does not want
to become fat that is why she limits her food intake. You warn or
caution her about which of the following?
A. Caffeine products affect the central nervous system and may cause
the mother to have a “nervous breakdown”
B. Malnutrition and its possible effects on growth and development
problems in the unborn fetus
C. Caffeine causes a stimulant effect on both mother and the baby
D. Studies show conclusively that caffeine causes mental retardation
50. Your health education plan for Geline stresses proper diet for a
pregnant woman and the prevention of non-communicable diseases
that are influenced by her lifestyle. These include the following
EXCEPT:
A. Cardiovascular diseases
B. Cancer
C. Diabetes Mellitus
D. Osteoporosis
ANSWER KEY:
SITUATIONAL
Qualitative research
Non-experimental design
right to compensation
11. Mario listens to Richard’s bilateral sounds and finds that congestion
is in the upper lobes of the lungs. The appropriate position to drain the
anterior and posterior apical segments of the lungs when Mario does
percussion would be:
13. When assessing Richard for chest percussion or chest vibration and
postural drainage, Mario would focus on the following EXCEPT:
16. When doing an initial assessment, the best way for you to identify
the client’s priority problem is to:
17. Upon establishing Mr. Regalado’s nursing needs, the next nursing
approach would be to:
19. Mr. Regalado’s lower extremities are swollen and shiny. He has
pitting pedal edema. When taking care of Mr. Regalado, which of the
following interventions would be the most appropriate immediate
nursing approach?
20. Mr. Regalado will be discharged from your unit within the hour.
Nursing actions when preparing a client for discharge include all
EXCEPT:
21. Considering her level of anxiety, the nurse can best assist Nancy
by:
Giving her clear but brief information at the level of her understanding
22. Nancy blames God for her situation. She is easily provoked to
tears and wants to be left alone, refusing to eat or talk to her family. A
religious person before, she now refuses to pray or go to church
stating that God has abandoned her. The nurse understands that
Nancy is grieving for her self and is in the stage of:
anger
23. The nurse visits Nancy and prods her to eat her food. Nancy
replies “what’s the use? My time is running out.” The nurse’s best
response would be:
24. The nurse feels sad about Nancy’s illness and tells her head nurse
during the end of shift endorsement that “it’s unfair for Nancy to have
cancer when she is still so young and with two kids”. The best
response of the head nurse would be:
Advise the nurse to “be strong and learn to control her feelings”
25. Realizing that she feels angry about Nancy’s condition, the nurse
learns that being self-aware is a conscious process that she should do
in any situation like this because:
How the nurse thinks and feels affect her actions towards her client
and her work
27. Mrs. Seva also tells the nurse that she is often constipated.
Because she is aging, what physical changes predispose her to
constipation?
29. Mrs. Seva talks about fear of being incontinent due to a prior
experience of dribbling urine when laughing or sneezing and when she
has a full bladder. Your most appropriate instruction would be to:
30. Mrs. Seva asked for instructions for skin care for her mother who
has urinary incontinence and is almost always in bed. Your instruction
would focus on prevention of skin irritation and breakdown by:
Thorough washing, rising and drying of skin area that get wet with
urine
31. Which of these clients has a problem with the transport of oxygen
from the lungs to the tissues:
32. You noted from the lab exams in the chart of M. Santos that he
has reduced oxygen in the blood. This condition is called:
Hypoxemia
33. You will do nasopharyngeal suctioning on Mr. Abad. Your guide for
the length of insertion of the tubing for an adult would be:
the distance from the tip of the nose to the tip of the ear lobe
34. While doing nasopharyngeal suctioning on Mr. Abad, the nurse can
avoid trauma to the area by:
Applying no suction while inserting the catheter
35. Myrna has difficulty breathing when on her back and must sit
upright in bed to breath effectively and comfortably. The nurse
documents this condition as:
Orthopnea
36. When taking blood pressure reading the cuff should be:
deflated fully then immediately start second reading for same client
cigarette smoking
38. In your health education class for clients with diabetes you teach
them the areas for control of Diabetes which include all EXCEPT
prevention nutrition
39. You teach your clients the difference between, Type I (IDDM) and
Type II (NDDM) diabetes. Which of the following is true?
genetics
Ryan who has chest injury, is pale and with difficulty breathing
44. The nurse applies dressing on the bleeding site. This intervention
is done to:
Promote hemostasis
45. After the treatment, the client is sent home and asked to come
back for follow-up care. Your responsibilities when the client is to be
discharged include the following EXCEPT:
Instructing the client to see you after discharge for further assistance
Client reported abdominal pain an hour after drinking black coffee for
three weeks now.
48. Geline tells you that she drinks black coffee frequently within the
day to “have energy and be wide awake” and she eats nothing for
breakfast and eats strictly vegetable salads for lunch and dinner to
lose weight. She has lost weight during the past two weeks. In
planning a healthy balanced diet with Geline, you will:
Discuss with her the importance of eating a variety of food from major
food groups with plenty of fluids.
49. Geline tells you that she drinks 4-5 cups of black coffee and diet
cola drinks. She also smokes up to a pack of cigarettes daily. She
confesses that she is in her 2nd month of pregnancy but does not want
to become fat that is why she limits her food intake. You warn or
caution her about which of the following?
50. Your health education plan for Geline stresses proper diet for a
pregnant woman and the prevention of non-communicable diseases
that are influenced by her lifestyle. These include the following
EXCEPT:
Cancer