1. Nurse Brenda is teaching a patient about a newly prescribed drug.

What could cause a geriatric patient to have difficulty retaining knowledge about prescribed medications? a. Decreased plasma drug levels b. Sensory deficits c. Lack of family support d. History of Tourette syndrome Answer B. Sensory deficits could cause a geriatric patient to have difficulty retaining knowledge about prescribed medications. Decreased plasma drug levels do not alter the patient s knowledge about the drug. A lack of family support may affect compliance, not knowledge retention. Toilette syndrome is unrelated to knowledge retention. 2. When examining a patient with abdominal pain the nurse in charge should assess: a. Any quadrant first b. The symptomatic quadrant first c. The symptomatic quadrant last d. The symptomatic quadrant either second or third Answer C. The nurse should systematically assess all areas of the abdomen, if time and the patient s condition permit, concluding with the symptomatic area. Otherwise, the nurse may elicit pain in the symptomatic area, causing the muscles in other areas to tighten. This would interfere with further assessment. 3. The nurse is assessing a postoperative adult patient. Which of the following should the nurse document as subjective data? a. Vital signs b. Laboratory test result c. Patient s description of pain d. Electrocardiographic (ECG) waveforms Answer C. Subjective data come directly from the patient and usually are recorded as direct quotations that reflect the patient s opinions or feelings about a situation. Vital signs, laboratory test result, and ECG waveforms are examples of objective data. 4. A male patient has a soft wrist-safety device. Which assessment finding should the nurse consider abnormal? a. A palpable radial pulse b. A palpable ulnar pulse c. Cool, pale fingers d. Pink nail beds Answer C. A safety device on the wrist may impair circulation and restrict blood supply to body tissues. Therefore, the nurse should assess the patient for signs of impaired circulation, such as cool, pale fingers. A palpable radial or lunar pulse and pink nail beds are normal findings. 5. Which of the following planes divides the body longitudinally into anterior and posterior regions? a. Frontal plane b. Sagittal plane c. Midsagittal plane d. Transverse plane Answer A. Frontal or coronal plane runs longitudinally at a right angle to a sagittal plane dividing the body in anterior and posterior regions. A sagittal plane runs longitudinally dividing the body into right and left regions; if exactly midline, it is called a midsagittal plane. A transverse plane runs horizontally at a right angle to the vertical axis, dividing the structure into superior and inferior regions.

6. A female patient with a terminal illness is in denial. Indicators of denial include: a. Shock dismay b. Numbness c. Stoicism d. Preparatory grief Answer A. Shock and dismay are early signs of denial-the first stage of grief. The other options are associated with depression a later stage of grief. 7. The nurse in charge is transferring a patient from the bed to a chair. Which action does the nurse take during this patient transfer? a. Position the head of the bed flat b. Helps the patient dangle the legs c. Stands behind the patient d. Places the chair facing away from the bed Answer B. After placing the patient in high Fowler s position and moving the patient to the side of the bed, the nurse helps the patient sit on the edge of the bed and dangle the legs; the nurse then faces the patient and places the chair next to and facing the head of the bed. 8. A female patient who speaks a little English has emergency gallbladder surgery, during discharge preparation, which nursing action would best help this patient understand wound care instruction? a. Asking frequently if the patient understands the instruction b. Asking an interpreter to replay the instructions to the patient. c. Writing out the instructions and having a family member read them to the patient d. Demonstrating the procedure and having the patient return the demonstration Answer D. Demonstrating by the nurse with a return demonstration by the patient ensures that the patient can perform wound care correctly. Patients may claim to understand discharge instruction when they do not. An interpreter of family member may communicate verbal or written instructions inaccurately. 9. Before administering the evening dose of a prescribed medication, the nurse on the evening shift finds an unlabeled, filled syringe in the patient s medication drawer. What should the nurse in charge do? a. Discard the syringe to avoid a medication error b. Obtain a label for the syringe from the pharmacy c. Use the syringe because it looks like it contains the same medication the nurse was prepared to give d. Call the day nurse to verify the contents of the syringe Answer A. As a safety precaution, the nurse should discard an unlabeled syringe that contains medication. The other options are considered unsafe because they promote error. 10. When administering drug therapy to a male geriatric patient, the nurse must stay especially alert for adverse effects. Which factor makes geriatric patients to adverse drug effects? a. Faster drug clearance b. Aging-related physiological changes c. Increased amount of neurons d. Enhanced blood flow to the GI tract Answer B. Aging-related physiological changes account for the increased frequency of adverse drug reactions in geriatric patients. Renal and hepatic changes cause drugs to clear more slowly in these patients. With increasing age, neurons are lost and blood flow to the GI tract decreases.

11. A female patient is being discharged after cataract surgery. After providing medication teaching, the nurse asks the patient to repeat the instructions. The nurse is performing which professional role? a. Manager b. Educator c. Caregiver d. Patient advocate Answer B. When teaching a patient about medications before discharge, the nurse is acting as an educator. The nurse acts as a manager when performing such activities as scheduling and making patient care assignments. The nurse performs the care giving role when providing direct care, including bathing patients and administering medications and prescribed treatments. The nurse acts as a patient advocate when making the patient s wishes known to the doctor. 12. A female patient exhibits signs of heightened anxiety. Which response by the nurse is most likely to reduce the patient s anxiety? a. Everything will be fine. Don t worry. b. Read this manual and then ask me any questions you may have. c. Why don t you listen to the radio? d. Let s talk about what s bothering you. Answer D. Anxiety may result from feeling of helplessness, isolation, or insecurity. This response helps reduce anxiety by encouraging the patient to express feelings. The nurse should be supportive and develop goals together with the patient to give the patient some control over an anxiety-inducing situation. Because the other options ignore the patient s feeling and block communication, they would not reduce anxiety. 13. A scrub nurse in the operating room has which responsibility? a. Positioning the patient b. Assisting with gowning and gloving c. Handling surgical instruments to the surgeon d. Applying surgical drapes Answer C. The scrub nurse assist the surgeon by providing appropriate surgical instruments and supplies, maintaining strict surgical asepsis and, with the circulating nurse, accounting for all gauze, sponges, needles, and instruments. The circulating nurse assists the surgeon and scrub nurse, positions the patient, applies appropriate equipment and surgical drapes, assists with gowning and gloving, and provides the surgeon and scrub nurse with supplies. 14. A patient is in the bathroom when the nurse enters to give a prescribed medication. What should the nurse in charge do? a. Leave the medication at the patient s bedside b. Tell the patient to be sure to take the medication. And then leave it at the bedside c. Return shortly to the patient s room and remain there until the patient takes the medication d. Wait for the patient to return to bed, and then leave the medication at the bedside Answer C. The nurse should return shortly to the patient s room and remain there until the patient takes the medication to verify that it was taken as directed. The nurse should never leave medication at the patient s bedside unless specifically requested to do so. 15. The physician orders heparin, 7,500 units, to be administered subcutaneously every 6 hours. The vial reads 10,000 units per milliliter. The nurse should anticipate giving how much heparin for each dose? a. ml b. ml

c. ml d. 1 ml Answer C. The nurse solves the problem as follows: 10,000 units/7,500 units = 1 ml/X 10,000 X = 7,500 X= 7,500/10,000 or ml 16. The nurse in charge measures a patient s temperature at 102 degrees F. what is the equivalent Centigrade temperature? a. 39 degrees C b. 47 degrees C c. 38.9 degrees C d. 40.1 degrees C Answer C. To convert Fahrenheit degrees to centigrade, use this formula: C degrees = (F degrees 32) x 5/9 C degrees = (102 32) 5/9 + 70 x 5/9 38.9 degrees C 17. To evaluate a patient for hypoxia, the physician is most likely to order which laboratory test? a. Red blood cell count b. Sputum culture c. Total hemoglobin d. Arterial blood gas (ABG) analysis Answer D. All of these test help evaluate a patient with respiratory problems. However, ABG analysis is the only test evaluates gas exchange in the lungs, providing information about patient s oxygenation status.

18. The nurse uses a stethoscope to auscultate a male patient s chest. Which statement about a stethoscope with a bell and diaphragm is true? a. The bell detects high-pitched sounds best b. The diaphragm detects high-pitched sounds best c. The bell detects thrills best d. The diaphragm detects low-pitched sounds best Answer B. The diaphragm of a stethoscope detects high-pitched sound best; the bell detects low pitched sounds best. Palpation detects thrills best. 19. A male patient is to be discharged with a prescription for an analgesic that is a controlled substance. During discharge teaching, the nurse should explain that the patient must fill this prescription how soon after the date on which it was written? a. Within 1 month b. Within 3 months c. Within 6 months d. Within 12 months Answer C. In most cases, an outpatient must fill a prescription for a controlled substance within 6 months of the date on which the prescription was written.

20. Which human element considered by the nurse in charge during assessment can affect drug administration? a. The patient s ability to recover b. The patient s occupational hazards c. The patient s socioeconomic status d. The patient s cognitive abilities Answer D. The nurse must consider the patient s cognitive abilities to understand drug instructions. If not, the nurse must find a family member or significant other to take on the responsibility of administering medications in the home setting. The patient s ability to recover, occupational hazards, and socioeconomic status do not affect drug administration. 21. An employer establishes a physical exercise area in the workplace and encourages all employees to use it. This is an example of which level of health promotion? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Passive prevention Answer A. Primary prevention precedes disease and applies to health patients. Secondary prevention focuses on patients who have health problems and are at risk for developing complications. Tertiary prevention enables patients to gain health from others activities without doing anything themselves. 22. What does the nurse in charge do when making a surgical bed? a. Leaves the bed in the high position when finished b. Places the pillow at the head of the bed c. Rolls the patient to the far side of the bed d. Tucks the top sheet and blanket under the bottom of the bed Answer A. When making a surgical bed, the nurse leaves the bed in the high position when finished. After placing the top linens on the bed without pouching them, the nurse fanfolds these linens to the side opposite from where the patient will enter and places the pillow on the bedside chair. All these actions promote transfer of the postoperative patient from the stretcher to the bed. When making an occupied bed or unoccupied bed, the nurse places the pillow at the head of the bed and tucks the top sheet and blanket under the bottom of the bed. When making an occupied bed, the nurse rolls the patient to the far side of the bed.

23. The physician prescribes 250 mg of a drug. The drug vial reads 500 mg/ml. how much of the drug should the nurse give? a. 2 ml b. 1 ml c. ml d. ml Answer C. The nurse should give ml of the drug. The dosage is calculated as follows: 250 mg/X=500 mg/1 ml 500x=250 X=1/2 ml 24. Nurse Mackey is monitoring a patient for adverse reactions during barbiturate therapy. What is the major disadvantage of barbiturate use?

a. Prolonged half-life b. Poor absorption c. Potential for drug dependence d. Potential for hepatotoxicity Answer C. Patients can become dependent on barbiturates, especially with prolonged use. Because of the rapid distribution of some barbiturates, no correlation exists between duration of action and half-life. Barbiturates are absorbed well and do not cause hepatotoxicity, although existing hepatic damage does require cautions use of the drug because barbiturates are metabolized in the liver. 25. Which nursing action is essential when providing continuous enteral feeding? a. Elevating the head of the bed b. Positioning the patient on the left side c. Warming the formula before administering it d. Hanging a full day s worth of formula at one time Answer A. Elevating the head of the bed during enteral feeding minimizes the risk of aspiration and allows the formula to flow in the patient s intestines. When such elevation is contraindicated, the patient should be positioned on the right side. The nurse should give enteral feeding at room temperature to minimize GI distress. To limit microbial growth, the nurse should hang only the amount of formula that can be infused in 3 hours. 26. When teaching a female patient how to take a sublingual tablet, the nurse should instruct the patient to place the table on the: a. Top of the tongue b. Roof of the mouth c. Floor of the mouth d. Inside of the cheek Answer C. The nurse should instruct the patient to touch the tip of the tongue to the roof of the mouth and then place the sublingual tablet on the floor of the mouth. Sublingual medications are absorbed directly into the bloodstream form the oral mucosa, bypassing the GI and hepatic systems. No drug is administered on top of the tongue or on the roof of the mouth. With the buccal route, the tablet is placed between the gum and the cheek. 27. Which action by the nurse in charge is essential when cleaning the area around a Jackson-Pratt wound drain? a. Cleaning from the center outward in a circular motion b. Removing the drain before cleaning the skin c. Cleaning briskly around the site with alcohol d. Wearing sterile gloves and a mask Answer A. The nurse always should clean around a wound drain, moving from center outward in ever-larger circles, because the skin near the drain site is more contaminated than the site itself. The nurse should never remove the drain before cleaning the skin. Alcohol should never be used to clean around a drain; it may irritate the skin and has no lasting effect on bacteria because it evaporates. The nurse should wear sterile gloves to prevent contamination, but a mask is not necessary. 28. The doctor orders dextrose 5% in water, 1,000 ml to be infused over 8 hours. The I.V. tubing delivers 15 drops per milliliter. The nurse in charge should run the I.V. infusion at a rate of: a. 15 drop per minute b. 21 drop per minute c. 32 drop per minute d. 125 drops per minute

Answer C. Giving 1,000 ml over 8 hours is the same as giving 125 ml over 1 hour (60 minutes) to find the number of milliliters per minute: 125/60 min = X/1 minute 60X = 125X = 2.1 ml/minute To find the number of drops/minute: 2.1 ml/X gtts = 1 ml/15 gtts X = 32 gtts/minute, or 32 drops/minute 29. A male patient undergoes a total abdominal hysterectomy. When assessing the patient 10 hours later, the nurse identifies which finding as an early sign of shock? a. Restlessness b. Pale, warm, dry skin c. Heart rate of 110 beats/minute d. Urine output of 30 ml/hour Answer A. Early in shock, hyperactivity of the sympathetic nervous system causes increased epinephrine secretion, which typically makes the patient restless, anxious, nervous, and irritable. It also decreases tissue perfusion to the skin, causing pale, cool clammy skin. An above-normal heart rate is a late sign of shock. A urine output of 30 ml/hour is within normal limits. 30. Which pulse should the nurse palpate during rapid assessment of an unconscious male adult? a. Radial b. Brachial c. Femoral d. Carotid Answer D. During a rapid assessment, the nurse s first priority is to check the patient s vital functions by assessing his airway, breathing, and circulation. To check a patient s circulation, the nurse must assess his heart and vascular network function. This is done by checking his skin color, temperature, mental status and, most importantly, his pulse. The nurse should use the carotid artery to check a patient s circulation. In a patient with a circulatory problems or a history of compromised circulation, the radial pulse may not be palpable. The brachial pulse is palpated during rapid assessment of an infant.

1. Myrna, who s 4 months pregnant asks the nurse how much and what type of exercise she should get during pregnancy. How should nurse Maricel counsel her? a. Try high-intensity aerobics, but limit sessions to 15 minutes daily. b. Perform gentle back-lying exercises for 30 minutes daily. c. Walk briskly for 10 to 15 minutes daily, and gradually increase this time. d. Exercise to raise the heart rate above 140 beats/minute for 20 minutes daily. 2. Linda, who s 37 weeks pregnant comes to the clinic for a prenatal checkup. To assess the client s preparation for parenting, nurse Kim might ask which question? a. Are you planning to have epidural anesthesia?

b. c. d.

Have you begun prenatal classes? What changes have you made at home to get ready for the baby? Can you tell me about the meals you typically eat each day?

3. Nurse Tanya is aware that the best place to detect fetal heart sounds for a client in the first trimester of pregnancy? a. Above the symphysis pubis b. Below the symphysis pubis c. Above the umbilicus d. At the umbilicus 4. Lovelyn, asks the nurse whether she can take castor oil for her constipation. How should the nurse respond? a. Yes, it produces no adverse effects. b. No, it can initiate premature uterine contractions. c. No, it can promote sodium retention. d. No, it can lead to increased absorption of fat-soluble vitamins. 5. A client at 35 weeks gestation complains of severe abdominal pain and passing clots. The client s vital signs are blood pressure 150/100 mm Hg, heart rate 95 beats/minute, respiratory rate 25 breaths/minute, and fetal heart tones 160 beats/minute. Nurse Nikki must determine the cause of the bleeding and respond appropriately to this emergency. Which of the following should the nurse do first? a. Examine the vagina to determine whether her client is in labor b. Assess the location and consistency of the uterus c. Perform an ultrasound to determine placental placement d. Prepare for immediate delivery 6. When assessing a client during her first prenatal visit, nurse Lucy discovers that the client had a reduction mammoplasty. The mother indicates she wants to breast-feed. What information should the nurse give to this mother regarding breast-feeding success? a. It s contraindicated for you to breast-feed following this type of surgery. b. I support your commitment; however, you may have to supplement each feeding with formula. c. You should check with your surgeon to determine whether breast-feeding would be possible. d. You should be able to breast-feed without difficulty. 7. When questioned, Alma admits she sometimes has several glasses of wine with dinner. Her alcohol consumption puts her fetus at risk for which condition? a. Alcohol addiction b. Anencephaly c. Down syndrome d. Learning disability 8. Nurse Helen has a client at 30 weeks gestation who has tested positive for the human immunodeficiency virus (HIV). What should the nurse tell the client when she says that she wants to breast-feed her baby? a. Encourage breast-feeding so that she can get her rest and get healthier b. Encourage breast-feeding because it s healthier for the baby c. Encourage breast-feeding to facilitate bonding d. Discourage breast-feeding because HIV can be transmitted through breast milk

9. During each prenatal checkup, nurse Paul obtains the client s weight and blood pressure and measures fundal height. What is another essential part of each prenatal checkup? a. Evaluating the client for edema b. Measuring the client s hemoglobin (Hb) level c. Obtaining pelvic measurements d. Determining the client s Rh factor 10. Which of the following instructions should nurse Dan give to a client who s 26 weeks pregnant and complains of constipation? a. Encourage her to increase her intake of roughage and to drink at least six glasses of water per day. b. Tell her to ask her caregiver for a mild laxative. c. Suggest the use of an over-the-counter stool softener. d. Tell her to go to the evaluation unit because constipation may cause contractions. 11. During the 6th month of pregnancy, Gail reports intermittent earaches and a constant feeling of fullness in the ears. What is the most likely cause of these symptoms? a. A serious neurologic disorder b. Eustachian tube vascularization c. Increasing progesterone levels d. An ear infection 12. Malou, 2 months pregnant, has hyperemesis gravidarum. Which expected outcome is most appropriate for her? a. Client will accept the pregnancy and stop vomiting. b. Client will gain weight according to the expected pattern for pregnancy. c. Client will remain hospitalized for the duration of pregnancy to relieve stress. d. Client will exhibit uterine growth within the expected norms for gestational age. 13. When assessing a pregnant client with diabetes mellitus, nurse Gio stays alert for signs and symptoms of a vaginal or urinary tract infection (UTI). Which condition makes this client more susceptible to such infections? a. Electrolyte imbalances b. Decreased insulin needs c. Hypoglycemia d. Glycosuria 14. Josephine, 11 weeks pregnant, is admitted to the facility with hyperemesis gravidarum. She tells the nurse she has never known anyone who had such severe morning sickness. The nurse understands that hyperemesis gravidarum results from: a. a neurologic disorder. b. inadequate nutrition. c. an unknown cause. d. hemolysis of fetal red blood cells (RBCs). 15. A client has come to the clinic for her first prenatal visit. Nurse Alex should include which of the following statements about using drugs safely during pregnancy in her teaching? a. During the first 3 months, avoid all medications except ones prescribed by your caregiver. b. Medications that are available over the counter are safe for you to use, even early on.

c. d.

All medications are safe after you ve reached the 5th month of pregnancy. Consult with your health care provider before taking any medications.

16. A pregnant client asks how she can best prepare her 3-year-old son for the upcoming birth of a sibling. Nurse Lou should make which suggestion? a. Tell your son about the childbirth about 1 month before your due date. b. Reassure your son that nothing is going to change. c. Reprimand your son if he displays immature behavior. d. Involve your son in planning and preparing for a sibling. 17. Nurse Cathy is caring for a 16-year-old pregnant client. The client is taking an iron supplement. What should this client drink to increase the absorption of iron? a. A glass of milk b. A cup of hot tea c. A liquid antacid d. A glass of orange juice 18. Nurse Rey is using Doppler ultrasound to assess a pregnant woman. When should the nurse expect to hear fetal heart tones? a. 7 weeks b. 11 weeks c. 17 weeks d. 21 weeks 19. Nurse Edith is caring for a client who s on ritodrine therapy to halt premature labor. What condition indicates an adverse reaction to ritodrine therapy? a. Hypoglycemia b. Crackles c. Bradycardia d. Hyperkalemia Answer B. Use of ritodrine can lead to pulmonary edema. Therefore, the nurse should assess for crackles and dyspnea. Blood glucose levels may temporarily rise, not fall, with ritodrine. Ritodrine may cause tachycardia, not bradycardia. Ritodrine may also cause hypokalemia, not hyperkalemia. 20. Noemi, a newly pregnant woman tells the nurse that she hasn t been taking her prenatal vitamins because they make her nauseated. In addition to telling the client how important taking the vitamins are, the nurse should advise her to: a. switch brands. b. take the vitamin on a full stomach. c. take the vitamin with orange juice for better absorption. d. take the vitamin first thing in the morning. Answer B. Prenatal vitamins commonly cause nausea and taking them on a full stomach may curb this. Switching brands may not be helpful and may be more costly. Orange juice tends to make pregnant women nauseated. The vitamins may be taken at night, rather than in the morning, to reduce nausea. 21. A client is scheduled for amniocentesis. When preparing her for the procedure, nurse Vince should do which of the following?

a. b. c. d.

Ask her to void. Instruct her to drink 1 L of fluid. Prepare her for I.V. anesthesia. Place her on her left side.

Answer A. To prepare a client for amniocentesis, the nurse should ask her to empty her bladder to reduce the risk of bladder perforation. Before transabdominal ultrasound, the nurse may instruct the client to drink 1 L of fluid to fill the bladder (unless ultrasound is done before amniocentesis to locate the placenta). I.V. anesthesia isn t given for amniocentesis. The client should be supine during the procedure; afterward, she should be placed on her left side to avoid supine hypotension, promote venous return, and ensure adequate cardiac output. 22. After determining that a pregnant client is Rh-negative, Dr. Smith orders an indirect Coombs test. What is the purpose of performing this test in a pregnant client? a. To determine the fetal blood Rh factor b. To determine the maternal blood Rh factor c. To detect maternal antibodies against fetal Rh-negative factor d. To detect maternal antibodies against fetal Rh-positive factor Answer D. The indirect Coombs test measures the number of antibodies against fetal Rh-positive factor in maternal blood. The maternal blood Rh factor is determined before the indirect Coombs test is done. No maternal antibodies against fetal Rh-negative factor exist. 23. During a routine prenatal visit, a pregnant client reports heartburn. To minimize her discomfort, nurse Faith should include which suggestion in the plan of care? a. Eat small, frequent meals. b. Limit fluid intake sharply. c. Drink more citrus juice. d. Take sodium bicarbonate. Answer A. To relieve heartburn, the nurse should advise a pregnant client to eat smaller meals at shorter intervals; drink six to eight 8-oz glasses of fluid daily to minimize regurgitation and reflux of stomach contents; and avoid citrus juice, which may act as a gastric irritant and worsen heartburn, and sodium bicarbonate, which may disrupt the body s sodium-potassium balance. 24. A pregnant client asks nurse Mary about the percentage of congenital anomalies caused by drug exposure. How should the nurse respond? a. 1% b. 10% c. 20% d. 60% Answer A. Drug exposure causes 1% of congenital anomalies. 25. Sandy, age 39, visits the nurse practitioner for a regular prenatal check-up. She s 32 weeks pregnant. When assessing her, the nurse should stay especially alert for signs and symptoms of: a. pregnancy-induced hypertension (PIH). b. iron deficiency anemia.

c. cephalopelvic disproportion. d. sexually transmitted diseases (STDs). Answer A. Mature pregnant clients are at increased risk for PIH and are more likely to require cesarean delivery. Also, their fetuses and neonates have a higher mortality and a higher incidence of trisomies. Iron deficiency anemia, cephalopelvic disproportion, and STDs may occur in any client regardless of age.

Answer 1. Answer C. Taking brisk walks is one of the easiest ways to exercise during pregnancy. The client should begin by walking slowly for 10 to 15 minutes per day and increase gradually to a comfortable speed and a duration of 30 to 45 minutes per day. The pregnant client should avoid high-intensity aerobics because these greatly increase oxygen consumption; pregnancy itself not only increases oxygen consumption but reduces oxygen reserve. Starting from the 4th month of pregnancy, the client should avoid back-lying exercises because in this position the enlarged uterus may reduce blood flow through the vena cava. The client should avoid exercises that raise the heart rate over 140 beats/minute because the cardiovascular system already is stressed by increased blood volume during pregnancy. 2. Answer C. During the third trimester, the pregnant client typically perceives the fetus as a separate being. To verify that this has occurred, the nurse should ask whether she has made appropriate changes at home such as obtaining infant supplies and equipment. The type of anesthesia planned doesn t reflect the client s preparation for parenting. The client should have begun prenatal classes earlier in the pregnancy. The nurse should have obtained dietary information during the first trimester to give the client time to make any necessary changes. 3. Answer A. In the first trimester, fetal heart sounds are loudest in the area of maximum intensity, just above the client s symphysis pubis at the midline. Fetal heart sounds aren t heard as well in the other locations. 4. Answer B. Castor oil can initiate premature uterine contractions in pregnant women. It also can produce other adverse effects, but it doesn t promote sodium retention. Castor oil isn t known to increase absorption of fat-soluble vitamins, although laxatives can decrease absorption if intestinal motility is increased. 5. Answer B. The nurse must determine whether placenta previa or abruptio placentae is the problem. (Fifty percent of all clients with hypertension will develop abruptio placenta.) In this case, the presenting symptoms are highly suggestive of an abruption, so the nurse must determine the level of the uterus and mark that level on the client s abdomen. She must also check the consistency of the uterus; a uterus that is filling with blood because the placenta has detached early is rigid. Bleeding from a placental previa is usually painless. A vaginal examination is contraindicated in the presence of bleeding. Most nurses haven t been taught how to perform an ultrasound. If the client has a placental abruption, birth will most likely be by cesarean section. 6. Answer B. Recent breast reduction surgeries are done in a way to protect the milk sacs and ducts, so breast-feeding after surgery is possible. Still, it s good to check with the surgeon to determine what breast reduction procedure was done. There is the possibility that reduction surgery may have decreased the mother s ability to meet all of her baby s nutritional needs, and some supplemental feeding may be required. Preparing the mother for this possibility is extremely important because the client s psychological adaptation to mothering may be dependent on how successfully she breast-feeds.

7. Answer D. Maternal alcohol use during pregnancy may cause fetal and neonatal central nervous system deficits such as learning disabilities. It also may lead to characteristic physical anomalies and growth retardation. Maternal alcohol use doesn t cause alcohol addiction in the fetus or neonate. Anencephaly occurs when the cranial end of the neural tube fails to fuse before the 26th day of gestation; this condition isn t related to maternal alcohol use. Down syndrome results from a chromosomal disorder. 8. Answer: D. Transmission of HIV can occur through breast milk, so breast-feeding should be discouraged in this case. 9. Answer A. During each prenatal checkup, the nurse should evaluate the client for edema, a possible sign of pregnancy-induced hypertension (PIH). If edema exists, the nurse should assess for high blood pressure and proteinuria other signs of PIH. Hb is measured during the first prenatal visit and again at 24 to 28 weeks gestation and at 36 weeks gestation. The pelvis is measured and the Rh factor determined during the first prenatal visit. 10. Answer A. The best instruction is to encourage the client to increase her intake of high-fiber foods (roughage) and to drink at least six glasses of water per day. Mild laxatives and stool softeners may be needed, but dietary changes should be tried first. Straining during defecation and diarrhea can stimulate uterine contractions, but telling the client to go to the evaluation unit doesn t address her concern. 11. Answer B. During pregnancy, increasing levels of estrogen not progesterone cause vascularization of the eustachian tubes, leading to such problems as earaches, impaired hearing, and a constant feeling of fullness in the ears. Nothing in the question implies that the client has a serious neurologic disorder or an ear infection. 12. Answer D. For a client with hyperemesis gravidarum, the goal of nursing care is to achieve optimal fetal growth, which can be evaluated by monitoring uterine growth through fundal height assessment. The nurse shouldn t assume that excessive vomiting signifies the client doesn t accept the pregnancy. Clients with hyperemesis gravidarum rarely gain weight according to the expected pattern. They may be hospitalized briefly to regulate fluid and electrolyte status, but they don t require hospitalization for the duration of pregnancy. In fact, hospitalization may add to the stress of pregnancy by causing family separation and financial concerns. 13. Answer D. Glycosuria predisposes the pregnant diabetic client to vaginal infections (especially Candida vaginitis) and UTIs, because the hormonal changes of pregnancy affect vaginal pH and the bladder. Electrolyte imbalances and hypoglycemia aren t associated with vaginal infections or UTIs. Insulin requirements may decrease in early pregnancy; however, as the client s food intake improves and maternal and fetal glycogen stores increase, insulin requirements also rise. 14. Answer C. The cause of hyperemesis gravidarum isn t known. However, etiologic theories implicate hormonal alterations and allergic or psychosomatic conditions. No evidence suggests that hyperemesis gravidarum results from a neurologic disorder, inadequate nutrition, or hemolysis of fetal RBCs. 15. Answer D. Because all medications can be potentially harmful to the growing fetus, telling the client to consult with her health care provider before taking any medications is the best teaching. The client needs to understand that any medication taken at any time during pregnancy can be teratogenic. 16. Answer D. Being involved in the pregnancy helps reinforce a child s position in the family and minimizes feelings of neglect and abandonment. Telling the child about the childbirth only 1 month before the due date

wouldn t allow enough time to prepare him for the sibling and would prevent him from conceptualizing the passage of time. Reassuring him that nothing will change would be misleading; instead, the parents should discuss which aspects of family life will be changed by the upcoming birth and which will remain the same. Parents should reward mature behavior and ignore immature behavior. 17. Answer D. Increasing vitamin C enhances the absorption of iron supplements. Taking an iron supplement with milk, tea, or an antacid reduces the absorption of iron. 18. Answer B. Using Doppler ultrasound, fetal heart tones may be heard as early as the 11th week of pregnancy. Using a stethoscope, fetal heart tones may be heard between 17 and 20 weeks of gestation. 1. a. b. c. d. Which intervention is an example of primary prevention? Administering digoxin (Lanoxicaps) to a patient with heart failure Administering a measles, mumps, and rubella immunization to an infant Obtaining a Papanicolaou smear to screen for cervical cancer Using occupational therapy to help a patient cope with arthritis

2. The nurse in charge is assessing a patient s abdomen. Which examination technique should the nurse use first? a. Auscultation b. Inspection c. Percussion d. Palpation 3. a. b. c. d. Which statement regarding heart sounds is correct? S1 and S2 sound equally loud over the entire cardiac area. S1 and S2 sound fainter at the apex S1 and S2 sound fainter at the base S1 is loudest at the apex, and S2 is loudest at the base

4. The nurse in charge identifies a patient s responses to actual or potential health problems during which step of the nursing process? a. Assessment b. Nursing diagnosis c. Planning d. Evaluation 5. A female patient is receiving furosemide (Lasix), 40 mg P.O. b.i.d. in the plan of care, the nurse should emphasize teaching the patient about the importance of consuming: a. Fresh, green vegetables b. Bananas and oranges c. Lean red meat d. Creamed corn 6. The nurse in charge must monitor a patient receiving chloramphenicol for adverse drug reaction. What is the most toxic reaction to chloramphenicol? a. Lethal arrhythmias b. Malignant hypertension

c. Status epilepticus d. Bone marrow suppression 7. A female patient is diagnosed with deep-vein thrombosis. Which nursing diagnosis should receive highest priority at this time? a. Impaired gas exchanges related to increased blood flow b. Fluid volume excess related to peripheral vascular disease c. Risk for injury related to edema d. Altered peripheral tissue perfusion related to venous congestion 8. a. b. c. d. When positioned properly, the tip of a central venous catheter should lie in the: Superior vena cava Basilica vein Jugular vein Subclavian vein

9. Nurse Margareth is revising a client s care plan. During which step of the nursing process does such revision take place? a. Assessment b. Planning c. Implementation d. Evaluation 10. A 65-year-old female who has diabetes mellitus and has sustained a large laceration on her left wrist asks the nurse, How long will it take for my scars to disappear? which statement would be the nurse s best response? a. The contraction phase of wound healing can take 2 to 3 years. b. Wound healing is very individual but within 4 months the scar should fade. c. With your history and the type of location of the injury, it s hard to say. d. If you don t develop an infection, the wound should heal any time between 1 and 3 years from now. 11. a. b. c. d. One aspect of implementation related to drug therapy is: Developing a content outline Documenting drugs given Establishing outcome criteria Setting realistic client goals

12. A female client is readmitted to the facility with a warm, tender, reddened area on her right calf. Which contributing factor would the nurse recognize as most important? a. A history of increased aspirin use b. Recent pelvic surgery c. An active daily walking program d. A history of diabetes 13. Which intervention should the nurse in charge try first for a client that exhibits signs of sleep disturbance? a. Administer sleeping medication before bedtime b. Ask the client each morning to describe the quantity of sleep during the previous night c. Teach the client relaxation techniques, such as guided imagery, medication, and progressive muscle

relaxation d. Provide the client with normal sleep aids, such as pillows, back rubs, and snacks 14. While examining a client s leg, the nurse notes an open ulceration with visible granulation tissue in the wound. Until a wound specialist can be contacted, which type of dressings is most appropriate for the nurse in charge to apply? a. Dry sterile dressing b. Sterile petroleum gauze c. Moist, sterile saline gauze d. Povidone-iodine-soaked gauze 15. A male client in a behavioral-health facility receives a 30-minute psychotherapy session, and provider uses a current procedure terminology (CPT) code that bills for a 50-minute session. Under the False Claims Act, such illegal behavior is known as: a. Unbundling b. Overbilling c. Upcoding d. Misrepresentation 16. A nurse assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that he s impotent and says that he s concerned about its effect on his marriage. In planning this client s care, the most appropriate intervention would be to: a. Encourage the client to ask questions about personal sexuality b. Provide time for privacy c. Provide support for the spouse or significant other d. Suggest referral to a sex counselor or other appropriate professional 17. Using Abraham Maslow s hierarchy of human needs, a nurse assigns highest priority to which client need? a. Security b. Elimination c. Safety d. Belonging 18. A male client is on prolonged bed rest has developed a pressure ulcer. The wound shows no signs of healing even though the client has received skin care and has been turned every 2 hours. Which factor is most likely responsible for the failure to heal? a. Inadequate vitamin D intake b. Inadequate protein intake c. Inadequate massaging of the affected area d. Low calcium level 19. A female client who received general anesthesia returns from surgery. Postoperatively, which nursing diagnosis takes highest priority for this client? a. Acute pain related to surgery b. Deficient fluid volume related to blood and fluid loss from surgery c. Impaired physical mobility related to surgery d. Risk for aspiration related to anesthesia

20. Nurse Cay inspects a client s back and notices small hemorrhagic spots. The nurse documents that the client has: a. Extravasation b. Osteomalacia c. Petechiae d. Uremia 21. a. b. c. d. Which document addresses the client s right to information, informed consent, and treatment refusal? Standard of Nursing Practice Patient s Bill of Rights Nurse Practice Act Code for Nurses

22. If a blood pressure cuff is too small for a client, blood pressure readings taken with such a cuff may do which of the following? a. Fail to show changes in blood pressure b. Produce a false-high measurement c. Cause sciatic nerve damage d. Produce a false-low measurement 23. Nurse Danny has been teaching a client about a high-protein diet. The teaching is successful if the client identifies which meal as high in protein? a. Baked beans, hamburger, and milk b. Spaghetti with cream sauce, broccoli, and tea c. Bouillon, spinach, and soda d. Chicken cutlet, spinach, and soda 24. A male client is admitted to the hospital with blunt chest trauma after a motor vehicle accident. The first nursing priority for this client would be to: a. Assess the client s airway b. Provide pain relief c. Encourage deep breathing and coughing d. Splint the chest wall with a pillow 25. A newly hired charge nurse assesses the staff nurses as competent individually but ineffective and nonproductive as a team. In addressing her concern, the charge nurse should understand that the usual reason for such a situation is: a. Unhappiness about the charge in leadership b. Unexpected feeling and emotions among the staff c. Fatigue from overwork and understaffing d. Failure to incorporate staff in decision making 26. A male client blood test results are as follows: white blood cell (WBC) count, 100ul; hemoglobin (Hb) level, 14 g/dl; hematocrit (HCT), 40%. Which goal would be most important for this client? a. Promote fluid balance b. Prevent infection c. Promote rest d. Prevent injury

27. Following a tonsillectomy, a female client returns to the medical-surgical unit. The client is lethargic and reports having a sore throat. Which position would be most therapeutic for this client? a. Semi-Fowler s b. Supine c. High-Fowler s d. Side-lying Answer D. Because of lethargy, the post tonsillectomy client is at risk for aspirating blood from the surgical wound. Therefore, placing the client in the side-lying position until he awake is best. The semi-Fowler s, supine, and high-Fowler s position don t allow for adequate oral drainage in a lethargic post tonsillectomy client, and increase the risk of blood aspiration 28. Nurse Berri inspects a client s pupil size and determines that it s 2 mm in the left eye and 3 mm in the right eye. Unequal pupils are known as: a. Anisocoria b. Ataxia c. Cataract d. Diplopia Answer A. Unequal pupils are called anisocoria. Ataxia is uncoordinated actions of involuntary muscle use. A cataract is an opacity of the eye s lens. Diplopia is double vision. 29. The nurse in charge is caring for an Italian client. He s complaining of pain, but he falls asleep right after his complaint and before the nurse can assess his pain. The nurse concludes that: a. He may have a low threshold for pain b. He was faking pain c. Someone else gave him medication d. The pain went away Answer A. People of Italian heritage tend to verbalize discomfort and pain. The pain was real to the client, and he may need medication when he wakes up. 30. A female client is admitted to the emergency department with complaints of chest pain shortness of breath. The nurse s assessment reveals jugular vein distention. The nurse knows that when a client has jugular vein distension, it s typically due to: a. A neck tumor b. An electrolyte imbalance c. Dehydration d. Fluid overload Answer D. Fluid overload causes the volume of blood within the vascular system to increase. This increase causes the vein to distend, which can be seen most obviously in the neck veins. A neck tumor doesn t typically cause jugular vein distention. An electrolyte imbalance may result in fluid overload, but it doesn t directly contribute to jugular vein distention Answers Answer B. Immunizing an infant is an example of primary prevention, which aims to prevent health problems. Administering digoxin to treat heart failure and obtaining a smear for a screening test are examples

for secondary prevention, which promotes early detection and treatment of disease. Using occupational therapy to help a patient cope with arthritis is an example of tertiary prevention, which aims to help a patient deal with the residual consequences of a problem or to prevent the problem from recurring. Answer B. Inspection always comes first when performing a physical examination. Percussion and palpation of the abdomen may affect bowel motility and therefore should follow auscultation. Answer D. The S1 sound the lub sound is loudest at the apex of the heart. It sounds longer, lower, and louder there than the S2 sounds. The S2 the dub sound is loudest at the base. It sounds shorter, sharper, higher, and louder there than S1. Answer B. The nurse identifies human responses to actual or potential health problems during the nursing diagnosis step of the nursing process. During the assessment step, the nurse systematically collects data about the patient or family. During the planning step, the nurse develops strategies to resolve or decrease the patient s problem. During the evaluation step, the nurse determines the effectiveness of the plan of care. Answer B. Because furosemide is a potassium-wasting diuretic, the nurse should plan to teach the patient to increase intake of potassium-rich foods, such as bananas and oranges. Fresh, green vegetables; lean red meat; and creamed corn are not good sources of potassium. Answer D. The most toxic reaction to chloramphenicol is bone marrow suppression. Chloramphenicol is not known to cause lethal arrhythmias, malignant hypertension, or status epilepticus. Answer D. Altered peripheral tissue perfusion related to venous congestion takes highest priority because venous inflammation and clot formation impede blood flow in a patient with deep-vein thrombosis. Option A is incorrect because impaired gas exchange is related to decreased, not increased, blood flow. Option B is inappropriate because no evidence suggest that this patient has a fluid volume excess. Option C may be warranted but is secondary to altered tissue perfusion. Answer A. When the central venous catheter is positioned correctly, its tip lies in the superior vena cava, inferior vena cava, or the right atrium that is, in central venous circulation. Blood flows unimpeded around the tip, allowing the rapid infusion of large amounts of fluid directly into circulation. The basilica, jugular, and subclavian veins are common insertion sites for central venous catheters. Answer D. During the evaluation step of the nursing process the nurse determines whether the goals established in the care plan have been achieved, and evaluates the success of the plan. If a goal is unmet or partially met the nurse reexamines the data and revises the plan. Assessment involves data collection. Planning involves setting priorities, establishing goals, and selecting appropriate interventions. Answer C. Wound healing in a client with diabetes will be delayed. Providing the client with a time frame could give the client false information. Answer B. Although documentation isn t a step in the nursing process, the nurse is legally required to document activities related to drug therapy, including the time of administration, the quantity, and the client s reaction. Developing a content outline, establishing outcome criteria, and setting realistic client goals are part of planning rather than implementation. Answer B. The client shows signs of deep vein thrombosis (DVT). The pelvic area is rich in blood supply, and thrombophlebitis of the deep vein is associated with pelvic surgery. Aspirin, an antiplatelet agent, and an active walking program help decrease the client s risk of DVT. In general, diabetes is a contributing factor associated with peripheral vascular disease. Answer D. The nurse should begin with the simplest interventions, such as pillows or snacks, before interventions that require greater skill such as relaxation techniques. Sleep medication should be avoided whenever possible. At some point, the nurse should do a thorough sleep assessment, especially if common sense interventions fail. Answer C. Moist, sterile saline dressings support would heal and are cost-effective. Dry sterile dressings adhere to the wound and debride the tissue when removed. Petroleum supports healing but is expensive. Povidone-iodine can irritate epithelial cells, so it shouldn t be left on an open wound.

Answer C. Upcoding is the practice of using a CPT code that s reimbursed at a higher rate than the code for the service actually provided. Unbundling, overbilling, and misrepresentation aren t the terms used for this illegal practice. Answer D. The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client s care. The nurse doesn t normally provide sex counseling. Therefore, providing time for privacy and providing support for the spouse or significant other are important, but not as important as referring the client to a sex counselor. Answer B. According to Maslow, elimination is a first-level or physiological need, and therefore takes priority over all other needs. Security and safety are second-level needs; belonging is a third-level need. Second- and third-level needs can be met only after a client s first-level needs have been satisfied. Answer B. A client on bed rest suffers from a lack of movement and a negative nitrogen balance. Therefore, inadequate protein intake impairs wound healing. Inadequate vitamin D intake and low calcium levels aren t factors in poor healing for this client. A pressure ulcer should never be massaged. Answer D. Risk for aspiration related to anesthesia takes priority for thins client because general anesthesia may impair the gag and swallowing reflexes, possibly leading to aspiration. The other options, although important, are secondary. Answer C. Petechiae are small hemorrhagic spots. Extravasation is the leakage of fluid in the interstitial space. Osteomalacia is the softening of bone tissue. Uremia is an excess of urea and other nitrogen products in the blood. Answer B. The Patient s Bill of Rights addresses the client s right to information, informed consent, timely responses to requests for services, and treatment refusal. A legal document, it serves as a guideline for the nurse s decision making. Standards of Nursing Practice, the Nurse Practice Act, and the Code for Nurses contain nursing practice parameters and primarily describe the use of the nursing process in providing care. Answer B. Using an undersized blood pressure cuff produces a falsely elevated blood pressure because the cuff can t record brachial artery measurements unless it s excessively inflated. The sciatic nerve wouldn t be damaged by hyperinflation of the blood pressure cuff because the sciatic nerve is located in the lower extremity. Answer A. Baked beans, hamburger, and milk are all excellent sources of protein. The spaghetti-broccoli-tea choice is high in carbohydrates. The bouillon-spinach-soda choice provides liquid and sodium as well as some iron, vitamins, and carbohydrates. Chicken provides protein but the chicken-spinach-soda combination provides less protein than the baked beans-hamburger-milk selection. Answer A. The first priority is to evaluate airway patency before assessing for signs of obstruction, sternal retraction, stridor, or wheezing. Airway management is always the nurse s first priority. Pain management and splinting are important for the client s comfort, but would come after airway assessment. Coughing and deep breathing may be contraindicated if the client has internal bleeding and other injuries. Answer B. The usual or most prevalent reason for lack of productivity in a group of competent nurses is inadequate communication or a situation in which the nurses have unexpected feeling and emotions. Although the other options could be contributing to the problematic situation, they re less likely to be the cause. Answer B. The client is at risk for infection because WBC count is dangerously low. Hb level and HCT are within normal limits; therefore, fluid balance, rest, and prevention of injury are inappropriate. .

COMmUNITY
ORRECT ANSWERS

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

1. A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following patient's medication does not cause urine discoloration? A. Sulfasalazine B. Levodopa C. Phenolphthalein D. Aspirin 2. You are responsible for reviewing the nursing unit's refrigerator. If you found the following drug in the refrigerator it should be removed from the refrigerator's contents? A. Corgard B. Humulin (injection) C. Urokinase D. Epogen (injection) 3. A 34 year old female has recently been diagnosed with an autoimmune disease. She has also recently discovered that she is pregnant. Which of the following is the only immunoglobulin that will provide protection to the fetus in the womb? A. IgA B. IgD C. IgE D. IgG 4. A second year nursing student has just suffered a needlestick while working with a patient that is positive for AIDS. Which of the following is the most important action that nursing student should take? A. Immediately see a social worker B. Start prophylactic AZT treatment C. Start prophylactic Pentamide treatment D. Seek counseling 5. A thirty five year old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect? A. Atherosclerosis B. Diabetic nephropathy C. Autonomic neuropathy D. Somatic neuropathy 6. You are taking the history of a 14 year old girl who has a (BMI) of 18. The girl reports inability to eat, induced vomiting and severe constipation. Which of the following would you most likely suspect? A. Multiple sclerosis B. Anorexia nervosa C. Bulimia D. Systemic sclerosis 7. A 24 year old female is admitted to the ER for confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Which of the following would you most likely suspect? A. Diverticulosis B. Hypercalcaemia C. Hypocalcaemia D. Irritable bowel syndrome 8. Rho gam is most often used to treat____ mothers that have a ____ infant. A. RH positive, RH positive B. RH positive, RH negative C. RH negative, RH positive D. RH negative, RH negative 9. A new mother has some questions about (PKU). Which of the following statements made by a nurse is not correct regarding PKU?

A. A Guthrie test can check the necessary lab values. B. The urine has a high concentration of phenylpyruvic acid C. Mental deficits are often present with PKU. D. The effects of PKU are reversible. 10. A patient has taken an overdose of aspirin. Which of the following should a nurse most closely monitor for during acute management of this patient? A. Onset of pulmonary edema B. Metabolic alkalosis C. Respiratory alkalosis D. Parkinson's disease type symptoms 11. A fifty-year-old blind and deaf patient has been admitted to your floor. As the charge nurse your primary responsibility for this patient is? A. Let others know about the patient's deficits B. Communicate with your supervisor your concerns about the patient's deficits. C. Continuously update the patient on the social environment. D. Provide a secure environment for the patient. 12. A patient is getting discharged from a SNF facility. The patient has a history of severe COPD and PVD. The patient is primarily concerned about their ability to breath easily. Which of the following would be the best instruction for this patient? A. Deep breathing techniques to increase O2 levels. B. Cough regularly and deeply to clear airway passages. C. Cough following bronchodilator utilization D. Decrease CO2 levels by increase oxygen take output during meals. 13. A nurse is caring for an infant that has recently been diagnosed with a congenital heart defect. Which of the following clinical signs would most likely be present? A. Slow pulse rate B. Weight gain C. Decreased systolic pressure D. Irregular WBC lab values 14. A mother has recently been informed that her child has Down's syndrome. You will be assigned to care for the child at shift change. Which of the following characteristics is not associated with Down's syndrome? A. Simian crease B. Brachycephaly C. Oily skin D. Hypotonicity 15. A patient has recently experienced a (MI) within the last 4 hours. Which of the following medications would most like be administered? A. Streptokinase B. Atropine C. Acetaminophen D. Coumadin

16. A patient asks a nurse, My doctor recommended I increase my intake of folic acid. What type of foods contain folic acids? A. Green vegetables and liver B. Yellow vegetables and red meat C. Carrots D. Milk 17. A nurse is putting together a presentation on meningitis. Which of the following microorganisms has noted been linked to meningitis in humans? A. S. pneumonia B. H. influenza C. N. meningitis D. Cl. difficile 18. A nurse is administering blood to a patient who has a low hemoglobin count. The patient asks how long to RBC's last in my body? The correct response is. A. The life span of RBC is 45 days. B. The life span of RBC is 60 days. C. The life span of RBC is 90 days. D. The life span of RBC is 120 days. 19. A 65 year old man has been admitted to the hospital for spinal stenosis surgery. When does the discharge training and planning begin for this patient? A. Following surgery B. Upon admit C. Within 48 hours of discharge D. Preoperative discussion 20. A child is 5 years old and has been recently admitted into the hospital. According to Erickson which of the following stages is the child in? A. Trust vs. mistrust B. Initiative vs. guilt C. Autonomy vs. shame D. Intimacy vs. isolation 21. A toddler is 16 months old and has been recently admitted into the hospital. According to Erickson which of the following stages is the toddler in? A. Trust vs. mistrust B. Initiative vs. guilt C. Autonomy vs. shame D. Intimacy vs. isolation 22. A young adult is 20 years old and has been recently admitted into the hospital. According to Erickson which of the following stages is the adult in? A. Trust vs. mistrust B. Initiative vs. guilt C. Autonomy vs. shame D. Intimacy vs. isolation 23. A nurse is making rounds taking vital signs. Which of the following vital signs is abnormal? A. 11 year old male 90 b.p.m, 22 resp/min., 100/70 mm Hg B. 13 year old female 105 b.p.m., 22 resp/min., 105/60 mm Hg C. 5 year old male- 102 b.p.m, 24 resp/min., 90/65 mm Hg D. 6 year old female- 100 b.p.m., 26 resp/min., 90/70mm Hg 24. When you are taking a patient's history, she tells you she has been depressed and is dealing with an anxiety disorder. Which of the following medications would the patient most likely be taking? A. Elavil B. Calcitonin

C. Pergolide D. Verapamil 25. Which of the following conditions would a nurse not administer erythromycin? A. Campylobacterial infection B. Legionnaire's disease C. Pneumonia D. Multiple Sclerosis Answer Key 1. D 2. A 3. D 4. B 5. C 6. B 7. B 8. C 9. D 10. D 11. D 12. C 13. B 14. C 15. A 16. A 17. D 18. D 19. B 20. B 21. A 22. D 23. B 24. A 25. D