New Era University

College of Nursing Mentoring Activity# SCORE Fundamentals of Nursing

Directions. Answer the following questions carefully. Write the answer on the space provided
1. A participant in the STROKE class asks what is a risk factor of stroke. Your best response is: A. More red blood cells thicken blood and make clots more possible. B. Increased RBC count is linked to high cholesterol. C. More red blood cell increases hemoglobin content. D. High RBC count increases blood pressure. Situation 11: Recognition of normal values is vital in assessment of clients with various disorders. 2. A nurse is reviewing the laboratory test results for a client with a diagnosis of severe dehydration. The nurse would expect the hematocrit level for this client to be which of the following? A. 60% B. 47% C. 45% D. 32% 3. A nurse is reviewing the electrolyte results of an assigned client and notes that the potassium level is 5.6 mEq/L. Which of the following would the nurse expect to note on the ECG as a result of this laboratory value? A. ST depression B. Inverted t wave C. Prominent U wave D. Tall peaked T waves 4. A nurse is reviewing the electrolyte results of an assigned client and notes that the potassium level is 3.2 mEq/L. Which of the following would the nurse expect to note on the ECG as a result of this laboratory value? A. U waves B. Absent P waves C. Elevated T waves D. Elevated ST segment 5. Dorothy underwent diagnostic test and the result of the blood examination are back. On reviewing the result the nurse notices which of the following as abnormal finding? A. Neutrophils 60% B. White blood cells (WBC) 9000/mm C. Erythrocyte sedimentation rate (ESR) is 39 mm/hr

D. Iron 75 mg/100 ml 6. Which of the following laboratory test result indicate presence of an infectious process? A. Erythrocyte sedimentation rate (ESR) 12 mm/hr B. White blood cells (WBC) 18,000/mm3 C. Iron 90 g/100ml D. Neutrophils 67% Situation 12: Pleural effusion is the accumulation of fluid in the pleural space. Question to 66 to 70 refer to this? 7. Which of the following is a finding that the nurse will be able to assess in a client with pleural effusion? A. Reduced or absent breath sound at the base of the lungs, dyspnea, tachypnea and shortness of breath. B. Hypoxemia C. Noisy respiration, crackles, stridor and wheezing D. Tracheal deviation towards the affected side, increased fremitus and loud breath sounds 8. Thoracentesis is performed to the client with effusion. The nurse knows that the removal of fluid should be slow. Rapid removal of fluid in thoracentesis might cause: A. Pneumothorax B. Pleurisy or Pleuritis C. Cardiovascular collapse D. Hypertension 9. 3 Days after thoracentesis, the client again exhibited respiratory distress. The nurse will know that the pleural effusion has reoccurred when she noticed a sharp stabbing pain during inspiration. The physician ordered a closed tube thoracotomy for the client. The nurse knows that the primary function of the chest tube is to: A. Restore positive intrathoracic pressure B. Restore negative intrathoracic pressure C. To visualize the intrathoracic content D. As a method of air administration 10. The chest tube is functioning properly if: A. There is an oscillation B. There is no bubbling in the drainage bottle C. There is a continuous bubbling in the water seal. D. The suction control bottle has a continuous bubbling 11. In a client with pleural effusion, the nurse is instructing a appropriate breathing technique. Which of the following is included in the teaching? A. Breath normally B. Hold the breath after each inspiration for 1 full minute

C. Practice abdominal breathing D. Inhale slowly and hold the breath for 3-5 seconds after each inhalation. Situation 13: Health care delivery system affects the health status of every Filipino. As a Nurse, Knowledge of this system is expected to ensure quality of life. 12. When should rehabilitation commence? A. The day before discharge B. When the patient desires C. Upon admission D. 24hours after discharge 13. What exemplified the preventive and promotive programs in the hospital? A. Hospitals as a center to prevent and control infection B. Program for smokers C. Program for alcoholics and drug addicts D. Wellness Center 14. Which makes nursing dynamic? A. Every patient is a unique physical, emotional, social and spiritual being B. The patient participate in the over all nursing care plan C. Nursing practice is expanding in the light of modern development that takes place D. The health status of the patient is constantly changing and the nurse must be cognizant and responsive to these changes. 15. Prevention is an important responsibility of the nurse in: A. Hospitals B. Community C. Workplace D. All of the above 16. This form of Health Insurance provides comprehensive prepaid health services to enrollees for a periodic payment. A. Health Maintenance Organization B. Medicare C. Philippine Health Insurance Act D. Hospital Maintenance Organization 17. Health care reports have different purposes. The availability of patients record to all health ream members demonstrates which of the following purposes: A. Legal documentation B. Education C. Research D. Vehicle for communication

18. When a nurse commits medication error she should accurately document clients response and her corresponding action. This is very important for which of the following purposes: A. Research B. Nursing Audit C. Legal documentation D. Vehicle for communication 19. POMR has been widely used in many teaching hospitals. One of its unique features is SOAPIE charting. The P in SOAPIE charting should include: A. Prescription of the doctor to the patients illness B. Plan of care for patient C. Patients perception of ones illness D. Nursing Problem and Nursing Diagnosis 20. The medical records that are organized into separate section from doctors or nurses has more disadvantages than advantages. This is classified as what type of recording? A. POMR B. SOAPIE C. Modified POMR D. SOMR 21. Which of the following is the advantage of SOMR or Traditional Recording? A. Increase efficiency of Data gathering B. Reinforces the use of the nursing process C. The caregiver can easily locate proper section for making charting entries D. Enhances effective communication among health care team members Situation 17: June is 24 year old client with symptoms of dyspnea, absent breath sounds on the right lung and chest X-ray revealed pleural effusion. The physician will perform thoracentesis 22. Thoracentesis is useful in treating which of the following pulmonary disorders except: A. Hemothorax B. Tuberculosis C. Hydrothorax D. Empyema 23. Which of the following psychological preparation is not relevant for him? A. Telling him that the gauge of the needle and anesthesia to be used B. Telling him to keep still during the procedure to facilitate the insertion of the needle in the correct place. C. Allow June to express his feeling and concerns D. Physicians explanation on the purpose of the procedure and how it will be done.

24. Before thoracentesis, the legal consideration you must check is: A. Consent is signed by the client B. Medicine preparation is correct C. Position of the client is correct D. Consent is signed by relative and physician 25. As a nurse, you know that the position for June before thoracentesis is: A. Orthopneic B. Knee-chest C. Low fowlers D. Sidelying position on the affected side

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MENTEE