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COMPREHENSIVE NURSING REVIEW by R. C.

REA

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Fundamentals of Nursing Maternity Nursing Pediatric Nursing Community Health Nursing Medical Surgical Nursing Psychiatric Nursing Professional Adjustment Leadership and Management Nursing Research

Compiled by:

RO !R" C# R!$A

2009 THE EVER POPULAR LAST MINUTE TIPS FOR

COMPREHENSIVE NURSING REVIEW by R. C. REA

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NURSING LICENSURE EXAMINATIONS In NP1, Please FOCUS on the following: 1 !ypes of leade"ship: #$to%"ati%& 'aisse( fai"e& )emo%"ati%& t"ansfo"mational& t"ansa%tional et% et% 2 Patte"n of *$"sing %a"e: P"ima"y n$"sing& %ase n$"sing& f$n%tional& team et% + ,-panded *$"sing "ole: *$"se anesthetist& *$"se p"a%titione"& *$"se "esea"%he" et% et% . 'e/els of p"e/ention by 'ea/ell and Cla"0 1emembe" that %"isis is always se%onda"y 2 + way bottle system: simply "e%onne%t the t$be& %ontin$o$s b$bble is a sign of lea0age& no b$bbling is obst"$%tion 3in the wate"seal4 and yo$ sho$ld palpate the s$""o$nding a"ea fo" s$b%$taneo$s emphysema 5 Ca"e of %lients with t"a%heostomy and s$%tioning a t"a%heostomy t$be 3ste"ile te%hni6$e4 0now the f$n%tions of the %$ff& obt$"ato" and the tie %a"e of %lients with pooling of se%"etions Post$"al d"ainage: do this befo"e meals& the positioning depending on the lo%ation of se%"etion& POP,7ICO 3a""angement4 that is positioning& pe"%$ssing& /ib"ating and %o$ghing et% st$dy s$%tioning 8 !he independent and the dependent /a"iable in "esea"%h 9 :now yo$" PU1, and #PP'I,) as well as ,;P,1I<,*!#' and *O*=,;P,1I<,*!#' also yo$" >U#*!I!#!I7, and >U#'I!#!I7, designs 9 I7 fl$id toni%ity: )2'1 is hype"toni% while '1 is isotoni% 10 Compli%ation of I7 and its inte"/ention s$%h as F'UI) O7,1'O#)& P?',@I!IS& I*FI'!1#!IO* 11 @lood t"ansf$sion 12 Compli%ation of immobility: ),CU@I!US U'C,1& ?APO P*,U<O*I#& #!,',C!#SIS& ),,P 7,I* !?1O<@OSIS 1+ !he 7I1!U, ,!?ICS and ,!?ICS: B$sti%e& fo"tit$de& p"$den%e& tempe"an%e& %ha"a%te"& do$ble effe%t& pate"nalism et% et% and the PatientCs bill of "ight 12 !ea%hing and lea"ning steps: <an initially needs info"mation and <O!I7#!IO* is needed fo" adhe"en%e to tea%hing Fi"st step in tea%hing is to #SS,SS ',#1*I*D *,,)S befo"e planning what to tea%h 15 S#F,!A: Ca$ses of inE$"ies a%%o"ding to age eg: elde"ly F falls& infant F s$ffo%ation and aspi"ation& adoles%en%e F s$i%ide and homi%ide Inte"/ention in an elde"ly %lient who falls f"e6$ently F 0eep the bed at the lowest possible position et% 19 @O* 1,SO'U!IO* 220 3CO), OF ,!?ICS4 1# 918+ #*) 815. 3CO<P#1, #*) CO*!1#S!4 and the CO*!I*UI*D P1OF,SSIO*#' ,)UC#!IO* 3!o enhan%e 0nowledge with "ega"d to spe%ifi% field of inte"est4 NP2 1 Stages of labo" !he fi"st stage $p to the fo$"th stage and the '#!,*! #C!I7, #*) !1#*SI!IO* of the fi"st stage st$dy the inte"/ention in all stages 1ead pillete"i fo" this 2 !he menst"$al %y%le& what glands se%"et what ho"mones !he <,*S!1U#'& P1O'IF,1#!I7,& S,C1,!O1A and ISC?,<IC phase what ho"mone is at pea0 d$"ing what stage et% et% + Ca$ses of bleeding d$"ing p"egnan%y: ,%topi%& ab"$ptio and p"e/ia pl$s thei" n$"sing inte"/ention . ,ndomet"iosis and ,ndomet"itis 2 I<CI : Pne$monia& )ia""hea and )eng$e espe%ially the b"eathing %$t off 3,g 50 fo" $nde" 2 months4& #%$teGCh"oni% %$toff 3#%$te dia""hea and ea" infe%tion $nde" 1. days4 !he inte"/entions fo" C?I') #& @ and C

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5 CO<<U*I!A ?,#'!? *U1SI*D P1OC,SS: #ssessment& Planning& Implementation and ,/al$ation "efe" to the )O? boo0 please "ead this one 8 <anage"ial p"in%iples PO)C !ypes of b$dgets )i"e%t& indi"e%t& %ash& %apital& ope"ational b$dgets 9 1ead pillete"i fo" : Cha"a%te"isti% of a toddle" and p"es%hool 3 eg : as0ing too many 6$estions& negati/isti% fo" toddle" P"es%hool F asso%iati/e& imagina"y& see the wo"ld on his own point of /iew& s$pe"ego de/elopment et% 4 9 POISO*I*D: 'ead& aspi"in& et% et% this is the %ommon %a$se of a%%ident among toddle"s 10 'e$0emia& #nemia and Si%0le %ell anemia& %hemothe"apy fo" pediat"i% %lients 11 *,H@O1* SC1,,*I*D 12 #mnio%entesis F 7OI)& Ult"asonog"aphy F )1I*:& 'eopolds <ane$/e" F 7OI)& Pa"a%entesis F 7OI) 1+ Changes d$"ing p"egnan%y 3eg: 'e$0o""hea& b"a-ton hi%0s& anemia4 and what %hanges o%%$"s ea"ly o" late 1efe" to Pillitte"i 1. P"egnan%y and n$t"ition: @alan%ed diet I +00 %al fo" p"egnant I200 %al fo" b"eastfeeding 12 PI? and <#D*,SIU< SU'F#!, 3%ns down& "" down& $Go down 4 p"io"ity : 11 NP3 AND NP4 1 @$"ns& Classifi%ation of @$"ns and *$"sing )iagnosis fo" @$"ns& )"$g $se in b$"ns 3Sil/e" S$lfadia(ine4& ,le%t"olyte %hanges in b$"n 3?ype"0alemia& ?yponate"mia4 !he H?O Pain ladde" s%ale& Pain medi%ations espe%ially )eme"ol& <o"phine and Fentanyl 1emembe" that P#I* is the ha"dest pa"t fo" the n$"se in %a"ing fo" a b$"ned /i%tim @$"n wo$nds heal by se%onda"y intention 2 *$"sing diagnosis afte" anesthesia : 1IS: FO1 I*F,C!IO* o" I*,FF,C!I7, #I1 C',#1#*C, + P#CU <O*I!O1I*D F >12 & SU1DIC#' F'OO1 <O*I!O1I*D F >+0 . Pan%"eatitis& Chole%ystitis& ?epatitis <o"phine %a$ses spasms in the sphin%te" of oddi ?epa @ is %a$sed by blood e-%hange ?epa # is o"o=fe%al both ha/e /a%%ines eithe" passi/e o" a%ti/e b$t if al"eady e-posed& Di/e P#SSI7, 2 )iabetes mellit$s& <etfo"min and %ont"ast medi$m 3stop metfo"min d$e to "enal to-i%ity4& Ins$lin "otation and administ"ation& diabetes "Gt foot%a"e #/oid wea"ing %an/ass shoes& %he%0 fo" the sensation& do not go o$tside witho$t slippe"s P,1IP?,1#' *,U1OP#!?A O?# d"$gs 5 ,le%t"olytes abno"mality espe%ially ?APOC#'C,<I# and ?AP,1G?APO:#',<I# !he ,CD %hanges in potassi$m alte"ation& inte"/ention and %a$ses 8 <yo%a"dial infa"%tion : ,CD %hanges as well as n$"sing inte"/ention Ca$ses and "is0 fa%to"s 1efe" to @1U**,1 9 Pha"ma%ologi% and *onpha"ma%ologi% pain "elief : D$ided image"y& @iofeedba%0& Int"athe%al 3into the spinal %anal di"e%tly to mi- with %sf4 and epid$"al 3 into the epid$"al spa%e 4 pain management side effe%ts of mo"phine in elde"ly F P1U1I!US and #'',1DIC 1;* and 11 ),P1,SSIO* 1eason fo" int"athe%al admininst"ation F p"e/ent @lood b"ain ba""ie" 9 @1,#S! and C,17IC#' %an%e" #ssessment& )iagnosis and !"eatment 10 <anagement fo" a %lient with CO'OS!O<A !he i""igation& diet and body image alte"ation as well as pe"iope"ati/e management of a %lient $nde"going yo$" #@)O<I*#' P,1I*,#' 1,S,C!IO* with pe"manent %olostomy )"$gs gi/en befo"e #P1 s$%h as neomy%in and s$lfas$(idine& )iet befo"e #P1 3low fibe"4& no"mal %olo" of the stoma E$st afte" #P1 3slightly bleeding& "ed and p"ot"$ding4 11 Ins$lin administ"ation& types and "otation 1efe" to b"$nne" 1 in%h away f"om ea%h inEe%tion site& administe" at "oom temp not %old to p"e/ent lipodyst"ophy& abdomen has the fastest abso"ption et% et% 12 Inte"/entions d$"ing hypo= and hype"gly%emia

COMPREHENSIVE NURSING REVIEW by R. C. REA

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1+ Ca"e of %lients with hype"= and hypothy"oidism& st$dy !#P#JO',G<,!?I<#JO', and 'UDO'CS SO'U!IO*& P!U Ca"e of %lients afte" thy"oide%tomy: <onito" fo" hypo%al%emia tea%h %lients ?,#) SUPPO1! by p$tting hands at the ba%0 of the ne%0 befo"e t"ying to mo/e the head 1. !$be"%$losis and 'ep"osy& its ea"ly G late sign and symptoms 12 #%$te and Ch"oni% "enal fail$"e Ca$ses 3PostGp"eGint"a4 and hemodialysis 15 #D*& 1he$mathoid and Ostea"th"itis& @ellCs Palsy and !"igeminal ne$"algia 18 St$dy "adiation and %hemothe"apy and thei" $s$al side effe%ts 3S0in b$"n& "edness& do not wet "adiation ma"04 <ammog"aphy& @S,& !S,& )1,& P"ostate and Colon %an%e"& Changes that o%%$"s d$"ing elde"ly& @ladde"& Colon and Ce"/i%al %an%e" )iagnosti% e-aminationGC,#& P"o%tosigmoidos%opy& @iopsy& Pap smea" 19 'a"yngeal %an%e" and t"a%heostomy %a"e 3"efe" to :o(ie" fo" t"a%heostomy %a"e4 NP5 1 In yo$" !est 7 st$dy the following: #n-iety and an-iety diso"de"s& !he le/el of an-iety and yo$" an-iolyti%s& S%hi(oph"enia: Pa"anoid type and Catatoni% type and yo$" n$"sing inte"/entions fo" these %lients as well as yo$" p"io"ity n$"sing diagnosis 2 )ep"ession and yo$" antidep"essants& <ania& Pe"sonality diso"de"s espe%ially yo$" #ntiso%ial& @o"de"line and Pa"anoid !he defense me%hanism $se fo" diffe"ent types of diso"de"s and the p"io"ity *U1SI*D )I#D*OSIS fo" ea%h psy%hiat"i% diso"de"s& #ntipsy%hoti% d"$gs its side effe%ts and n$"sing inte"/ention fo" ea%h side effe%ts + ,le%t"o%on/$lsi/e the"apy& !ho$ght p"o%ess dist$"ban%e manifestation s$%h as Clang #sso%iation& P"ess$"ed spee%h& !ho$ght blo%0ing& Ho"d salad& pe"se/e"ation et% et% #lte"ation in pe"%eption and tho$ght li0e hall$%ination and del$sion !ypes of del$sions eg "eligio$s and pe"se%$to"y #%ti/ities and diet as well as n$"sing diagnosis fo" a %lient with <ania& )ep"essed and #l(heime"KsG)ementia patient . ,ating diso"de"s and the t"eatments of %hoi%e 3@eha/io" the"apy fo" #no"e-ia& Psy%hothe"apy fo" the Pe"sonality )iso"de"s& Cogniti/e the"apy fo" dep"ession 4 #lways answe" LS!#A HI!? !?, C'I,*!L espe%ially if the 6$estion is abo$t an-iety diso"de"s and pani% atta%0s #lways %hoose an option that will en%o$"age /e"bali(ation of feelings& ne/e" answe" an option with the wo"d H?A 2 St$dy yo$" %o$nte" t"ansfe"en%e and yo$" t"ansfe"en%e& Dla$%oma& Cata"a%t and %"$t%hG%ane wal0ing !he p"in%iples of body me%hani%s& %"anial ne"/e f$n%tioning and how to assess them as well as thei" dist$"ban%es espe%ially @ells and !"igeminal *e$"algia <enie"eCs disease& )eli"$m& )ementia& C7#GSt"o0e pathophysiology and Fa%to"s 5 Psy%hothe"apy : @eha/io" the"apy = a/e"sion& ope"ant %onditioning 3positi/e "einfo"%ement4 systemati% desensiti(ation Cogniti/e the"apy is the PSAC?O!?,1#PA of %hoi%e fo" dep"ession St$dy the"ape$ti% milie$ = gene"al pt management& en/i"onmental manip$lation& $ses demo%"ati% leade"ship to test new patte"ns of beha/io" Comm$nity meeting is the hea"t of milie$ the"apy Pha"ma%othe"apy: )"$g %lassifi%ation and side effe%ts of #*!IPSAC?O!IC& #*;IO'A!ICS& #*!I<#*IC 3!eg"et"ol& 'ithi$m& )epa0ene4 8 !"ansfe" of %lients f"om @,) to C?#I1 as well as <O7I*D C'I,*! UP I* @,) 31,#) :OJI,14 9 S$ppo"ting the %lient in: SUPI*, 3eg p"e/ent ne%0 hype"e-tension by p$tting pillow4& FOH',1S 3p"e/ent poste"io" %$"/at$"e of the spine4& )O1S#' 1,CU<@,*! 3p"e/ent hype"e-tension of the 0nee4 #*) SI),'AI*D position 3P"e/ent late"al fle-ion of the ste"no%leidomastoid4 9 ,6$ipments fo" immobility : !"o%hante" "ollGsandbags = p"e/ent e-te"nal "otation of the hips Pillow to s$ppo"t ba%0& head& a"ms and sho$lde"s Footboa"d to p"e/ent footd"op !"ape(e ba" to mo/e the %lient $p in bed :nee gat%h o" pillow = to slightly fle- the %lients 0nee 10 I*!1O)UC, C?#*D, D1#)U#''A = St$dy methods of implementing %hange s$%h as FO1C, FI,') #*#'ASIS = !?, )1I7I*D #*) !?, 1,S!1#I*I*D FO1C,S& FOCUS = FI*) O1D#*IJ, C'#1IFA U*),1S!#*) SO'U!IO* !?, P)S# CAC', = P'#* )O S!U)A #C!

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!?, 5 !,C?*IC#' !IPS FO1 !?, @O#1) ,;#<I*#!IO* 1 #%%ept the fa%t that yo$ %an ne/e" 0now e/e"ything !he"efo"e& on%e yo$ see an $nfamilia" 6$estion that was ne/e" been ta$ght& $se yo$" test ta0ing st"ategies 2 If yo$ a"e in !est I& II& III& and I7 and yo$ a"e being as0ed to p"io"iti(e& Use #@C fi"st and then <aslowCs ?ie"a"%hy of needs + !he $se of yo$" n$"sing p"o%ess is he"alded by the wo"d: L!he *$"se Ho$ld o" !he n$"seCs initial a%tionL 1emembe" to #ssess fi"st befo"e inte"/ening If the sit$ation and the 6$estion al"eady assessed the patient& then p"o%eed with the ne-t step . ,n%i"%le yo$" modifie"s Some people ma0e mista0es be%a$se of fail$"e to see the wo"d& L,;C,P!L o" L*O!L o" LI*#PP1OP1I#!,L& et% !he magi% wo"dsM 2 Use yo$" 6$estionnai"es as yo$" s%"at%h Ao$ %an w"ite anything on that pape" If yo$ will s0ip a n$mbe"& pla%e an aste"is0 o" en%i"%le the n$mbe" 5 )O *O! US, @'U*! P,*CI' #lways $se a sha"p one and shade lightly # sha"pened pen%il will gi/e a /e"y da"0 shade e/en if yo$ will shade it lightly Use the sides of the pen%il not the tip Use <O*DO' *U<@,1 2 O*'A Some b"ands espe%ially those made in %hina pen%ils a"e s$bstanda"d !he ma%hine will %he%0 the lead If yo$ a"e I*CO*SIS!,*! with yo$" shading li0e an alte"ing da"0 and light shades& yo$ will F#I' the boa"ds be%a$se of te%hni%alities

1efe"en%es: #dele Pillitte"i <#!,1*#' N C?I') ?,#'!? *U1SI*D: Ca"e of the Childbea"ing N Child"ea"ing Family 2002 www n$"sing%"ib %om www s%"ibd %om

Ca"e has been ta0en to %onfi"m the a%%$"a%y of the info"mation p"esented *e/e"theless& it is diffi%$lt to ens$"e that all the info"mation p"esented is enti"ely a%%$"ate fo" all %i"%$mstan%es& and the a$tho" %annot a%%ept any "esponsibility fo" any e""o" o" omission !he a$tho" ma0es no wa""anty& e-p"essed o" implied& with "espe%t to this wo"0& and dis%laims any liability& loss& o" damage as a %onse6$en%e& di"e%tly o" indi"e%tly& of the $se and appli%ation of any of the %ontents of this wo"0

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PRAYERS TO ST. JOSEPH OF CUPERTINO FOR SUCCESS IN EXAMINATIONS


First Pra !r

O D"eat St Boseph of C$pe"tino who while on ea"th did obtain f"om Dod the g"a%e to be as0ed at yo$" e-amination only the 6$estions yo$ 0new& obtain fo" me a li0e fa/o$" in the e-aminations fo" whi%h I am now p"epa"ing In "et$"n I p"omise to ma0e yo$ 0nown and %a$se yo$ to be in/o0ed !h"o$gh Ch"ist o$" 'o"d St Boseph of C$pe"tino& P"ay fo" $s #men
S!"#$% Pra !r

O St Boseph of C$pe"tino who by yo$" p"aye" obtained f"om Dod to be as0ed at yo$" e-amination& the only p"eposition yo$ 0new D"ant that I may li0e yo$ s$%%eed in the *$"sing 'i%ens$"e ,-amination In "et$"n& I p"omise to ma0e yo$ 0nown and %a$se yo$ to be in/o0ed O St Boseph of C$pe"tino p"ay fo" me O ?oly Dhost enlighten me O$" 'ady of Dood St$dies p"ay fo" me Sa%"ed ?ead of Bes$s& Seat of di/ine wisdom& enlighten me

PRAYER TO SAINT JUDE THADDEUS, PATRON OF THE IMPOSSIBLE


<ost ?oly #postle St B$de& faithf$l se"/ant and f"iend of Bes$s& the %h$"%h hono"s and in/o0es yo$ $ni/e"sally as the pat"on of diffi%$lt %ases& of things almost despai"ed of& p"ay fo" me I am so helpless and alone Inte"%ede to Dod fo" me that ?e b"ings /isible and speedy help whe"e help is almost despai"ed of Come to my assistan%e in this g"eat need that I may "e%ei/e the %onsolation and help of hea/en in all my ne%essities& t"ib$lations and s$ffe"ings pa"ti%$la"ly Ohe"e ma0e yo$" "e6$estP and that I may p"aise Dod with yo$ and all the saints fo"e/e" I p"omise& O @lessed St B$de& to be e/e" mindf$l of this g"eat fa/o" g"anted to me by Dod and to always hono" yo$ as my spe%ial and powe"f$l pat"on and to g"atef$lly en%o$"age de/otion to yo$ #men

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PRINCIPLES OF TEST TA&ING


I' PRINCIPLE OF CONTRADICTION Hhen two options %ont"adi%t ea%h othe"& the"e is a highe" %han%e of one of them being the %o""e%t answe" ,-ample: Hhi%h physiologi% effe%t sho$ld the n$"se e-pe%t in a %lient addi%ted to hall$%inogensQ # )ilated p$pils @ Const"i%ted p$pils C @"ady%a"dia ) @"adypnea II' PRINCIPLE OF COMMONALIT( AND DIFFERENCE !wo o" mo"e options that has the same essential %onfig$"ation and tho$ght is $nli0ely the %o""e%t answe" ,-ample: Hhen inEe%ting s$b%$taneo$s inEe%tion in an obese patient& it sho$ld be angled at a"o$nd: # .2R @ 90R C 190R ) Pa"allel to the s0in III' PRINCIPLE OF CENTRAL TENDENC( Co""e%t answe"s in an all n$me"i% options is most li0ely lo%ated in between the e-t"emes ,-ample: Hhat is the :7O "ate of @!Q # 2 gttsGmin @ 10 gttsGmin C 12 gttsGmin ) 20 gttsGmin IV' PRINCIPLE OF POSITIVE AND NEGATIVE HARMON( # positi/e 6$estion will always as0 fo" a positi/e answe" and so is a negati/e 6$estion FO1<U'#: 3=4 3=4 F I >$estion 3I4 3I4 F I >$estion 3=4 3I4 F = >$estion ,-ample: #ll b$t one of the following is an #n-iolyti%: 3I4 3=4 # !"an-ene @ <iltown C #ta"a) Pa"lodel V' PRINCIPLE OF IMPRO)A)LE EXTREMES ,-t"eme modifie"s& s$%h as always& all& ne/e"& o" only ma0e it mo"e li0ely that the 6$estion is false ?e"e is a mo"e %omplete list of ,;!1,<, modifie"s #ll& e/e"y& nothing& none& best& absol$tely& always& ne/e"& wo"st& absol$tely not& only& nobody& e/e"ybody& %e"tainly& in/a"iably& no one& e/e"yone& %e"tainly not ,-ample: !he most effe%ti/e way in limiting the n$mbe" of mi%"oo"ganism in the hospital is: # Using st"i%t asepti% te%hni6$e in all p"o%ed$"es @ Hea"ing mas0 and gown in %a"e of all patients with %omm$ni%able diseases C Ste"ili(ation of all inst"$ments ) ?andwashing VI' PRINCIPLE OF INITIATIVE CRITICAL THIN&ING 1 Co/e" the options 2 1ead the 6$estion %a"ef$lly + !"y answe"ing the 6$estion witho$t loo0ing at the options . Sele%t the option that most %losely mat%hes yo$" answe" ,-ample: !he n$"se 0new that the no"mal %olo" of <i%hielKs stoma sho$ld be: # @"i%0 1ed @ D"ay C @l$e ) Pale Pin0

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VII' PRINCIPLE OF GRAMMATICAL HARMON( Options that do not %oin%ide with the g"ammati%al %onfig$"ation of the stem is *O! the %o""e%t answe" Choi%es that a"e g"ammati%ally in%o""e%t o" %ontain typog"aphi%al e""o"s a"e p"obably not the %o""e%t answe" ,-ample: Hhen planning a %a"e fo" a %lient who is pan%ytopeni%& !he maEo" goal sho$ld be: C P"e/ent hemo""hage& infe%tion and de%"ease o-ygenation @ #dministe"ing an o"al i"on p"epa"ation C P"e/enting Fatig$e and fl$id o/e"load ) ,n%o$"aging a %ons$mption of a ne$t"openi% diet VIII' PRINCIPLE OF UM)RELLA EFFECT # %hoi%e that is mo"e in%l$si/e is $s$ally the %o""e%t answe" ,-ample: !o /iew a pe"son holisti%ally& the n$"se sho$ld thin0 of him o" he" as: # Physi%al being who e-pe"ien%es pathology and so%iologi%al %hanges @ So%ial being who needs the dynami%s of g"o$p inte"a%tion C Psy%hologi%al being whose mind infl$en%es his o" he" health stat$s ) @iopsy%hoso%ial being who is in %onstant inte"a%tion with the en/i"onment IX' Pri$"i*+! #, A)C, Mas+#-.s Hi!rar"/ a$% N0rsi$1 Pr#"!ss Hhen 6$estions "e6$i"e p"io"iti(ation& these p"in%iples sho$ld apply :eywo"ds that indi%ate the need to p"io"iti(e in%l$de: @,S! 7I!#' ,SS,*!I#' P1I<#1A FI1S! ?ID?,S! P1IO1I!A I<<,)I#!, I*I!I#' <OS! I<PO1!#*! *,;! ,-ample: # n$"se is "e/iewing the plan of %a"e fo" a p"egant %lient with a diagnosis of si%0le %ell anemia Hhi%h n$"sing diagnosis& if stated on the plan of %a"e& wo$ld the n$"se sele%t as "e%ei/ing the highest p"io"ityQ # #n-iety @ Ineffe%ti/e %oping C )ist$"bed body image ) )efi%ient fl$id /ol$me ,-ample: Hhen %a"ing fo" #ida afte" a %hest s$"ge"y& yo$" p"io"ity wo$ld be to maintain: # S$pplementa"y o-ygen @ Chest t$be d"ainage C @lood "epla%ement ) 7entilation e-%hange X' Pri$"i*+! #, 2T!++ M! M#r!3 In Psy%hiat"i% *$"sing& 1emembe" to fo%$s on the %lientKs feeling& %on%e"ns& an-ieties and fea"s !his is best s$mma"i(ed by a "esponse that en%o$"ages the %lientKs /e"bali(ation of feelings ,-ample: # mothe" says to the n$"se& SI am af"aid that my %hild might ha/e anothe" sei($"eT Hhi%h "esponse by the n$"se is most the"ape$ti%Q # SHhy wo""y abo$t something yo$ %annot %ont"olQT @ S<ost %hild"en will ne/e" e-pe"ien%e a se%ond sei($"eT C S!ell me what f"ightens yo$ the most abo$t sei($"es T ) S!ylenol %an p"e/ent anothe" sei($"e f"om o%%$"ingT XI' Pri$"i*+! #, R!a**!ari$1 Visa1! # wo"d o" ph"ase that appea"s in the 6$estion and then "eappea"s at one of the . %hoi%es is the most p"obable answe" ,-ample: # %h"oni%ally ill s%hool=age %hild is most /$lne"able to whi%h st"esso"Q # <$tilation an-iety @ #nti%ipato"y g"ief C #n-iety o/e" s%hool absen%es ) Fea" of hospital p"o%ed$"es

COMPREHENSIVE NURSING REVIEW by R. C. REA

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XII' T/! Dr01 T!"/$i40! <ost d"$gs& espe%ially psy%hot"opi% medi%ations eithe" a%t as a C*S Stim$lant o" a C*S dep"essant !he st"ategy "e/ol/es in dete"mining whi%h a"e the Cent"al ne"/o$s system e-%itations and whi%h a"e the Cent"al ne"/o$s system inhibitions If + of the options a"e all C*S $p and 1 is C*S down& pi%0 the C*S down If + of the options a"e all C*S down and 1 is C*S $p& pi%0 the C*S $p ,-ample: !he n$"se is assessing a %lient who has E$st been admitted to the eme"gen%y depa"tment Hhi%h signs wo$ld s$ggest an o/e"dose of an antian-iety agentQ # Combati/eness& sweating& and %onf$sion @ #gitation& hype"a%ti/ity& and g"andiose ideation C S$spi%io$sness& dilated p$pils& and in%"eased blood p"ess$"e ) ,motionally bl$nt& letha"gy and impai"ed memo"y

COMPREHENSIVE NURSING REVIEW by R. C. REA

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CO*!,*!S

FU*)#<,*!#'S OF *U1SI*D M MMM 12 <#!,1*I!A *U1SI*D MMMMMMMM MMM ++ P,)I#!1IC *U1SI*DMMMMMMMMM MMM28 CO<<U*I!A ?,#'!? *U1SI*D MMMMMMM58 <,)IC#' SU1DIC#' *U1SI*D MMMMMM M 92 PSAC?I#!1IC *U1SI*D MMMMMMMM 118 P1OF,SSIO*#' #)BUS!<,*! M MMMMMM 1.1 ',#),1S?IP and <#*#D,<,*! MMMMMM 1.. *U1SI*D 1,S,#1C? MMMMMMMM MMM 125 CO<P1,?,*SI7, ,;#<I*#!IO* MMMMMM 18+

COMPREHENSIVE NURSING REVIEW by R. C. REA

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COMPREHENSIVE NURSING REVIEW by R. C. REA

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FUNDAMENTALS OF NURSING PART 1 1 Using the p"in%iples of standa"d p"e%a$tions& the n$"se wo$ld wea" glo/es in what n$"sing inte"/entionsQ a P"o/iding a ba%0 massage b Feeding a %lient % P"o/iding hai" %a"e d P"o/iding o"al hygiene 2 !he n$"se is p"epa"ing to ta0e /ital sign in an ale"t %lient admitted to the hospital with dehyd"ation se%onda"y to /omiting and dia""hea Hhat is the best method $sed to assess the %lientKs tempe"at$"eQ a O"al b #-illa"y % 1adial d ?eat sensiti/e tape + # n$"se obtained a %lientKs p$lse and fo$nd the "ate to be abo/e no"mal !he n$"se do%$ment this findings as: a !a%hypnea b ?ype" py"e-ia % #""ythmia d !a%hy%a"dia . Hhi%h of the following a%tions sho$ld the n$"se ta0e to $se a wide base s$ppo"t when assisting a %lient to get $p in a %hai"Q a @end at the waist and pla%e a"ms $nde" the %lientKs a"ms and lift b Fa%e the %lient& bend 0nees and pla%e hands on %lientKs fo"ea"m and lift % Sp"ead his o" he" feet apa"t d !ighten his o" he" pel/i% m$s%les 2 # %lient had o"al s$"ge"y following a moto" /ehi%le a%%ident !he n$"se assessing the %lient finds the s0in fl$shed and wa"m Hhi%h of the following wo$ld be the best method to ta0e the %lientKs body tempe"at$"eQ a O"al b #-illa"y % #"te"ial line d 1e%tal 5 # %lient who is $n%ons%io$s needs f"e6$ent mo$th %a"e Hhen pe"fo"ming a mo$th %a"e& the best position of a %lient is: a Fowle"Ks position b Side lying % S$pine d !"endelenb$"g 8 # %lient is hospitali(ed fo" the fi"st time& whi%h of the following a%tions ens$"e the safety of the %lientQ a :eep $nne%essa"y f$"nit$"e o$t of the way b :eep the lights on at all time % :eep side "ails $p at all time d :eep all e6$ipment o$t of /iew 9 # wal0=in %lient ente"s into the %lini% with a %hief %omplaint of abdominal pain and dia""hea !he n$"se ta0es the %lientKs /ital sign he"eafte" Hhat ph"ase of n$"sing p"o%ess is being implemented he"e by the n$"seQ a #ssessment b )iagnosis % Planning d Implementation 9 It is best des%"ibe as a systemati%& "ational method of planning and p"o/iding n$"sing %a"e fo" indi/id$al& families& g"o$p and %omm$nity a #ssessment b *$"sing P"o%ess % )iagnosis d Implementation 10 ,-%hange of gases ta0es pla%e in whi%h of the following o"ganQ a :idney b '$ngs % 'i/e" d ?ea"t 11 !he Chambe" of the hea"t that "e%ei/es o-ygenated blood f"om the l$ngs is theQ a 'eft at"i$m

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b 1ight at"i$m % 'eft /ent"i%le d 1ight /ent"i%le # m$s%$la" enla"ge po$%h o" sa% that lies slightly to the left whi%h is $sed fo" tempo"a"y sto"age of foodM a Dallbladde" b U"ina"y bladde" % Stoma%h d '$ngs !he ability of the body to defend itself against s%ientifi% in/ading agent s$%h as ba%e"ia& to-in& /i"$ses and fo"eign body a ?o"mones b Se%"etion % Imm$nity d Dlands ?o"mones se%"eted by Islets of 'ange"hans a P"ogeste"one b !estoste"one % Ins$lin d ?emoglobin It is a t"anspa"ent memb"ane that fo%$ses the light that ente"s the eyes to the "etina a 'ens b S%le"a % Co"nea d P$pils Hhi%h of the following is in%l$ded in O"emKs theo"yQ a <aintenan%e of a s$ffi%ient inta0e of ai" b Self pe"%eption % 'o/e and belonging d Physiologi% needs Hhi%h of the following %l$ste" of data belong to <aslowKs hie"a"%hy of needs a 'o/e and belonging b Physiologi% needs % Self a%t$ali(ation d #ll of the abo/e !his is %ha"a%te"i(ed by se/e"e symptoms "elati/ely of sho"t d$"ation a Ch"oni% Illness b #%$te Illness % Pain d Synd"ome Hhi%h of the following is the n$"seKs "ole in the health p"omotion a ?ealth "is0 app"aisal b !ea%h %lient to be effe%ti/e health %ons$me" % Ho"0site wellness d *one of the abo/e It is des%"ibe as a %olle%tion of people who sha"e some att"ib$tes of thei" li/es a Family b Illness % Comm$nity d *$"sing Fi/e teaspoon is e6$i/alent to how many millilite"s OmlPQ a +0 ml b 22 ml % 12 ml d 82 ml 1900 ml is e6$al to how many lite"sQ a 19 b 19000 % 190 d 2900 Hhi%h of the following is the abb"e/iation of d"opsQ a Dtt b Dtts % )p d )"

COMPREHENSIVE NURSING REVIEW by R. C. REA

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2. !he abb"e/iation fo" mi%"o d"op isM a Ugtt b gtt % md" d mgts 22 Hhi%h of the following is the meaning of P1*Q a Hhen ad/i%e b Immediately % Hhen ne%essa"y d *ow 25 Hhi%h of the following is the app"op"iate meaning of C@1Q a Ca"dia% @oa"d 1oom b Complete @ath"oom % Complete @ed 1est d Complete @oa"d 1oom 28 1 tsp is e6$als to how many d"opsQ a 12 b 50 % 10 d +0 29 20 %% is e6$al to how many mlQ a 2 b 20 % 2000 d 20000 29 1 %$p is e6$al to how many o$n%esQ a 9 b 90 % 900 d 9000 +0 !he n$"se m$st /e"ify the %lientKs identity befo"e administ"ation of medi%ation Hhi%h of the following is the safest way to identify the %lientQ a #s0 the %lient his name b Che%0 the %lientKs identifi%ation band % State the %lientKs name alo$d and ha/e the %lient "epeat it d Che%0 the "oom n$mbe" +1 !he n$"se p"epa"es to administe" b$%%al medi%ation !he medi%ine sho$ld be pla%edM a On the %lientKs s0in b @etween the %lientKs %hee0s and g$ms % Unde" the %lientKs tong$e d On the %lientKs %onE$%ti/a +2 !he n$"se administe"s %leansing enema !he %ommon position fo" this p"o%ed$"e isM a Sims left late"al b )o"sal 1e%$mbent % S$pine d P"one ++ # %lient %omplains of diffi%$lty of swallowing& when the n$"se t"y to administe" %aps$le medi%ation Hhi%h of the following meas$"es the n$"se sho$ld doQ a )issol/e the %aps$le in a glass of wate" b @"ea0 the %aps$le and gi/e the %ontent with an applesa$%e % Che%0 the a/ailability of a li6$id p"epa"ation d C"ash the %aps$le and pla%e it $nde" the tong$e +. Hhi%h of the following is the app"op"iate "o$te of administ"ation fo" ins$linQ a Int"am$s%$la" b Int"ade"mal % S$b%$taneo$s d Int"a/eno$s +2 !he n$"se is o"de"ed to administe" ampi%illin %aps$le !IP p o !he n$"se sho$d gi/e the medi%ationM a !h"ee times a day o"ally b !h"ee times a day afte" meals % !wo time a day by mo$th d !wo times a day befo"e meals +5 @a%0 Ca"e is best des%"ibe as: a Ca"ing fo" the ba%0 by means of massage b Hashing of the ba%0

COMPREHENSIVE NURSING REVIEW by R. C. REA

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% #ppli%ation of %old %omp"ess at the ba%0 d #ppli%ation of hot %omp"ess at the ba%0 It "efe"s to the p"epa"ation of the bed with a new set of linens a @ed bath b @ed ma0ing % @ed shampoo d @ed lining Hhi%h of the following is the most impo"tant p$"pose of handwashing a !o p"omote hand %i"%$lation b !o p"e/ent the t"ansfe" of mi%"oo"ganism % !o a/oid to$%hing the %lient with a di"ty hand d !o p"o/ide %omfo"t Hhat sho$ld be done in o"de" to p"e/ent %ontaminating of the en/i"onment in bed ma0ingQ a #/oid f$nning soiled linens b St"ip all linens at the same time % Finished both sides at the time d ,mb"a%e soiled linen !he most impo"tant p$"pose of %leansing bed bath is: a !o %leanse& "ef"esh and gi/e %omfo"t to the %lient who m$st "emain in bed b !o e-pose the ne%essa"y pa"ts of the body % !o de/elop s0ills in bed bath d !o %he%0 the body tempe"at$"e of the %lient in bed Hhi%h of the following te%hni6$e in/ol/es the sense of sightQ a Inspe%tion b Palpation % Pe"%$ssion d #$s%$ltation !he fi"st te%hni6$es $sed e-amining the abdomen of a %lient is: a Palpation b #$s%$ltation % Pe"%$ssion d Inspe%tion # te%hni6$e in physi%al e-amination that is $se to assess the mo/ement of ai" th"o$gh the t"a%heob"on%hial t"ee: a Palpation b #$s%$ltation % Inspe%tion d Pe"%$ssion #n inst"$ment $sed fo" a$s%$ltation is: a Pe"%$ssion=hamme" b #$diomete" % Stethos%ope d Sphygmomanomete" 1esonan%e is best des%"ibe as: a So$nds %"eated by ai" filled l$ngs b Sho"t& high pit%h and th$dding % <ode"ately lo$d with m$si%al 6$ality d )"$m=li0e !he best position fo" e-amining the "e%t$m is: a P"one b SimKs % :nee=%hest d 'ithotomy It "efe"s to the manne" of wal0ing a Dait b 1ange of motion % Fle-ion and e-tension d ?opping !he n$"se as0ed the %lient to "ead the Snellen %ha"t Hhi%h of the following is tested: a Opti% b Olfa%to"y % O%$lomoto" d !"o%lea" #nothe" name fo" 0nee=%hest position is: a Den$=do"sal

COMPREHENSIVE NURSING REVIEW by R. C. REA

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b Den$=pe%to"al % 'ithotomy d SimKs 20 !he n$"se p"epa"e I< inEe%tion that is i""itating to the s$b%$taneo$s tiss$e Hhi%h of the following is the best a%tion in o"de" to p"e/ent t"a%0ing of the medi%ation a Use a small ga$ge needle b #pply i%e on the inEe%tion site % #dministe" at a .2R angle d Use the J=t"a%0 te%hni6$e

ANS5ERS ,#r FUNDAMENTALS OF NURSING PART 1 1d 2b +d .b 2b 5b 8% 9a 9b 10 b 11 a 12 % 1+ % 1. % 12 % 15 a 18 d 19 b 19 b 20 % 21 b 22 a 2+ b 2. a 22 % 25 % 28 b 29 b 29 a +0 a +1 b +2 a ++ % +. % +2 a +5 a +8 b +9 b +9 a .0 a .1 a .2 d .+ b .. % .2 a .5 % .8 a .9 a .9 b 20 d

COMPREHENSIVE NURSING REVIEW by R. C. REA

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FUNDAMENTALS OF NURSING PART 2 1 !he most app"op"iate n$"sing o"de" fo" a patient who de/elops dyspnea and sho"tness of b"eath wo$ld beM a <aintain the patient on st"i%t bed "est at all times b <aintain the patient in an o"thopnei% position as needed % #dministe" o-ygen by 7ent$"i mas0 at 2.V& as needed d #llow a 1 ho$" "est pe"iod between a%ti/ities 2 !he n$"se obse"/es that <" #dams begins to ha/e in%"eased diffi%$lty b"eathing She ele/ates the head of the bed to the high Fowle" position& whi%h de%"eases his "espi"ato"y dist"ess !he n$"se do%$ments this b"eathing as: a !a%hypnea b ,$pn%a % O"thopnea d ?ype"/entilation + !he physi%ian o"de"s a platelet %o$nt to be pe"fo"med on <"s Smith afte" b"ea0fast !he n$"se is "esponsible fo": a Inst"$%ting the patient abo$t this diagnosti% test b H"iting the o"de" fo" this test % Di/ing the patient b"ea0fast d #ll of the abo/e . <"s <it%hell has been gi/en a %opy of he" diet !he n$"se dis%$sses the foods allowed on a 200=mg low sodi$m diet !hese in%l$de: a # ham and Swiss %heese sandwi%h on whole wheat b"ead b <ashed potatoes and b"oiled %hi%0en % # tossed salad with oil and /inega" and oli/es d Chi%0en bo$illon 2 !he physi%ian o"de"s a maintenan%e dose of 2&000 $nits of s$b%$taneo$s hepa"in Oan anti%oag$lantP daily *$"sing "esponsibilities fo" <"s <it%hell now in%l$de: a 1e/iewing daily a%ti/ated pa"tial th"omboplastin time O#P!!P and p"oth"ombin time b 1epo"ting an #P!! abo/e .2 se%onds to the physi%ian % #ssessing the patient fo" signs and symptoms of f"an0 and o%%$lt bleeding d #ll of the abo/e 5 !he fo$" main %on%epts %ommon to n$"sing that appea" in ea%h of the %$""ent %on%ept$al models a"e: a Pe"son& n$"sing& en/i"onment& medi%ine b Pe"son& health& n$"sing& s$ppo"t systems % Pe"son& health& psy%hology& n$"sing d Pe"son& en/i"onment& health& n$"sing 8 In <aslowKs hie"a"%hy of physiologi% needs& the h$man need of g"eatest p"io"ity is: a 'o/e b ,limination % *$t"ition d O-ygen 9 !he family of an a%%ident /i%tim who has been de%la"ed b"ain=dead seems amenable to o"gan donation Hhat sho$ld the n$"se doQ a )is%o$"age them f"om ma0ing a de%ision $ntil thei" g"ief has eased b 'isten to thei" %on%e"ns and answe" thei" 6$estions honestly % ,n%o$"age them to sign the %onsent fo"m "ight away d !ell them the body will not be a/ailable fo" a wa0e o" f$ne"al 9 # new head n$"se on a $nit is dist"essed abo$t the poo" staffing on the 11 p m to 8 a m shift Hhat sho$ld she doQ a Complain to he" fellow n$"ses b Hait $ntil she 0nows mo"e abo$t the $nit % )is%$ss the p"oblem with he" s$pe"/iso" d Info"m the staff that they m$st /ol$ntee" to "otate 10 Hhi%h of the following p"in%iples of p"ima"y n$"sing has p"o/en the most satisfying to the patient and n$"seQ a Contin$ity of patient %a"e p"omotes effi%ient& %ost=effe%ti/e n$"sing %a"e b #$tonomy and a$tho"ity fo" planning a"e best delegated to a n$"se who 0nows the patient well % #%%o$ntability is %lea"est when one n$"se is "esponsible fo" the o/e"all plan and its implementation

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!he holisti% app"oa%h p"o/ides fo" a the"ape$ti% "elationship& %ontin$ity& and effi%ient n$"sing %a"e If n$"se administe"s an inEe%tion to a patient who "ef$ses that inEe%tion& she has %ommitted: a #ssa$lt and batte"y b *egligen%e % <alp"a%ti%e d *one of the abo/e If patient as0s the n$"se he" opinion abo$t a pa"ti%$la" physi%ians and the n$"se "eplies that the physi%ian is in%ompetent& the n$"se %o$ld be held liable fo": a Slande" b 'ibel % #ssa$lt d 1espondent s$pe"io" # "egiste"ed n$"se "ea%hes to answe" the telephone on a b$sy pediat"i% $nit& momenta"ily t$"ning away f"om a + month=old infant she has been weighing !he infant falls off the s%ale& s$ffe"ing a s0$ll f"a%t$"e !he n$"se %o$ld be %ha"ged with: a )efamation b #ssa$lt % @atte"y d <alp"a%ti%e Hhi%h of the following is an e-ample of n$"sing malp"a%ti%eQ a !he n$"se administe"s peni%illin to a patient with a do%$mented histo"y of alle"gy to the d"$g !he patient e-pe"ien%es an alle"gi% "ea%tion and has %e"eb"al damage "es$lting f"om ano-ia b !he n$"se applies a hot wate" bottle o" a heating pad to the abdomen of a patient with abdominal %"amping % !he n$"se assists a patient o$t of bed with the bed lo%0ed in positionW the patient slips and f"a%t$"es his "ight h$me"$s d !he n$"se administe"s the w"ong medi%ation to a patient and the patient /omits !his info"mation is do%$mented and "epo"ted to the physi%ian and the n$"sing s$pe"/iso" Hhi%h of the following signs and symptoms wo$ld the n$"se e-pe%t to find when assessing an #sian patient fo" postope"ati/e pain following abdominal s$"ge"yQ a )e%"eased blood p"ess$"e and hea"t "ate and shallow "espi"ations b >$iet %"ying % Immobility& diapho"esis& and a/oidan%e of deep b"eathing o" %o$ghing d Changing position e/e"y 2 ho$"s # patient is admitted to the hospital with %omplaints of na$sea& /omiting& dia""hea& and se/e"e abdominal pain Hhi%h of the following wo$ld immediately ale"t the n$"se that the patient has bleeding f"om the DI t"a%tQ a Complete blood %o$nt b D$aia% test % 7ital signs d #bdominal gi"th !he %o""e%t se6$en%e fo" assessing the abdomen is: a !ympani% pe"%$ssion& meas$"ement of abdominal gi"th& and inspe%tion b #ssessment fo" distention& tende"ness& and dis%olo"ation a"o$nd the $mbili%$s % Pe"%$ssions& palpation& and a$s%$ltation d #$s%$ltation& pe"%$ssion& and palpation ?igh=pit%hed g$"gles head o/e" the "ight lowe" 6$ad"ant a"e: a # sign of in%"eased bowel motility b # sign of de%"eased bowel motility % *o"mal bowel so$nds d # sign of abdominal %"amping # patient abo$t to $nde"go abdominal inspe%tion is best pla%ed in whi%h of the following positionsQ a P"one b !"endelenb$"g % S$pine d Side=lying Fo" a "e%tal e-amination& the patient %an be di"e%ted to ass$me whi%h of the following positionsQ a Den$pe%te"ol b Sims % ?o"i(ontal "e%$mbent d #ll of the abo/e )$"ing a 1ombe"g test& the n$"se as0s the patient to ass$me whi%h positionQ a Sitting b Standing

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+2

++

% Den$pe%to"al d !"endelenb$"g If a patientKs blood p"ess$"e is 120G95& his p$lse p"ess$"e is: a 2. b 95 % 120 d 2.5 # patient is 0ept off food and fl$ids fo" 10 ho$"s befo"e s$"ge"y ?is o"al tempe"at$"e at 9 a m is 99 9 F O+8 8 CP !his tempe"at$"e "eading p"obably indi%ates: a Infe%tion b ?ypothe"mia % #n-iety d )ehyd"ation Hhi%h of the following pa"amete"s sho$ld be %he%0ed when assessing "espi"ationsQ a 1ate b 1hythm % Symmet"y d #ll of the abo/e # +9=yea" old patientKs /ital signs at 9 a m a"e a-illa"y tempe"at$"e 99 5 F O+8 5 CPW p$lse "ate& 99W "espi"ato"y "ate& +0 Hhi%h findings sho$ld be "epo"tedQ a 1espi"ato"y "ate only b !empe"at$"e only % P$lse "ate and tempe"at$"e d !empe"at$"e and "espi"ato"y "ate #ll of the following %an %a$se ta%hy%a"dia e-%ept: a Fe/e" b ,-e"%ise % Sympatheti% ne"/o$s system stim$lation d Pa"asympatheti% ne"/o$s system stim$lation Palpating the mid%la/i%$la" line is the %o""e%t te%hni6$e fo" assessing a @aseline /ital signs b Systoli% blood p"ess$"e % 1espi"ato"y "ate d #pi%al p$lse !he absen%e of whi%h p$lse may not be a signifi%ant finding when a patient is admitted to the hospitalQ a #pi%al b 1adial % Pedal d Femo"al Hhi%h of the following patients is at g"eatest "is0 fo" de/eloping p"ess$"e $l%e"sQ a #n ale"t& %h"oni% a"th"iti% patient t"eated with ste"oids and aspi"in b #n 99=yea" old in%ontinent patient with gast"i% %an%e" who is %onfined to his bed at home % #n apatheti% 5+=yea" old COP) patient "e%ei/ing nasal o-ygen /ia %ann$la d # %onf$sed 89=yea" old patient with %ongesti/e hea"t fail$"e OC?FP who "e6$i"es assistan%e to get o$t of bed !he physi%ian o"de"s the administ"ation of high=h$midity o-ygen by fa%e mas0 and pla%ement of the patient in a high Fowle"Ks position #fte" assessing <"s Pa$l& the n$"se w"ites the following n$"sing diagnosis: Impai"ed gas e-%hange "elated to in%"eased se%"etions Hhi%h of the following n$"sing inte"/entions has the g"eatest potential fo" imp"o/ing this sit$ationQ a ,n%o$"age the patient to in%"ease he" fl$id inta0e to 200 ml e/e"y 2 ho$"s b Pla%e a h$midifie" in the patientKs "oom % Contin$e administe"ing o-ygen by high h$midity fa%e mas0 d Pe"fo"m %hest physiothe"aphy on a "eg$la" s%hed$le !he most %ommon defi%ien%y seen in al%oholi%s is: a !hiamine b 1ibofla/in % Py"ido-ine d Pantotheni% a%id Hhi%h of the following statement is in%o""e%t abo$t a patient with dysphagiaQ a !he patient will find p$"eed o" soft foods& s$%h as %$sta"ds& easie" to swallow than wate" b Fowle"Ks o" semi Fowle"Ks position "ed$%es the "is0 of aspi"ation d$"ing swallowing % !he patient sho$ld always feed himself d !he n$"se sho$ld pe"fo"m o"al hygiene befo"e assisting with feeding !o assess the 0idney f$n%tion of a patient with an indwelling $"ina"y OFoleyP %athete"& the n$"se meas$"es his ho$"ly $"ine o$tp$t She sho$ld notify the physi%ian if the $"ine o$tp$t is:

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 20

+.

+2

+5

+8

+9

+9

.0

.1

.2

.+

..

a 'ess than +0 mlGho$" b 5. ml in 2 ho$"s % 90 ml in + ho$"s d 122 ml in . ho$"s Ce"tain s$bstan%es in%"ease the amo$nt of $"ine p"od$%ed !hese in%l$de: a Caffeine=%ontaining d"in0s& s$%h as %offee and %ola b @eets % U"ina"y analgesi%s d :aolin with pe%tin O:aope%tateP # male patient who had s$"ge"y 2 days ago fo" head and ne%0 %an%e" is abo$t to ma0e his fi"st attempt to amb$late o$tside his "oom !he n$"se notes that he is steady on his feet and that his /ision was $naffe%ted by the s$"ge"y Hhi%h of the following n$"sing inte"/entions wo$ld be app"op"iateQ a ,n%o$"age the patient to wal0 in the hall alone b )is%o$"age the patient f"om wal0ing in the hall fo" a few mo"e days % #%%ompany the patient fo" his wal0 d Cons$it a physi%al the"apist befo"e allowing the patient to amb$late # patient has e-a%e"bation of %h"oni% obst"$%ti/e p$lmona"y disease OCOP)P manifested by sho"tness of b"eathW o"thopnea: thi%0& tena%io$s se%"etionsW and a d"y ha%0ing %o$gh #n app"op"iate n$"sing diagnosis wo$ld be: a Ineffe%ti/e ai"way %lea"an%e "elated to thi%0& tena%io$s se%"etions b Ineffe%ti/e ai"way %lea"an%e "elated to d"y& ha%0ing %o$gh % Ineffe%ti/e indi/id$al %oping to COP) d Pain "elated to immobili(ation of affe%ted leg <"s 'im begins to %"y as the n$"se dis%$sses hai" loss !he best "esponse wo$ld be: a S)onKt wo""y ItKs only tempo"a"yT b SHhy a"e yo$ %"yingQ I didnKt get to the bad news yetT % SAo$" hai" is "eally p"ettyT d SI 0now this will be diffi%$lt fo" yo$& b$t yo$" hai" will g"ow ba%0 afte" the %ompletion of %hemothe"aphyT #n additional 7itamin C is "e6$i"ed d$"ing all of the following pe"iods e-%ept: a Infan%y b Ao$ng ad$lthood % Childhood d P"egnan%y # p"es%"ibed amo$nt of o-ygen s needed fo" a patient with COP) to p"e/ent: a Ca"dia% a""est "elated to in%"eased pa"tial p"ess$"e of %a"bon dio-ide in a"te"ial blood OPaCO2P b Ci"%$lato"y o/e"load d$e to hype"/olemia % 1espi"ato"y e-%itement d Inhibition of the "espi"ato"y hypo-i% stim$l$s #fte" 1 wee0 of hospitali(ation& <" D"ay de/elops hypo0alemia Hhi%h of the following is the most signifi%ant symptom of his diso"de"Q a 'etha"gy b In%"eased p$lse "ate and blood p"ess$"e % <$s%le wea0ness d <$s%le i""itability Hhi%h of the following n$"sing inte"/entions p"omotes patient safetyQ a #sses the patientKs ability to amb$late and t"ansfe" f"om a bed to a %hai" b )emonst"ate the signal system to the patient % Che%0 to see that the patient is wea"ing his identifi%ation band d #ll of the abo/e St$dies ha/e shown that abo$t .0V of patients fall o$t of bed despite the $se of side "ailsW this has led to whi%h of the following %on%l$sionsQ a Side "ails a"e ineffe%ti/e b Side "ails sho$ld not be $sed % Side "ails a"e a dete""ent that p"e/ent a patient f"om falling o$t of bed d Side "ails a"e a "eminde" to a patient not to get o$t of bed ,-amples of patients s$ffe"ing f"om impai"ed awa"eness in%l$de all of the following e-%ept: a # semi%ons%io$s o" o/e" fatig$ed patient b # diso"iented o" %onf$sed patient % # patient who %annot %a"e fo" himself at home d # patient demonst"ating symptoms of d"$gs o" al%ohol withd"awal !he most %ommon inE$"y among elde"ly pe"sons is: a #the"os%leoti% %hanges in the blood /essels b In%"eased in%iden%e of gallbladde" disease % U"ina"y !"a%t Infe%tion

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 21

d ?ip f"a%t$"e .2 !he most %ommon psy%hogeni% diso"de" among elde"ly pe"son is: a )ep"ession b Sleep dist$"ban%es Os$%h as bi(a""e d"eamsP % Inability to %on%ent"ate d )e%"eased appetite .5 Hhi%h of the following /as%$la" system %hanges "es$lts f"om agingQ a In%"eased pe"iphe"al "esistan%e of the blood /essels b )e%"eased blood flow % In%"eased wo"0 load of the left /ent"i%le d #ll of the abo/e .8 Hhi%h of the following is the most %ommon %a$se of dementia among elde"ly pe"sonsQ a Pa"0insonKs disease b <$ltiple s%le"osis % #myot"ophi% late"al s%le"osis O'o$ De"higKs diseaseP d #l(heime"Ks disease .9 !he n$"seKs most impo"tant legal "esponsibility afte" a patientKs death in a hospital is: a Obtaining a %onsent of an a$topsy b *otifying the %o"one" o" medi%al e-amine" % 'abeling the %o"pse app"op"iately d ,ns$"ing that the attending physi%ian iss$es the death %e"tifi%ation .9 @efo"e "igo" mo"tis o%%$"s& the n$"se is "esponsible fo": a P"o/iding a %omplete bath and d"essing %hange b Pla%ing one pillow $nde" the bodyKs head and sho$lde"s % 1emo/ing the bodyKs %lothing and w"apping the body in a sh"o$d d #llowing the body to "ela- no"mally 20 Hhen a patient in the te"minal stages of l$ng %an%e" begins to e-hibit loss of %ons%io$sness& a maEo" n$"sing p"io"ity is to: a P"ote%t the patient f"om inE$"y b Inse"t an ai"way % ,le/ate the head of the bed d Hithd"aw all pain medi%ations

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 22

ANS5ERS a$% RATIONALES ,#r FUNDAMENTALS OF NURSING PART 2

2 + . 2

5 8

9 10

11 12 1+

1.

12

)' Hhen a patient de/elops dyspnea and sho"tness of b"eath& the o"thopnei% position en%o$"ages ma-im$m %hest e-pansion and 0eeps the abdominal o"gans f"om p"essing against the diaph"agm& th$s imp"o/ing /entilation @ed "est and o-ygen by 7ent$"i mas0 at 2.V wo$ld imp"o/e o-ygenation of the tiss$es and %ells b$t m$st be o"de"ed by a physi%ian #llowing fo" "est pe"iods de%"eases the possibility of hypo-ia C' O"thopnea is diffi%$lty of b"eathing e-%ept in the $p"ight position !a%hypnea is "apid "espi"ation %ha"a%te"i(ed by 6$i%0& shallow b"eaths ,$pnea is no"mal "espi"ation X 6$iet& "hythmi%& and witho$t effo"t C' # platelet %o$nt e/al$ates the n$mbe" of platelets in the %i"%$lating blood /ol$me !he n$"se is "esponsible fo" gi/ing the patient b"ea0fast at the s%hed$led time !he physi%ian is "esponsible fo" inst"$%ting the patient abo$t the test and fo" w"iting the o"de" fo" the test )' <ashed potatoes and b"oiled %hi%0en a"e low in nat$"al sodi$m %hlo"ide ?am& oli/es& and %hi%0en bo$illon %ontain la"ge amo$nts of sodi$m and a"e %ont"aindi%ated on a low sodi$m diet D' #ll of the identified n$"sing "esponsibilities a"e pe"tinent when a patient is "e%ei/ing hepa"in !he no"mal a%ti/ated pa"tial th"omboplastin time is 15 to 22 se%onds and the no"mal p"oth"ombin time is 12 to 12 se%ondsW these le/els m$st "emain within two to two and one half the no"mal le/els #ll patients "e%ei/ing anti%oag$lant the"apy m$st be obse"/ed fo" signs and symptoms of f"an0 and o%%$lt bleeding Oin%l$ding hemo""hage& hypotension& ta%hy%a"dia& ta%hypnea& "estlessness& pallo"& %old and %lammy s0in& thi"st and %onf$sionPW blood p"ess$"e sho$ld be meas$"ed e/e"y . ho$"s and the patient sho$ld be inst"$%ted to "epo"t p"omptly any bleeding that o%%$"s with tooth b"$shing& bowel mo/ements& $"ination o" hea/y p"olonged menst"$ation D' !he fo%$s %on%epts that ha/e been a%%epted by all theo"ists as the fo%$s of n$"sing p"a%ti%e f"om the time of Flo"en%e *ightingale in%l$de the pe"son "e%ei/ing n$"sing %a"e& his en/i"onment& his health on the health illness %ontin$$m& and the n$"sing a%tions ne%essa"y to meet his needs D' <aslow& who defined a need as a satisfa%tion whose absen%e %a$ses illness& %onside"ed o-ygen to be the most impo"tant physiologi% needW witho$t it& h$man life %o$ld not e-ist #%%o"ding to this theo"y& othe" physiologi% needs Oin%l$ding food& wate"& elimination& shelte"& "est and sleep& a%ti/ity and tempe"at$"e "eg$lationP m$st be met befo"e p"o%eeding to the ne-t hie"a"%hi%al le/els on psy%hoso%ial needs )' !he b"ain=dead patientKs family needs s$ppo"t and "eass$"an%e in ma0ing a de%ision abo$t o"gan donation @e%a$se t"ansplants a"e done within ho$"s of death& de%isions abo$t o"gan donation m$st be made as soon as possible ?owe/e"& the familyKs %on%e"ns m$st be add"essed befo"e membe"s a"e as0ed to sign a %onsent fo"m !he body of an o"gan dono" is a/ailable fo" b$"ial C' #ltho$gh a new head n$"se sho$ld initially spend time obse"/ing the $nit fo" its st"engths and wea0ness& she sho$ld ta0e a%tion if a p"oblem th"eatens patient safety In this %ase& the s$pe"/iso" is the "eso$"%e pe"son to app"oa%h D' St$dies ha/e shown that patients and n$"ses both "espond well to p"ima"y n$"sing %a"e $nits Patients feel less an-io$s and isolated and mo"e se%$"e be%a$se they a"e allowed to pa"ti%ipate in planning thei" own %a"e *$"ses feel pe"sonal satisfa%tion& m$%h of it "elated to positi/e feedba%0 f"om the patients !hey also seem to gain a g"eate" sense of a%hie/ement and esp"it de %o"ps A' #ssa$lt is the $nE$stifiable attempt o" th"eat to to$%h o" inE$"e anothe" pe"son @atte"y is the $nlawf$l to$%hing of anothe" pe"son o" the %a""ying o$t of th"eatened physi%al ha"m !h$s& any a%t that a n$"se pe"fo"ms on the patient against his will is %onside"ed assa$lt and batte"y A' O"al %omm$ni%ation that inE$"es an indi/id$alKs "ep$tation is %onside"ed slande" H"itten %omm$ni%ation that does the same is %onside"ed libel D' <alp"a%ti%e is defined as inE$"io$s o" $np"ofessional a%tions that ha"m anothe" It in/ol/es p"ofessional mis%ond$%t& s$%h as omission o" %ommission of an a%t that a "easonable and p"$dent n$"se wo$ld o" wo$ld not do In this e-ample& the standa"d of %a"e was b"ea%hedW a +=month=old infant sho$ld ne/e" be left $nattended on a s%ale A' !he th"ee elements ne%essa"y to establish a n$"sing malp"a%ti%e a"e n$"sing e""o" Oadministe"ing peni%illin to a patient with a do%$mented alle"gy to the d"$gP& inE$"y O%e"eb"al damageP& and p"o-imal %a$se Oadministe"ing the peni%illin %a$sed the %e"eb"al damageP #pplying a hot wate" bottle o" heating pad to a patient witho$t a physi%ianKs o"de" does not in%l$de the th"ee "e6$i"ed %omponents #ssisting a patient o$t of bed with the bed lo%0ed in position is the %o""e%t n$"sing p"a%ti%eW the"efo"e& the f"a%t$"e was not the "es$lt of malp"a%ti%e #dministe"ing an in%o""e%t medi%ation is a n$"sing e""o"W howe/e"& if s$%h a%tion "es$lted in a se"io$s illness o" %h"oni% p"oblem& the n$"se %o$ld be s$ed fo" malp"a%ti%e C' #n #sian patient is li0ely to hide his pain Conse6$ently& the n$"se m$st obse"/e fo" obEe%ti/e signs In an abdominal s$"ge"y patient& these might in%l$de immobility& diapho"esis& and a/oidan%e of deep

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 2+

15

18

19 19

20

21 22 2+ 2. 22

25 28

29

29

+0 +1 +2

b"eathing o" %o$ghing& as well as in%"eased hea"t "ate& shallow "espi"ations Ostemming f"om pain $pon mo/ing the diaph"agm and "espi"ato"y m$s%lesP& and g$a"ding o" "igidity of the abdominal wall S$%h a patient is $nli0ely to display emotion& s$%h as %"ying )' !o assess fo" DI t"a%t bleeding when f"an0 blood is absent& the n$"se has two options: She %an test fo" o%%$lt blood in /omit$s& if p"esent& o" in stool X th"o$gh g$aia% O?emo%%$ltP test # %omplete blood %o$nt does not p"o/ide immediate "es$lts and does not always immediately "efle%t blood loss Changes in /ital signs may be %a$se by fa%to"s othe" than blood loss #bdominal gi"th is $n"elated to blood loss D' @e%a$se pe"%$ssion and palpation %an affe%t bowel motility and th$s bowel so$nds& they sho$ld follow a$s%$ltation in abdominal assessment !ympani% pe"%$ssion& meas$"ement of abdominal gi"th& and inspe%tion a"e methods of assessing the abdomen #ssessing fo" distention& tende"ness and dis%olo"ation a"o$nd the $mbili%$s %an indi%ate /a"io$s bowel="elated %onditions& s$%h as %hole%ystitis& appendi%itis and pe"itonitis C' ?ype"a%ti/e so$nds indi%ate in%"eased bowel motilityW two o" th"ee so$nds pe" min$te indi%ate de%"eased bowel motility #bdominal %"amping with hype"a%ti/e& high pit%hed tin0ling bowel so$nds %an indi%ate a bowel obst"$%tion C' !he s$pine position Oalso %alled the do"sal positionP& in whi%h the patient lies on his ba%0 with his fa%e $pwa"d& allows fo" easy a%%ess to the abdomen In the p"one position& the patient lies on his abdomen with his fa%e t$"ned to the side In the !"endelenb$"g position& the head of the bed is tilted downwa"d to +0 to .0 deg"ees so that the $ppe" body is lowe" than the legs In the late"al position& the patient lies on his side D' #ll of these positions a"e app"op"iate fo" a "e%tal e-amination In the gen$pe%to"al O0nee=%hestP position& the patient 0neels and "ests his %hest on the table& fo"ming a 90 deg"ee angle between the to"so and $ppe" legs In SimsK position& the patient lies on his left side with the left a"m behind the body and his "ight leg fle-ed In the ho"i(ontal "e%$mbent position& the patient lies on his ba%0 with legs e-tended and hips "otated o$twa"d )' )$"ing a 1ombe"g test& whi%h e/al$ates fo" senso"y o" %e"ebella" ata-ia& the patient m$st stand with feet togethe" and a"ms "esting at the sidesYfi"st with eyes open& then with eyes %losed !he need to mo/e the feet apa"t to maintain this stan%e is an abno"mal finding A' !he p$lse p"ess$"e is the diffe"en%e between the systoli% and diastoli% blood p"ess$"e "eadings X in this %ase& 2. D' # slightly ele/ated tempe"at$"e in the immediate p"eope"ati/e o" post ope"ati/e pe"iod may "es$lt f"om the la%0 of fl$ids befo"e s$"ge"y "athe" than f"om infe%tion #n-iety will not %a$se an ele/ated tempe"at$"e ?ypothe"mia is an abno"mally low body tempe"at$"e D' !he 6$ality and effi%ien%y of the "espi"ato"y p"o%ess %an be dete"mined by app"aising the "ate& "hythm& depth& ease& so$nd& and symmet"y of "espi"ations D' Unde" no"mal %onditions& a healthy ad$lt b"eathes in a smooth $ninte""$pted patte"n 12 to 20 times a min$te !h$s& a "espi"ato"y "ate of +0 wo$ld be abno"mal # no"mal ad$lt body tempe"at$"e& as meas$"ed on an o"al the"momete"& "anges between 98R and 100RF O+5 1R and +8 9RCPW an a-illa"y tempe"at$"e is app"o-imately one deg"ee lowe" and a "e%tal tempe"at$"e& one deg"ee highe" !h$s& an a-illa"y tempe"at$"e of 99 5RF O+8 5RCP wo$ld be %onside"ed abno"mal !he "esting p$lse "ate in an ad$lt "anges f"om 50 to 100 beatsGmin$te& so a "ate of 99 is no"mal D' Pa"asympatheti% ne"/o$s system stim$lation of the hea"t de%"eases the hea"t "ate as well as the fo"%e of %ont"a%tion& "ate of imp$lse %ond$%tion and blood flow th"o$gh the %o"ona"y /essels Fe/e"& e-e"%ise& and sympatheti% stim$lation all in%"ease the hea"t "ate D' !he api%al p$lse Othe p$lse at the ape- of the hea"tP is lo%ated on the mid%la/i%$la" line at the fo$"th& fifth& o" si-th inte"%ostal spa%e @ase line /ital signs in%l$de p$lse "ate& tempe"at$"e& "espi"ato"y "ate& and blood p"ess$"e @lood p"ess$"e is typi%ally assessed at the ante%$bital fossa& and "espi"ato"y "ate is assessed best by obse"/ing %hest mo/ement with ea%h inspi"ation and e-pi"ation C' @e%a$se the pedal p$lse %annot be dete%ted in 10V to 20V of the pop$lation& its absen%e is not ne%essa"ily a signifi%ant finding ?owe/e"& the p"esen%e o" absen%e of the pedal p$lse sho$ld be do%$mented $pon admission so that %hanges %an be identified d$"ing the hospital stay #bsen%e of the api%al& "adial& o" femo"al p$lse is abno"mal and sho$ld be in/estigated )' P"ess$"e $l%e"s a"e most li0ely to de/elop in patients with impai"ed mental stat$s& mobility& a%ti/ity le/el& n$t"ition& %i"%$lation and bladde" o" bowel %ont"ol #ge is also a fa%to" !h$s& the 99=yea" old in%ontinent patient who has impai"ed n$t"ition Of"om gast"i% %an%e"P and is %onfined to bed is at g"eate" "is0 A' #de6$ate hyd"ation thins and loosens p$lmona"y se%"etions and also helps to "epla%e fl$ids lost f"om ele/ated tempe"at$"e& diapho"esis& dehyd"ation and dyspnea ?igh= h$midity ai" and %hest physiothe"apy help li6$efy and mobili(e se%"etions A' Ch"oni% al%oholism %ommonly "es$lts in thiamine defi%ien%y and othe" symptoms of maln$t"ition C' # patient with dysphagia Odiffi%$lty swallowingP "e6$i"es assistan%e with feeding Feeding himself is a long="ange e-pe%ted o$t%ome Soft foods& Fowle"Ks o" semi=Fowle"Ks position& and o"al hygiene befo"e eating sho$ld be pa"t of the feeding "egimen

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 2.

++ A' # $"ine o$tp$t of less than +0mlGho$" indi%ates hypo/olemia o" olig$"ia& whi%h is "elated to 0idney
f$n%tion and inade6$ate fl$id inta0e

+. A' Fl$ids %ontaining %affeine ha/e a di$"eti% effe%t @eets and $"ina"y analgesi%s& s$%h as py"idi$m& %an
%olo" $"ine "ed :aope%tate is an anti dia""heal medi%ation

+2 C' # hospitali(ed s$"gi%al patient lea/ing his "oom fo" the fi"st time fea"s "eEe%tion and othe"s sta"ing at
him& so he sho$ld not wal0 alone #%%ompanying him will offe" mo"al s$ppo"t& enabling him to fa%e the "est of the wo"ld Patients sho$ld begin amb$lation as soon as possible afte" s$"ge"y to de%"ease %ompli%ations and to "egain st"ength and %onfiden%e Haiting to %ons$lt a physi%al the"apist is $nne%essa"y A' !hi%0& tena%io$s se%"etions& a d"y& ha%0ing %o$gh& o"thopnea& and sho"tness of b"eath a"e signs of ineffe%ti/e ai"way %lea"an%e Ineffe%ti/e ai"way %lea"an%e "elated to d"y& ha%0ing %o$gh is in%o""e%t be%a$se the %o$gh is not the "eason fo" the ineffe%ti/e ai"way %lea"an%e Ineffe%ti/e indi/id$al %oping "elated to COP) is w"ong be%a$se the etiology fo" a n$"sing diagnosis sho$ld not be a medi%al diagnosis OCOP)P and be%a$se no data indi%ate that the patient is %oping ineffe%ti/ely Pain "elated to immobili(ation of affe%ted leg wo$ld be an app"op"iate n$"sing diagnosis fo" a patient with a leg f"a%t$"e D' SI 0now this will be diffi%$ltT a%0nowledges the p"oblem and s$ggests a "esol$tion to it S)onKt wo""y T offe"s some "elief b$t doesnKt "e%ogni(e the patientKs feelings S I didnKt get to the bad news yetT wo$ld be inapp"op"iate at any time SAo$" hai" is "eally p"ettyT offe"s no %onsolation o" alte"nati/es to the patient )' #dditional 7itamin C is needed in g"owth pe"iods& s$%h as infan%y and %hildhood& and d$"ing p"egnan%y to s$pply demands fo" fetal g"owth and mate"nal tiss$es Othe" %onditions "e6$i"ing e-t"a /itamin C in%l$de wo$nd healing& fe/e"& infe%tion and st"ess D' )eli/e"y of mo"e than 2 lite"s of o-ygen pe" min$te to a patient with %h"oni% obst"$%ti/e p$lmona"y disease OCOP)P& who is $s$ally in a state of %ompensated "espi"ato"y a%idosis O"etaining %a"bon dio-ide OCO2PP& %an inhibit the hypo-i% stim$l$s fo" "espi"ation #n in%"eased pa"tial p"ess$"e of %a"bon dio-ide in a"te"ial blood OP#CO2P wo$ld not initially "es$lt in %a"dia% a""est Ci"%$lato"y o/e"load and "espi"ato"y e-%itement ha/e no "ele/an%e to the 6$estion C' P"esenting symptoms of hypo0alemia O a se"$m potassi$m le/el below + 2 m,6Glite"P in%l$de m$s%le wea0ness& %h"oni% fatig$e& and %a"dia% dys"hythmias !he %ombined effe%ts of inade6$ate food inta0e and p"olonged dia""hea %an deplete the potassi$m sto"es of a patient with DI p"oblems D' #ssisting a patient with amb$lation and t"ansfe" f"om a bed to a %hai" allows the n$"se to e/al$ate the patientKs ability to %a""y o$t these f$n%tions safely )emonst"ating the signal system and p"o/iding an oppo"t$nity fo" a "et$"n demonst"ation ens$"es that the patient 0nows how to ope"ate the e6$ipment and en%o$"ages him to %all fo" assistan%e when needed Che%0ing the patientKs identifi%ation band /e"ifies the patientKs identity and p"e/ents identifi%ation mista0es in d"$g administ"ation D' Sin%e abo$t .0V of patients fall o$t of bed despite the $se of side "ails& side "ails %annot be said to p"e/ent fallsW howe/e"& they do se"/e as a "eminde" that the patient sho$ld not get o$t of bed !he othe" answe"s a"e in%o""e%t inte"p"etations of the statisti%al data C' # patient who %annot %a"e fo" himself at home does not ne%essa"ily ha/e impai"ed awa"enessW he may simply ha/e some deg"ee of immobility D' ?ip f"a%t$"e& the most %ommon inE$"y among elde"ly pe"sons& $s$ally "es$lts f"om osteopo"osis !he othe" answe"s a"e diseases that %an o%%$" in the elde"ly f"om physiologi% %hanges A' Sleep dist$"ban%es& inability to %on%ent"ate and de%"eased appetite a"e symptoms of dep"ession& the most %ommon psy%hogeni% diso"de" among elde"ly pe"sons Othe" symptoms in%l$de diminished memo"y& apathy& disinte"est in appea"an%e& withd"awal& and i""itability )ep"ession typi%ally begins befo"e the onset of old age and $s$ally is %a$sed by psy%hoso%ial& geneti%& o" bio%hemi%al fa%to"s D' #ging de%"eases elasti%ity of the blood /essels& whi%h leads to in%"eased pe"iphe"al "esistan%e and de%"eased blood flow !hese %hanges& in t$"n& in%"ease the wo"0 load of the left /ent"i%le D' #l(heime"Ws disease& sometimes 0nown as senile dementia of the Alzheimers type or primary degenerative dementia& is an insidio$sW p"og"essi/e& i""e/e"sible& and degene"ati/e disease of the b"ain whose etiology is still $n0nown Parkinsons disease is a ne$"ologi% diso"de" %a$sed by lesions in the e-t"apy"amidial system and manifested by t"emo"s& m$s%le "igidity& hypo0inesis& dysphagia& and dysphonia Multiple sclerosis, a p"og"essi/e& degene"ati/e disease in/ol/ing demyelination of the ne"/e fibe"s& $s$ally begins in yo$ng ad$lthood and is ma"0ed by pe"iods of "emission and e-a%e"bation Amyotrophic lateral sclerosis& a disease ma"0ed by p"og"essi/e degene"ation of the ne$"ons& e/ent$ally "es$lts in at"ophy of all the m$s%lesW in%l$ding those ne%essa"y fo" "espi"ation C' !he n$"se is legally "esponsible fo" labeling the %o"pse when death o%%$"s in the hospital She may be in/ol/ed in obtaining %onsent fo" an a$topsy o" notifying the %o"one" o" medi%al e-amine" of a patientKs deathW howe/e"& she is not legally "esponsible fo" pe"fo"ming these f$n%tions !he attending physi%ian may need info"mation f"om the n$"se to %omplete the death %e"tifi%ate& b$t he is "esponsible fo" iss$ing it )' !he n$"se m$st pla%e a pillow $nde" the de%"eased pe"sonKs head and sho$lde"s to p"e/ent blood f"om settling in the fa%e and dis%olo"ing it She is "e6$i"ed to bathe only soiled a"eas of the body sin%e the

+5

+8

+9 +9

.0 .1

.2 .+ .. .2

.5 .8

.9

.9

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 22

mo"ti%ian will wash the enti"e body @efo"e w"apping the body in a sh"o$d& the n$"se pla%es a %lean gown on the body and %loses the eyes and mo$th 20 A' ,ns$"ing the patientKs safety is the most essential a%tion at this time !he othe" n$"sing a%tions may be ne%essa"y b$t a"e not a maEo" p"io"ity

FUNDAMENTALS OF NURSING PART 3 1 Hhi%h element in the %i"%$la" %hain of infe%tion %an be eliminated by p"ese"/ing s0in integ"ityQ a ?ost b 1ese"/oi" % <ode of t"ansmission d Po"tal of ent"y 2 Hhi%h of the following will p"obably "es$lt in a b"ea0 in ste"ile te%hni6$e fo" "espi"ato"y isolationQ a Opening the patientKs window to the o$tside en/i"onment b !$"ning on the patientKs "oom /entilato" % Opening the doo" of the patientKs "oom leading into the hospital %o""ido" d Failing to wea" glo/es when administe"ing a bed bath + Hhi%h of the following patients is at g"eate" "is0 fo" %ont"a%ting an infe%tionQ a # patient with le$0openia b # patient "e%ei/ing b"oad=spe%t"$m antibioti%s % # postope"ati/e patient who has $nde"gone o"thopedi% s$"ge"y d # newly diagnosed diabeti% patient . ,ffe%ti/e hand washing "e6$i"es the $se of: a Soap o" dete"gent to p"omote em$lsifi%ation b ?ot wate" to dest"oy ba%te"ia % # disinfe%tant to in%"ease s$"fa%e tension d #ll of the abo/e 2 #fte" "o$tine patient %onta%t& hand washing sho$ld last at least: a +0 se%onds b 1 min$te % 2 min$te d + min$tes 5 Hhi%h of the following p"o%ed$"es always "e6$i"es s$"gi%al asepsisQ a 7aginal instillation of %onE$gated est"ogen b U"ina"y %athete"i(ation % *asogast"i% t$be inse"tion d Colostomy i""igation 8 Ste"ile te%hni6$e is $sed whene/e": a St"i%t isolation is "e6$i"ed b !e"minal disinfe%tion is pe"fo"med % In/asi/e p"o%ed$"es a"e pe"fo"med d P"ote%ti/e isolation is ne%essa"y 9 Hhi%h of the following %onstit$tes a b"ea0 in ste"ile te%hni6$e while p"epa"ing a ste"ile field fo" a d"essing %hangeQ a Using ste"ile fo"%eps& "athe" than ste"ile glo/es& to handle a ste"ile item b !o$%hing the o$tside w"appe" of ste"ili(ed mate"ial witho$t ste"ile glo/es % Pla%ing a ste"ile obEe%t on the edge of the ste"ile field d Po$"ing o$t a small amo$nt of sol$tion O12 to +0 mlP befo"e po$"ing the sol$tion into a ste"ile %ontaine" 9 # nat$"al body defense that plays an a%ti/e "ole in p"e/enting infe%tion is: a Aawning b @ody hai" % ?i%%$pping d 1apid eye mo/ements 10 #ll of the following statement a"e t"$e abo$t donning ste"ile glo/es e-%ept: a !he fi"st glo/e sho$ld be pi%0ed $p by g"asping the inside of the %$ff b !he se%ond glo/e sho$ld be pi%0ed $p by inse"ting the glo/ed finge"s $nde" the %$ff o$tside the glo/e

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 25

11

12

1+

1.

12

15

18

19

19

20

21

!he glo/es sho$ld be adE$sted by sliding the glo/ed finge"s $nde" the ste"ile %$ff and p$lling the glo/e o/e" the w"ist d !he inside of the glo/e is %onside"ed ste"ile Hhen "emo/ing a %ontaminated gown& the n$"se sho$ld be %a"ef$l that the fi"st thing she to$%hes is the: a Haist tie and ne%0 tie at the ba%0 of the gown b Haist tie in f"ont of the gown % C$ffs of the gown d Inside of the gown Hhi%h of the following n$"sing inte"/entions is %onside"ed the most effe%ti/e fo"m o" $ni/e"sal p"e%a$tionsQ a Cap all $sed needles befo"e "emo/ing them f"om thei" sy"inges b )is%a"d all $sed $n%apped needles and sy"inges in an impenet"able p"ote%ti/e %ontaine" % Hea" glo/es when administe"ing I< inEe%tions d Follow ente"i% p"e%a$tions #ll of the following meas$"es a"e "e%ommended to p"e/ent p"ess$"e $l%e"s e-%ept: a <assaging the "eddened a"e with lotion b Using a wate" o" ai" matt"ess % #dhe"ing to a s%hed$le fo" positioning and t$"ning d P"o/iding meti%$lo$s s0in %a"e Hhi%h of the following blood tests sho$ld be pe"fo"med befo"e a blood t"ansf$sionQ a P"oth"ombin and %oag$lation time b @lood typing and %"oss=mat%hing % @leeding and %lotting time d Complete blood %o$nt OC@CP and ele%t"olyte le/els !he p"ima"y p$"pose of a platelet %o$nt is to e/al$ate the: a Potential fo" %lot fo"mation b Potential fo" bleeding % P"esen%e of an antigen=antibody "esponse d P"esen%e of %a"dia% en(ymes Hhi%h of the following white blood %ell OH@CP %o$nts %lea"ly indi%ates le$0o%ytosisQ a .&200GmmZ b 8&000GmmZ % 10&000GmmZ d 22&000GmmZ #fte" 2 days of di$"eti% the"apy with 20mg of f$"osemide O'asi-P daily& a patient begins to e-hibit fatig$e& m$s%le %"amping and m$s%le wea0ness !hese symptoms p"obably indi%ate that the patient is e-pe"ien%ing: a ?ypo0alemia b ?ype"0alemia % #no"e-ia d )ysphagia Hhi%h of the following statements abo$t %hest ;="ay is falseQ a *o %ont"adi%tions e-ist fo" this test b @efo"e the p"o%ed$"e& the patient sho$ld "emo/e all Eewel"y& metalli% obEe%ts& and b$ttons abo/e the waist % # signed %onsent is not "e6$i"ed d ,ating& d"in0ing& and medi%ations a"e allowed befo"e this test !he most app"op"iate time fo" the n$"se to obtain a sp$t$m spe%imen fo" %$lt$"e is: a ,a"ly in the mo"ning b #fte" the patient eats a light b"ea0fast % #fte" ae"osol the"apy d #fte" %hest physiothe"apy # patient with no 0nown alle"gies is to "e%ei/e peni%illin e/e"y 5 ho$"s Hhen administe"ing the medi%ation& the n$"se obse"/es a fine "ash on the patientKs s0in !he most app"op"iate n$"sing a%tion wo$ld be to: a Hithhold the mode"ation and notify the physi%ian b #dministe" the medi%ation and notify the physi%ian % #dministe" the medi%ation with an antihistamine d #pply %o"n sta"%h soa0s to the "ash #ll of the following n$"sing inte"/entions a"e %o""e%t when $sing the J=t"a%0 method of d"$g inEe%tion e-%ept: a P"epa"e the inEe%tion site with al%ohol b Use a needle thatKs a least 1T long % #spi"ate fo" blood befo"e inEe%tion d 1$b the site /igo"o$sly afte" the inEe%tion to p"omote abso"ption

COMPREHENSIVE NURSING REVIEW by R. C. REA

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22 !he %o""e%t method fo" dete"mining the /ast$s late"alis site fo" I < inEe%tion is to: a 'o%ate the $ppe" aspe%t of the $ppe" o$te" 6$ad"ant of the b$tto%0 abo$t 2 to 9 %m below the ilia% %"est b Palpate the lowe" edge of the a%"omion p"o%ess and the midpoint late"al aspe%t of the a"m % Palpate a 1T %i"%$la" a"ea ante"io" to the $mbili%$s d )i/ide the a"ea between the g"eate" femo"al t"o%hante" and the late"al femo"al %ondyle into thi"ds& and sele%t the middle thi"d on the ante"io" of the thigh 2+ !he mid=deltoid inEe%tion site is seldom $sed fo" I < inEe%tions be%a$se it: a Can a%%ommodate only 1 ml o" less of medi%ation b @"$ises too easily % Can be $sed only when the patient is lying down d )oes not "eadily pa"ente"al medi%ation 2. !he app"op"iate needle si(e fo" ins$lin inEe%tion is: a 19D& 1 [T long b 22D& 1T long % 22D& 1 [T long d 22D& 2G9T long 22 !he app"op"iate needle ga$ge fo" int"ade"mal inEe%tion is: a 20D b 22D % 22D d 25D 25 Pa"ente"al peni%illin %an be administe"ed as an: a I< inEe%tion o" an I7 sol$tion b I7 o" an int"ade"mal inEe%tion % Int"ade"mal o" s$b%$taneo$s inEe%tion d I< o" a s$b%$taneo$s inEe%tion 28 !he physi%ian o"de"s g" 10 of aspi"in fo" a patient !he e6$i/alent dose in millig"ams is: a 0 5 mg b 10 mg % 50 mg d 500 mg 29 !he physi%ian o"de"s an I7 sol$tion of de-t"ose 2V in wate" at 100mlGho$" Hhat wo$ld the flow "ate be if the d"op fa%to" is 12 gtt F 1 mlQ a 2 gttGmin$te b 1+ gttGmin$te % 22 gttGmin$te d 20 gttGmin$te 29 Hhi%h of the following is a sign o" symptom of a hemolyti% "ea%tion to blood t"ansf$sionQ a ?emoglobin$"ia b Chest pain % U"ti%a"ia d )istended ne%0 /eins +0 Hhi%h of the following %onditions may "e6$i"e fl$id "est"i%tionQ a Fe/e" b Ch"oni% Obst"$%ti/e P$lmona"y )isease % 1enal Fail$"e d )ehyd"ation +1 #ll of the following a"e %ommon signs and symptoms of phlebitis e-%ept: a Pain o" dis%omfo"t at the I7 inse"tion site b ,dema and wa"mth at the I7 inse"tion site % # "ed st"ea0 e-iting the I7 inse"tion site d F"an0 bleeding at the inse"tion site +2 !he best way of dete"mining whethe" a patient has lea"ned to instill ea" medi%ation p"ope"ly is fo" the n$"se to: a #s0 the patient if heGshe has $sed ea" d"ops befo"e b ?a/e the patient "epeat the n$"seKs inst"$%tions $sing he" own wo"ds % )emonst"ate the p"o%ed$"e to the patient and en%o$"age to as0 6$estions d #s0 the patient to demonst"ate the p"o%ed$"e ++ Hhi%h of the following types of medi%ations %an be administe"ed /ia gast"ostomy t$beQ a #ny o"al medi%ations b Caps$les whole %ontents a"e dissol/e in wate" % ,nte"i%=%oated tablets that a"e tho"o$ghly dissol/ed in wate" d <ost tablets designed fo" o"al $se& e-%ept fo" e-tended=d$"ation %ompo$nds +. # patient who de/elops hi/es afte" "e%ei/ing an antibioti% is e-hibiting d"$g:

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 29

+2

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.+

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a !ole"an%e b Idiosyn%"asy % Syne"gism d #lle"gy # patient has "et$"ned to his "oom afte" femo"al a"te"iog"aphy #ll of the following a"e app"op"iate n$"sing inte"/entions e-%ept: a #ssess femo"al& popliteal& and pedal p$lses e/e"y 12 min$tes fo" 2 ho$"s b Che%0 the p"ess$"e d"essing fo" sang$ineo$s d"ainage % #ssess a /ital signs e/e"y 12 min$tes fo" 2 ho$"s d O"de" a hemoglobin and hemato%"it %o$nt 1 ho$" afte" the a"te"iog"aphy !he n$"se e-plains to a patient that a %o$gh: a Is a p"ote%ti/e "esponse to %lea" the "espi"ato"y t"a%t of i""itants b Is p"ima"ily a /ol$nta"y a%tion % Is ind$%ed by the administ"ation of an antit$ssi/e d"$g d Can be inhibited by SsplintingT the abdomen #n infe%ted patient has %hills and begins shi/e"ing !he best n$"sing inte"/ention is to: a #pply i%ed al%ohol sponges b P"o/ide in%"eased %ool li6$ids % P"o/ide additional bed%lothes d P"o/ide in%"eased /entilation # %lini%al n$"se spe%ialist is a n$"se who has: a @een %e"tified by the *ational 'eag$e fo" *$"sing b 1e%ei/ed %"edentials f"om the Philippine *$"sesK #sso%iation % D"ad$ated f"om an asso%iate deg"ee p"og"am and is a "egiste"ed p"ofessional n$"se d Completed a maste"Ks deg"ee in the p"es%"ibed %lini%al a"ea and is a "egiste"ed p"ofessional n$"se !he p$"pose of in%"easing $"ine a%idity th"o$gh dieta"y means is to: a )e%"ease b$"ning sensations b Change the $"ineKs %olo" % Change the $"ineKs %on%ent"ation d Inhibit the g"owth of mi%"oo"ganisms Clay %olo"ed stools indi%ate: a Uppe" DI bleeding b Impending %onstipation % #n effe%t of medi%ation d @ile obst"$%tion In whi%h step of the n$"sing p"o%ess wo$ld the n$"se as0 a patient if the medi%ation she administe"ed "elie/ed his painQ a #ssessment b #nalysis % Planning d ,/al$ation #ll of the following a"e good so$"%es of /itamin # e-%ept: a Hhite potatoes b Ca""ots % #p"i%ots d ,gg yol0s Hhi%h of the following is a p"ima"y n$"sing inte"/ention ne%essa"y fo" all patients with a Foley Cathete" in pla%eQ a <aintain the d"ainage t$bing and %olle%tion bag le/el with the patientKs bladde" b I""igate the patient with 1V *eospo"in sol$tion th"ee times a daily % Clamp the %athete" fo" 1 ho$" e/e"y . ho$"s to maintain the bladde"Ks elasti%ity d <aintain the d"ainage t$bing and %olle%tion bag below bladde" le/el to fa%ilitate d"ainage by g"a/ity !he ,'IS# test is $sed to: a S%"een blood dono"s fo" antibodies to h$man imm$nodefi%ien%y /i"$s O?I7P b !est blood to be $sed fo" t"ansf$sion fo" ?I7 antibodies % #id in diagnosing a patient with #I)S d #ll of the abo/e !he two blood /essels most %ommonly $sed fo" !P* inf$sion a"e the: a S$b%la/ian and E$g$la" /eins b @"a%hial and s$b%la/ian /eins % Femo"al and s$b%la/ian /eins d @"a%hial and femo"al /eins ,ffe%ti/e s0in disinfe%tion befo"e a s$"gi%al p"o%ed$"e in%l$des whi%h of the following methodsQ a Sha/ing the site on the day befo"e s$"ge"y

COMPREHENSIVE NURSING REVIEW by R. C. REA

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#pplying a topi%al antisepti% to the s0in on the e/ening befo"e s$"ge"y ?a/ing the patient ta0e a t$b bath on the mo"ning of s$"ge"y ?a/ing the patient showe" with an antisepti% soap on the e/ening /Fbefo"e and the mo"ning of s$"ge"y Hhen t"ansfe""ing a patient f"om a bed to a %hai"& the n$"se sho$ld $se whi%h m$s%les to a/oid ba%0 inE$"yQ a #bdominal m$s%les b @a%0 m$s%les % 'eg m$s%les d Uppe" a"m m$s%les !h"ombophlebitis typi%ally de/elops in patients with whi%h of the following %onditionsQ a In%"eases pa"tial th"omboplastin time b #%$te p$ls$s pa"ado-$s % #n impai"ed o" t"a$mati(ed blood /essel wall d Ch"oni% Obst"$%ti/e P$lmona"y )isease OCOP)P In a "e%$mbent& immobili(ed patient& l$ng /entilation %an be%ome alte"ed& leading to s$%h "espi"ato"y %ompli%ations as: a 1espi"ato"y a%idosis& ate%le%tasis& and hypostati% pne$monia b #ppne$sti% b"eathing& atypi%al pne$monia and "espi"ato"y al0alosis % Cheyne=St"o0es "espi"ations and spontaneo$s pne$motho"ad :$ssmailKs "espi"ations and hypo/entilation Immobility impai"s bladde" elimination& "es$lting in s$%h diso"de"s as a In%"eased $"ine a%idity and "ela-ation of the pe"ineal m$s%les& %a$sing in%ontinen%e b U"ine "etention& bladde" distention& and infe%tion % )i$"esis& nat"i$"esis& and de%"eased $"ine spe%ifi% g"a/ity d )e%"eased %al%i$m and phosphate le/els in the $"ine

b % d

COMPREHENSIVE NURSING REVIEW by R. C. REA

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ANS5ERS a$% RATIONALES ,#r FUNDAMENTALS OF NURSING PART 3

1 2

+ . 2 5 8

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12

1+ 1.

D In the %i"%$la" %hain of infe%tion& pathogens m$st be able to lea/e thei" "ese"/oi" and be t"ansmitted to a s$s%eptible host th"o$gh a po"tal of ent"y& s$%h as b"o0en s0in C 1espi"ato"y isolation& li0e st"i%t isolation& "e6$i"es that the doo" to the doo" patientKs "oom "emain %losed ?owe/e"& the patientKs "oom sho$ld be well /entilated& so opening the window o" t$"ning on the /ent"i%$la" is desi"able !he n$"se does not need to wea" glo/es fo" "espi"ato"y isolation& b$t good hand washing is impo"tant fo" all types of isolation A 'e$0openia is a de%"eased n$mbe" of le$0o%ytes Owhite blood %ellsP& whi%h a"e impo"tant in "esisting infe%tion *one of the othe" sit$ations wo$ld p$t the patient at "is0 fo" %ont"a%ting an infe%tionW ta0ing b"oad=spe%t"$m antibioti%s might a%t$ally "ed$%e the infe%tion "is0 A Soaps and dete"gents a"e $sed to help "emo/e ba%te"ia be%a$se of thei" ability to lowe" the s$"fa%e tension of wate" and a%t as em$lsifying agents ?ot wate" may lead to s0in i""itation o" b$"ns A )epending on the deg"ee of e-pos$"e to pathogens& hand washing may last f"om 10 se%onds to . min$tes #fte" "o$tine patient %onta%t& hand washing fo" +0 se%onds effe%ti/ely minimi(es the "is0 of pathogen t"ansmission ) !he $"ina"y system is no"mally f"ee of mi%"oo"ganisms e-%ept at the $"ina"y meat$s #ny p"o%ed$"e that in/ol/es ente"ing this system m$st $se s$"gi%ally asepti% meas$"es to maintain a ba%te"ia=f"ee state C #ll in/asi/e p"o%ed$"es& in%l$ding s$"ge"y& %athete" inse"tion& and administ"ation of pa"ente"al the"apy& "e6$i"e ste"ile te%hni6$e to maintain a ste"ile en/i"onment #ll e6$ipment m$st be ste"ile& and the n$"se and the physi%ian m$st wea" ste"ile glo/es and maintain s$"gi%al asepsis In the ope"ating "oom& the n$"se and physi%ian a"e "e6$i"ed to wea" ste"ile gowns& glo/es& mas0s& hai" %o/e"s& and shoe %o/e"s fo" all in/asi/e p"o%ed$"es St"i%t isolation "e6$i"es the $se of %lean glo/es& mas0s& gowns and e6$ipment to p"e/ent the t"ansmission of highly %omm$ni%able diseases by %onta%t o" by ai"bo"ne "o$tes !e"minal disinfe%tion is the disinfe%tion of all %ontaminated s$pplies and e6$ipment afte" a patient has been dis%ha"ged to p"epa"e them fo" "e$se by anothe" patient !he p$"pose of p"ote%ti/e O"e/e"seP isolation is to p"e/ent a pe"son with se"io$sly impai"ed "esistan%e f"om %oming into %onta%t who potentially pathogeni% o"ganisms C !he edges of a ste"ile field a"e %onside"ed %ontaminated Hhen ste"ile items a"e allowed to %ome in %onta%t with the edges of the field& the ste"ile items also be%ome %ontaminated ) ?ai" on o" within body a"eas& s$%h as the nose& t"aps and holds pa"ti%les that %ontain mi%"oo"ganisms Aawning and hi%%$pping do not p"e/ent mi%"oo"ganisms f"om ente"ing o" lea/ing the body 1apid eye mo/ement ma"0s the stage of sleep d$"ing whi%h d"eaming o%%$"s D !he inside of the glo/e is always %onside"ed to be %lean& b$t not ste"ile A !he ba%0 of the gown is %onside"ed %lean& the f"ont is %ontaminated So& afte" "emo/ing glo/es and washing hands& the n$"se sho$ld $ntie the ba%0 of the gownW slowly mo/e ba%0wa"d away f"om the gown& holding the inside of the gown and 0eeping the edges off the floo"W t$"n and fold the gown inside o$tW dis%a"d it in a %ontaminated linen %ontaine"W then wash he" hands again ) #%%o"ding to the Cente"s fo" )isease Cont"ol OC)CP& blood=to=blood %onta%t o%%$"s most %ommonly when a health %a"e wo"0e" attempts to %ap a $sed needle !he"efo"e& $sed needles sho$ld ne/e" be "e%appedW instead they sho$ld be inse"ted in a spe%ially designed p$n%t$"e "esistant& labeled %ontaine" Hea"ing glo/es is not always ne%essa"y when administe"ing an I < inEe%tion ,nte"i% p"e%a$tions p"e/ent the t"ansfe" of pathogens /ia fe%es A *$"ses and othe" health %a"e p"ofessionals p"e/io$sly belie/ed that massaging a "eddened a"ea with lotion wo$ld p"omote /eno$s "et$"n and "ed$%e edema to the a"ea ?owe/e"& "esea"%h has shown that massage only in%"eases the li0elihood of %ell$la" is%hemia and ne%"osis to the a"ea ) @efo"e a blood t"ansf$sion is pe"fo"med& the blood of the dono" and "e%ipient m$st be %he%0ed fo" %ompatibility !his is done by blood typing Oa test that dete"mines a pe"sonKs blood typeP and %"oss= mat%hing Oa p"o%ed$"e that dete"mines the %ompatibility of the dono"Ks and "e%ipientKs blood afte" the blood types has been mat%hedP If the blood spe%imens a"e in%ompatible& hemolysis and antigen=antibody "ea%tions will o%%$"

COMPREHENSIVE NURSING REVIEW by R. C. REA

| +1

12 A Platelets a"e dis0=shaped %ells that a"e essential fo" blood %oag$lation # platelet %o$nt dete"mines the
n$mbe" of th"ombo%ytes in blood a/ailable fo" p"omoting hemostasis and assisting with blood %oag$lation afte" inE$"y It also is $sed to e/al$ate the patientKs potential fo" bleedingW howe/e"& this is not its p"ima"y p$"pose !he no"mal %o$nt "anges f"om 120&000 to +20&000Gmm + # %o$nt of 100&000Gmm+ o" less indi%ates a potential fo" bleedingW %o$nt of less than 20&000Gmm+ is asso%iated with spontaneo$s bleeding D 'e$0o%ytosis is any t"ansient in%"ease in the n$mbe" of white blood %ells Ole$0o%ytesP in the blood *o"mal H@C %o$nts "ange f"om 2&000 to 100&000Gmm+ !h$s& a %o$nt of 22&000Gmm+ indi%ates le$0o%ytosis A Fatig$e& m$s%le %"amping& and m$s%le wea0nesses a"e symptoms of hypo0alemia Oan inade6$ate potassi$m le/elP& whi%h is a potential side effe%t of di$"eti% the"apy !he physi%ian $s$ally o"de"s s$pplemental potassi$m to p"e/ent hypo0alemia in patients "e%ei/ing di$"eti%s #no"e-ia is anothe" symptom of hypo0alemia )ysphagia means diffi%$lty swallowing A P"egnan%y o" s$spe%ted p"egnan%y is the only %ont"aindi%ation fo" a %hest ;="ay ?owe/e"& if a %hest ;="ay is ne%essa"y& the patient %an wea" a lead ap"on to p"ote%t the pel/i% "egion f"om "adiation Bewel"y& metalli% obEe%ts& and b$ttons wo$ld inte"fe"e with the ;="ay and th$s sho$ld not be wo"n abo/e the waist # signed %onsent is not "e6$i"ed be%a$se a %hest ;="ay is not an in/asi/e e-amination ,ating& d"in0ing and medi%ations a"e allowed be%a$se the ;="ay is of the %hest& not the abdominal "egion A Obtaining a sp$t$m spe%imen ea"ly in this mo"ning ens$"es an ade6$ate s$pply of ba%te"ia fo" %$lt$"ing and de%"eases the "is0 of %ontamination f"om food o" medi%ation A Initial sensiti/ity to peni%illin is %ommonly manifested by a s0in "ash& e/en in indi/id$als who ha/e not been alle"gi% to it p"e/io$sly @e%a$se of the dange" of anaphyla%ti% sho%0& he n$"se sho$ld withhold the d"$g and notify the physi%ian& who may %hoose to s$bstit$te anothe" d"$g #dministe"ing an antihistamine is a dependent n$"sing inte"/ention that "e6$i"es a w"itten physi%ianKs o"de" #ltho$gh applying %o"n sta"%h to the "ash may "elie/e dis%omfo"t& it is not the n$"seKs top p"io"ity in s$%h a potentially life=th"eatening sit$ation D !he J=t"a%0 method is an I < inEe%tion te%hni6$e in whi%h the patientKs s0in is p$lled in s$%h a way that the needle t"a%0 is sealed off afte" the inEe%tion !his p"o%ed$"e seals medi%ation deep into the m$s%le& the"eby minimi(ing s0in staining and i""itation 1$bbing the inEe%tion site is %ont"aindi%ated be%a$se it may %a$se the medi%ation to e-t"a/asate into the s0in D !he /ast$s late"alis& a long& thi%0 m$s%le that e-tends the f$ll length of the thigh& is /iewed by many %lini%ians as the site of %hoi%e fo" I < inEe%tions be%a$se it has "elati/ely few maEo" ne"/es and blood /essels !he middle thi"d of the m$s%le is "e%ommended as the inEe%tion site !he patient %an be in a s$pine o" sitting position fo" an inEe%tion into this site A !he mid=deltoid inEe%tion site %an a%%ommodate only 1 ml o" less of medi%ation be%a$se of its si(e and lo%ation Oon the deltoid m$s%le of the a"m& %lose to the b"a%hial a"te"y and "adial ne"/eP D # 22D& 2G9T needle is the "e%ommended si(e fo" ins$lin inEe%tion be%a$se ins$lin is administe"ed by the s$b%$taneo$s "o$te #n 19D& 1 [T needle is $s$ally $sed fo" I < inEe%tions in %hild"en& typi%ally in the /ast$s late"alis # 22D& 1 [T needle is $s$ally $sed fo" ad$lt I < inEe%tions& whi%h a"e typi%ally administe"ed in the /ast$s late"alis o" /ent"ogl$teal site D @e%a$se an int"ade"mal inEe%tion does not penet"ate deeply into the s0in& a small=bo"e 22D needle is "e%ommended !his type of inEe%tion is $sed p"ima"ily to administe" antigens to e/al$ate "ea%tions fo" alle"gy o" sensiti/ity st$dies # 20D needle is $s$ally $sed fo" I < inEe%tions of oil=based medi%ationsW a 22D needle fo" I < inEe%tionsW and a 22D needle& fo" I < inEe%tionsW and a 22D needle& fo" s$b%$taneo$s ins$lin inEe%tions A Pa"ente"al peni%illin %an be administe"ed I < o" added to a sol$tion and gi/en I 7 It %annot be administe"ed s$b%$taneo$sly o" int"ade"mally D g" 10 - 50mgGg" 1 F 500 mg C 100mlG50 min ; 12 gttG 1 ml F 22 gttGmin$te A ?emoglobin$"ia& the abno"mal p"esen%e of hemoglobin in the $"ine& indi%ates a hemolyti% "ea%tion Oin%ompatibility of the dono"Ks and "e%ipientKs bloodP In this "ea%tion& antibodies in the "e%ipientKs plasma %ombine "apidly with dono" 1@CKsW the %ells a"e hemoly(ed in eithe" %i"%$lato"y o" "eti%$loendothelial system ?emolysis o%%$"s mo"e "apidly in #@O in%ompatibilities than in 1h in%ompatibilities Chest pain and $"ti%a"ia may be symptoms of impending anaphyla-is )istended ne%0 /eins a"e an indi%ation of hype"/olemia C In "eal fail$"e& the 0idney loses thei" ability to effe%ti/ely eliminate wastes and fl$ids @e%a$se of this& limiting the patientKs inta0e of o"al and I 7 fl$ids may be ne%essa"y Fe/e"& %h"oni% obst"$%ti/e p$lmona"y disease& and dehyd"ation a"e %onditions fo" whi%h fl$ids sho$ld be en%o$"aged D Phlebitis& the inflammation of a /ein& %an be %a$sed by %hemi%al i""itants OI 7 sol$tions o" medi%ationsP& me%hani%al i""itants Othe needle o" %athete" $sed d$"ing /enip$n%t$"e o" %ann$lationP& o" a lo%ali(ed alle"gi% "ea%tion to the needle o" %athete" Signs and symptoms of phlebitis in%l$de pain o" dis%omfo"t& edema and heat at the I 7 inse"tion site& and a "ed st"ea0 going $p the a"m o" leg f"om the I 7 inse"tion site

15 18

19

19 20

21

22

2+ 2.

22

25 28 29 29

+0 +1

COMPREHENSIVE NURSING REVIEW by R. C. REA

| +2

+2 D 1et$"n demonst"ation p"o/ides the most %e"tain e/iden%e fo" e/al$ating the effe%ti/eness of patient
tea%hing

++ D Caps$les& ente"i%=%oated tablets& and most e-tended d$"ation o" s$stained "elease p"od$%ts sho$ld not
be dissol/ed fo" $se in a gast"ostomy t$be !hey a"e pha"ma%e$ti%ally man$fa%t$"ed in these fo"ms fo" /alid "easons& and alte"ing them dest"oys thei" p$"pose !he n$"se sho$ld see0 an alte"nate physi%ianKs o"de" when an o"de"ed medi%ation is inapp"op"iate fo" deli/e"y by t$be D # d"$g=alle"gy is an ad/e"se "ea%tion "es$lting f"om an imm$nologi% "esponse following a p"e/io$s sensiti(ing e-pos$"e to the d"$g !he "ea%tion %an "ange f"om a "ash o" hi/es to anaphyla%ti% sho%0 Tolerance to a d"$g means that the patient e-pe"ien%es a de%"easing physiologi% "esponse to "epeated administ"ation of the d"$g in the same dosage Idiosyncrasy is an indi/id$alKs $ni6$e hype"sensiti/ity to a d"$g& food& o" othe" s$bstan%eW it appea"s to be geneti%ally dete"mined Synergism& is a d"$g inte"a%tion in whi%h the s$m of the d"$gKs %ombined effe%ts is g"eate" than that of thei" sepa"ate effe%ts D # hemoglobin and hemato%"it %o$nt wo$ld be o"de"ed by the physi%ian if bleeding we"e s$spe%ted !he othe" answe"s a"e app"op"iate n$"sing inte"/entions fo" a patient who has $nde"gone femo"al a"te"iog"aphy A Co$ghing& a p"ote%ti/e "esponse that %lea"s the "espi"ato"y t"a%t of i""itants& $s$ally is in/ol$nta"yW howe/e" it %an be /ol$nta"y& as when a patient is ta$ght to pe"fo"m %o$ghing e-e"%ises #n antit$ssi/e d"$g inhibits %o$ghing Splinting the abdomen s$ppo"ts the abdominal m$s%les when a patient %o$ghs C In an infe%ted patient& shi/e"ing "es$lts f"om the bodyKs attempt to in%"ease heat p"od$%tion and the p"od$%tion of ne$t"ophils and phago%ytoti% a%tion th"o$gh in%"eased s0eletal m$s%le tension and %ont"a%tions Initial /aso%onst"i%tion may %a$se s0in to feel %old to the to$%h #pplying additional bed %lothes helps to e6$ali(e the body tempe"at$"e and stop the %hills #ttempts to %ool the body "es$lt in f$"the" shi/e"ing& in%"eased metabloism& and th$s in%"eased heat p"od$%tion D # %lini%al n$"se spe%ialist m$st ha/e %ompleted a maste"Ks deg"ee in a %lini%al spe%ialty and be a "egiste"ed p"ofessional n$"se !he *ational 'eag$e of *$"sing a%%"edits ed$%ational p"og"ams in n$"sing and p"o/ides a testing se"/i%e to e/al$ate st$dent n$"sing %ompeten%e b$t it does not %e"tify n$"ses !he #me"i%an *$"ses #sso%iation identifies "e6$i"ements fo" %e"tifi%ation and offe"s e-aminations fo" %e"tifi%ation in many a"eas of n$"sing & s$%h as medi%al s$"gi%al n$"sing !hese %e"tifi%ation O%"edentialingP demonst"ates that the n$"se has the 0nowledge and the ability to p"o/ide high 6$ality n$"sing %a"e in the a"ea of he" %e"tifi%ation # g"ad$ate of an asso%iate deg"ee p"og"am is not a %lini%al n$"se spe%ialist: howe/e"& she is p"epa"ed to p"o/ide bed side n$"sing with a high deg"ee of 0nowledge and s0ill She m$st s$%%essf$lly %omplete the li%ensing e-amination to be%ome a "egiste"ed p"ofessional n$"se D <i%"oo"ganisms $s$ally do not g"ow in an a%idi% en/i"onment D @ile %olo"s the stool b"own #ny inflammation o" obst"$%tion that impai"s bile flow will affe%t the stool pigment& yielding light& %lay=%olo"ed stool Uppe" DI bleeding "es$lts in bla%0 o" ta""y stool Constipation is %ha"a%te"i(ed by small& ha"d masses <any medi%ations and foods will dis%olo" stool X fo" e-ample& d"$gs %ontaining i"on t$"n stool bla%0 W beets t$"n stool "ed D In the e/al$ation step of the n$"sing p"o%ess& the n$"se m$st de%ide whethe" the patient has a%hie/ed the e-pe%ted o$t%ome that was identified in the planning phase A !he main so$"%es of /itamin # a"e yellow and g"een /egetables Os$%h as %a""ots& sweet potatoes& s6$ash& spina%h& %olla"d g"eens& b"o%%oli& and %abbageP and yellow f"$its Os$%h as ap"i%ots& and %antalo$peP #nimal so$"%es in%l$de li/e"& 0idneys& %"eam& b$tte"& and egg yol0s D <aintaing the d"ainage t$bing and %olle%tion bag le/el with the patientKs bladde" %o$ld "es$lt in "efl$of $"ine into the 0idney I""igating the bladde" with *eospo"in and %lamping the %athete" fo" 1 ho$" e/e"y . ho$"s m$st be p"es%"ibed by a physi%ian D !he ,'IS# test of /eno$s blood is $sed to assess blood and potential blood dono"s to h$man imm$nodefi%ien%y /i"$s O?I7P # positi/e ,'IS# test %ombined with /a"io$s signs and symptoms helps to diagnose a%6$i"ed imm$nodefi%ien%y synd"ome O#I)SP D !a%hypnea Oan abno"mally "apid "ate of b"eathingP wo$ld indi%ate that the patient was still hypo-i% Odefi%ient in o-ygenP !he pa"tial p"ess$"es of a"te"ial o-ygen and %a"bon dio-ide listed a"e within the no"mal "ange ,$pnea "efe"s to no"mal "espi"ation D St$dies ha/e shown that showe"ing with an antisepti% soap befo"e s$"ge"y is the most effe%ti/e method of "emo/ing mi%"oo"ganisms f"om the s0in Sha/ing the site of the intended s$"ge"y might %a$se b"ea0s in the s0in& the"eby in%"easing the "is0 of infe%tionW howe/e"& if indi%ated& sha/ing& sho$ld be done immediately befo"e s$"ge"y& not the day befo"e # topi%al antisepti% wo$ld not "emo/e mi%"oo"ganisms and wo$ld be benefi%ial only afte" p"ope" %leaning and "insing !$b bathing might t"ansfe" o"ganisms to anothe" body site "athe" than "inse them away C !he leg m$s%les a"e the st"ongest m$s%les in the body and sho$ld bea" the g"eatest st"ess when lifting <$s%les of the abdomen& ba%0& and $ppe" a"ms may be easily inE$"ed C !he fa%to"s& 0nown as 7i"%howKs t"iad& %olle%ti/ely p"edispose a patient to th"omboplebitisW impai"ed /eno$s "et$"n to the hea"t& blood hype"%oag$lability& and inE$"y to a blood /essel wall In%"eased pa"tial th"omboplastin time indi%ates a p"olonged bleeding time d$"ing fib"in %lot fo"mation& %ommonly the

+.

+2 +5 +8

+9

+9 .0

.1 .2 .+ .. .2 .5

.8 .9

COMPREHENSIVE NURSING REVIEW by R. C. REA

| ++

"es$lt of anti%oag$lant Ohepa"inP the"apy #"te"ial blood diso"de"s Os$%h as p$ls$s pa"ado-$sP and l$ng diseases Os$%h as COP)P do not ne%essa"ily impede /eno$s "et$"n of inE$"e /essel walls .9 A @e%a$se of "est"i%ted "espi"ato"y mo/ement& a "e%$mbent& immobili(e patient is at pa"ti%$la" "is0 fo" "espi"ato"y a%idosis f"om poo" gas e-%hangeW atele%tasis f"om "ed$%ed s$"fa%tant and a%%$m$lated m$%$s in the b"on%hioles& and hypostati% pne$monia f"om ba%te"ial g"owth %a$sed by stasis of m$%$s se%"etions 20 ) !he immobili(ed patient %ommonly s$ffe"s f"om $"ine "etention %a$sed by de%"eased m$s%le tone in the pe"ine$m !his leads to bladde" distention and $"ine stagnation& whi%h p"o/ide an e-%ellent medi$m fo" ba%te"ial g"owth leading to infe%tion Immobility also "es$lts in mo"e al0aline $"ine with e-%essi/e amo$nts of %al%i$m& sodi$m and phosphate& a g"ad$al de%"ease in $"ine p"od$%tion& and an in%"eased spe%ifi% g"a/ity

COMPREHENSIVE NURSING REVIEW by R. C. REA

| +.

MATERNIT( NURSING Part 1 1 Hhen assessing the ade6$a%y of spe"m fo" %on%eption to o%%$"& whi%h of the following is the most $sef$l %"ite"ionQ a Spe"m %o$nt b Spe"m motility % Spe"m mat$"ity d Semen /ol$me # %o$ple who wants to %on%ei/e b$t has been $ns$%%essf$l d$"ing the last 2 yea"s has $nde"gone many diagnosti% p"o%ed$"es Hhen dis%$ssing the sit$ation with the n$"se& one pa"tne" states& SHe 0now se/e"al f"iends in o$" age g"o$p and all of them ha/e thei" own %hild al"eady& Hhy %anKt we ha/e oneQT Hhi%h of the following wo$ld be the most pe"tinent n$"sing diagnosis fo" this %o$pleQ a Fea" "elated to the $n0nown b Pain "elated to n$me"o$s p"o%ed$"es % Ineffe%ti/e family %oping "elated to infe"tility d Self=esteem dist$"ban%e "elated to infe"tility Hhi%h of the following $"ina"y symptoms does the p"egnant woman most f"e6$ently e-pe"ien%e d$"ing the fi"st t"imeste"Q a )ys$"ia b F"e6$en%y % In%ontinen%e d @$"ning ?ea"tb$"n and flat$len%e& %ommon in the se%ond t"imeste"& a"e most li0ely the "es$lt of whi%h of the followingQ a In%"eased plasma ?CD le/els b )e%"eased intestinal motility % )e%"eased gast"i% a%idity d ,le/ated est"ogen le/els On whi%h of the following a"eas wo$ld the n$"se e-pe%t to obse"/e %hloasmaQ a @"east& a"eola& and nipples b Chest& ne%0& a"ms& and legs % #bdomen& b"east& and thighs d Chee0s& fo"ehead& and nose # p"egnant %lient states that she SwaddlesT when she wal0s !he n$"seKs e-planation is based on whi%h of the following as the %a$seQ a !he la"ge si(e of the newbo"n b P"ess$"e on the pel/i% m$s%les % 1ela-ation of the pel/i% Eoints d ,-%essi/e weight gain Hhi%h of the following "ep"esents the a/e"age amo$nt of weight gained d$"ing p"egnan%yQ a 12 to 22 lb b 12 to 22 lb % 2. to +0 lb d 22 to .0 lb Hhen tal0ing with a p"egnant %lient who is e-pe"ien%ing a%hing swollen& leg /eins& the n$"se wo$ld e-plain that this is most p"obably the "es$lt of whi%h of the followingQ a !h"ombophlebitis b P"egnan%y=ind$%ed hype"tension

COMPREHENSIVE NURSING REVIEW by R. C. REA

| +2

10

11

12

1+

1.

12

15

18

19

19

20

% P"ess$"e on blood /essels f"om the enla"ging $te"$s d !he fo"%e of g"a/ity p$lling down on the $te"$s Ce"/i%al softening and $te"ine so$ffle a"e %lassified as whi%h of the followingQ a )iagnosti% signs b P"es$mpti/e signs % P"obable signs d Positi/e signs Hhi%h of the following wo$ld the n$"se identify as a p"es$mpti/e sign of p"egnan%yQ a ?ega" sign b *a$sea and /omiting % S0in pigmentation %hanges d Positi/e se"$m p"egnan%y test Hhi%h of the following %ommon emotional "ea%tions to p"egnan%y wo$ld the n$"se e-pe%t to o%%$" d$"ing the fi"st t"imeste"Q a Int"o/e"sion& ego%ent"ism& na"%issism b #w0wa"dness& %l$msiness& and $natt"a%ti/eness % #n-iety& passi/ity& e-t"o/e"sion d #mbi/alen%e& fea"& fantasies )$"ing whi%h of the following wo$ld the fo%$s of %lasses be mainly on physiologi% %hanges& fetal de/elopment& se-$ality& d$"ing p"egnan%y& and n$t"itionQ a P"ep"egnant pe"iod b Fi"st t"imeste" % Se%ond t"imeste" d !hi"d t"imeste" Hhi%h of the following wo$ld be disad/antage of b"east feedingQ a In/ol$tion o%%$"s mo"e "apidly b !he in%iden%e of alle"gies in%"eases d$e to mate"nal antibodies % !he fathe" may "esent the infantKs demands on the mothe"Ks body d !he"e is a g"eate" %han%e fo" e""o" d$"ing p"epa"ation Hhi%h of the following wo$ld %a$se a false=positi/e "es$lt on a p"egnan%y testQ a !he test was pe"fo"med less than 10 days afte" an abo"tion b !he test was pe"fo"med too ea"ly o" too late in the p"egnan%y % !he $"ine sample was sto"ed too long at "oom tempe"at$"e d # spontaneo$s abo"tion o" a missed abo"tion is impending F?1 %an be a$s%$ltated with a fetos%ope as ea"ly as whi%h of the followingQ a 2 wee0s gestation b 10 wee0s gestation % 12 wee0s gestation d 20 wee0s gestation # %lient '<P began B$ly 2 ?e" ,)) sho$ld be whi%h of the followingQ a Ban$a"y 2 b <a"%h 29 % #p"il 12 d O%tobe" 12 Hhi%h of the following f$ndal heights indi%ates less than 12 wee0sK gestation when the date of the '<P is $n0nownQ a Ute"$s in the pel/is b Ute"$s at the -iphoid % Ute"$s in the abdomen d Ute"$s at the $mbili%$s Hhi%h of the following dange" signs sho$ld be "epo"ted p"omptly d$"ing the antepa"t$m pe"iodQ a Constipation b @"east tende"ness % *asal st$ffiness d 'ea0ing amnioti% fl$id Hhi%h of the following p"enatal labo"ato"y test /al$es wo$ld the n$"se %onside" as signifi%antQ a ?emato%"it ++ 2V b 1$bella tite" less than 1:9 % Hhite blood %ells 9&000Gmm+ d One ho$" gl$%ose %hallenge test 110 gGd' Hhi%h of the following %ha"a%te"isti%s of %ont"a%tions wo$ld the n$"se e-pe%t to find in a %lient e-pe"ien%ing t"$e labo"Q a O%%$""ing at i""eg$la" inte"/als b Sta"ting mainly in the abdomen % D"ad$ally in%"easing inte"/als

COMPREHENSIVE NURSING REVIEW by R. C. REA

| +5

d In%"easing intensity with wal0ing 21 )$"ing whi%h of the following stages of labo" wo$ld the n$"se assess S%"owningTQ a Fi"st stage b Se%ond stage % !hi"d stage d Fo$"th stage 22 @a"bit$"ates a"e $s$ally not gi/en fo" pain "elief d$"ing a%ti/e labo" fo" whi%h of the following "easonsQ a !he neonatal effe%ts in%l$de hypotonia& hypothe"mia& gene"ali(ed d"owsiness& and "el$%tan%e to feed fo" the fi"st few days b !hese d"$gs "eadily %"oss the pla%ental ba""ie"& %a$sing dep"essi/e effe%ts in the newbo"n 2 to + ho$"s afte" int"am$s%$la" inEe%tion % !hey "apidly t"ansfe" a%"oss the pla%enta& and la%0 of an antagonist ma0e them gene"ally inapp"op"iate d$"ing labo" d #d/e"se "ea%tions may in%l$de mate"nal hypotension& alle"gi% o" to-i% "ea%tion o" pa"tial o" total "espi"ato"y fail$"e 2+ Hhi%h of the following n$"sing inte"/entions wo$ld the n$"se pe"fo"m d$"ing the thi"d stage of labo"Q a Obtain a $"ine spe%imen and othe" labo"ato"y tests b #ssess $te"ine %ont"a%tions e/e"y +0 min$tes % Coa%h fo" effe%ti/e %lient p$shing d P"omote pa"ent=newbo"n inte"a%tion 2. Hhi%h of the following a%tions demonst"ates the n$"seKs $nde"standing abo$t the newbo"nKs the"mo"eg$lato"y abilityQ a Pla%ing the newbo"n $nde" a "adiant wa"me" b S$%tioning with a b$lb sy"inge % Obtaining an #pga" s%o"e d Inspe%ting the newbo"nKs $mbili%al %o"d 22 Immediately befo"e e-p$lsion& whi%h of the following %a"dinal mo/ements o%%$"Q a )es%ent b Fle-ion % ,-tension d ,-te"nal "otation 25 @efo"e bi"th& whi%h of the following st"$%t$"es %onne%ts the "ight and left a$"i%les of the hea"tQ a Umbili%al /ein b Fo"amen o/ale % )$%t$s a"te"ios$s d )$%t$s /enos$s 28 Hhi%h of the following when p"esent in the $"ine may %a$se a "eddish stain on the diape" of a newbo"nQ a <$%$s b U"i% a%id %"ystals % @ili"$bin d ,-%ess i"on 29 Hhen assessing the newbo"nKs hea"t "ate& whi%h of the following "anges wo$ld be %onside"ed no"mal if the newbo"n we"e sleepingQ a 90 beats pe" min$te b 100 beats pe" min$te % 120 beats pe" min$te d 1.0 beats pe" min$te 29 Hhi%h of the following is t"$e "ega"ding the fontanels of the newbo"nQ a !he ante"io" is t"iang$la" shapedW the poste"io" is diamond shaped b !he poste"io" %loses at 19 monthsW the ante"io" %loses at 9 to 12 wee0s % !he ante"io" is la"ge in si(e when %ompa"ed to the poste"io" fontanel d !he ante"io" is b$lgingW the poste"io" appea"s s$n0en +0 Hhi%h of the following g"o$ps of newbo"n "efle-es below a"e p"esent at bi"th and "emain $n%hanged th"o$gh ad$lthoodQ a @lin0& %o$gh& "ooting& and gag b @lin0& %o$gh& snee(e& gag % 1ooting& snee(e& swallowing& and %o$gh d Stepping& blin0& %o$gh& and snee(e +1 Hhi%h of the following des%"ibes the @abins0i "efle-Q a !he newbo"nKs toes will hype"e-tend and fan apa"t f"om do"sifle-ion of the big toe when one side of foot is st"o0ed $pwa"d f"om the ball of the heel and a%"oss the ball of the foot b !he newbo"n abd$%ts and fle-es all e-t"emities and may begin to %"y when e-posed to s$dden mo/ement o" lo$d noise % !he newbo"n t$"ns the head in the di"e%tion of stim$l$s& opens the mo$th& and begins to s$%0 when %hee0& lip& o" %o"ne" of mo$th is to$%hed

COMPREHENSIVE NURSING REVIEW by R. C. REA

| +8

+2

++

+.

+2

+5

+8

+9

+9

.0

.1

.2

!he newbo"n will attempt to %"awl fo"wa"d with both a"ms and legs when he is pla%ed on his abdomen on a flat s$"fa%e Hhi%h of the following statements best des%"ibes hype"emesis g"a/ida"$mQ a Se/e"e anemia leading to ele%t"olyte& metaboli%& and n$t"itional imbalan%es in the absen%e of othe" medi%al p"oblems b Se/e"e na$sea and /omiting leading to ele%t"olyte& metaboli%& and n$t"itional imbalan%es in the absen%e of othe" medi%al p"oblems % 'oss of appetite and %ontin$o$s /omiting that %ommonly "es$lts in dehyd"ation and $ltimately de%"easing mate"nal n$t"ients d Se/e"e na$sea and dia""hea that %an %a$se gast"ointestinal i""itation and possibly inte"nal bleeding Hhi%h of the following wo$ld the n$"se identify as a %lassi% sign of PI?Q a ,dema of the feet and an0les b ,dema of the hands and fa%e % Height gain of 1 lbGwee0 d ,a"ly mo"ning heada%he In whi%h of the following types of spontaneo$s abo"tions wo$ld the n$"se assess da"0 b"own /aginal dis%ha"ge and a negati/e p"egnan%y testsQ a !h"eatened b Imminent % <issed d In%omplete Hhi%h of the following fa%to"s wo$ld the n$"se s$spe%t as p"edisposing a %lient to pla%enta p"e/iaQ a <$ltiple gestation b Ute"ine anomalies % #bdominal t"a$ma d 1enal o" /as%$la" disease Hhi%h of the following wo$ld the n$"se assess in a %lient e-pe"ien%ing ab"$ptio pla%entaQ a @"ight "ed& painless /aginal bleeding b Con%ealed o" e-te"nal da"0 "ed bleeding % Palpable fetal o$tline d Soft and nontende" abdomen Hhi%h of the following is des%"ibed as p"emat$"e sepa"ation of a no"mally implanted pla%enta d$"ing the se%ond half of p"egnan%y& $s$ally with se/e"e hemo""hageQ a Pla%enta p"e/ia b ,%topi% p"egnan%y % In%ompetent %e"/id #b"$ptio pla%entae Hhi%h of the following may happen if the $te"$s be%omes o/e"stim$lated by o-yto%in d$"ing the ind$%tion of labo"Q a Hea0 %ont"a%tion p"olonged to mo"e than 80 se%onds b !etani% %ont"a%tions p"olonged to mo"e than 90 se%onds % In%"eased pain with b"ight "ed /aginal bleeding d In%"eased "estlessness and an-iety Hhen p"epa"ing a %lient fo" %esa"ean deli/e"y& whi%h of the following 0ey %on%epts sho$ld be %onside"ed when implementing n$"sing %a"eQ a Inst"$%t the mothe"Ks s$ppo"t pe"son to "emain in the family lo$nge $ntil afte" the deli/e"y b #""ange fo" a staff membe" of the anesthesia depa"tment to e-plain what to e-pe%t postope"ati/ely % <odify p"eope"ati/e tea%hing to meet the needs of eithe" a planned o" eme"gen%y %esa"ean bi"th d ,-plain the s$"ge"y& e-pe%ted o$t%ome& and 0ind of anestheti%s Hhi%h of the following best des%"ibes p"ete"m labo"Q a 'abo" that begins afte" 20 wee0s gestation and befo"e +8 wee0s gestation b 'abo" that begins afte" 12 wee0s gestation and befo"e +8 wee0s gestation % 'abo" that begins afte" 2. wee0s gestation and befo"e 29 wee0s gestation d 'abo" that begins afte" 29 wee0s gestation and befo"e .0 wee0s gestation Hhen P1O< o%%$"s& whi%h of the following p"o/ides e/iden%e of the n$"seKs $nde"standing of the %lientKs immediate needsQ a !he %ho"ion and amnion "$pt$"e . ho$"s befo"e the onset of labo" b P1O< "emo/es the fet$s most effe%ti/e defense against infe%tion % *$"sing %a"e is based on fetal /iability and gestational age d P1O< is asso%iated with malp"esentation and possibly in%ompetent %e"/iHhi%h of the following fa%to"s is the $nde"lying %a$se of dysto%iaQ a *$"tional b <e%hani%al % ,n/i"onmental

COMPREHENSIVE NURSING REVIEW by R. C. REA

| +9

d <edi%al .+ Hhen $te"ine "$pt$"e o%%$"s& whi%h of the following wo$ld be the p"io"ityQ a 'imiting hypo/olemi% sho%0 b Obtaining blood spe%imens % Instit$ting %omplete bed "est d Inse"ting a $"ina"y %athete" .. Hhi%h of the following is the n$"seKs initial a%tion when $mbili%al %o"d p"olapse o%%$"sQ a @egin monito"ing mate"nal /ital signs and F?1 b Pla%e the %lient in a 0nee=%hest position in bed % *otify the physi%ian and p"epa"e the %lient fo" deli/e"y d #pply a ste"ile wa"m saline d"essing to the e-posed %o"d .2 Hhi%h of the following amo$nts of blood loss following bi"th ma"0s the %"ite"ion fo" des%"ibing postpa"t$m hemo""hageQ a <o"e than 200 ml b <o"e than +00 ml % <o"e than .00 ml d <o"e than 200 ml .5 Hhi%h of the following is the p"ima"y p"edisposing fa%to" "elated to mastitisQ a ,pidemi% infe%tion f"om noso%omial so$"%es lo%ali(ing in the la%tife"o$s glands and d$%ts b ,ndemi% infe%tion o%%$""ing "andomly and lo%ali(ing in the pe"igland$la" %onne%ti/e tiss$e % !empo"a"y $"ina"y "etention d$e to de%"eased pe"%eption of the $"ge to a/oid d @"east inE$"y %a$sed by o/e"distention& stasis& and %"a%0ing of the nipples .8 Hhi%h of the following best des%"ibes th"ombophlebitisQ a Inflammation and %lot fo"mation that "es$lt when blood %omponents %ombine to fo"m an agg"egate body b Inflammation and blood %lots that e/ent$ally be%ome lodged within the p$lmona"y blood /essels % Inflammation and blood %lots that e/ent$ally be%ome lodged within the femo"al /ein d Inflammation of the /as%$la" endotheli$m with %lot fo"mation on the /essel wall .9 Hhi%h of the following assessment findings wo$ld the n$"se e-pe%t if the %lient de/elops )7!Q a <id%alf pain& tende"ness and "edness along the /ein b Chills& fe/e"& malaise& o%%$""ing 2 wee0s afte" deli/e"y % <$s%le pain the p"esen%e of ?omans sign& and swelling in the affe%ted limb d Chills& fe/e"& stiffness& and pain o%%$""ing 10 to 1. days afte" deli/e"y .9 Hhi%h of the following a"e the most %ommonly assessed findings in %ystitisQ a F"e6$en%y& $"gen%y& dehyd"ation& na$sea& %hills& and flan0 pain b *o%t$"ia& f"e6$en%y& $"gen%y dys$"ia& hemat$"ia& fe/e" and s$p"ap$bi% pain % )ehyd"ation& hype"tension& dys$"ia& s$p"ap$bi% pain& %hills& and fe/e" d ?igh fe/e"& %hills& flan0 pain na$sea& /omiting& dys$"ia& and f"e6$en%y 20 Hhi%h of the following best "efle%ts the f"e6$en%y of "epo"ted postpa"t$m Sbl$esTQ a @etween 10V and .0V of all new mothe"s "epo"t some fo"m of postpa"t$m bl$es b @etween +0V and 20V of all new mothe"s "epo"t some fo"m of postpa"t$m bl$es % @etween 20V and 90V of all new mothe"s "epo"t some fo"m of postpa"t$m bl$es d @etween 22V and 80V of all new mothe"s "epo"t some fo"m of postpa"t$m bl$es 21 Fo" the %lient who is $sing o"al %ont"a%epti/es& the n$"se info"ms the %lient abo$t the need to ta0e the pill at the same time ea%h day to a%%omplish whi%h of the followingQ a )e%"ease the in%iden%e of na$sea b <aintain ho"monal le/els % 1ed$%e side effe%ts d P"e/ent d"$g inte"a%tions 22 Hhen tea%hing a %lient abo$t %ont"a%eption Hhi%h of the following wo$ld the n$"se in%l$de as the most effe%ti/e method fo" p"e/enting se-$ally t"ansmitted infe%tionsQ a Spe"mi%ides b )iaph"agm % Condoms d 7ase%tomy 2+ Hhen p"epa"ing a woman who is 2 days postpa"t$m fo" dis%ha"ge& "e%ommendations fo" whi%h of the following %ont"a%epti/e methods wo$ld be a/oidedQ a )iaph"agm b Female %ondom % O"al %ont"a%epti/es d 1hythm method 2. Fo" whi%h of the following %lients wo$ld the n$"se e-pe%t that an int"a$te"ine de/i%e wo$ld $#t be "e%ommendedQ a Homan o/e" age +2 b *$llipa"o$s woman

COMPREHENSIVE NURSING REVIEW by R. C. REA

| +9

22

25

28

29

29

50

51

52

5+

5.

52

% P"omis%$o$s yo$ng ad$lt d Postpa"t$m %lient # %lient in he" thi"d t"imeste" tells the n$"se& SIKm %onstipated all the time\T Hhi%h of the following sho$ld the n$"se "e%ommendQ a )aily enemas b 'a-ati/es % In%"eased fibe" inta0e d )e%"eased fl$id inta0e Hhi%h of the following wo$ld the n$"se $se as the basis fo" the tea%hing plan when %a"ing fo" a p"egnant teenage" %on%e"ned abo$t gaining too m$%h weight d$"ing p"egnan%yQ a 10 po$nds pe" t"imeste" b 1 po$nd pe" wee0 fo" .0 wee0s % [ po$nd pe" wee0 fo" .0 wee0s d # total gain of 22 to +0 po$nds !he %lient tells the n$"se that he" last menst"$al pe"iod sta"ted on Ban$a"y 1. and ended on Ban$a"y 20 Using *ageleKs "$le& the n$"se dete"mines he" ,)) to be whi%h of the followingQ a Septembe" 28 b O%tobe" 21 % *o/embe" 8 d )e%embe" 28 Hhen ta0ing an obstet"i%al histo"y on a p"egnant %lient who states& SI had a son bo"n at +9 wee0s gestation& a da$ghte" bo"n at +0 wee0s gestation and I lost a baby at abo$t 9 wee0s&T the n$"se sho$ld "e%o"d he" obstet"i%al histo"y as whi%h of the followingQ a D2 !2 P0 #0 '2 b D+ !1 P1 #0 '2 % D+ !2 P0 #0 '2 d D. !2 P1 #1 '2 Hhen p"epa"ing to listen to the fetal hea"t "ate at 12 wee0sK gestation& the n$"se wo$ld $se whi%h of the followingQ a Stethos%ope pla%ed midline at the $mbili%$s b )opple" pla%ed midline at the s$p"ap$bi% "egion % Fetos%ope pla%ed midway between the $mbili%$s and the -iphoid p"o%ess d ,-te"nal ele%t"oni% fetal monito" pla%ed at the $mbili%$s Hhen de/eloping a plan of %a"e fo" a %lient newly diagnosed with gestational diabetes& whi%h of the following inst"$%tions wo$ld be the p"io"ityQ a )ieta"y inta0e b <edi%ation % ,-e"%ise d Dl$%ose monito"ing # %lient at 2. wee0s gestation has gained 5 po$nds in . wee0s Hhi%h of the following wo$ld be the p"io"ity when assessing the %lientQ a Dl$%os$"ia b )ep"ession % ?andGfa%e edema d )ieta"y inta0e # %lient 12 wee0sK p"egnant %ome to the eme"gen%y depa"tment with abdominal %"amping and mode"ate /aginal bleeding Spe%$l$m e-amination "e/eals 2 to + %ms %e"/i%al dilation !he n$"se wo$ld do%$ment these findings as whi%h of the followingQ a !h"eatened abo"tion b Imminent abo"tion % Complete abo"tion d <issed abo"tion Hhi%h of the following wo$ld be the p"io"ity n$"sing diagnosis fo" a %lient with an e%topi% p"egnan%yQ a 1is0 fo" infe%tion b Pain % :nowledge )efi%it d #nti%ipato"y D"ie/ing @efo"e assessing the postpa"t$m %lientKs $te"$s fo" fi"mness and position in "elation to the $mbili%$s and midline& whi%h of the following sho$ld the n$"se do fi"stQ a #ssess the /ital signs b #dministe" analgesia % #mb$late he" in the hall d #ssist he" to $"inate Hhi%h of the following sho$ld the n$"se do when a p"imipa"a who is la%tating tells the n$"se that she has so"e nipplesQ

COMPREHENSIVE NURSING REVIEW by R. C. REA

| .0

55

58

59

59

80

81

82

8+

8.

82

a !ell he" to b"east feed mo"e f"e6$ently b #dministe" a na"%oti% befo"e b"east feeding % ,n%o$"age he" to wea" a n$"sing b"assie"e d Use soap and wate" to %lean the nipples !he n$"se assesses the /ital signs of a %lient& . ho$"sK postpa"t$m that a"e as follows: @P 90G50W tempe"at$"e 100 .]FW p$lse 100 wea0& th"eadyW 1 20 pe" min$te Hhi%h of the following sho$ld the n$"se do fi"stQ a 1epo"t the tempe"at$"e to the physi%ian b 1e%he%0 the blood p"ess$"e with anothe" %$ff % #ssess the $te"$s fo" fi"mness and position d )ete"mine the amo$nt of lo%hia !he n$"se assesses the postpa"t$m /aginal dis%ha"ge Olo%hiaP on fo$" %lients Hhi%h of the following assessments wo$ld wa""ant notifi%ation of the physi%ianQ a # da"0 "ed dis%ha"ge on a 2=day postpa"t$m %lient b # pin0 to b"ownish dis%ha"ge on a %lient who is 2 days postpa"t$m % #lmost %olo"less to %"eamy dis%ha"ge on a %lient 2 wee0s afte" deli/e"y d # b"ight "ed dis%ha"ge 2 days afte" deli/e"y # postpa"t$m %lient has a tempe"at$"e of 101 .]F& with a $te"$s that is tende" when palpated& "emains $n$s$ally la"ge& and not des%ending as no"mally e-pe%ted Hhi%h of the following sho$ld the n$"se assess ne-tQ a 'o%hia b @"easts % In%ision d U"ine Hhi%h of the following is the p"io"ity fo%$s of n$"sing p"a%ti%e with the %$""ent ea"ly postpa"t$m dis%ha"geQ a P"omoting %omfo"t and "esto"ation of health b ,-plo"ing the emotional stat$s of the family % Fa%ilitating safe and effe%ti/e self=and newbo"n %a"e d !ea%hing abo$t the impo"tan%e of family planning Hhi%h of the following a%tions wo$ld be least effe%ti/e in maintaining a ne$t"al the"mal en/i"onment fo" the newbo"nQ a Pla%ing infant $nde" "adiant wa"me" afte" bathing b Co/e"ing the s%ale with a wa"med blan0et p"io" to weighing % Pla%ing %"ib %lose to n$"se"y window fo" family /iewing d Co/e"ing the infantKs head with a 0nit sto%0inette # newbo"n who has an asymmet"i%al <o"o "efle- "esponse sho$ld be f$"the" assessed fo" whi%h of the followingQ a !alipes e6$ino/a"$s b F"a%t$"ed %la/i%le % Congenital hypothy"oidism d In%"eased int"a%"anial p"ess$"e )$"ing the fi"st . ho$"s afte" a male %i"%$m%ision& assessing fo" whi%h of the following is the p"io"ityQ a Infe%tion b ?emo""hage % )is%omfo"t d )ehyd"ation !he mothe" as0s the n$"se SHhatKs w"ong with my sonKs b"eastsQ Hhy a"e they so enla"gedQT Hhish of the following wo$ld be the best "esponse by the n$"seQ a S!he b"east tiss$e is inflamed f"om the t"a$ma e-pe"ien%ed with bi"thT b S# de%"ease in mate"ial ho"mones p"esent befo"e bi"th %a$ses enla"gement&T % SAo$ sho$ld dis%$ss this with yo$" do%to" It %o$ld be a malignan%yT d S!he tiss$e has hype"t"ophied while the baby was in the $te"$sT Immediately afte" bi"th the n$"se notes the following on a male newbo"n: "espi"ations 89W api%al hea"th "ate 150 @P<& nost"il fla"ingW mild inte"%ostal "et"a%tionsW and g"$nting at the end of e-pi"ation Hhi%h of the following sho$ld the n$"se doQ a Call the assessment data to the physi%ianKs attention b Sta"t o-ygen pe" nasal %ann$la at 2 'Gmin % S$%tion the infantKs mo$th and na"es d 1e%ogni(e this as no"mal fi"st pe"iod of "ea%ti/ity !he n$"se hea"s a mothe" telling a f"iend on the telephone abo$t $mbili%al %o"d %a"e Hhi%h of the following statements by the mothe" indi%ates effe%ti/e tea%hingQ a S)aily soap and wate" %leansing is bestT b ^#l%ohol helps it d"y and 0ills ge"msT % S#n antibioti% ointment applied daily p"e/ents infe%tionT

COMPREHENSIVE NURSING REVIEW by R. C. REA

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d S?e %an ha/e a t$b bath ea%h dayT 85 # newbo"n weighing +000 g"ams and feeding e/e"y . ho$"s needs 120 %alo"iesG0g of body weight e/e"y 2. ho$"s fo" p"ope" g"owth and de/elopment ?ow many o$n%es of 20 %alGo( fo"m$la sho$ld this newbo"n "e%ei/e at ea%h feeding to meet n$t"itional needsQ a 2 o$n%es b + o$n%es % . o$n%es d 5 o$n%es 88 !he postte"m neonate with me%oni$m=stained amnioti% fl$id needs %a"e designed to espe%ially monito" fo" whi%h of the followingQ a 1espi"ato"y p"oblems b Dast"ointestinal p"oblems % Integ$menta"y p"oblems d ,limination p"oblems 89 Hhen meas$"ing a %lientKs f$ndal height& whi%h of the following te%hni6$es denotes the %o""e%t method of meas$"ement $sed by the n$"seQ a F"om the -iphoid p"o%ess to the $mbili%$s b F"om the symphysis p$bis to the -iphoid p"o%ess % F"om the symphysis p$bis to the f$nd$s d F"om the f$nd$s to the $mbili%$s 89 # %lient with se/e"e p"ee%lampsia is admitted with of @P 150G110& p"otein$"ia& and se/e"e pitting edema Hhi%h of the following wo$ld be most impo"tant to in%l$de in the %lientKs plan of %a"eQ a )aily weights b Sei($"e p"e%a$tions % 1ight late"al positioning d St"ess "ed$%tion 90 # postpa"t$m p"imipa"a as0s the n$"se& SHhen %an we ha/e se-$al inte"%o$"se againQT Hhi%h of the following wo$ld be the n$"seKs best "esponseQ a S#nytime yo$ both want to T b S#s soon as %hoose a %ont"a%epti/e method T % SHhen the dis%ha"ge has stopped and the in%ision is healed T d S#fte" yo$" 5 wee0s e-amination T 91 Hhen p"epa"ing to administe" the /itamin : inEe%tion to a neonate& the n$"se wo$ld sele%t whi%h of the following sites as app"op"iate fo" the inEe%tionQ a )eltoid m$s%le b #nte"io" femo"is m$s%le % 7ast$s late"alis m$s%le d Dl$te$s ma-im$s m$s%le 92 Hhen pe"fo"ming a pel/i% e-amination& the n$"se obse"/es a "ed swollen a"ea on the "ight side of the /aginal o"ifi%e !he n$"se wo$ld do%$ment this as enla"gement of whi%h of the followingQ a Clito"is b Pa"otid gland % S0eneKs gland d @a"tholinKs gland 9+ !o diffe"entiate as a female& the ho"monal stim$lation of the emb"yo that m$st o%%$" in/ol/es whi%h of the followingQ a In%"ease in mate"nal est"ogen se%"etion b )e%"ease in mate"nal and"ogen se%"etion % Se%"etion of and"ogen by the fetal gonad d Se%"etion of est"ogen by the fetal gonad 9. # %lient at 9 wee0sK gestation %alls %omplaining of slight na$sea in the mo"ning ho$"s Hhi%h of the following %lient inte"/entions sho$ld the n$"se 6$estionQ a !a0ing 1 teaspoon of bi%a"bonate of soda in an 9=o$n%e glass of wate" b ,ating a few low=sodi$m %"a%0e"s befo"e getting o$t of bed % #/oiding the inta0e of li6$ids in the mo"ning ho$"s d ,ating si- small meals a day instead of thee la"ge meals 92 !he n$"se do%$ments positi/e ballottement in the %lientKs p"enatal "e%o"d !he n$"se $nde"stands that this indi%ates whi%h of the followingQ a Palpable %ont"a%tions on the abdomen b Passi/e mo/ement of the $nengaged fet$s % Fetal 0i%0ing felt by the %lient d ,nla"gement and softening of the $te"$s 95 )$"ing a pel/i% e-am the n$"se notes a p$"ple=bl$e tinge of the %e"/i- !he n$"se do%$ments this as whi%h of the followingQ a @"a-ton=?i%0s sign

COMPREHENSIVE NURSING REVIEW by R. C. REA

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98

99

99

90

91

92

9+

9.

92

95

98

b Chadwi%0Ks sign % DoodellKs sign d <%)onaldKs sign )$"ing a p"enatal %lass& the n$"se e-plains the "ationale fo" b"eathing te%hni6$es d$"ing p"epa"ation fo" labo" based on the $nde"standing that b"eathing te%hni6$es a"e most impo"tant in a%hie/ing whi%h of the followingQ a ,liminate pain and gi/e the e-pe%tant pa"ents something to do b 1ed$%e the "is0 of fetal dist"ess by in%"easing $te"opla%ental pe"f$sion % Fa%ilitate "ela-ation& possibly "ed$%ing the pe"%eption of pain d ,liminate pain so that less analgesia and anesthesia a"e needed #fte" . ho$"s of a%ti/e labo"& the n$"se notes that the %ont"a%tions of a p"imig"a/ida %lient a"e not st"ong eno$gh to dilate the %e"/i- Hhi%h of the following wo$ld the n$"se anti%ipate doingQ a Obtaining an o"de" to begin I7 o-yto%in inf$sion b #dministe"ing a light sedati/e to allow the patient to "est fo" se/e"al ho$" % P"epa"ing fo" a %esa"ean se%tion fo" fail$"e to p"og"ess d In%"easing the en%o$"agement to the patient when p$shing begins # m$ltig"a/ida at +9 wee0sK gestation is admitted with painless& b"ight "ed bleeding and mild %ont"a%tions e/e"y 8 to 10 min$tes Hhi%h of the following assessments sho$ld be a/oidedQ a <ate"nal /ital sign b Fetal hea"t "ate % Cont"a%tion monito"ing d Ce"/i%al dilation Hhi%h of the following wo$ld be the n$"seKs most app"op"iate "esponse to a %lient who as0s why she m$st ha/e a %esa"ean deli/e"y if she has a %omplete pla%enta p"e/iaQ a SAo$ will ha/e to as0 yo$" physi%ian when he "et$"ns T b SAo$ need a %esa"ean to p"e/ent hemo""hage T % S!he pla%enta is %o/e"ing most of yo$" %e"/i- T d S!he pla%enta is %o/e"ing the opening of the $te"$s and blo%0ing yo$" baby T !he n$"se $nde"stands that the fetal head is in whi%h of the following positions with a fa%e p"esentationQ a Completely fle-ed b Completely e-tended % Pa"tially e-tended d Pa"tially fle-ed Hith a fet$s in the left=ante"io" b"ee%h p"esentation& the n$"se wo$ld e-pe%t the fetal hea"t "ate wo$ld be most a$dible in whi%h of the following a"easQ a #bo/e the mate"nal $mbili%$s and to the "ight of midline b In the lowe"=left mate"nal abdominal 6$ad"ant % In the lowe"="ight mate"nal abdominal 6$ad"ant d #bo/e the mate"nal $mbili%$s and to the left of midline !he amnioti% fl$id of a %lient has a g"eenish tint !he n$"se inte"p"ets this to be the "es$lt of whi%h of the followingQ a 'an$go b ?yd"amnio % <e%oni$m d 7e"ni# patient is in labo" and has E$st been told she has a b"ee%h p"esentation !he n$"se sho$ld be pa"ti%$la"ly ale"t fo" whi%h of the followingQ a >$i%0ening b Ophthalmia neonato"$m % Pi%a d P"olapsed $mbili%al %o"d Hhen des%"ibing di(ygoti% twins to a %o$ple& on whi%h of the following wo$ld the n$"se base the e-planationQ a !wo o/a fe"tili(ed by sepa"ate spe"m b Sha"ing of a %ommon pla%enta % ,a%h o/a with the same genotype d Sha"ing of a %ommon %ho"ion Hhi%h of the following "efe"s to the single %ell that "ep"od$%es itself afte" %on%eptionQ a Ch"omosome b @lasto%yst % Jygote d !"ophoblast In the late 1920s& %ons$me"s and health %a"e p"ofessionals began %hallenging the "o$tine $se of analgesi%s and anestheti%s d$"ing %hildbi"th Hhi%h of the following was an o$tg"owth of this %on%eptQ a 'abo"& deli/e"y& "e%o/e"y& postpa"t$m O')1PP

COMPREHENSIVE NURSING REVIEW by R. C. REA

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b *$"se=midwife"y % Clini%al n$"se spe%ialist d P"epa"ed %hildbi"th 99 # %lient has a midpel/i% %ont"a%t$"e f"om a p"e/io$s pel/i% inE$"y d$e to a moto" /ehi%le a%%ident as a teenage" !he n$"se is awa"e that this %o$ld p"e/ent a fet$s f"om passing th"o$gh o" a"o$nd whi%h st"$%t$"e d$"ing %hildbi"thQ a Symphysis p$bis b Sa%"al p"omonto"y % Is%hial spines d P$bi% a"%h 99 Hhen tea%hing a g"o$p of adoles%ents abo$t /a"iations in the length of the menst"$al %y%le& the n$"se $nde"stands that the $nde"lying me%hanism is d$e to /a"iations in whi%h of the following phasesQ a <enst"$al phase b P"olife"ati/e phase % Se%"eto"y phase d Is%hemi% phase 100 Hhen tea%hing a g"o$p of adoles%ents abo$t male ho"mone p"od$%tion& whi%h of the following wo$ld the n$"se in%l$de as being p"od$%ed by the 'eydig %ellsQ a Folli%le=stim$lating ho"mone b !estoste"one % 'e$teini(ing ho"mone d Donadot"opin "eleasing ho"mone

COMPREHENSIVE NURSING REVIEW by R. C. REA

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ANS5ERS a$% RATIONALES ,#r MATERNIT( NURSING Part 1

)' #ltho$gh all of the fa%to"s listed a"e impo"tant& spe"m motility is the most signifi%ant %"ite"ion when assessing male infe"tility Spe"m %o$nt& spe"m mat$"ity& and semen /ol$me a"e all signifi%ant& b$t they a"e not as signifi%ant spe"m motility 2 D @ased on the pa"tne"Ks statement& the %o$ple is /e"bali(ing feelings of inade6$a%y and negati/e feelings abo$t themsel/es and thei" %apabilities !h$s& the n$"sing diagnosis of self=esteem dist$"ban%e is most app"op"iate Fea"& pain& and ineffe%ti/e family %oping also may be p"esent b$t as se%onda"y n$"sing diagnoses + ) P"ess$"e and i""itation of the bladde" by the g"owing $te"$s d$"ing the fi"st t"imeste" is "esponsible fo" %a$sing $"ina"y f"e6$en%y )ys$"ia& in%ontinen%e& and b$"ning a"e symptoms asso%iated with $"ina"y t"a%t infe%tions . C )$"ing the se%ond t"imeste"& the "ed$%tion in gast"i% a%idity in %onE$n%tion with p"ess$"e f"om the g"owing $te"$s and smooth m$s%le "ela-ation& %an %a$se hea"tb$"n and flat$len%e ?CD le/els in%"ease in the fi"st& not the se%ond& t"imeste" )e%"ease intestinal motility wo$ld most li0ely be the %a$se of %onstipation and bloating ,st"ogen le/els de%"ease in the se%ond t"imeste" 2 D Chloasma& also %alled the mas0 of p"egnan%y& is an i""eg$la" hype"pigmented a"ea fo$nd on the fa%e It is not seen on the b"easts& a"eola& nipples& %hest& ne%0& a"ms& legs& abdomen& o" thighs 5 C )$"ing p"egnan%y& ho"monal %hanges %a$se "ela-ation of the pel/i% Eoints& "es$lting in the typi%al SwaddlingT gait Changes in post$"e a"e "elated to the g"owing fet$s P"ess$"e on the s$""o$nding m$s%les %a$sing dis%omfo"t is d$e to the g"owing $te"$s Height gain has no effe%t on gait 8 C !he a/e"age amo$nt of weight gained d$"ing p"egnan%y is 2. to +0 lb !his weight gain %onsists of the following: fet$s X 8 2 lbW pla%enta and memb"ane X 1 2 lbW amnioti% fl$id X 2 lbW $te"$s X 2 2 lbW b"easts X + lbW and in%"eased blood /ol$me X 2 to . lbW e-t"a/as%$la" fl$id and fat X . to 9 lb # gain of 12 to 22 lb is ins$ffi%ient& whe"eas a weight gain of 12 to 22 lb is ma"ginal # weight gain of 22 to .0 lb is %onside"ed e-%essi/e 9 C' P"ess$"e of the g"owing $te"$s on blood /essels "es$lts in an in%"eased "is0 fo" /eno$s stasis in the lowe" e-t"emities S$bse6$ently& edema and /a"i%ose /ein fo"mation may o%%$" !h"ombophlebitis is an inflammation of the /eins d$e to th"omb$s fo"mation P"egnan%y=ind$%ed hype"tension is not asso%iated with these symptoms D"a/ity plays only a mino" "ole with these symptoms 9 C' Ce"/i%al softening ODoodell signP and $te"ine so$ffl_ a"e two p"obable signs of p"egnan%y P"obable signs a"e obEe%ti/e findings that st"ongly s$ggest p"egnan%y Othe" p"obable signs in%l$de ?ega" sign& whi%h is softening of the lowe" $te"ine segmentW Pis0a%e0 sign& whi%h is enla"gement and softening of the $te"$sW se"$m labo"ato"y testsW %hanges in s0in pigmentationW and $lt"asoni% e/iden%e of a gestational sa% P"es$mpti/e signs a"e s$bEe%ti/e signs and in%l$de ameno""heaW na$sea and /omitingW $"ina"y f"e6$en%yW b"east tende"ness and %hangesW e-%essi/e fatig$eW $te"ine enla"gementW and 6$i%0ening 10 )' P"es$mpti/e signs of p"egnan%y a"e s$bEe%ti/e signs Of the signs listed& only na$sea and /omiting a"e p"es$mpti/e signs ?ega" sign& s0in pigmentation %hanges& and a positi/e se"$m p"egnan%y test a"e %onside"ed p"obably signs& whi%h a"e st"ongly s$ggesti/e of p"egnan%y 11 D' )$"ing the fi"st t"imeste"& %ommon emotional "ea%tions in%l$de ambi/alen%e& fea"& fantasies& o" an-iety !he se%ond t"imeste" is a pe"iod of well=being a%%ompanied by the in%"eased need to lea"n abo$t fetal g"owth and de/elopment Common emotional "ea%tions d$"ing this t"imeste" in%l$de na"%issism& passi/ity& o" int"o/e"sion #t times the woman may seem ego%ent"i% and self=%ente"ed )$"ing the thi"d t"imeste"& the woman typi%ally feels aw0wa"d& %l$msy& and $natt"a%ti/e& often be%oming mo"e int"o/e"ted o" "efle%ti/e of he" own %hildhood 12 ) Fi"st=t"imeste" %lasses %ommonly fo%$s on s$%h iss$es as ea"ly physiologi% %hanges& fetal de/elopment& se-$ality d$"ing p"egnan%y& and n$t"ition Some ea"ly %lasses may in%l$de p"egnant %o$ples Se%ond and thi"d t"imeste" %lasses may fo%$s on p"epa"ation fo" bi"th& pa"enting& and newbo"n %a"e

COMPREHENSIVE NURSING REVIEW by R. C. REA

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1+ C Hith b"east feeding& the fathe"Ks body is not %apable of p"o/iding the mil0 fo" the newbo"n& whi%h may
inte"fe"e with feeding the newbo"n& p"o/iding fewe" %han%es fo" bonding& o" he may be Eealo$s of the infantKs demands on his wifeKs time and body @"east feeding is ad/antageo$s be%a$se $te"ine in/ol$tion o%%$"s mo"e "apidly& th$s minimi(ing blood loss !he p"esen%e of mate"nal antibodies in b"east mil0 helps de%"ease the in%iden%e of alle"gies in the newbo"n # g"eate" %han%e fo" e""o" is asso%iated with bottle feeding *o p"epa"ation is "e6$i"ed fo" b"east feeding A # false=positi/e "ea%tion %an o%%$" if the p"egnan%y test is pe"fo"med less than 10 days afte" an abo"tion Pe"fo"ming the tests too ea"ly o" too late in the p"egnan%y& sto"ing the $"ine sample too long at "oom tempe"at$"e& o" ha/ing a spontaneo$s o" missed abo"tion impending %an all p"od$%e false=negati/e "es$lts D !he F?1 %an be a$s%$ltated with a fetos%ope at abo$t 20 wee0Ks gestation F?1 $s$ally is a$s%$latated at the midline s$p"ap$bi% "egion with )opple" $lt"aso$nd t"ansd$%e" at 10 to 12 wee0Ks gestation F?1& %annot be hea"d any ea"lie" than 10 wee0sK gestation C' !o dete"mine the ,)) when the date of the %lientKs '<P is 0nown $se *agele "$le !o the fi"st day of the '<P& add 8 days& s$bt"a%t + months& and add 1 yea" Oif appli%ableP to a""i/e at the ,)) as follows: 2 I 8 F 12 OB$lyP min$s + F . O#p"ilP !he"efo"e& the %lientKs ,)) is #p"il 12 A' Hhen the '<P is $n0nown& the gestational age of the fet$s is estimated by $te"ine si(e o" position Of$ndal heightP !he p"esen%e of the $te"$s in the pel/is indi%ates less than 12 wee0sK gestation #t app"o-imately 12 to 1. wee0s& the f$nd$s is o$t of the pel/is abo/e the symphysis p$bis !he f$nd$s is at the le/el of the $mbili%$s at app"o-imately 20 wee0sK gestation and "ea%hes the -iphoid at te"m o" .0 wee0s D )ange" signs that "e6$i"e p"ompt "epo"ting lea0ing of amnioti% fl$id& /aginal bleeding& bl$""ed /ision& "apid weight gain& and ele/ated blood p"ess$"e Constipation& b"east tende"ness& and nasal st$ffiness a"e %ommon dis%omfo"ts asso%iated with p"egnan%y ) # "$bella tite" sho$ld be 1:9 o" g"eate" !h$"s& a finding of a tite" less than 1:9 is signifi%ant& indi%ating that the %lient may not possess imm$nity to "$bella # hemato%"it of ++ 2V a white blood %ell %o$nt of 9&000Gmm+& and a 1 ho$" gl$%ose %hallenge test of 110 gGdl a"e with no"mal pa"amete"s D Hith t"$e labo"& %ont"a%tions in%"ease in intensity with wal0ing In addition& t"$e labo" %ont"a%tions o%%$" at "eg$la" inte"/als& $s$ally sta"ting in the ba%0 and sweeping a"o$nd to the abdomen !he inte"/al of t"$e labo" %ont"a%tions g"ad$ally sho"tens ) C"owing& whi%h o%%$"s when the newbo"nKs head o" p"esenting pa"t appea"s at the /aginal opening& o%%$"s d$"ing the se%ond stage of labo" )$"ing the fi"st stage of labo"& %e"/i%al dilation and effa%ement o%%$" )$"ing the thi"d stage of labo"& the newbo"n and pla%enta a"e deli/e"ed !he fo$"th stage of labo" lasts f"om 1 to . ho$"s afte" bi"th& d$"ing whi%h time the mothe" and newbo"n "e%o/e" f"om the physi%al p"o%ess of bi"th and the mothe"Ks o"gans $nde"go the initial "eadE$stment to the nonp"egnant state C @a"bit$"ates a"e "apidly t"ansfe""ed a%"oss the pla%ental ba""ie"& and la%0 of an antagonist ma0es them gene"ally inapp"op"iate d$"ing a%ti/e labo" *eonatal side effe%ts of ba"bit$"ates in%l$de %ent"al ne"/o$s system dep"ession& p"olonged d"owsiness& delayed establishment of feeding Oe g d$e to poo" s$%0ing "efle- o" poo" s$%0ing p"ess$"eP !"an6$ili(e"s a"e asso%iated with neonatal effe%ts s$%h as hypotonia& hypothe"mia& gene"ali(ed d"owsiness& and "el$%tan%e to feed fo" the fi"st few days *a"%oti% analgesi% "eadily %"oss the pla%ental ba""ie"& %a$sing dep"essi/e effe%ts in the newbo"n 2 to + ho$"s afte" int"am$s%$la" inEe%tion 1egional anesthesia is asso%iated with ad/e"se "ea%tions s$%h as mate"nal hypotension& alle"gi% o" to-i% "ea%tion& o" pa"tial o" total "espi"ato"y fail$"e D )$"ing the thi"d stage of labo"& whi%h begins with the deli/e"y of the newbo"n& the n$"se wo$ld p"omote pa"ent=newbo"n inte"a%tion by pla%ing the newbo"n on the mothe"Ks abdomen and en%o$"aging the pa"ents to to$%h the newbo"n Colle%ting a $"ine spe%imen and othe" labo"ato"y tests is done on admission d$"ing the fi"st stage of labo" #ssessing $te"ine %ont"a%tions e/e"y +0 min$tes is pe"fo"med d$"ing the latent phase of the fi"st stage of labo" Coa%hing the %lient to p$sh effe%ti/ely is app"op"iate d$"ing the se%ond stage of labo" A' !he newbo"nKs ability to "eg$late body tempe"at$"e is poo" !he"efo"e& pla%ing the newbo"n $nde" a "adiant wa"me" aids in maintaining his o" he" body tempe"at$"e S$%tioning with a b$lb sy"inge helps maintain a patent ai"way Obtaining an #pga" s%o"e meas$"es the newbo"nKs immediate adE$stment to e-t"a$te"ine life Inspe%ting the $mbili%al %o"d aids in dete%ting %o"d anomalies D' Immediately befo"e e-p$lsion o" bi"th of the "est of the body& the %a"dinal mo/ement of e-te"nal "otation o%%$"s )es%ent fle-ion& inte"nal "otation& e-tension& and "estit$tion Oin this o"de"P o%%$" befo"e e-te"nal "otation )' !he fo"amen o/ale is an opening between the "ight and left a$"i%les Oat"iaP that sho$ld %lose sho"tly afte" bi"th so the newbo"n will not ha/e a m$"m$" o" mi-ed blood t"a/eling th"o$gh the /as%$la" system !he $mbili%al /ein& d$%t$s a"te"ios$s& and d$%t$s /enos$s a"e oblite"ated at bi"th )' U"i% a%id %"ystals in the $"ine may p"od$%e the "eddish Sb"i%0 d$stT stain on the diape" <$%$s wo$ld not p"od$%e a stain @ili"$bin and i"on a"e f"om hepati% adaptation ) !he no"mal hea"t "ate fo" a newbo"n that is sleeping is app"o-imately 100 beats pe" min$te If the newbo"n was awa0e& the no"mal hea"t "ate wo$ld "ange f"om 120 to 150 beats pe" min$te

1.

12 15 18

19 19 20 21

22

2+

2.

22 25 28 29

COMPREHENSIVE NURSING REVIEW by R. C. REA

| .5

29 C !he ante"io" fontanel is la"ge" in si(e than the poste"io" fontanel #dditionally& the ante"io" fontanel&
whi%h is diamond shaped& %loses at 19 months& whe"eas the poste"io" fontanel& whi%h is t"iang$la" shaped& %loses at 9 to 12 wee0s *eithe" fontanel sho$ld appea" b$lging& whi%h may indi%ate in%"eased int"a%"anial p"ess$"e& o" s$n0en& whi%h may indi%ate dehyd"ation ) @lin0& %o$gh& snee(e& swallowing and gag "efle-es a"e all p"esent at bi"th and "emain $n%hanged th"o$gh ad$lthood 1efle-es s$%h as "ooting and stepping s$bside within the fi"st yea" A Hith the babins0i "efle-& the newbo"nKs toes hype"e-tend and fan apa"t f"om do"sifle-ion of the big toe when one side of foot is st"o0ed $pwa"d fo"m the heel and a%"oss the ball of the foot Hith the sta"tle "efle-& the newbo"n abd$%ts and fle-es all e-t"emities and may begin to %"y when e-posed to s$dden mo/ement of lo$d noise Hith the "ooting and s$%0ing "efle-& the newbo"n t$"ns his head in the di"e%tion of stim$l$s& opens the mo$th& and begins to s$%0 when the %hee0s& lip& o" %o"ne" of mo$th is to$%hed Hith the %"awl "efle-& the newbo"n will attempt to %"awl fo"wa"d with both a"ms and legs when he is pla%ed on his abdomen on a flat s$"fa%e ) !he des%"iption of hype"emesis g"a/ida"$m in%l$des se/e"e na$sea and /omiting& leading to ele%t"olyte& metaboli%& and n$t"itional imbalan%es in the absen%e of othe" medi%al p"oblems ?ype"emesis is not a fo"m of anemia 'oss of appetite may o%%$" se%onda"y to the na$sea and /omiting of hype"emesis& whi%h& if it %ontin$es& %an deplete the n$t"ients t"anspo"ted to the fet$s )ia""hea does not o%%$" with hype"emesis )' ,dema of the hands and fa%e is a %lassi% sign of PI? <any healthy p"egnant woman e-pe"ien%e foot and an0le edema # weight gain of 2 lb o" mo"e pe" wee0 indi%ates a p"oblem ,a"ly mo"ning heada%he is not a %lassi% sign of PI? C' In a missed abo"tion& the"e is ea"ly fetal int"a$te"ine death& and p"od$%ts of %on%eption a"e not e-pelled !he %e"/i- "emains %losedW the"e may be a da"0 b"own /aginal dis%ha"ge& negati/e p"egnan%y test& and %essation of $te"ine g"owth and b"east tende"ness # th"eatened abo"tion is e/iden%ed with %"amping and /aginal bleeding in ea"ly p"egnan%y& with no %e"/i%al dilation #n in%omplete abo"tion p"esents with bleeding& %"amping& and %e"/i%al dilation #n in%omplete abo"tion in/ol/es only e-p$lsion of pa"t of the p"od$%ts of %on%eption and bleeding o%%$"s with %e"/i%al dilation A' <$ltiple gestation is one of the p"edisposing fa%to"s that may %a$se pla%enta p"e/ia Ute"ine anomalies abdominal t"a$ma& and "enal o" /as%$la" disease may p"edispose a %lient to ab"$ptio pla%entae )' # %lient with ab"$ptio pla%entae may e-hibit %on%ealed o" da"0 "ed bleeding& possibly "epo"ting s$dden intense lo%ali(ed $te"ine pain !he $te"$s is typi%ally fi"m to boa"dli0e& and the fetal p"esenting pa"t may be engaged @"ight "ed& painless /aginal bleeding& a palpable fetal o$tline and a soft nontende" abdomen a"e manifestations of pla%enta p"e/ia D' #b"$ptio pla%entae is des%"ibed as p"emat$"e sepa"ation of a no"mally implanted pla%enta d$"ing the se%ond half of p"egnan%y& $s$ally with se/e"e hemo""hage Pla%enta p"e/ia "efe"s to implantation of the pla%enta in the lowe" $te"ine segment& %a$sing painless bleeding in the thi"d t"imeste" of p"egnan%y ,%topi% p"egnan%y "efe"s to the implantation of the p"od$%ts of %on%eption in a site othe" than the endomet"i$m In%ompetent %e"/i- is a %ond$%tion %ha"a%te"i(ed by painf$l dilation of the %e"/i%al os witho$t $te"ine %ont"a%tions )' ?ype"stim$lation of the $te"$s s$%h as with o-yto%in d$"ing the ind$%tion of labo" may "es$lt in tetani% %ont"a%tions p"olonged to mo"e than 90se%onds& whi%h %o$ld lead to s$%h %ompli%ations as fetal dist"ess& ab"$ptio pla%entae& amnioti% fl$id embolism& la%e"ation of the %e"/i-& and $te"ine "$pt$"e Hea0 %ont"a%tions wo$ld not o%%$" Pain& b"ight "ed /aginal bleeding& and in%"eased "estlessness and an-iety a"e not asso%iated with hype"stim$lation C' # 0ey point to %onside" when p"epa"ing the %lient fo" a %esa"ean deli/e"y is to modify the p"eope"ati/e tea%hing to meet the needs of eithe" a planned o" eme"gen%y %esa"ean bi"th& the depth and b"eadth of inst"$%tion will depend on %i"%$mstan%es and time a/ailable #llowing the mothe"Ks s$ppo"t pe"son to "emain with he" as m$%h as possible is an impo"tant %on%ept& altho$gh doing so depends on many /a"iables #""anging fo" ne%essa"y e-planations by /a"io$s staff membe"s to be in/ol/ed with the %lientKs %a"e is a n$"sing "esponsibility !he n$"se is "esponsible fo" "einfo"%ing the e-planations abo$t the s$"ge"y& e-pe%ted o$t%ome& and type of anestheti% to be $sed !he obstet"i%ian is "esponsible fo" e-plaining abo$t the s$"ge"y and o$t%ome and the anesthesiology staff is "esponsible fo" e-planations abo$t the type of anesthesia to be $sed A' P"ete"m labo" is best des%"ibed as labo" that begins afte" 20 wee0sK gestation and befo"e +8 wee0sK gestation !he othe" time pe"iods a"e ina%%$"ate )' P1O< %an p"e%ipitate many potential and a%t$al p"oblemsW one of the most se"io$s is the fet$s loss of an effe%ti/e defense against infe%tion !his is the %lientKs most immediate need at this time !ypi%ally& P1O< o%%$"s abo$t 1 ho$"& not . ho$"s& befo"e labo" begins Fetal /iability and gestational age a"e less immediate %onside"ations that affe%t the plan of %a"e <alp"esentation and an in%ompetent %e"/i- may be %a$ses of P1O< )' )ysto%ia is diffi%$lt& painf$l& p"olonged labo" d$e to me%hani%al fa%to"s in/ol/ing the fet$s Opassenge"P& $te"$s Opowe"sP& pel/is OpassageP& o" psy%he *$t"itional& en/i"onment& and medi%al fa%to"s may %ont"ib$te to the me%hani%al fa%to"s that %a$se dysto%ia

+0 +1

+2

++ +.

+2 +5

+8

+9

+9

.0 .1

.2

COMPREHENSIVE NURSING REVIEW by R. C. REA

| .8

.+ A' Hith $te"ine "$pt$"e& the %lient is at "is0 fo" hypo/olemi% sho%0 !he"efo"e& the p"io"ity is to p"e/ent
and limit hypo/olemi% sho%0 Immediate steps sho$ld in%l$de gi/ing o-ygen& "epla%ing lost fl$ids& p"o/iding d"$g the"apy as needed& e/al$ating fetal "esponses and p"epa"ing fo" s$"ge"y Obtaining blood spe%imens& instit$ting %omplete bed "est& and inse"ting a $"ina"y %athete" a"e ne%essa"y in p"epa"ation fo" s$"ge"y to "emedy the "$pt$"e )' !he immediate p"io"ity is to minimi(e p"ess$"e on the %o"d !h$s the n$"seKs initial a%tion in/ol/es pla%ing the %lient on bed "est and then pla%ing the %lient in a 0nee=%hest position o" lowe"ing the head of the bed& and ele/ating the mate"nal hips on a pillow to minimi(e the p"ess$"e on the %o"d <onito"ing mate"nal /ital signs and F?1& notifying the physi%ian and p"epa"ing the %lient fo" deli/e"y& and w"apping the %o"d with ste"ile saline soa0ed wa"m ga$(e a"e impo"tant @$t these a%tions ha/e no effe%t on minimi(ing the p"ess$"e on the %o"d D' Postpa"t$m hemo""hage is defined as blood loss of mo"e than 200 ml following bi"th #ny amo$nt less than this not %onside"ed postpa"t$m hemo""hage D' Hith mastitis& inE$"y to the b"east& s$%h as o/e"distention& stasis& and %"a%0ing of the nipples& is the p"ima"y p"edisposing fa%to" ,pidemi% and endemi% infe%tions a"e p"obable so$"%es of infe%tion fo" mastitis !empo"a"y $"ina"y "etention d$e to de%"eased pe"%eption of the $"ge to /oid is a %ont"ib$to"y fa%to" to the de/elopment of $"ina"y t"a%t infe%tion& not mastitis D' !h"ombophlebitis "efe"s to an inflammation of the /as%$la" endotheli$m with %lot fo"mation on the wall of the /essel @lood %omponents %ombining to fo"m an agg"egate body des%"ibe a th"omb$s o" th"ombosis Clots lodging in the p$lmona"y /as%$lat$"e "efe"s to p$lmona"y embolismW in the femo"al /ein& femo"al th"ombophlebitis C' Classi% symptoms of )7! in%l$de m$s%le pain& the p"esen%e of ?omans sign& and swelling of the affe%ted limb <id%alf pain& tende"ness& and "edness& along the /ein "efle%t s$pe"fi%ial th"ombophlebitis Chills& fe/e" and malaise o%%$""ing 2 wee0s afte" deli/e"y "efle%t pel/i% th"ombophlebitis Chills& fe/e"& stiffness and pain o%%$""ing 10 to 1. days afte" deli/e"y s$ggest femo"al th"ombophlebitis )' <anifestations of %ystitis in%l$de& f"e6$en%y& $"gen%y& dys$"ia& hemat$"ia no%t$"ia& fe/e"& and s$p"ap$bi% pain )ehyd"ation& hype"tension& and %hills a"e not typi%ally asso%iated with %ystitis ?igh fe/e" %hills& flan0 pain& na$sea& /omiting& dys$"ia& and f"e6$en%y a"e asso%iated with p/eloneph"itis C' #%%o"ding to statisti%al "epo"ts& between 20V and 90V of all new mothe"s "epo"t some fo"m of postpa"t$m bl$es !he "anges of 10V to .0V& +0V to 20V& and 22V to 80V a"e in%o""e%t ) 1eg$la" timely ingestion of o"al %ont"a%epti/es is ne%essa"y to maintain ho"monal le/els of the d"$gs to s$pp"ess the a%tion of the hypothalam$s and ante"io" pit$ita"y leading to inapp"op"iate se%"etion of FS? and '? !he"efo"e& folli%les do not mat$"e& o/$lation is inhibited& and p"egnan%y is p"e/ented !he est"ogen %ontent of the o"al site %ont"a%epti/e may %a$se the na$sea& "ega"dless of when the pill is ta0en Side effe%ts and d"$g inte"a%tions may o%%$" with o"al %ont"a%epti/es "ega"dless of the time the pill is ta0en C Condoms& when $sed %o""e%tly and %onsistently& a"e the most effe%ti/e %ont"a%epti/e method o" ba""ie" against ba%te"ial and /i"al se-$ally t"ansmitted infe%tions #ltho$gh spe"mi%ides 0ill spe"m& they do not p"o/ide "eliable p"ote%tion against the sp"ead of se-$ally t"ansmitted infe%tions& espe%ially int"a%ell$la" o"ganisms s$%h as ?I7 Inse"tion and "emo/al of the diaph"agm along with the $se of the spe"mi%ides may %a$se /aginal i""itations& whi%h %o$ld pla%e the %lient at "is0 fo" infe%tion t"ansmission <ale ste"ili(ation eliminates spe"mato(oa f"om the eEa%$late& b$t it does not eliminate ba%te"ial andGo" /i"al mi%"oo"ganisms that %an %a$se se-$ally t"ansmitted infe%tions A !he diaph"agm m$st be fitted indi/id$ally to ens$"e effe%ti/eness @e%a$se of the %hanges to the "ep"od$%ti/e st"$%t$"es d$"ing p"egnan%y and following deli/e"y& the diaph"agm m$st be "efitted& $s$ally at the 5 wee0sK e-amination following %hildbi"th o" afte" a weight loss of 12 lbs o" mo"e In addition& fo" ma-im$m effe%ti/eness& spe"mi%idal Eelly sho$ld be pla%ed in the dome and a"o$nd the "im ?owe/e"& spe"mi%idal Eelly sho$ld not be inse"ted into the /agina $ntil in/ol$tion is %ompleted at app"o-imately 5 wee0s Use of a female %ondom p"ote%ts the "ep"od$%ti/e system f"om the int"od$%tion of semen o" spe"mi%ides into the /agina and may be $sed afte" %hildbi"th O"al %ont"a%epti/es may be sta"ted within the fi"st postpa"t$m wee0 to ens$"e s$pp"ession of o/$lation Fo" the %o$ple who has dete"mined the femaleKs fe"tile pe"iod& $sing the "hythm method& a/oidan%e of inte"%o$"se d$"ing this pe"iod& is safe and effe%ti/e C #n IU) may in%"ease the "is0 of pel/i% inflammato"y disease& espe%ially in women with mo"e than one se-$al pa"tne"& be%a$se of the in%"eased "is0 of se-$ally t"ansmitted infe%tions #n UI) sho$ld not be $sed if the woman has an a%ti/e o" %h"oni% pel/i% infe%tion& postpa"t$m infe%tion& endomet"ial hype"plasia o" %a"%inoma& o" $te"ine abno"malities #ge is not a fa%to" in dete"mining the "is0s asso%iated with IU) $se <ost IU) $se"s a"e o/e" the age of +0 #ltho$gh the"e is a slightly highe" "is0 fo" infe"tility in women who ha/e ne/e" been p"egnant& the IU) is an a%%eptable option as long as the "is0= benefit "atio is dis%$ssed IU)s may be inse"ted immediately afte" deli/e"y& b$t this is not "e%ommended be%a$se of the in%"eased "is0 and "ate of e-p$lsion at this time C )$"ing the thi"d t"imeste"& the enla"ging $te"$s pla%es p"ess$"e on the intestines !his %o$pled with the effe%t of ho"mones on smooth m$s%le "ela-ation %a$ses de%"eased intestinal motility Ope"istalsisP In%"easing fibe" in the diet will help fe%al matte" pass mo"e 6$i%0ly th"o$gh the intestinal t"a%t& th$s

..

.2 .5

.8

.9

.9 20 21

22

2+

2.

22

COMPREHENSIVE NURSING REVIEW by R. C. REA

| .9

25

28

29 29

50

51

52

5+

5.

52

de%"easing the amo$nt of wate" that is abso"bed #s a "es$lt& stool is softe" and easie" to pass ,nemas %o$ld p"e%ipitate p"ete"m labo" andGo" ele%t"olyte loss and sho$ld be a/oided 'a-ati/es may %a$se p"ete"m labo" by stim$lating pe"istalsis and may inte"fe"e with the abso"ption of n$t"ients Use fo" mo"e than 1 wee0 %an also lead to la-ati/e dependen%y 'i6$id in the diet helps p"o/ide a semisolid& soft %onsisten%y to the stool ,ight to ten glasses of fl$id pe" day a"e essential to maintain hyd"ation and p"omote stool e/a%$ation D !o ens$"e ade6$ate fetal g"owth and de/elopment d$"ing the .0 wee0s of a p"egnan%y& a total weight gain 22 to +0 po$nds is "e%ommended: 1 2 po$nds in the fi"st 10 wee0sW 9 po$nds by +0 wee0sW and 28 2 po$nds by .0 wee0s !he p"egnant woman sho$ld gain less weight in the fi"st and se%ond t"imeste" than in the thi"d )$"ing the fi"st t"imeste"& the %lient sho$ld only gain 1 2 po$nds in the fi"st 10 wee0s& not 1 po$nd pe" wee0 # weight gain of [ po$nd pe" wee0 wo$ld be 20 po$nds fo" the total p"egnan%y& less than the "e%ommended amo$nt ) !o %al%$late the ,)) by *ageleKs "$le& add 8 days to the fi"st day of the last menst"$al pe"iod and %o$nt ba%0 + months& %hanging the yea" app"op"iately !o obtain a date of Septembe" 28& 8 days ha/e been added to the last day of the '<P O"athe" than the fi"st day of the '<PP& pl$s . months Oinstead of + monthsP we"e %o$nted ba%0 !o obtain the date of *o/embe" 8& 8 days ha/e been s$bt"a%ted Oinstead of addedP f"om the fi"st day of '<P pl$s *o/embe" indi%ates %o$nting ba%0 2 months Oinstead of + monthsP f"om Ban$a"y !o obtain the date of )e%embe" 28& 8 days we"e added to the last day of the '<P O"athe" than the fi"st day of the '<PP and )e%embe" indi%ates %o$nting ba%0 only 1 month Oinstead of + monthsP f"om Ban$a"y D' !he %lient has been p"egnant fo$" times& in%l$ding %$""ent p"egnan%y ODP @i"th at +9 wee0sK gestation is %onside"ed f$ll te"m O!P& while bi"th fo"m 20 wee0s to +9 wee0s is %onside"ed p"ete"m OPP # spontaneo$s abo"tion o%%$""ed at 9 wee0s O#P She has two li/ing %hild"en O'P )' #t 12 wee0s gestation& the $te"$s "ises o$t of the pel/is and is palpable abo/e the symphysis p$bis !he )opple" intensifies the so$nd of the fetal p$lse "ate so it is a$dible !he $te"$s has me"ely "isen o$t of the pel/is into the abdominal %a/ity and is not at the le/el of the $mbili%$s !he fetal hea"t "ate at this age is not a$dible with a stethos%ope !he $te"$s at 12 wee0s is E$st abo/e the symphysis p$bis in the abdominal %a/ity& not midway between the $mbili%$s and the -iphoid p"o%ess #t 12 wee0s the F?1 wo$ld be diffi%$lt to a$s%$ltate with a fetos%ope #ltho$gh the e-te"nal ele%t"oni% fetal monito" wo$ld p"oEe%t the F?1& the $te"$s has not "isen to the $mbili%$s at 12 wee0s A' #ltho$gh all of the %hoi%es a"e impo"tant in the management of diabetes& diet the"apy is the mainstay of the t"eatment plan and sho$ld always be the p"io"ity Homen diagnosed with gestational diabetes gene"ally need only diet the"apy witho$t medi%ation to %ont"ol thei" blood s$ga" le/els ,-e"%ise& is impo"tant fo" all p"egnant women and espe%ially fo" diabeti% women& be%a$se it b$"ns $p gl$%ose& th$s de%"easing blood s$ga" ?owe/e"& dieta"y inta0e& not e-e"%ise& is the p"io"ity #ll p"egnant women with diabetes sho$ld ha/e pe"iodi% monito"ing of se"$m gl$%ose ?owe/e"& those with gestational diabetes gene"ally do not need daily gl$%ose monito"ing !he standa"d of %a"e "e%ommends a fasting and 2=ho$" postp"andial blood s$ga" le/el e/e"y 2 wee0s C' #fte" 20 wee0sK gestation& when the"e is a "apid weight gain& p"ee%lampsia sho$ld be s$spe%ted& whi%h may be %a$sed by fl$id "etention manifested by edema& espe%ially of the hands and fa%e !he th"ee %lassi% signs of p"ee%lampsia a"e hype"tension& edema& and p"otein$"ia #ltho$gh $"ine is %he%0ed fo" gl$%ose at ea%h %lini% /isit& this is not the p"io"ity )ep"ession may %a$se eithe" ano"e-ia o" e-%essi/e food inta0e& leading to e-%essi/e weight gain o" loss !his is not& howe/e"& the p"io"ity %onside"ation at this time Height gain tho$ght to be %a$sed by e-%essi/e food inta0e wo$ld "e6$i"e a 2.=ho$" diet "e%all ?owe/e"& e-%essi/e inta0e wo$ld not be the p"ima"y %onside"ation fo" this %lient at this time )' C"amping and /aginal bleeding %o$pled with %e"/i%al dilation signifies that te"mination of the p"egnan%y is ine/itable and %annot be p"e/ented !h$s& the n$"se wo$ld do%$ment an imminent abo"tion In a th"eatened abo"tion& %"amping and /aginal bleeding a"e p"esent& b$t the"e is no %e"/i%al dilation !he symptoms may s$bside o" p"og"ess to abo"tion In a %omplete abo"tion all the p"od$%ts of %on%eption a"e e-pelled # missed abo"tion is ea"ly fetal int"a$te"ine death witho$t e-p$lsion of the p"od$%ts of %on%eption )' Fo" the %lient with an e%topi% p"egnan%y& lowe" abdominal pain& $s$ally $nilate"al& is the p"ima"y symptom !h$s& pain is the p"io"ity #ltho$gh the potential fo" infe%tion is always p"esent& the "is0 is low in e%topi% p"egnan%y be%a$se pathogeni% mi%"oo"ganisms ha/e not been int"od$%ed f"om e-te"nal so$"%es !he %lient may ha/e a limited 0nowledge of the pathology and t"eatment of the %ondition and will most li0ely e-pe"ien%e g"ie/ing& b$t this is not the p"io"ity at this time D' @efo"e $te"ine assessment is pe"fo"med& it is essential that the woman empty he" bladde" # f$ll bladde" will inte"fe"e with the a%%$"a%y of the assessment by ele/ating the $te"$s and displa%ing to the side of the midline 7ital sign assessment is not ne%essa"y $nless an abno"mality in $te"ine assessment is identified Ute"ine assessment sho$ld not %a$se a%$te pain that "e6$i"es administ"ation of analgesia #mb$lating the %lient is an essential %omponent of postpa"t$m %a"e& b$t is not ne%essa"y p"io" to assessment of the $te"$s A' Feeding mo"e f"e6$ently& abo$t e/e"y 2 ho$"s& will de%"ease the infantKs f"anti%& /igo"o$s s$%0ing f"om h$nge" and will de%"ease b"east engo"gement& soften the b"east& and p"omote ease of %o""e%t lat%hing=on

COMPREHENSIVE NURSING REVIEW by R. C. REA

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fo" feeding *a"%oti%s administe"ed p"io" to b"east feeding a"e passed th"o$gh the b"east mil0 to the infant& %a$sing e-%essi/e sleepiness *ipple so"eness is not se/e"e eno$gh to wa""ant na"%oti% analgesia #ll postpa"t$m %lients& espe%ially la%tating mothe"s& sho$ld wea" a s$ppo"ti/e b"assie"e with wide %otton st"aps !his does not& howe/e"& p"e/ent o" "ed$%e nipple so"eness Soaps a"e d"ying to the s0in of the nipples and sho$ld not be $sed on the b"easts of la%tating mothe"s )"y nipple s0in p"edisposes to %"a%0s and fiss$"es& whi%h %an be%ome so"e and painf$l D' # wea0& th"eady p$lse ele/ated to 100 @P< may indi%ate impending hemo""hagi% sho%0 #n in%"eased p$lse is a %ompensato"y me%hanism of the body in "esponse to de%"eased fl$id /ol$me !h$s& the n$"se sho$ld %he%0 the amo$nt of lo%hia p"esent !empe"at$"es $p to 100 .9F in the fi"st 2. ho$"s afte" bi"th a"e "elated to the dehyd"ating effe%ts of labo" and a"e %onside"ed no"mal #ltho$gh "e%he%0ing the blood p"ess$"e may be a %o""e%t %hoi%e of a%tion& it is not the fi"st a%tion that sho$ld be implemented in light of the othe" data !he data indi%ate a potential impending hemo""hage #ssessing the $te"$s fo" fi"mness and position in "elation to the $mbili%$s and midline is impo"tant& b$t the n$"se sho$ld %he%0 the e-tent of /aginal bleeding fi"st !hen it wo$ld be app"op"iate to %he%0 the $te"$s& whi%h may be a possible %a$se of the hemo""hage D' #ny b"ight "ed /aginal dis%ha"ge wo$ld be %onside"ed abno"mal& b$t espe%ially 2 days afte" deli/e"y& when the lo%hia is typi%ally pin0 to b"ownish 'o%hia "$b"a& a da"0 "ed dis%ha"ge& is p"esent fo" 2 to + days afte" deli/e"y @"ight "ed /aginal bleeding at this time s$ggests late postpa"t$m hemo""hage& whi%h o%%$"s afte" the fi"st 2. ho$"s following deli/e"y and is gene"ally %a$sed by "etained pla%ental f"agments o" bleeding diso"de"s 'o%hia "$b"a is the no"mal da"0 "ed dis%ha"ge o%%$""ing in the fi"st 2 to + days afte" deli/e"y& %ontaining epithelial %ells& e"yth"o%yes& le$0o%ytes and de%id$a 'o%hia se"osa is a pin0 to b"ownish se"osang$ineo$s dis%ha"ge o%%$""ing f"om + to 10 days afte" deli/e"y that %ontains de%id$a& e"yth"o%ytes& le$0o%ytes& %e"/i%al m$%$s& and mi%"oo"ganisms 'o%hia alba is an almost %olo"less to yellowish dis%ha"ge o%%$""ing f"om 10 days to + wee0s afte" deli/e"y and %ontaining le$0o%ytes& de%id$a& epithelial %ells& fat& %e"/i%al m$%$s& %holeste"ol %"ystals& and ba%te"ia A' !he data s$ggests an infe%tion of the endomet"ial lining of the $te"$s !he lo%hia may be de%"eased o" %opio$s& da"0 b"own in appea"an%e& and fo$l smelling& p"o/iding f$"the" e/iden%e of a possible infe%tion #ll the %lientKs data indi%ate a $te"ine p"oblem& not a b"east p"oblem !ypi%ally& t"ansient fe/e"& $s$ally 101]F& may be p"esent with b"east engo"gement Symptoms of mastitis in%l$de infl$en(a=li0e manifestations 'o%ali(ed infe%tion of an episiotomy o" C=se%tion in%ision "a"ely %a$ses systemi% symptoms& and $te"ine in/ol$tion wo$ld not be affe%ted !he %lient data do not in%l$de dys$"ia& f"e6$en%y& o" $"gen%y& symptoms of $"ina"y t"a%t infe%tions& whi%h wo$ld ne%essitate assessing the %lientKs $"ine C' @e%a$se of ea"ly postpa"t$m dis%ha"ge and limited time fo" tea%hing& the n$"seKs p"io"ity is to fa%ilitate the safe and effe%ti/e %a"e of the %lient and newbo"n #ltho$gh p"omoting %omfo"t and "esto"ation of health& e-plo"ing the familyKs emotional stat$s& and tea%hing abo$t family planning a"e impo"tant in postpa"t$mGnewbo"n n$"sing %a"e& they a"e not the p"io"ity fo%$s in the limited time p"esented by ea"ly post=pa"t$m dis%ha"ge C' ?eat loss by "adiation o%%$"s when the infantKs %"ib is pla%ed too nea" %old walls o" windows !h$s pla%ing the newbo"nKs %"ib %lose to the /iewing window wo$ld be least effe%ti/e @ody heat is lost th"o$gh e/apo"ation d$"ing bathing Pla%ing the infant $nde" the "adiant wa"me" afte" bathing will assist the infant to be "ewa"med Co/e"ing the s%ale with a wa"med blan0et p"io" to weighing p"e/ents heat loss th"o$gh %ond$%tion # 0nit %ap p"e/ents heat loss f"om the head a la"ge head& a la"ge body s$"fa%e a"ea of the newbo"nKs body )' # f"a%t$"ed %la/i%le wo$ld p"e/ent the no"mal <o"o "esponse of symmet"i%al se6$ential e-tension and abd$%tion of the a"ms followed by fle-ion and add$%tion In talipes e6$ino/a"$s O%l$bfootP the foot is t$"ned medially& and in planta" fle-ion& with the heel ele/ated !he feet a"e not in/ol/ed with the <o"o "efle- ?ypothy"oiddism has no effe%t on the p"imiti/e "efle-es #bsen%e of the <o"o" "efle- is the most signifi%ant single indi%ato" of %ent"al ne"/o$s system stat$s& b$t it is not a sign of in%"eased int"a%"anial p"ess$"e )' ?emo""hage is a potential "is0 following any s$"gi%al p"o%ed$"e #ltho$gh the infant has been gi/en /itamin : to fa%ilitate %lotting& the p"ophyla%ti% dose is often not s$ffi%ient to p"e/ent bleeding #ltho$gh infe%tion is a possibility& signs will not appea" within . ho$"s afte" the s$"gi%al p"o%ed$"e !he p"ima"y dis%omfo"t of %i"%$m%ision o%%$"s d$"ing the s$"gi%al p"o%ed$"e& not afte"wa"d #ltho$gh feedings a"e withheld p"io" to the %i"%$m%ision& the %han%es of dehyd"ation a"e minimal )' !he p"esen%e of e-%essi/e est"ogen and p"ogeste"one in the mate"nal=fetal blood followed by p"ompt withd"awal at bi"th p"e%ipitates b"east engo"gement& whi%h will spontaneo$sly "esol/e in . to 2 days afte" bi"th !he t"a$ma of the bi"th p"o%ess does not %a$se inflammation of the newbo"nKs b"east tiss$e *ewbo"ns do not ha/e b"east malignan%y !his "eply by the n$"se wo$ld %a$se the mothe" to ha/e $nd$e an-iety @"east tiss$e does not hype"t"ophy in the fet$s o" newbo"ns D' !he fi"st 12 min$tes to 1 ho$" afte" bi"th is the fi"st pe"iod of "ea%ti/ity in/ol/ing "espi"ato"y and %i"%$lato"y adaptation to e-t"a$te"ine life !he data gi/en "efle%t the no"mal %hanges d$"ing this time pe"iod !he infantKs assessment data "efle%t no"mal adaptation !h$s& the physi%ian does not need to be

COMPREHENSIVE NURSING REVIEW by R. C. REA

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notified and o-ygen is not needed !he data do not indi%ate the p"esen%e of %ho0ing& gagging o" %o$ghing& whi%h a"e signs of e-%essi/e se%"etions S$%tioning is not ne%essa"y )' #ppli%ation of 80V isop"opyl al%ohol to the %o"d minimi(es mi%"oo"ganisms Oge"mi%idalP and p"omotes d"ying !he %o"d sho$ld be 0ept d"y $ntil it falls off and the st$mp has healed #ntibioti% ointment sho$ld only be $sed to t"eat an infe%tion& not as a p"ophyla-is Infants sho$ld not be s$bme"ged in a t$b of wate" $ntil the %o"d falls off and the st$mp has %ompletely healed )' !o dete"mine the amo$nt of fo"m$la needed& do the following mathemati%al %al%$lation + 0g - 120 %alG0g pe" day F +50 %alo"iesGday feeding 6 . ho$"s F 5 feedings pe" day F 50 %alo"ies pe" feeding: 50 %alo"ies pe" feedingW 50 %alo"ies pe" feeding with fo"m$la 20 %alGo( F + o$n%es pe" feeding @ased on the %al%$lation 2& . o" 5 o$n%es a"e in%o""e%t A' Int"a$te"ine ano-ia may %a$se "ela-ation of the anal sphin%te" and emptying of me%oni$m into the amnioti% fl$id #t bi"th some of the me%oni$m fl$id may be aspi"ated& %a$sing me%hani%al obst"$%tion o" %hemi%al pne$monitis !he infant is not at in%"eased "is0 fo" gast"ointestinal p"oblems ,/en tho$gh the s0in is stained with me%oni$m& it is noninfe%tio$s Oste"ileP and noni""itating !he postte"m me%oni$m= stained infant is not at additional "is0 fo" bowel o" $"ina"y p"oblems C' !he n$"se sho$ld $se a nonelasti%& fle-ible& pape" meas$"ing tape& pla%ing the (e"o point on the s$pe"io" bo"de" of the symphysis p$bis and st"et%hing the tape a%"oss the abdomen at the midline to the top of the f$nd$s !he -iphoid and $mbili%$s a"e not app"op"iate landma"0s to $se when meas$"ing the height of the f$nd$s O<%)onaldKs meas$"ementP )' Homen hospitali(ed with se/e"e p"ee%lampsia need de%"eased C*S stim$lation to p"e/ent a sei($"e Sei($"e p"e%a$tions p"o/ide en/i"onmental safety sho$ld a sei($"e o%%$" @e%a$se of edema& daily weight is impo"tant b$t not the p"io"ity P"e%lampsia %a$ses /asospasm and the"efo"e %an "ed$%e $te"o=pla%ental pe"f$sion !he %lient sho$ld be pla%ed on he" left side to ma-imi(e blood flow& "ed$%e blood p"ess$"e& and p"omote di$"esis Inte"/entions to "ed$%e st"ess and an-iety a"e /e"y impo"tant to fa%ilitate %oping and a sense of %ont"ol& b$t sei($"e p"e%a$tions a"e the p"io"ity C' Cessation of the lo%hial dis%ha"ge signifies healing of the endomet"i$m 1is0 of hemo""hage and infe%tion a"e minimal + wee0s afte" a no"mal /aginal deli/e"y !elling the %lient anytime is inapp"op"iate be%a$se this "esponse does not p"o/ide the %lient with the spe%ifi% info"mation she is "e6$esting Choi%e of a %ont"a%epti/e method is impo"tant& b$t not the spe%ifi% %"ite"ia fo" safe "es$mption of se-$al a%ti/ity C$lt$"ally& the 5=wee0sK e-amination has been $sed as the time f"ame fo" "es$ming se-$al a%ti/ity& b$t it may be "es$med ea"lie" C !he middle thi"d of the /ast$s late"alis is the p"efe""ed inEe%tion site fo" /itamin : administ"ation be%a$se it is f"ee of blood /essels and ne"/es and is la"ge eno$gh to abso"b the medi%ation !he deltoid m$s%le of a newbo"n is not la"ge eno$gh fo" a newbo"n I< inEe%tion InEe%tions into this m$s%le in a small %hild might %a$se damage to the "adial ne"/e !he ante"io" femo"is m$s%le is the ne-t safest m$s%le to $se in a newbo"n b$t is not the safest @e%a$se of the p"o-imity of the s%iati% ne"/e& the gl$te$s ma-im$s m$s%le sho$ld not be $ntil the %hild has been wal0ing 2 yea"s D @a"tholinKs glands a"e the glands on eithe" side of the /aginal o"ifi%e !he %lito"is is female e"e%tile tiss$e fo$nd in the pe"ineal a"ea abo/e the $"eth"a !he pa"otid glands a"e open into the mo$th S0eneKs glands open into the poste"io" wall of the female $"ina"y meat$s D !he fetal gonad m$st se%"ete est"ogen fo" the emb"yo to diffe"entiate as a female #n in%"ease in mate"nal est"ogen se%"etion does not effe%t diffe"entiation of the emb"yo& and mate"nal est"ogen se%"etion o%%$"s in e/e"y p"egnan%y <ate"nal and"ogen se%"etion "emains the same as befo"e p"egnan%y and does not effe%t diffe"entiation Se%"etion of and"ogen by the fetal gonad wo$ld p"od$%e a male fet$s A Using bi%a"bonate wo$ld in%"ease the amo$nt of sodi$m ingested& whi%h %an %a$se %ompli%ations ,ating low=sodi$m %"a%0e"s wo$ld be app"op"iate Sin%e li6$ids %an in%"ease na$sea a/oiding them in the mo"ning ho$"s when na$sea is $s$ally the st"ongest is app"op"iate ,ating si- small meals a day wo$ld 0eep the stoma%h f$ll& whi%h often de%"ease na$sea ) @allottement indi%ates passi/e mo/ement of the $nengaged fet$s @allottement is not a %ont"a%tion Fetal 0i%0ing felt by the %lient "ep"esents 6$i%0ening ,nla"gement and softening of the $te"$s is 0nown as Pis0a%e0Ks sign ) Chadwi%0Ks sign "efe"s to the p$"ple=bl$e tinge of the %e"/i- @"a-ton ?i%0s %ont"a%tions a"e painless %ont"a%tions beginning a"o$nd the .th month DoodellKs sign indi%ates softening of the %e"/i- Fle-ibility of the $te"$s against the %e"/i- is 0nown as <%)onaldKs sign C @"eathing te%hni6$es %an "aise the pain th"eshold and "ed$%e the pe"%eption of pain !hey also p"omote "ela-ation @"eathing te%hni6$es do not eliminate pain& b$t they %an "ed$%e it Positioning& not b"eathing& in%"eases $te"opla%ental pe"f$sion A !he %lientKs labo" is hypotoni% !he n$"se sho$ld %all the physi%al and obtain an o"de" fo" an inf$sion of o-yto%in& whi%h will assist the $te"$s to %onta%t mo"e fo"%ef$lly in an attempt to dilate the %e"/i#dministe"ing light sedati/e wo$ld be done fo" hype"toni% $te"ine %ont"a%tions P"epa"ing fo" %esa"ean se%tion is $nne%essa"y at this time O-yto%in wo$ld in%"ease the $te"ine %ont"a%tions and hopef$lly p"og"ess labo" befo"e a %esa"ean wo$ld be ne%essa"y It is too ea"ly to anti%ipate %lient p$shing with %ont"a%tions

COMPREHENSIVE NURSING REVIEW by R. C. REA

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99 D !he signs indi%ate pla%enta p"e/ia and /aginal e-am to dete"mine %e"/i%al dilation wo$ld not be done
be%a$se it %o$ld %a$se hemo""hage #ssessing mate"nal /ital signs %an help dete"mine mate"nal physiologi% stat$s Fetal hea"t "ate is impo"tant to assess fetal well=being and sho$ld be done <onito"ing the %ont"a%tions will help e/al$ate the p"og"ess of labo" 90 D # %omplete pla%enta p"e/ia o%%$"s when the pla%enta %o/e"s the opening of the $te"$s& th$s blo%0ing the passageway fo" the baby !his "esponse e-plains what a %omplete p"e/ia is and the "eason the baby %annot %ome o$t e-%ept by %esa"ean deli/e"y !elling the %lient to as0 the physi%ian is a poo" "esponse and wo$ld in%"ease the patientKs an-iety #ltho$gh a %esa"ean wo$ld help to p"e/ent hemo""hage& the statement does not e-plain why the hemo""hage %o$ld o%%$" Hith a %omplete p"e/ia& the pla%enta is %o/e"ing all the %e"/i-& not E$st most of it 91 ) Hith a fa%e p"esentation& the head is %ompletely e-tended Hith a /e"te- p"esentation& the head is %ompletely o" pa"tially fle-ed Hith a b"ow Ofo"eheadP p"esentation& the head wo$ld be pa"tially e-tended 92 D Hith this p"esentation& the fetal $ppe" to"so and ba%0 fa%e the left $ppe" mate"nal abdominal wall !he fetal hea"t "ate wo$ld be most a$dible abo/e the mate"nal $mbili%$s and to the left of the middle !he othe" positions wo$ld be in%o""e%t 9+ C' !he g"eenish tint is d$e to the p"esen%e of me%oni$m 'an$go is the soft& downy hai" on the sho$lde"s and ba%0 of the fet$s ?yd"amnios "ep"esents e-%essi/e amnioti% fl$id 7e"ni- is the white& %heesy s$bstan%e %o/e"ing the fet$s 9. D' In a b"ee%h position& be%a$se of the spa%e between the p"esenting pa"t and the %e"/i-& p"olapse of the $mbili%al %o"d is %ommon >$i%0ening is the womanKs fi"st pe"%eption of fetal mo/ement Ophthalmia neonato"$m $s$ally "es$lts f"om mate"nal gono""hea and is %onE$n%ti/itis Pi%a "efe"s to the o"al inta0e of nonfood s$bstan%es 92 A' )i(ygoti% Of"ate"nalP twins in/ol/e two o/a fe"tili(ed by sepa"ate spe"m <ono(ygoti% Oidenti%alP twins in/ol/e a %ommon pla%enta& same genotype& and %ommon %ho"ion 95 C' !he (ygote is the single %ell that "ep"od$%es itself afte" %on%eption !he %h"omosome is the mate"ial that ma0es $p the %ell and is gained f"om ea%h pa"ent @lasto%yst and t"ophoblast a"e late" te"ms fo" the emb"yo afte" (ygote 98 D' P"epa"ed %hildbi"th was the di"e%t "es$lt of the 1920Ks %hallenging of the "o$tine $se of analgesi% and anestheti%s d$"ing %hildbi"th !he ')1P was a m$%h late" %on%ept and was not a di"e%t "es$lt of the %hallenging of "o$tine $se of analgesi%s and anestheti%s d$"ing %hildbi"th 1oles fo" n$"se midwi/es and %lini%al n$"se spe%ialists did not de/elop f"om this %hallenge 99 C' !he is%hial spines a"e lo%ated in the mid=pel/i% "egion and %o$ld be na""owed d$e to the p"e/io$s pel/i% inE$"y !he symphysis p$bis& sa%"al p"omonto"y& and p$bi% a"%h a"e not pa"t of the mid=pel/is 99 )' 7a"iations in the length of the menst"$al %y%le a"e d$e to /a"iations in the p"olife"ati/e phase !he menst"$al& se%"eto"y and is%hemi% phases do not %ont"ib$te to this /a"iation 100 ) !estoste"one is p"od$%ed by the 'eyding %ells in the seminife"o$s t$b$les Folli%le=stim$lating ho"mone and le$tein(ing ho"mone a"e "eleased by the ante"io" pit$ita"y gland !he hypothalam$s is "esponsible fo" "eleasing gonadot"opin="eleasing ho"mone

COMPREHENSIVE NURSING REVIEW by R. C. REA

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MATERNIT( NURSING Part 2 1 S$ppose <elissa Ch$ng as0s yo$ whethe" mate"nal %hild health n$"sing is a p"ofession Hhat 6$alifies an a%ti/ity as a p"ofessionQ a <embe"s s$pe"/ise othe" people b <embe"s $se a distin%t body of 0nowledge % <embe"s enEoy good wo"0ing %onditions d <embe"s "e%ei/e "elati/ely high pay 2 *$"sing is %hanging be%a$se so%ial %hange affe%ts %a"e Hhi%h of the following is a t"end that is o%%$""ing in n$"sing be%a$se of so%ial %hangeQ a So many %hild"en a"e t"eated in amb$lato"y $nits that n$"ses a"e ha"dly needed b Imm$ni(ations a"e no longe" needed fo" infe%tio$s diseases % !he $se of s0illed te%hnology has made n$"sing %a"e mo"e %ompled P"egnant women a"e so healthy today that they "a"ely need p"enatal %a"e + !he best des%"iption if the family n$"se p"a%titione" "ole is a !o gi/e bedside %a"e to %"iti%ally ill family membe"s b !o s$pe"/ise the health of %hild"en $p to age 19 yea"s % !o p"o/ide health s$pe"/ision fo" families d !o s$pe"/ise women d$"ing p"egnan%y

. !he )elos 1eyes family was a single=pa"ent one befo"e <"s )elos 1eyes "ema""ied Hhat is a %ommon %on%e"n of single=pa"ent familiesQ a !oo many people gi/e ad/i%e b Finan%es a"e inade6$ate % Child"en miss many days of s%hool d Child"en donKt 0now any othe" family li0e thei"s 2 <"s )elos 1eyes se"/es many "oles in he" family If& when yo$ tal0 to 7e"oni%a& he" da$ghte"& she inte""$pts to say& S)onKt tell o$" family se%"ets&T she is f$lfilling what family "oleQ a )e%ision=ma0e" b Date0eepe" % P"oblem=sol/e" d @"ead=ea"ne" 5 !he )elos 1eyes family %onsists of two pa"entsW 7e"oni%a& 12W and Paolo& 2 <"s )elos 1eyes is 2 months p"egnant Hhi%h of )$/allKs family life stages is the family %$""ently e-pe"ien%ingQ a P"egnan%y stage b P"es%hool stage

COMPREHENSIVE NURSING REVIEW by R. C. REA

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% d

S%hool=age stage 'a$n%hing stage

8 Hhile she is in the hospital& Ca"mela ma0es the following statements Hhi%h is the best e-ample of ste"eotypingQ a <y do%to" is f$nnyW he tells Eo0es and ma0es me la$gh b IKm glad IKm @atang$e`o be%a$se all @atang$e`os a"e sma"t % IKm s$"e my leg will heal 6$i%0lyW IKm o/e"all healthy d I li0e foods in @atangas& altho$gh not if it tastes too spi%y 9 <onet 1i/e"a tells yo$ she $sed to w""y be%a$se she de/eloped b"easts late" than most of he" f"iends @"east de/elopment is te"med: a #d"ena"%he b <ama"%he % !hela"%he d <ena"%he 9 S$ppose Baypee <analo tells yo$ that he is %onside"ing a /ase%tomy afte" the bi"th of his new %hild 7ase%tomy is the in%ision of whi%h o"ganQ a !estes b 7as defe"ens % Fallopian t$be d ,pididymis 10 a b % d On physi%al e-amination& <onet 1i/e"a is fo$nd to ha/e %ysto%ele # %ysto%ele is: # seba%eo$s %yst a"ising f"om a /$l/a" fold P"ot"$sion of the intestine into the /agina P"olapse of the $te"$s and %e"/i- into the /agina ?e"niation of the bladde" into the /aginal wall

11 <onet 1i/e"a typi%ally has a menst"$al %y%le of +. days She tells yo$ she had %oit$s on days 9& 10& 12& and 20 of he" last %y%le Hhi%h is the day on whi%h she most li0ely %on%ei/edQ a# !he 9th day %# !he 10th day % )ay 12 d )ay 20 12 !he <analoKs neighbo" Cah"ell is a woman who has se- with women #nothe" te"m fo" this se-$al o"ientation is a 'esbian b Celibate % Day d 7oye$" 1+ S$ppose 1oseann& 18 yea"s old& tells yo$ that she wants to $se fe"tility awa"eness method of %ont"a%eption ?ow will she dete"mine he" fe"tile daysQ a She will noti%e that she feels hot& as if she has an ele/ated tempe"at$"e b She sho$ld assess whethe" he" %e"/i%al m$%$s is thin and wate"y % She sho$ld monito" he" emotions fo" s$dden ange" o" %"ying d She sho$ld assess whethe" he" b"easts feels sensiti/e to %ool ai" 1. S$ppose 1oseann& 18 yea"s old& %hooses to $se a %ombination o"al %ont"a%epti/e OCOCP as he" family planning method Hhat is a dange" sign of COCs yo$ wo$ld as0 he" to "epo"tQ a # st$ffy o" "$nny nose b #"th"itis=li0e symptoms % Slight weight gain d <ig"aine heada%he 12 S$ppose 1oseann& 18 yea"s old& %hooses s$b%$taneo$s implants O*o"plantP as he" method of "ep"od$%ti/e life planning ?ow long will these implants be effe%ti/eQ a One month b 12 months % Fi/e yea"s d 10 yea"s

COMPREHENSIVE NURSING REVIEW by R. C. REA

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15 1oseann& 18 yea"s old& wants to t"y female %ondoms as he" "ep"od$%ti/e life planning method Hhi%h inst"$%tion wo$ld yo$ gi/e he"Q a !he ho"mone the %ondom "eleases may %a$se mild weight gain b She sho$ld inse"t the %ondom befo"e any penile penet"ation % She sho$ld %oat the %ondom with a spe"mi%ide befo"e $se d Female %ondoms& $nli0e male %ondoms& %an be "e$sed 18 1oseann& 18 yea"s old& as0s yo$ how a t$bal ligation p"e/ents p"egnan%y Hhi%h wo$ld be the best answe"Q a Spe"m %an no longe" "ea%h the o/a be%a$se fallopian t$bes a"e blo%0ed b Spe"m %an not ente" the $te"$s be%a$se the %e"/i%al ent"an%e is blo%0ed % P"ostaglandins "eleased f"om the %$t fallopian t$bes %an 0ill spe"m d !he o/a"y no longe" "eleases o/a as the"e is no whe"e fo" them to go 19 a b % d 19 a b % d !he #tien(as a"e a %o$ple $nde"going testing fo" infe"tility Infe"tility is said to e-ist when: # %o$ple has been t"ying to %on%ei/e fo" 1 yea" # woman has no %hild"en # woman has no $te"$s # %o$ple has wanted a %hild fo" 5 months D$adal$pe #tien(a is diagnosed as ha/ing endomet"iosis !his %ondition inte"fe"es with fe"tility be%a$se: !he o/a"ies stop p"od$%ing ade6$ate est"ogen !he $te"ine %e"/i- be%omes inflamed and swollen P"ess$"e on the pit$ita"y leads to de%"eased FS? le/els ,ndomet"ial implants %an blo%0 the fallopian t$bes

20 D$adal$pe #tien(a is s%hed$led to ha/e a hyste"osalpingog"am Hhi%h of the following inst"$%tions wo$ld yo$ gi/e he" "ega"ding this p"o%ed$"eQ a She may feel some mild %"amping when the dye is inse"ted b !he sonog"am of the $te"$s will "e/eal any t$mo"s p"esent % She will not be able to %on%ei/e fo" th"ee months afte" the p"o%ed$"e d <ay women e-pe"ien%e mild bleeding as an afte"effe%t 21 1$el <a"asigan as0s yo$ what a"tifi%ial insemination by dono" entails Hhi%h wo$ld be yo$" best answe"Q a #"tifi%ial spe"m a"e inEe%ted /aginally to test t$bal paten%y b )ono" spe"m a"e int"od$%ed /aginally into the $te"$s of the %e"/i% !he h$sbandKs spe"m is administe"ed int"a/eno$sly wee0ly d )ono" spe"m a"e inEe%ted int"aabdominally into ea%h o/a"y 22 D$adal$pe #tien(a is ha/ing a gamete int"afallopian t"ansfe" ODIF!P p"o%ed$"e Hhat ma0es he" a good %andidate fo" this p"o%ed$"eQ a She has patent fallopian t$bes& so fe"tili(ed o/a %an be implanted into them b She is 1h negati/e& a ne%essa"y stip$lation to "$le o$t 1h in%ompatibility % She has a no"mal $te"$s& so spe"m %an be inEe%ted th"o$gh the %e"/i- into it d ?e" h$sband is ta0ing sildenafil O7iag"aP& so all his pe"m will be motile 2+ a b % d 2. a b % d Bean S$a"e( is p"egnant with he" fi"st %hild ?e" phenotype "efe"s to: ?e" %on%ept of he"self as male o" female Hhethe" she has .5 %h"omosomes o" not ?e" a%t$al geneti% %omposition ?e" o$twa"d appea"an%e Bean S$a"e( is a balan%ed t"anslo%ation %a""ie" fo" )own synd"ome !his te"m means that: #ll of he" %hild"en will be bo"n with some aspe%ts of )own synd"ome #ll of he" female and none of he" male %hild"en will ha/e )own synd"ome She has a g"eate" than a/e"age %han%e a %hild will ha/e )own synd"ome It is impossible fo" any of he" %hild"en to be bo"n with )own synd"ome

22 Bean S$a"e( was told at a geneti% %o$nseling session tat she is a balan%ed t"anslo%ation %a""ie" fo" )own synd"ome Hhat wo$ld be yo$" best a%tion "ega"ding this info"mationQ a @e %e"tain all of he" family $nde"stand what this means b )is%$ss the %ost of /a"io$s abo"tion te%hni6$es with Bean % @e s$"e Bean 0nows she sho$ld not ha/e any mo"e %hild"en d #s0 Bean is she has any 6$estions that yo$ %o$ld answe" fo" he"

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25 Bean S$a"e(Ks %hild is bo"n with )own Synd"ome Hhat is a %ommon physi%al feat$"e of newbo"n with this diso"de"Q a Spasti% and stiff m$s%les b 'oose s0in at ba%0 of ne%0 % # white lo%0 of fo"ehead hai" d H"in0les on soles of the feet 28 1i(alyn as0s how m$%h longe" he" do%to" will "efe" to the baby inside he" as an emb"yo Hhat wo$ld be yo$" best e-planationQ a !his te"m is $sed d$"ing the time befo"e fe"tili(ation b ?e" baby will be a fet$s as soon as the pla%enta fo"ms c# #fte" the 20th wee0 of p"egnan%y& the baby is %alled (ygote d F"om the time of implantation $ntil 2 to 9 wee0s& the baby is an emb"yo 29 1i(alyn is wo""ied that he" baby will be bo"n with %ongenital hea"t disease Hhat assessment of a fet$s at bi"th is impo"tant to help dete%t %ongenital hea"t defe%tsQ a #ssessing whethe" the Hha"tonKs Eelly if the %o"d has a p? highe" than 8 2 b #ssessing whethe" the $mbili%al %o"d has two a"te"ies and one /ein % <eas$"ing the length of the %o"d to be %e"tain that it is longe" than th"ee feet d )ete"mining that the %olo" of the $mbili%al %o"d is not g"een 29 1i(alyn as0s yo$ why he" do%to" is %on%e"ned abo$t whethe" he" fet$s $s p"od$%ing s$"fa%tant o" not Ao$" best answe" wo$ld be: a S$"fa%tant 0eeps l$ngs f"om %ollapsing on e-pi"ation& and th$s aids newbo"n b"eathing b S$"fa%tant is p"od$%ed by the fetal li/e"& so its p"e%$"so" "e/eals li/e" mat$"ity % S$"fa%tant is the p"e%$"so" to Ig< antibody p"od$%tion& so it p"e/ents infe%tion d S$"fa%tant "e/eals mat$"e 0idney f$n%tion& as it is p"od$%ed by 0idney glome"$li +0 1i(alyn is s%hed$led to ha/e an $lt"aso$nd e-amination Hhat inst"$%tion wo$ld yo$ gi/e he" befo"e he" e-aminationQ a 7oid immediately befo"e the p"o%ed$"e to "ed$%e yo$" bladde" si(e b !he int"a/eno$s fl$id inf$sed to dilate yo$" $te"$s does not h$"t the fet$s % Ao$ will need to d"in0 at least + glasses of fl$id befo"e the p"o%ed$"e d Ao$ %an ha/e medi%ine fo" pain fo" any %ont"a%tions %a$sed by the test +1 1i(alyn is s%hed$led to ha/e an amnio%entesis to test fo" fetal mat$"ity Hhat inst"$%tion wo$ld yo$ gi/e he" befo"e this p"o%ed$"eQ a 7oid immediately befo"e the p"o%ed$"e to "ed$%e yo$" bladde" si(e b !he -="ay $sed to "e/eal yo$" fet$sK position has no long=te"m effe%ts % !he int"a/eno$s fl$id inf$sed to dilate yo$" $te"$s does not h$"t the fet$s d *o mo"e amnioti% fl$id fo"ms afte"wa"d& whi%h is why only a small amo$nt is "emo/ed +2 @e"nadette sometimes feels ambi/alent abo$t being p"egnant Hhat is the psy%hologi%al tas0 yo$Kd li0e to see he" %omplete d$"ing the fi"st t"imeste" of p"egnan%yQ a 7iew mo"ning si%0ness as tole"able b #%%ept the fa%t that sheKs p"egnant % #%%ept the fa%t that a baby is g"owing inside he" d Choose a name fo" the baby ++ @e"nadette is awa"e that sheKs been showing some na"%issism sin%e be%oming p"egnant Hhi%h of he" a%tions best des%"ibes na"%issismQ a ?e" s0in feels Sp$lled thinT a%"oss he" abdomen b ?e" tho$ghts tend to be mainly abo$t he"self % She feels a need to sleep a lot mo"e than $s$al d She often feels Sn$mbT o" as if sheKs ta0en a na"%oti% +. @e"nadette did a $"ine p"egnan%y test b$t was s$"p"ised to lea"n that a positi/e "es$lt is not a s$"e sign if p"egnan%y She as0s yo$ what wo$ld be a positi/e sign Ao$ tell he" wo$ld be if: a She is ha/ing %onsistent $te"ine g"owth b She %an feel the fet$s mo/e inside he" % hCD %an be fo$nd in he" bloodst"eam d !he fetal hea"t %an be seen on $lt"aso$nd

COMPREHENSIVE NURSING REVIEW by R. C. REA

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+2 @e"nadetteKs do%to" told he" she had a positi/e Chadwi%0Ks sign She as0s yo$ what this means& and yo$ tell he" that: a ?e" abdomen is soft and tende" b ?e" $te"$s has tipped fo"wa"d % Ce"/i%al m$%$s is %lea" and sti%0y d ?e" /agina has da"0ened in %olo" +5 @e"nadette o/e"hea"d he" do%to" say that ins$lin is not as effe%ti/e d$"ing p"egnan%y as $s$al !hat made he" wo""y that she is de/eloping diabetes& li0e he" a$nt ?ow wo$ld yo$ e-plain how de%"eased ins$lin effe%ti/eness safeg$a"ds the fet$sQ a )e%"eased effe%ti/eness p"e/ents the fet$s f"om being hypogly%emi% b If ins$lin is ineffe%ti/e it %annot %"oss the pla%enta and ha"m the fet$s % !he lessened a%tion p"e/ents the fet$s f"om gaining too m$%h weight d !he mothe"& not the fet$s& is g$a"ded by this de%"eased ins$lin a%tion +8 1i(a C$a feels well She as0s yo$ why she needs to %ome fo" p"enatal %a"e !he best "eason fo" he" to "e%ei/e "eg$la" %a"e is: a )is%o/e"ing alle"gies %an help eliminate ea"ly bi"th b It helps do%$ment how many p"egnan%ies o%%$" ea%h yea" % It p"o/ides time fo" ed$%ation abo$t p"egnan%y and bi"th d It dete"mines whethe" p"egnan%ies today a"e planned o" not +9 a b % d Hhy is it impo"tant to as0 1i(a abo$t past s$"ge"y on a p"egnan%y health histo"yQ !o test he" "e%ent and long=te"m memo"y #dhesions f"om s$"ge"y %o$ld limit $te"ine g"owth !o assess she %o$ld be alle"gi% to any medi%ation !o dete"mine if she has effe%ti/e heath ins$"an%e

+9 1i(a "epo"ts that the palms of he" hands a"e always it%hy Ao$ noti%e s%"at%hes on them when yo$ do a physi%al e-am Hhat is the most li0ely %a$se of this finding d$"ing p"egnan%yQ a She m$st ha/e be%ome alle"gi% to dishwashing soap b She has an alle"gy to he" fet$s and will p"obably abo"t % ?e" weight gain has st"et%hed the s0in o/e" he" hands d !his is a %ommon "ea%tion to in%"easing est"ogen le/els .0 1i(a has not had a pel/i% e-am sin%e she was in highs%hool Hhat ad/i%e wo$ld yo$ gi/e he" to help he" "ela- d$"ing he" fi"st p"enatal pel/i% e-amQ a ?a/e he" ta0e a deep b"eath and hold it d$"ing the e-am b !ell he" to bea" down slightly as the spe%$l$m is inse"ted % Singing o$t lo$d helps& be%a$se this p$shes down the diaph"agm d She sho$ld b"eathe slowly and e/enly d$"ing the e-am .1 1i(a has pel/i% meas$"ements ta0en Hhat si(e sho$ld the is%hial t$be"osity diamete" be to be %onside"ed ade6$ateQ a 5 %m b !wi%e the width of the %onE$gate diamete" % 11 %m d ?alf the width of the symphysis p$bis Sit$ation: One of the n$"sing "oles in %a"ing fo" the p"egnant family is p"omoting fetal and mate"nal health .2 Hhi%h statement by 7anna )elgado wo$ld ale"t yo$ that she needs mo"e tea%hing abo$t safe p"a%ti%es d$"ing p"egnan%yQ a SI ta0e eithe" a showe" o" t$b bath& be%a$se I 0now both a"e safe T b SI wash my b"easts with %lea" wate"& not with soap daily T % SIKm glad I donKt ha/e to as0 my boyf"iend to $se %ondoms anymo"e T d SIKm wea"ing low=heeled shoes to t"y and a/oid ba%0a%he T .+ 7anna des%"ibes he" typi%al day to yo$ Hhat wo$ld ale"t yo$ that she may need f$"the" p"egnan%y ad/i%eQ a SI Eog "athe" than wal0 e/e"y time I %an fo" e-e"%ise T b SI always go to sleep on my side& not on my ba%0 T % SI pa%0 my l$n%h in the mo"ning when IKm not so ti"ed T d SI wal0 a"o$nd my des0 e/e"y ho$" to p"e/ent /a"i%osities T

COMPREHENSIVE NURSING REVIEW by R. C. REA

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.. a b % d

7anna tells yo$ that she is de/eloping painf$l hemo""hoids #d/i%e yo$ wo$ld gi/e he" wo$ld be: !a0e a tablespoon of mine"al oil with ea%h of yo$" meals Omit fibe" f"om yo$" diet !his will p"e/ent %onstipation 'ie on yo$" stoma%h daily to d"ain blood f"om the "e%tal /eins Hit%h ha(el pads feel %ool against swollen hemo""hoids

.2 7anna has an0le edema by the end of ea%h day Hhi%h statement by he" wo$ld "e/eal that she $nde"stands what %a$ses thisQ a SI 0now this is a beginning %ompli%ationW IKll %all my do%to" tonight T b SI $nde"stand this is f"om eating too m$%h saltW IKll "est"i%t that mo"e T % SIKll "est in a SimsK position to ta0e p"ess$"e off lowe" e-t"emity /eins T d SIKll wal0 fo" half an ho$" e/e"y day to "elie/e thisW IKll t"y wal0ing mo"e T

ANS5ERS ,#r MATERNIT( NURSING Part 1 @CC@@ C@C@) )#@)C @##)# @#)C) @)@#C #@@)) #C@)) CC#)C

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PEDIATRIC NURSING 1 Hhile pe"fo"ming physi%al assessment of a 12 month=old& the n$"se notes that the infantKs ante"io" fontanelle is still slightly open Hhi%h of the following is the n$"seKs most app"op"iate a%tionQ a *otify the physi%ian immediately be%a$se the"e is a p"oblem b Pe"fo"m an intensi/e ne$"ologi% e-amination % Pe"fo"m an intensi/e de/elopmental e-amination d )o nothing be%a$se this is a no"mal finding fo" the age Hhen tea%hing a mothe" abo$t int"od$%ing solid foods to he" %hild& whi%h of the following indi%ates the ea"liest age at whi%h this sho$ld be doneQ a 1 month b 2 months % + months d . months !he infant of a s$bstan%e=ab$sing mothe" is at "is0 fo" de/eloping a sense of whi%h of the followingQ a <ist"$st b Shame % D$ilt d Infe"io"ity Hhi%h of the following toys sho$ld the n$"se "e%ommend fo" a 2=month=oldQ a # big "ed balloon b # teddy bea" with b$tton eyes % # p$sh=p$ll wooden t"$%0 d # %olo"f$l b$sy bo!he mothe" of a 2=month=old is %on%e"ned that she may be spoiling he" baby by pi%0ing he" $p when she %"ies Hhi%h of the following wo$ld be the n$"seKs best "esponseQ a S 'et he" %"y fo" a while befo"e pi%0ing he" $p& so yo$ donKt spoil he"T b S@abies need to be held and %$ddledW yo$ wonKt spoil he" this wayT % SC"ying at this age means the baby is h$ng"yW gi/e he" a bottleT d SIf yo$ lea/e he" alone she will lea"n how to %"y he"self to sleepT Hhen assessing an 19=month=old& the n$"se notes a %ha"a%te"isti% p"ot"$ding abdomen Hhi%h of the following wo$ld e-plain the "ationale fo" this findingQ a In%"eased food inta0e owing to age b Unde"de/eloped abdominal m$s%les % @owlegged post$"e d 'inea" g"owth %$"/e

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If pa"ents 0eep a toddle" dependent in a"eas whe"e he is %apable of $sing s0ills& the toddle will de/elop a sense of whi%h of the followingQ a <ist"$st b Shame % D$ilt d Infe"io"ity Hhi%h of the following is an app"op"iate toy fo" an 19=month=oldQ a <$ltiple=pie%e p$((le b <iniat$"e %a"s % Finge" paints d Comi% boo0 Hhen tea%hing pa"ents abo$t the %hildKs "eadiness fo" toilet t"aining& whi%h of the following signs sho$ld the n$"se inst"$%t them to wat%h fo" in the toddle"Q a )emonst"ates d"yness fo" . ho$"s b )emonst"ates ability to sit and wal0 % ?as a new sibling fo" stim$lation d 7e"bali(es desi"e to go to the bath"oom Hhen tea%hing pa"ents abo$t typi%al toddle" eating patte"ns& whi%h of the following sho$ld be in%l$dedQ a Food SEagsT b P"efe"en%e to eat alone % Consistent table manne"s d In%"ease in appetite Hhi%h of the following s$ggestions sho$ld the n$"se offe" the pa"ents of a .=yea"=old boy who "esists going to bed at nightQ a S#llow him to fall asleep in yo$" "oom& then mo/e him to his own bed T b S!ell him that yo$ will lo%0 him in his "oom if he gets o$t of bed one mo"e time T % S,n%o$"age a%ti/e play at bedtime to ti"e him o$t so he will fall asleep faste" T d S1ead him a sto"y and allow him to play 6$ietly in his bed $ntil he falls asleep T Hhen p"o/iding the"ape$ti% play& whi%h of the following toys wo$ld best p"omote imaginati/e play in a .=yea"=oldQ a 'a"ge blo%0s b )"ess=$p %lothes % Hooden p$((le d @ig wheels Hhi%h of the following a%ti/ities& when /oi%ed by the pa"ents following a tea%hing session abo$t the %ha"a%te"isti%s of s%hool=age %ogniti/e de/elopment wo$ld indi%ate the need fo" additional tea%hingQ a Colle%ting baseball %a"ds and ma"bles b O"de"ing dolls a%%o"ding to si(e % Conside"ing simple p"oblem=sol/ing options d )e/eloping plans fo" the f$t$"e # hospitali(ed s%hoolage" states: SIKm not af"aid of this pla%e& IKm not af"aid of anything T !his statement is most li0ely an e-ample of whi%h of the followingQ a 1eg"ession b 1ep"ession % 1ea%tion fo"mation d 1ationali(ation #fte" tea%hing a g"o$p of pa"ents abo$t a%%ident p"e/ention fo" s%hoolage"s& whi%h of the following statements by the g"o$p wo$ld indi%ate the need fo" mo"e tea%hingQ a SS%hoolage"s a"e mo"e a%ti/e and ad/ent$"o$s than a"e yo$nge" %hild"en T b SS%hoolage"s a"e mo"e s$s%eptible to home ha(a"ds than a"e yo$nge" %hild"en T % SS%hoolage"s a"e $nable to $nde"stand potential dange"s a"o$nd them T d SS%hoola"ge"s a"e less s$bEe%t to pa"ental %ont"ol than a"e yo$nge" %hild"en T Hhi%h of the following s0ills is the most signifi%ant one lea"ned d$"ing the s%hoolage pe"iodQ a Colle%ting b O"de"ing % 1eading d So"ting # %hild age 8 was $nable to "e%ei/e the measles& m$mps& and "$bella O<<1P /a%%ine at the "e%ommended s%hed$led time Hhen wo$ld the n$"se e-pe%t to administe" <<1 /a%%ineQ a In a month f"om now b In a yea" f"om now % #t age 10 d #t age 1+ !he adoles%entKs inability to de/elop a sense of who he is and what he %an be%ome "es$lts in a sense of whi%h of the followingQ

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a Shame b D$ilt % Infe"io"ity d 1ole diff$sion Hhi%h of the following wo$ld be most app"op"iate fo" a n$"se to $se when des%"ibing mena"%he to a 1+= yea"=oldQ a # femaleKs fi"st menst"$ation o" menst"$al Spe"iodsT b !he fi"st yea" of menst"$ation o" Spe"iodT % !he enti"e menst"$al %y%le o" f"om one Spe"iodT to anothe" d !he onset of $te"ine mat$"ation o" pea0 g"owth # 1.=yea"=old boy has a%ne and a%%o"ding to his pa"ents& dominates the bath"oom by $sing the mi""o" all the time Hhi%h of the following "ema"0s by the n$"se wo$ld be least helpf$l in tal0ing to the boy and his pa"entsQ a S!his is p"obably the only %on%e"n he has abo$t his body So donKt wo""y abo$t it o" the time he spends on it T b S!eenage"s a"e an-io$s abo$t how thei" pee"s pe"%ei/e them So they spend a lot of time g"ooming T % S# teen may de/elop a poo" self=image when e-pe"ien%ing a%ne )o yo$ feel this way sometimesQT d SAo$ appea" to be 0eeping yo$" fa%e well washed Ho$ld yo$ feel %omfo"table dis%$ssing yo$" %leansing methodQT Hhi%h of the following sho$ld the n$"se s$spe%t when noting that a +=yea"=old is engaging in e-pli%it se-$al beha/io" d$"ing doll playQ a !he %hild is e-hibiting no"mal p"e=s%hool %$"iosity b !he %hild is a%ting o$t pe"sonal e-pe"ien%es % !he %hild does not 0now how to play with dolls d !he %hild is p"obably de/elopmentally delayed Hhi%h of the following statements by the pa"ents of a %hild with s%hool phobia wo$ld indi%ate the need fo" f$"the" tea%hingQ a SHeKll 0eep him at home $ntil phobia s$bsides T b SHeKll wo"0 with his tea%he"s and %o$nselo"s at s%hool T % SHeKll t"y to en%o$"age him to tal0 abo$t his p"oblem T d SHeKll dis%$ss possible sol$tions with him and his %o$nselo" T Hhen de/eloping a tea%hing plan fo" a g"o$p of high s%hool st$dents abo$t teenage p"egnan%y& the n$"se wo$ld 0eep in mind whi%h of the followingQ a !he in%iden%e of teenage p"egnan%ies is in%"easing b <ost teenage p"egnan%ies a"e planned % )enial of the p"egnan%y is %ommon ea"ly on d !he "is0 fo" %ompli%ations d$"ing p"egnan%y is "a"e Hhen assessing a %hild with a %left palate& the n$"se is awa"e that the %hild is at "is0 fo" mo"e f"e6$ent episodes of otitis media d$e to whi%h of the followingQ a 'owe"ed "esistan%e f"om maln$t"ition b Ineffe%ti/e f$n%tioning of the ,$sta%hian t$bes % Pl$gging of the ,$sta%hian t$bes with food pa"ti%les d #sso%iated %ongenital defe%ts of the middle ea" Hhile pe"fo"ming a ne$"ode/elopmental assessment on a +=month=old infant& whi%h of the following %ha"a%te"isti%s wo$ld be e-pe%tedQ a # st"ong <o"o "efleb # st"ong pa"a%h$te "efle% 1olling f"om f"ont to ba%0 d 'ifting of head and %hest when p"one @y the end of whi%h of the following wo$ld the n$"se most %ommonly e-pe%t a %hildKs bi"th weight to t"ipleQ a . months b 8 months % 9 months d 12 months Hhi%h of the following best des%"ibes pa"allel play between two toddle"sQ a Sha"ing %"ayons to %olo" sepa"ate pi%t$"es b Playing a boa"d game with a n$"se % Sitting nea" ea%h othe" while playing with sepa"ate dolls d Sha"ing thei" dolls with two diffe"ent n$"ses Hhi%h of the following wo$ld the n$"se identify as the initial p"io"ity fo" a %hild with a%$te lympho%yti% le$0emiaQ a Instit$ting infe%tion %ont"ol p"e%a$tions

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b ,n%o$"aging ade6$ate inta0e of i"on="i%h foods % #ssisting with %oping with %h"oni% illness d #dministe"ing medi%ations /ia I< inEe%tions Hhi%h of the following info"mation& when /oi%ed by the mothe"& wo$ld indi%ate to the n$"se that she $nde"stands home %a"e inst"$%tions following the administ"ation of a diphthe"ia& tetan$s& and pe"t$ssis inEe%tionQ a <eas$"es to "ed$%e fe/e" b *eed fo" dieta"y "est"i%tions % 1easons fo" s$bse6$ent "ash d <eas$"es to %ont"ol s$bse6$ent dia""hea Hhi%h of the following a%tions by a %omm$nity health n$"se is most app"op"iate when noting m$ltiple b"$ises and b$"ns on the poste"io" t"$n0 of an 19=month=old %hild d$"ing a home /isitQ a 1epo"t the %hildKs %ondition to P"ote%ti/e Se"/i%es immediately b S%hed$le a follow=$p /isit to %he%0 fo" mo"e b"$ises % *otify the %hildKs physi%ian immediately d )on nothing be%a$se this is a no"mal finding in a toddle" Hhi%h of the following is being $sed when the mothe" of a hospitali(ed %hild %alls the st$dent n$"se and states& SAo$ idiot& yo$ ha/e no idea how to %a"e fo" my si%0 %hildTQ a )ispla%ement b P"oEe%tion % 1ep"ession d Psy%hosis Hhi%h of the following sho$ld the n$"se e-pe%t to note as a f"e6$ent %ompli%ation fo" a %hild with %ongenital hea"t diseaseQ a S$s%eptibility to "espi"ato"y infe%tion b @leeding tenden%ies % F"e6$ent /omiting and dia""hea d Sei($"e diso"de" Hhi%h of the following wo$ld the n$"se do fi"st fo" a +=yea"=old boy who a""i/es in the eme"gen%y "oom with a tempe"at$"e of 102 deg"ees& inspi"ato"y st"ido"& and "estlessness& who is lea"ning fo"wa"d and d"oolingQ a #$s%$ltate his l$ngs and pla%e him in a mist tent b ?a/e him lie down and "est afte" en%o$"aging fl$ids % ,-amine his th"oat and pe"fo"m a th"oat %$lt$"e d *otify the physi%ian immediately and p"epa"e fo" int$bation Hhi%h of the following wo$ld the n$"se need to 0eep in mind as a p"edisposing fa%to" when fo"m$lating a tea%hing plan fo" %hild with a $"ina"y t"a%t infe%tionQ a # sho"te" $"eth"a in females b F"e6$ent emptying of the bladde" % In%"eased fl$id inta0e d Ingestion of a%idi% E$i%es Hhi%h of the following sho$ld the n$"se do fi"st fo" a 12=yea"=old boy with a f$ll leg %ast who is s%"eaming in $n"elenting pain and e-hibiting "ight foot pallo" signifying %ompa"tment synd"omeQ a <edi%ate him with a%etaminophen b *otify the physi%ian immediately % 1elease the t"a%tion d <onito" him e/e"y 2 min$tes #t whi%h of the following ages wo$ld the n$"se e-pe%t to administe" the /a"i%ella (oste" /a%%ine to %hildQ a #t bi"th b 2 months % 5 months d 12 months Hhen dis%$ssing no"mal infant g"owth and de/elopment with pa"ents& whi%h of the following toys wo$ld the n$"se s$ggest as most app"op"iate fo" an 9=month=oldQ a P$sh=p$ll toys b 1attle % 'a"ge blo%0s d <obile Hhi%h of the following aspe%ts of psy%hoso%ial de/elopment is ne%essa"y fo" the n$"se to 0eep in mind when p"o/iding %a"e fo" the p"es%hool %hildQ a !he %hild %an $se %omple- "easoning to thin0 o$t sit$ations b Fea" of body m$tilation is a %ommon p"es%hool fea" % !he %hild engages in %ompetiti/e types of play d Immediate g"atifi%ation is ne%essa"y to de/elop initiati/e Hhi%h of the following is %ha"a%te"isti% of a p"es%hoole" with mid mental "eta"dationQ

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a Slow to feed self b 'a%0 of spee%h % <a"0ed moto" delays d Dait disability Hhi%h of the following assessment findings wo$ld lead the n$"se to s$spe%t )own synd"ome in an infantQ a Small tong$e b !"ans/e"se palma" %"ease % 'a"ge nose d 1est"i%ted Eoint mo/ement Hhile assessing a newbo"n with %left lip& the n$"se wo$ld be ale"t that whi%h of the following will most li0ely be %omp"omisedQ a S$%0ing ability b 1espi"ato"y stat$s % 'o%omotion d DI f$n%tion Hhen p"o/iding postope"ati/e %a"e fo" the %hild with a %left palate& the n$"se sho$ld position the %hild in whi%h of the following positionsQ a S$pine b P"one % In an infant seat d On the side Hhile assessing a %hild with pylo"i% stenosis& the n$"se is li0ely to note whi%h of the followingQ a 1eg$"gitation b Steato""hea % P"oEe%tile /omiting d SC$""ant EellyT stools Hhi%h of the following n$"sing diagnoses wo$ld be inapp"op"iate fo" the infant with gast"oesophageal "efl$- OD,1PQ a Fl$id /ol$me defi%it b 1is0 fo" aspi"ation % #lte"ed n$t"ition: less than body "e6$i"ements d #lte"ed o"al m$%o$s memb"anes Hhi%h of the following pa"amete"s wo$ld the n$"se monito" to e/al$ate the effe%ti/eness of thi%0ened feedings fo" an infant with gast"oesophageal "efl$- OD,1PQ a 7omiting b Stools % Ute"ine d Height )is%ha"ge tea%hing fo" a %hild with %elia% disease wo$ld in%l$de inst"$%tions abo$t a/oiding whi%h of the followingQ a 1i%e b <il0 % Hheat d Chi%0en Hhi%h of the following wo$ld the n$"se e-pe%t to assess in a %hild with %elia% disease ha/ing a %elia% %"isis se%onda"y to an $ppe" "espi"ato"y infe%tionQ a 1espi"ato"y dist"ess b 'etha"gy % Hate"y dia""hea d Height gain Hhi%h of the following sho$ld the n$"se do fi"st afte" noting that a %hild with ?i"s%hsp"$ng disease has a fe/e" and wate"y e-plosi/e dia""heaQ a *otify the physi%ian immediately b #dministe" antidia""heal medi%ations % <onito" %hild e/e" +0 min$tes d *othing& this is %ha"a%te"isti% of ?i"s%hsp"$ng disease # newbo"nKs fail$"e to pass me%oni$m within the fi"st 2. ho$"s afte" bi"th may indi%ate whi%h of the followingQ a ?i"s%hsp"$ng disease b Celia% disease % Int$ss$s%eption d #bdominal wall defe%t Hhen assessing a %hild fo" possible int$ss$s%eption& whi%h of the following wo$ld be least li0ely to p"o/ide /al$able info"mationQ a Stool inspe%tion

COMPREHENSIVE NURSING REVIEW by R. C. REA

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Pain patte"n Family histo"y #bdominal palpation

ANS5ERS a$% RATIONALES ,#r PEDIATRIC NURSING

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D' !he ante"io" fontanelle typi%ally %loses anywhe"e between 12 to 19 months of age !h$s& assessing the ante"io" fontanelle as still being slightly open is a no"mal finding "e6$i"ing no f$"the" a%tion @e%a$se it is no"mal finding fo" this age& notifying he physi%ian o" pe"fo"ming additional e-aminations a"e inapp"op"iate D' Solid foods a"e not "e%ommended befo"e age . to 5 months be%a$se of the s$%0ing "efle- and the immat$"ity of the gast"ointestinal t"a%t and imm$ne system !he"efo"e& the ea"liest age at whi%h to int"od$%e foods is . months #ny time ea"lie" wo$ld be inapp"op"iate A' #%%o"ding to ,"i0son& infants need to ha/e thei" needs met %onsistently and effe%ti/ely to de/elop a sense of t"$st #n infant whose needs a"e %onsistently $nmet o" who e-pe"ien%es signifi%ant delays in ha/ing them met& s$%h as in the %ase of the infant of a s$bstan%e=ab$sing mothe"& will de/elop a sense of $n%e"tainty& leading to mist"$st of %a"egi/e"s and the en/i"onment !oddle"s de/elop a sense of shame when thei" a$tonomy needs a"e not met %onsistently P"es%hoole"s de/elop a sense of g$ilt when thei" sense of initiati/e is thwa"ted S%hoolage"s de/elop a sense of infe"io"ity when they do not de/elop a sense of ind$st"y D' # b$sy bo- fa%ilitates the fine moto" de/elopment that o%%$"s between . and 5 months @alloons a"e %ont"aindi%ated be%a$se small %hild"en may aspi"ate balloons @e%a$se the b$tton eyes of a teddy bea" may deta%h and be aspi"ated& this toy is $nsafe fo" %hild"en yo$nge" than + yea"s # 2=month=old is too yo$ng to $se a p$sh=p$ll toy )' Infants need to ha/e thei" se%$"ity needs met by being held and %$ddled #t 2 months of age& they a"e $nable to ma0e the %onne%tion between %"ying and attention !his asso%iation does not o%%$" $ntil late infan%y o" ea"ly toddle"hood 'etting the infant %"y fo" a time befo"e pi%0ing $p the infant o" lea/ing the infant alone to %"y he"self to sleep inte"fe"es with meeting the infantKs need fo" se%$"ity at this /e"y yo$ng age Infants %"y fo" many "easons #ss$ming that the %hild s h$ng"y may %a$se o/e"feeding p"oblems s$%h as obesity )' Unde"de/eloped abdominal m$s%$lat$"e gi/es the toddle" a %ha"a%te"isti%ally p"ot"$ding abdomen )$"ing toddle"hood& food inta0e de%"eases& not in%"eases !oddle"s a"e %ha"a%te"isti%ally bowlegged be%a$se the leg m$s%les m$st bea" the weight of the "elati/ely la"ge t"$n0 !oddle" g"owth patte"ns o%%$" in a stepli0e& not linea" patte"n )' #%%o"ding to ,"i0son& toddle"s e-pe"ien%e a sense of shame when they a"e not allowed to de/elop app"op"iate independen%e and a$tonomy Infants de/elop mist"$st when thei" needs a"e not %onsistently g"atified P"es%hoole"s de/elop g$ilt when thei" initiati/e needs a"e not met while s%hoolage"s de/elop a sense of infe"io"ity when thei" ind$st"y needs a"e not met C' Ao$ng toddle"s a"e still senso"imoto" lea"ne"s and they enEoy the e-pe"ien%e of feeling diffe"ent te-t$"es !h$s& finge" paints wo$ld be an app"op"iate toy %hoi%e <$ltiple=pie%e toys& s$%h as p$((le& a"e too diffi%$lt to manip$late and may be ha(a"do$s if the pie%es a"e small eno$gh to be aspi"ated <iniat$"e

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%a"s also ha/e a high potential fo" aspi"ation Comi% boo0s a"e on too high a le/el fo" toddle"s #ltho$gh they may enEoy loo0ing at some of the pi%t$"es& toddle"s a"e mo"e li0ely to "ip a %omi% boo0 apa"t D' !he %hild m$st be able to sate the need to go to the bath"oom to initiate toilet t"aining Us$ally& a %hild needs to be d"y fo" only 2 ho$"s& not . ho$"s !he %hild also m$st be able to sit& wal0& and s6$at # new sibling wo$ld most li0ely hinde" toilet t"aining A' !oddle"s be%ome pi%0y eate"s& e-pe"ien%ing food Eags and eating la"ge amo$nts one day and /e"y little the ne-t # toddle"Ks food gags e-p"ess a p"efe"en%e fo" the "it$alism of eating one type of food fo" se/e"al days at a time !oddle"s typi%ally enEoy so%iali(ation and limiting othe"s at meal time !oddle"s p"efe" to feed themsel/es and th$s a"e too yo$ng to ha/e table manne"s # toddle"Ks appetite and need fo" %alo"ies& p"otein& and fl$id de%"ease d$e to the d"amati% slowing of g"owth "ate D' P"es%hoole"s %ommonly ha/e fea"s of the da"0& being left alone espe%ially at bedtime& and ghosts& whi%h may affe%t the %hildKs going to bed at night >$iet play and time with pa"ents is a positi/e bedtime "o$tine that p"o/ides se%$"ity and also "eadies the %hild fo" sleep !he %hild sho$ld sleep in his own bed !elling the %hild abo$t lo%0ing him in his "oom will /iewed by the %hild as a th"eat #dditionally& a lo%0ed doo" is f"ightening and potentially ha(a"do$s 7igo"o$s a%ti/ity at bedtime sti"s $p the %hild and ma0es mo"e diffi%$lt to fall asleep )' )"ess=$p %lothes enhan%e imaginati/e play and imagination& allowing p"es%hoole"s to engage in "i%h fantasy play @$ilding blo%0s and wooden p$((les a"e app"op"iate fo" en%o$"aging fine moto" de/elopment @ig wheels and t"i%y%les en%o$"age g"oss moto" de/elopment D' !he s%hool=aged %hild is in the stage of %on%"ete ope"ations& ma"0ed by ind$%ti/e "easoning& logi%al ope"ations& and "e/e"sible %on%"ete tho$ght !he ability to %onside" the f$t$"e "e6$i"es fo"mal tho$ght ope"ations& whi%h a"e not de/eloped $ntil adoles%en%e Colle%ting baseball %a"ds and ma"bles& o"de"ing dolls by si(e& and simple p"oblem=sol/ing options a"e e-amples of the %on%"ete ope"ational thin0ing of the s%hoolage" C' 1ea%tion fo"mation is the s%hoolage"Ks typi%al defensi/e "esponse when hospitali(ed In "ea%tion fo"mation& e-p"ession of $na%%eptable tho$ghts o" beha/io"s is p"e/ented Oo" o/e""iddenP by the e-agge"ated e-p"ession of opposite tho$ghts o" types of beha/io"s 1eg"ession is seen in toddle"s and p"esh%oole"s when they "et"eat o" "et$"n to an ea"lie" le/el of de/elopment 1ep"ession "efe"s to the in/ol$nta"y blo%0ing of $npleasant feelings and e-pe"ien%es f"om oneKs awa"eness 1ationali(ation is the attempt to ma0e e-%$ses to E$stify $na%%eptable feelings o" beha/io"s C' !he s%hoolage"Ks %ogniti/e le/el is s$ffi%iently de/eloped to enable good $nde"standing of and adhe"en%e to "$les !h$s& s%hoolage"s sho$ld be able to $nde"stand the potential dange"s a"o$nd them Hith g"owth %omes g"eate" f"eedom and %hild"en be%ome mo"e ad/ent$"o$s and da"ing !he s%hool=aged %hild is also still p"one to a%%idents and home ha(a"ds& espe%ially be%a$se of in%"eased moto" abilities and independen%e Pl$s the home ha(a"ds diffe" f"om othe" age g"o$ps !hese ha(a"ds& whi%h a"e potentially lethal b$t tempting& may in%l$de fi"ea"ms& al%ohol& and medi%ations S%hool=age %hild"en begin to inte"nali(e thei" own %ont"ols and need less o$tside di"e%tion Pl$s the %hild is away f"om home mo"e often Some pa"ental o" %a"egi/e" assistan%e is still needed to answe" 6$estions and p"o/ide g$idan%e fo" de%isions and "esponsibilities C' !he most signifi%ant s0ill lea"ned d$"ing the s%hool=age pe"iod is "eading )$"ing this time the %hild de/elops fo"mal ad$lt a"ti%$lation patte"ns and lea"ns that wo"ds %an be a""anged in st"$%t$"e Colle%ti/e& o"de"ing& and so"ting& altho$gh impo"tant& a"e not most signifi%ant s0ills lea"ned C' @ased on the "e%ommendations of the #me"i%an #%ademy of Family Physi%ians and the #me"i%an #%ademy of Pediat"i%s& the <<1 /a%%ine sho$ld be gi/en at the age of 10 if the %hild did not "e%ei/e it between the ages of . to 5 yea"s as "e%ommended Imm$ni(ation fo" diphthe"ia and tetan$s is "e6$i"ed at age 1+ D' #%%o"ding to ,"i0son& "ole diff$sion de/elops when the adoles%ent does not de/elop a sense of identity and a sense o" whe"e he fits in !oddle"s de/elop a sense of shame when they do not a%hie/e a$tonomy P"es%hoole"s de/elop a sense of g$ilt when they do not de/elop a sense of initiati/e S%hool=age %hild"en de/elop a sense of infe"io"ity when they do not de/elop a sense of ind$st"y A' <ena"%he "efe"s to the onset of the fi"st menst"$ation o" menst"$al pe"iod and "efe"s only to the fi"st %y%le Ute"ine g"owth and b"oadening of the pel/i% gi"dle o%%$"s befo"e mena"%he A' Stating that this is p"obably the only %on%e"n the adoles%ent has and telling the pa"ents not to wo""y abo$t it o" the time he" spends on it sh$ts off f$"the" in/estigation and is li0ely to ma0e the adoles%ent and his pa"ents feel defensi/e !he statement abo$t pee" a%%eptan%e and time spent in f"ont of the mi""o" fo" the de/elopment of self image p"o/ides info"mation abo$t the adoles%entKs needs to the pa"ents and may help to gain t"$st with the adoles%ent #s0ing the adoles%ent how he feels abo$t the a%ne will en%o$"age the adoles%ent to sha"e his feelings )is%$ssing the %leansing method shows inte"est and %on%e"n fo" the adoles%ent and also %an help to identify any patient=tea%hing needs fo" the adoles%ent "ega"ding %leansing )' P"es%hoole"s sho$ld be de/elopmentally in%apable of demonst"ating e-pli%it se-$al beha/io" If a %hild does so& the %hild has been e-posed to s$%h beha/io"& and se-$al ab$se sho$ld be s$spe%ted ,-pli%it se-$al beha/io" d$"ing doll play is not a %ha"a%te"isti% of p"es%hool de/elopment no" symptomati% of de/elopmental delay Hhethe" o" no" the %hild 0nows how to play with dolls is i""ele/ant

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 52

22 A' !he pa"ents need mo"e tea%hing if they state that they will 0eep the %hild home $ntil the phobia
s$bsides )oing so "einfo"%es the %hildKs feelings of wo"thlessness and dependen%y !he %hild sho$ld attend s%hool e/en d$"ing "esol$tion of the p"oblem #llowing the %hild to /e"bali(e helps the %hild to /entilate feelings and may help to $n%o/e" %a$ses and sol$tions Collabo"ation with the tea%he"s and %o$nselo"s at s%hool may lead to $n%o/e"ing the %a$se of the phobia and to the de/elopment of sol$tions !he %hild sho$ld pa"ti%ipate and play an a%ti/e "ole in de/eloping possible sol$tions C' !he adoles%ent who be%omes p"egnant typi%ally denies the p"egnan%y ea"ly on ,a"ly "e%ognition by a pa"ent o" health %a"e p"o/ide" may be %"$%ial to timely initiation of p"enatal %a"e !he in%iden%e of adoles%ent p"egnan%y has de%lined sin%e 1991& yet mo"bidity "emains high <ost teenage p"egnan%ies a"e $nplanned and o%%$" o$t of wedlo%0 !he p"egnant adoles%ent is at high "is0 fo" physi%al %ompli%ations in%l$ding p"emat$"e labo" and low=bi"th=weight infants& high neonatal mo"tality& i"on defi%ien%y anemia& p"olonged labo"& and fetopel/i% disp"opo"tion as well as n$me"o$s psy%hologi%al %"ises )' @e%a$se of the st"$%t$"al defe%t& %hild"en with %left palate may ha/e ineffe%ti/e f$n%tioning of thei" ,$sta%hian t$bes %"eating f"e6$ent bo$ts of otitis media <ost %hild"en with %left palate "emain well= no$"ished and maintain ade6$ate n$t"ition th"o$gh the $se of p"ope" feeding te%hni6$es Food pa"ti%les do not pass th"o$gh the %left and into the ,$sta%hian t$bes !he"e is no asso%iation between %left palate and %ongenial ea" defo"mities D' # +=month=old infant sho$ld be able to lift the head and %hest when p"one !he <o"o "efle- typi%ally diminishes o" s$bsides by + months !he pa"a%h$te "efle- appea"s at 9 months 1olling f"om f"ont to ba%0 $s$ally is a%%omplished at abo$t 2 months D' # %hildKs bi"th weight $s$ally t"iples by 12 months and do$bles by . months *o spe%ifi% bi"th weight pa"amete"s a"e established fo" 8 o" 9 months C' !oddle"s engaging in pa"allel play will play nea" ea%h othe"& b$t not with ea%h othe" !h$s& when two toddle"s sit nea" ea%h othe" b$t play with sepa"ate dolls& they a"e e-hibiting pa"allel play Sha"ing %"ayons& playing a boa"d game with a n$"se& o" sha"ing dolls with two diffe"ent n$"ses a"e all e-amples of %oope"ati/e play A' #%$te lympho%yti% le$0emia O#''P %a$ses le$0openia& "es$lting in imm$nos$pp"ession and in%"easing the "is0 of infe%tion& a leading %a$se of death in %hild"en with #'' !he"efo"e& the initial p"io"ity n$"sing inte"/ention wo$ld be to instit$te infe%tion %ont"ol p"e%a$tions to de%"ease the "is0 of infe%tion I"on="i%h foods help with anemia& b$t dieta"y i"on is not an initial inte"/ention !he p"ognosis of #'' $s$ally is good ?owe/e"& late" on& the n$"se may need to assist the %hild and family with %oping sin%e death and dying may still be an iss$e in need of dis%$ssion InEe%tions sho$ld be dis%o$"aged& owing to in%"eased "is0 f"om bleeding d$e to th"ombo%ytopenia A' !he pe"t$sis %omponent may "es$lt in fe/e" and the tetan$s %omponent may "es$lt in inEe%tion so"eness !he"efo"e& the mothe"Ks /e"bali(ation of info"mation abo$t meas$"es to "ed$%e fe/e" indi%ates $nde"standing *o dieta"y "est"i%tions a"e ne%essa"y afte" this inEe%tion is gi/en # s$bse6$ent "ash is mo"e li0ely to be seen 2 to 10 days afte" "e%ei/ing the <<1 /a%%ine& not the diphthe"ia& pe"t$ssis& and tetan$s /a%%ine )ia""hea is not asso%iated with this /a%%ine A' <$ltiple b"$ises and b$"ns on a toddle" a"e signs %hild ab$se !he"efo"e& the n$"se is "esponsible fo" "epo"ting the %ase to P"ote%ti/e Se"/i%es immediately to p"ote%t the %hild f"om f$"the" ha"m S%hed$ling a follow=$p /isit is inapp"op"iate be%a$se additional ha"m may %ome to the %hild if the n$"se waits fo" f$"the" assessment data #ltho$gh the n$"se sho$ld notify the physi%ian& the goal is to initiate meas$"es to p"ote%t the %hildKs safety *otifying the physi%ian immediately does not initiate the "emo/al of the %hild f"om ha"m no" does it absol/e the n$"se f"om "esponsibility <$ltiple b"$ises and b$"ns a"e not no"mal toddle" inE$"ies )' !he mothe" is $sing p"oEe%tion& the defense me%hanism $sed when a pe"son att"ib$tes his o" he" own $ndesi"able t"aits to anothe" )ispla%ement is the t"ansfe" of emotion onto an $n"elated obEe%t& s$%h as when the mothe" wo$ld 0i%0 a %hai" o" bang the doo" sh$t 1ep"ession is the s$bme"ging of painf$l ideas into the $n%ons%io$s Psy%hosis is a state of being o$t of to$%h with "eality A' Child"en with %ongenital hea"t disease a"e mo"e p"one to "espi"ato"y infe%tions @leeding tenden%ies& f"e6$ent /omiting& and dia""hea and sei($"e diso"de"s a"e not asso%iated with %ongenital hea"t disease D' !he %hild is e-hibiting %lassi% signs of epiglottitis& always a pediat"i% eme"gen%y !he physi%ian m$st be notified immediately and the n$"se m$st be p"epa"ed fo" an eme"gen%y int$bation o" t"a%heostomy F$"the" assessment with a$s%$ltating l$ngs and pla%ing the %hild in a mist tent wastes /al$able time !he sit$ation is a possible life=th"eatening eme"gen%y ?a/ing the %hild lie down wo$ld %a$se additional dist"ess and may "es$lt in "espi"ato"y a""est !h"oat e-amination may "es$lt in la"yngospasm that %o$ld be fatal A' In females& the $"eth"a is sho"te" than in males !his de%"eases the distan%e fo" o"ganisms to t"a/el& the"eby in%"easing the %han%e of the %hild de/eloping a $"ina"y t"a%t infe%tion F"e6$ent emptying of the bladde" wo$ld help to de%"ease $"ina"y t"a%t infe%tions by a/oiding sphin%te" st"ess In%"eased fl$id inta0e enables the bladde" to be %lea"ed mo"e f"e6$ently& th$s helping to p"e/ent $"ina"y t"a%t infe%tions !he inta0e of a%idi% E$i%es helps to 0eep the $"ine p? a%idi% and th$s de%"ease the %han%e of flo"a de/elopment

2+

2.

22 25 28

29

29

+0

+1

+2 ++

+.

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 55

+2 )' Compa"tment synd"ome is an eme"gent sit$ation and the physi%ian needs to be notified immediately so
that inte"/entions %an be initiated to "elie/e the in%"easing p"ess$"e and "esto"e %i"%$lation #%etaminophen O!ylenolP will be ineffe%ti/e sin%e the pain is "elated to the in%"easing p"ess$"e and tiss$e is%hemia !he %ast& not t"a%tion& is being $sed in this sit$ation fo" immobili(ation& so "eleasing the t"a%tion wo$ld be inapp"op"iate In this sit$ation& spe%ifi% a%tion not %ontin$ed monito"ing is indi%ated D' !he /a"i%ella (oste" /a%%ine O7J7P is a li/e /a%%ine gi/en afte" age 12 months !he fi"st dose of hepatitis @ /a%%ine is gi/en at bi"th to 2 months& then at 1 to . months& and then again at 5 to 19 months )taP is "o$tinely gi/en at 2& .& 5& and 12 to 19 months and a booste" at . to 5 yea"s C' @e%a$se the 9=month=old is "efining his g"oss moto" s0ills& being able to sit $ns$ppo"ted and also imp"o/ing his fine moto" s0ills& p"obably %apable of ma0ing hand=to=hand t"ansfe"s& la"ge blo%0s wo$ld be the most app"op"iate toy sele%tion P$sh=p$ll toys wo$ld be mo"e app"op"iate fo" the 10 to 12=month= old as he o" she begins to %"$ise the en/i"onment 1attles and mobiles a"e mo"e app"op"iate fo" infants in the 1 to + month age "ange <obiles pose a dange" to olde" infants be%a$se of possible st"ang$lation )' )$"ing the p"es%hool pe"iod& the %hild has maste"ed a sense of a$tonomy and goes on to maste" a sense of initiati/e )$"ing this pe"iod& the %hild %ommonly e-pe"ien%es mo"e fea"s than at any othe" time One %ommon fea" is fea" of the body m$tilation& espe%ially asso%iated with painf$l e-pe"ien%es !he p"es%hool %hild $ses simple& not %omple-& "easoning& engages in asso%iati/e& not %ompetiti/e& play Ointe"a%ti/e and %oope"ati/e play with sha"ingP& and is able to tole"ate longe" pe"iods of delayed g"atifi%ation A' <ild mental "eta"dation "efe"s to de/elopment disability in/ol/ing an I> 20 to 80 !ypi%ally& the %hild is not noted as being "eta"ded& b$t e-hibits slowness in pe"fo"ming tas0s& s$%h as self=feeding& wal0ing& and ta0ing 'ittle o" no spee%h& ma"0ed moto" delays& and gait disabilities wo$ld be seen in mo"e se/e"e fo"ms mental "eta"dation ) )own synd"ome is %ha"a%te"i(ed by the following a t"ans/e"se palma" %"ease Osimian %"easeP& sepa"ated sagittal s$t$"e& obli6$e palpeb"al fiss$"es& small nose& dep"essed nasal b"idge& high=a"%hed palate& e-%ess and la- s0in& wide spa%ing and planta" %"ease between the se%ond and big toes& hype"e-tensible and la- Eoints& la"ge p"ot"$ding tong$e& and m$s%le wea0ness A' @e%a$se of the defe%t& the %hild will be $nable to f"om the mo$th ade6$ately a"o$nd nipple& the"eby "e6$i"ing spe%ial de/i%es to allow fo" feeding and s$%0ing g"atifi%ation 1espi"ato"y stat$s may be %omp"omised if the %hild is fed imp"ope"ly o" d$"ing postope"ati/e pe"iod& 'o%omotion wo$ld be a p"oblem fo" the olde" infant be%a$se of the $se of "est"aints DI f$n%tioning is not %omp"omised in the %hild with a %left lip )' Postope"ati/ely %hild"en with %left palate sho$ld be pla%ed on thei" abdomens to fa%ilitate d"ainage If the %hild is pla%ed in the s$pine position& he o" she may aspi"ate Using an infant seat does not fa%ilitate d"ainage Side=lying does not fa%ilitate d"ainage as well as the p"one position C' P"oEe%tile /omiting is a 0ey symptom of pylo"i% stenosis 1eg$"gitation is seen mo"e %ommonly with D,1 Steato""hea o%%$"s in malabso"ption diso"de"s s$%h as %elia% disease SC$""ant EellyT stools a"e %ha"a%te"isti% of int$ss$s%eption D' D,1 is the ba%0flow of gast"i% %ontents into the esophag$s "es$lting f"om "ela-ation o" in%ompeten%e of the lowe" esophageal O%a"dia%P sphin%te" *o alte"ation in the o"al m$%o$s memb"anes o%%$"s with this diso"de" Fl$id /ol$me defi%it& "is0 fo" aspi"ation& and alte"ed n$t"ition a"e app"op"iate n$"sing diagnoses A' !hi%0ened feedings a"e $sed with D,1 to stop the /omiting !he"efo"e& the n$"se wo$ld monito" the %hildKs /omiting to e/al$ate the effe%ti/eness of $sing the thi%0ened feedings *o "elationship e-ists between feedings and %ha"a%te"isti%s of stools and $te"ine If feedings a"e ineffe%ti/e& this sho$ld be noted befo"e the"e is any %hange in the %hildKs weight C' Child"en with %elia% disease %annot tole"ate o" digest gl$ten !he"efo"e& be%a$se of its gl$ten %ontent& wheat and wheat=%ontaining p"od$%ts m$st be a/oided 1i%e& mil0& and %hi%0en do not %ontain gl$ten and need not be a/oided C' ,pisodes of %elia% %"ises a"e p"e%ipitated by infe%tions& ingestion of gl$ten& p"olonged fasting& o" e-pos$"e to anti%holine"gi% d"$gs Celia% %"isis is typi%ally %ha"a%te"i(ed by se/e"e wate"y dia""hea 1espi"ato"y dist"ess is $nli0ely in a "o$tine $ppe" "espi"ato"y infe%tion I""itability& "athe" than letha"gy& is mo"e li0ely @e%a$se of the fl$id loss asso%iated with the se/e"e wate"y dia""hea& the %hildKs weight is mo"e li0ely to be de%"eased A' Fo" the %hild with ?i"s%hsp"$ng disease& fe/e" and e-plosi/e dia""hea indi%ate ente"o%olitis& a life= th"eatening sit$ation !he"efo"e& the physi%ian sho$ld be notified immediately Dene"ally& be%a$se of the intestinal obst"$%tion and inade6$ate p"op$lsi/e intestinal mo/ement& antidia""heals a"e not $sed to t"eat ?i"s%hsp"$ng disease !he %hild is a%$tely ill and "e6$i"es inte"/ention& with monito"ing mo"e f"e6$ently than e/e"y +0 min$tes ?i"s%hsp"$ng disease typi%ally p"esents with %h"oni% %onstipation A Fail$"e to pass me%oni$m within the fi"st 2. ho$"s afte" bi"th may be an indi%ation of ?i"s%hsp"$ng disease& a %ongenital anomaly "es$lting in me%hani%al obst"$%tion d$e to inade6$ate motility in an intestinal segment Fail$"e to pass me%oni$m is not asso%iated with %elia% disease& int$ss$s%eption& o" abdominal wall defe%t C @e%a$se int$ss$s%eption is not belie/ed to ha/e a familial tenden%y& obtaining a family histo"y wo$ld p"o/ide the least amo$nt of info"mation Stool inspe%tion& pain patte"n& and abdominal palpation wo$ld "e/eal possible indi%ato"s of int$ss$s%eption C$""ent& Eelly=li0e stools %ontaining blood and m$%$s a"e an

+5 +8

+9

+9

.0

.1

.2 .+ .. .2

.5 .8

.9

.9

20

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 58

indi%ation of int$ss$s%eption #%$te& episodi% abdominal pain is %ha"a%te"isti%s of int$ss$s%eption # sa$sage=shaped mass may be palpated in the "ight $ppe" 6$ad"ant

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COMMUNIT( HEALTH NURSING Part 1 SI!U#!IO* : ,pidemiology and 7ital statisti%s is a /e"y impo"tant tool that a n$"se %o$ld $se in %ont"olling the sp"ead of disease in the %omm$nity and at the same time& s$"/eying the impa%t of the disease on the pop$lation and p"e/ent itKs f$t$"e o%%$""en%e 1 It is %on%e"ned with the st$dy of fa%to"s that infl$en%e the o%%$""en%e and dist"ib$tion of diseases& defe%ts& disability o" death whi%h o%%$"s in g"o$ps o" agg"egation of indi/id$als A' E*i%!6i#+#1 @ )emog"aphi%s C 7ital Statisti%s ) ?ealth Statisti%s 2 Hhi%h of the following is the ba%0bone in disease p"e/entionQ A' E*i%!6i#+#1 @ )emog"aphi%s C 7ital Statisti%s ) ?ealth Statisti%s + Hhi%h of the following type of "esea"%h %o$ld show how %omm$nity e-pe%tations %an "es$lt in the a%t$al p"o/ision of se"/i%esQ # @asi% 1esea"%h )' O*!rati#$a+ R!s!ar"/ C #%tion 1esea"%h ) #pplied 1esea"%h . #n o$tb"ea0 of measles has been "epo"ted in Comm$nity # #s a n$"se& whi%h of the following is yo$" fi"st a%tion fo" an ,pidemiologi%al in/estigationQ # Classify if the o$tb"ea0 of measles is epidemi% o" E$st spo"adi% @ 1epo"t the in%iden%e into the 1?U C )ete"mine the fi"st day when the o$tb"ea0 o%%$""ed D' I%!$ti, i, it is t/! %is!as! -/i"/ it is r!*#rt!% t# 7! 2 #fte" the epidemiologi%al in/estigation p"od$%ed final %on%l$sions& whi%h of the following is yo$" initial step in yo$" ope"ational p"o%ed$"e d$"ing disease o$tb"ea0Q A' C##r%i$at! *!rs#$$!+ ,r#6 M0$i"i*a+ t# t/! Nati#$a+ +!8!+ @ Colle%t pe"tinent labo"ato"y spe%imen to %onfi"m disease %a$sation C Imm$ni(e nea"by %omm$nities with <easles ) ,d$%ate the %omm$nity in f$t$"e p"e/ention of simila" o$tb"ea0s 5 !he main %on%e"n of a p$bli% health n$"se is the p"e/ention of disease& p"olonging of life and

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p"omoting physi%al health and effi%ien%y th"o$gh whi%h of the followingQ # Use of epidemiologi%al tools and /ital health statisti%s @ )ete"mine the sp"ead and o%%$""en%e of the disease C Politi%al empowe"ment and So%io ,%onomi% #ssistan%e D' Or1a$i9!% C#660$it E,,#rts 8 In o"de" to %ont"ol a disease effe%ti/ely& whi%h of the following m$st fi"st be 0nownQ 1 !he %onditions s$""o$nding its o%%$""en%e 2 Fa%to"s that do not fa/o" its de/elopment + !he %ondition that do not s$""o$nd its o%%$""en%e . Fa%to"s that fa/o"s its de/elopment # 1 and + )' 1 a$% 4 C 2 and + ) 2 and . 9 #ll of the following a"e $ses of epidemiology e-%ept: # !o st$dy the histo"y of health pop$lation and the "ise and fall of disease @ !o diagnose the health of the %omm$nity and the %ondition of the people C' T# *r#8i%! s066ar %ata #$ /!a+t/ s!r8i"! %!+i8!r ) !o identify g"o$ps needing spe%ial attention 9 @efo"e "epo"ting the fa%t of p"esen%e of an epidemi%& whi%h of the following is of most impo"tan%e to dete"mineQ A' Ar! t/! ,a"ts "#6*+!t!: @ Is the disease "ealQ C Is the disease tangibleQ ) Is it epidemi% o" endemi%Q 10 #n $n0nown epidemi% has E$st been "epo"ted in @a"angay )e0b$de0b$ People said that affe%ted pe"son demonst"ates hemo""hagi% type of fe/e" Ao$ a"e designated now to plan fo" epidemiologi%al in/estigation #""ange the se6$en%e of e/ents in a%%o"dan%e with the %o""e%t o$tline plan fo" epidemiologi%al in/estigation 1 1epo"t the p"esen%e of deng$e 2 S$mma"i(e data and %on%l$de the final pi%t$"e of epidemi% + 1elate the o%%$""en%e to the pop$lation g"o$p& fa%ilities& food s$pply and %a""ie"s . )ete"mine if the disease is fa%t$al o" "eal 2 )ete"mine any $n$s$al p"e/alen%e of the disease and its nat$"eW is it epidemi%& spo"adi%& endemi% o" pandemi%Q 5 )ete"mine onset and the geog"aphi%al limitation of the disease

# .&1&+&2&2&5 )' 4,1,5,;,3,2 C 2&.&5&2&1&+ ) 2&.&5&1&2&+ , 1&2&+&.&2&5 11 In the o%%$""en%e of S#1S and othe" pandemi%s& whi%h of the following is the most /ital "ole of a n$"se in epidemiologyQ # ?ealth p"omotion @ )isease p"e/ention C' S0r8!i++a$"! ) Casefinding 12 <easles o$tb"ea0 has been "epo"ted in @a"angay @ahay !o"o& #fte" %ond$%ting an epidemiologi%al in/estigation yo$ ha/e %onfi"med that the o$tb"ea0 is fa%t$al Ao$ a"e tas0ed to lead a team of medi%al wo"0e"s fo" ope"ational p"o%ed$"e in disease o$tb"ea0 #""ange the %o""e%t se6$en%e of e/ents that yo$ m$st do to effe%ti/ely %ontain the disease 1 C"eate a final "epo"t and "e%ommendation 2 Pe"fo"m nasopha"yngeal swabbing to infe%ted indi/id$als + Pe"fo"m mass measles imm$ni(ation to /$lne"able g"o$ps . Pe"fo"m an en/i"onmental sanitation s$"/ey on the immediate en/i"onment 2 O"gani(e yo$" team and Coo"dinate the pe"sonnels 5 ,d$%ate the %omm$nity on disease t"ansmission # 1&2&+&.&2&5 @ 5&2&.&+&2&1 C 2&5&.&2&+&1 D' 5,2,3,4,;,1 1+ #ll of the following a"e f$n%tion of *$"se @$de0 in epidemiology e-%ept A' La7#rat#r Dia1$#sis @ S$"/eillan%e of disease o%%$""en%e C Follow $p %ases and %onta%ts ) 1efe" %ases to hospitals if ne%essa"y , Isolate %ases of %omm$ni%able disease 1. #ll of the following a"e pe"fo"med in team o"gani(ation e-%ept # O"ientation and demonst"ation of methodology to be employed @ #"ea assignments of team membe"s C Che%0 teamKs e6$ipments and pa"aphe"nalia D' A"ti8! "as! ,i$%i$1 a$% S0r8!i++a$"! 12 Hhi%h of the following is the final o$tp$t of data "epo"ting in epidemiologi%al ope"ational p"o%ed$"eQ A' R!"#66!$%ati#$

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@ ,/al$ation C Final 1epo"t ) P"elimina"y "epo"t 15 !he offi%e in %ha"ge with "egiste"ing /ital fa%ts in the Philippines is none othe" than the # PCSO @ P#DCO1 C )O? D' NSO 18 !he following a"e possible so$"%es of )ata e-%ept: A' E<*!ri!$"! @ Cens$s C S$"/eys ) 1esea"%h 19 !his "efe"s to systemati% st$dy of /ital e/ents s$%h as bi"ths& illnesses& ma""iages& di/o"%es and deaths # ,pidemiology @ )emog"aphi%s C' Vita+ Statisti"s ) ?ealth Statisti%s 19 In %ase of %le"i%al e""o"s in yo$" bi"th %e"tifi%ate& Hhe"e sho$ld yo$ go to ha/e it %o""e%tedQ # *SO @ Co$"t of #ppeals C <$ni%ipal !"ial Co$"t D' L#"a+ Ci8i+ R!1istrar 20 #%asia E$st ga/e bi"th to 'estat& # healthy baby boy Hho a"e going to "epo"t the bi"th of @aby 'estatQ # *$"se @ <idwife C O@ Dyne D' )irt/ Att!$%a$t 21 In "epo"ting the bi"th of @aby 'estat& whe"e will he be "egiste"edQ A' At t/! L#"a+ Ci8i+ R!1istrar @ In the *ational Statisti%s Offi%e C In the City ?ealth )epa"tment ) In the Field ?ealth Se"/i%es and Info"mation System <ain Offi%e 22 )eeEay& !he bi"th attendant noti%ed that 'estat has low set of ea"s& <i%"ognathia& <i%"o%ephaly and a typi%al %at li0e %"y Hhat sho$ld )eeEay doQ # @"ing 'estat immediately to the nea"est hospital @ #s0 his assistant to %all the nea"by pediat"i%ian

C @"ing 'estat to the nea"est pediat"i% %lini% D' Ca++ a Ta<i a$% t#1!t/!r -it/ A"asia, )ri$1 L!stat t# t/! $!ar!st /#s*ita+ 2+ )eeEay wo$ld s$spe%t whi%h diso"de"Q # !"isomy 21 @ !$"ne"s Synd"ome C' Cri D0 C/at ) :linefelte"s Synd"ome 2. )eeEay %o$ld e-pe%t whi%h of the following %ongenital anomaly that wo$ld a%%ompany this diso"de"Q A' AVSD @ P)# C !OF ) !OD7 25 Hhi%h p"esidential de%"ee o"de"s "epo"ting of bi"ths within +0 days afte" its o%%$""en%eQ A' ;51 @ 2.1 C 995 ) 922 22 !hese "ates a"e "efe""ed to the total li/ing pop$lation& It m$st be p"es$med that the total pop$lation was e-posed to the "is0 of o%%$""en%e of the e/ent # 1ate @ 1atio C' Cr0%!=G!$!ra+ Rat!s ) Spe%ifi% 1ate 25 !hese a"e $sed to des%"ibe the "elationship between two n$me"i%al 6$antities o" meas$"es of e/ents witho$t ta0ing pa"ti%$la" %onside"ations to the time o" pla%e # 1ate )' Rati#s C C"$deGDene"al 1ate ) Spe%ifi% 1ate 28 !his is the most sensiti/e inde- in dete"mining the gene"al health %ondition of a %omm$nity sin%e it "efle%ts the %hanges in the en/i"onment and medi%al %onditions of a %omm$nity # C"$de death "ate )' I$,a$t 6#rta+it rat! C <ate"nal mo"tality "ate ) Fetal death "ate 29 #%%o"ding to the H?O& whi%h of the following is the most f"e6$ent %a$se of death in %hild"en $nde"fi/e wo"ldwide in the 200+ H?O S$"/eyQ A' N!#$ata+

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@ Pne$monia C )ia""hea ) ?I7G#I)S 29 In the Philippines& what is the most %ommon %a$se of death of infants a%%o"ding to the latest s$"/eyQ # Pne$monia @ )ia""hea C' Ot/!r *!ri$ata+ "#$%iti#$ ) 1espi"ato"y %ondition of fet$s and newbo"n +0 !he maEo" %a$se of mo"tality f"om 1999 $p to 2002 in the Philippines a"e A' Dis!as!s #, t/! /!art @ )iseases of the /as%$la" system C Pne$monias ) !$be"%$losis +1 #li%ia& a 9 yea" old %hild as0ed yo$ S Hhat is the %ommon %a$se of death in my age g"o$p he"e in the PhilippinesQ S !he n$"se is %o""e%t if he will answe" # Pne$monia is the top leading %a$se of death in %hild"en age 2 to 9 @ <alignant neoplasm if %ommon in yo$" age g"o$p C' Pr#7a7i+it -is!, (#0 6i1/t %i! %0! t# a""i%!$ts ) )iseases of the "espi"ato"y system is the most %ommon %a$se of death in %hild"en +2 In %hild"en 1 to . yea"s old& whi%h is the most %ommon %a$se of deathQ # )ia""hea @ #%%idents C' P$!06#$ia ) )iseases of the hea"t ++ Ho"0ing in the %omm$nity as a P?* fo" almost 10 yea"s& #ida 0new the fl$%t$ation in /ital statisti%s She 0new that the most %ommon %a$se of mo"bidity among the Filipinos is # )iseases of the hea"t @ )ia""hea C' P$!06#$ia ) 7as%$la" system diseases +. *$"se #ida also 0new that most mate"nal deaths a"e %a$sed by # ?emo""hage )' Ot/!r C#6*+i"ati#$s r!+at!% t# *r!1$a$" #""0rri$1 i$ t/! "#0rs! #, +a7#r, %!+i8!r a$% *0!r*!ri06 C ?ype"tension %ompli%ating p"egnan%y& %hildbi"th and p$e"pe"i$m ) #bo"tion SI!U#!IO* : @a"angay Pinoy@S* has the

following data in yea" 2005 1 B$ly 1 pop$lation : 22.&+15 2 'i/ebi"ths : 2&299 + )eaths f"om mate"nal %a$se : 12 . )eath f"om C7) : +&029 2 )eaths $nde" 1 yea" of age : 2+ 5 Fetal deaths : 9 8 )eaths $nde" 29 days : 9 9 )eath d$e to "abies : .2 9 1egiste"ed %ases of "abies : .2 10 People with pne$monia : 89 11 People e-posed with pne$monia : 2&29+ 12 !otal n$mbe" of deaths f"om all %a$ses : 10&999 !he following 6$estions "efe" to these data +2 Hhat is the %"$de bi"th "ate of @a"angay Pinoy@S*Q # 90G100&000 @ 9G100 C 90G1000 D' >=1??? +5 Hhat is the %a$se spe%ifi% death "ate f"om %a"dio/as%$la" diseasesQ # 28G100 )' 11>1=1??,??? C 28G100&000 ) 1 1G1000 +8 Hhat is the <ate"nal <o"tality "ate of this ba"angayQ A' ;'55=1??? @ 2 99G1000 C 1 +5G1000 ) + 58G1000 +9 Hhat is the fetal death "ateQ A' 3'4>=1??? @ 10 0.G1000 C + 1.G1000 ) + 1.G100&000 +9 Hhat is the atta%0 "ate of pne$moniaQ # + 0.G1000 @ 8 19G1000 C +2 92G100 D' 3'?4=1?? .0 )ete"mine the Case fatality "atio of "abies in this @a"angay # 1G100 )' 1??@ C 1V ) 100G1000 .1 !he following a"e all f$n%tions of the n$"se

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in /ital statisti%s& whi%h of the following is notQ A' C#$s#+i%at! Data @ Colle%ts )ata C #naly(e )ata ) !ab$late )ata .2 !he following a"e *otifiable diseases that needs to ha/e a tally sheet in data "epo"ting& Hhi%h one is notQ # ?ype"tension @ @"on%hiolitis C Chemi%al Poisoning D' A""i%!$ts .+ Hhi%h of the following "e6$i"es "epo"ting within 2. ho$"sQ # *eonatal tetan$s )' M!as+!s C ?ype"tension ) !etan$s .. Hhi%h #%t de%la"ed that all %omm$ni%able disease be "epo"ted to the nea"est health stationQ # 1092 @ 1991 C' 35A3 ) 5582 .2 In the 1?U !eam& Hhi%h p"ofessional is di"e%tly "esponsible in %a"ing a si%0 pe"son who is homebo$ndQ A' Mi%-i,! @ *$"se C @?H ) Physi%ian .5 )$"ing epidemi%s& whi%h of the following epidemiologi%al f$n%tion will yo$ ha/e to pe"fo"m fi"stQ # !ea%hing the %omm$nity on disease p"e/ention @ #ssessment on s$spe%ted %ases C <onito" the %ondition of people affe%ted D' D!t!r6i$i$1 t/! s#0r"! a$% $at0r! #, t/! !*i%!6i" .8 Hhi%h of the following is a POI*! SOU1C, epidemi%Q # )eng$e ? F @ <ala"ia C' C#$ta6i$at!% 5at!r S#0r"! ) !$be"%$losis .9 #ll b$t one is a %ha"a%te"isti% of a point so$"%e epidemi%& whi%h one is notQ # !he sp"ead of the disease is %a$sed by a %ommon /ehi%le

@ !he disease is $s$ally %a$sed by %ontaminated food C' T/!r! is a 1ra%0a+ i$"r!as! #, "as!s ) ,pidemi% is $s$ally s$dden .9 !he only <i%"oo"ganism monito"ed in %ases of %ontaminated wate" is # 7ib"io Chole"a )' Es"/!ri"/ia C#+i C ,ntamoeba ?istolyti%a ) Colifo"m !est 20 )eng$e in%"ease in n$mbe" d$"ing B$ne& B$ly and #$g$st !his patte"n is %alled # ,pidemi% @ ,ndemi% C' C "+i"a+ ) Se%$la" SI!U#!IO* : Field health se"/i%es and info"mation system p"o/ides s$mma"y data on health se"/i%e deli/e"y and sele%ted p"og"am f"om the ba"angay le/el $p to the national le/el #s a n$"se& yo$ sho$ld 0now the p"o%ess on how these info"mation be%ame p"o%essed and %onsolidated 21 #ll of the following a"e obEe%ti/es of F?SIS ,-%ept A' T# "#6*+!t! t/! "+i$i"a+ *i"t0r! #, "/r#$i" %is!as! a$% %!s"ri7! t/!ir $at0ra+ /ist#r @ !o p"o/ide standa"di(ed& fa%ility le/el data base whi%h %an be a%%essed fo" mo"e in depth st$dies C !o minimi(e "e%o"ding and "epo"ting b$"den allowing mo"e time fo" patient %a"e and p"omoti/e a%ti/ities ) !o ens$"e that data "epo"ted a"e $sef$l and a%%$"ate and a"e disseminated in a timely and easy to $se fashion 22 Hhat is the f$ndamental blo%0 o" fo$ndation of the field health se"/i%e info"mation systemQ A' Fa6i+ tr!at6!$t r!"#r% @ !a"get Client list C 1epo"ting fo"ms ) O$tp$t "e%o"d 2+ Hhat is the p"ima"y ad/antage of ha/ing a ta"get %lient listQ A' N0rs!s $!!% $#t t# 1# 7a"B t# FTR t# 6#$it#r tr!at6!$t a$% s!r8i"!s t# 7!$!,i"iari!s t/0s sa8i$1 ti6! a$% !,,#rt @ ?elp monito" se"/i%e "ende"ed to %lients in gene"al C Fa%ilitate monito"ing and s$pe"/ision of se"/i%es ) Fa%ilitates easie" "epo"ting 2. Hhi%h of the following is $sed to monito"

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pa"ti%$la" g"o$ps that a"e 6$alified as eligible to a %e"tain p"og"am of the )O?Q # Family t"eatment "e%o"d )' Tar1!t C+i!$t +ist C 1epo"ting fo"ms ) O$tp$t "e%o"d 22 In $sing the tally sheet& what is the "e%ommended f"e6$en%y in tallying a%ti/ities and se"/i%esQ A' Dai+ @ Hee0ly C <onthly ) >$a"te"ly 25 Hhen is the %o$nting of the tally sheet doneQ # #t the end of the day @ #t the end of the wee0 C' At t/! !$% #, t/! 6#$t/ ) #t the end of the yea" 28 !a"get %lient list will be t"ansmitted to the ne-t fa%ility in the fo"m of # Family t"eatment "e%o"d @ !a"get Client list C' R!*#rti$1 ,#r6s ) O$tp$t "e%o"d 29 #ll b$t one of the following a"e eligible ta"get %lient list # 'ep"osy %ases @ !@ %ases C P"enatal %a"e D' Diarr/!a "as!s 29 !his is the only me%hanism th"o$gh whi%h data a"e "o$tinely t"ansmitted f"om on%e fa%ility to anothe" # Family t"eatment "e%o"d @ !a"get Client list C' R!*#rti$1 ,#r6s ) O$tp$t "e%o"d 50 F?SISG>=+ O" the "epo"t fo" en/i"onmental health a%ti/ities is p"epa"ed how f"e6$entlyQ # )aily @ Hee0ly C' C0art!r+ ) Aea"ly 51 *$"se @$de0 is p"epa"ing the "epo"ting fo"m fo" wee0ly notifiable diseases ?e 0new that he will %ode the "epo"t fo"m as # F?SISG,=1 @ F?SISG,=2 C F?SISG,=+ D' FHSIS=MD1

52 In p"epa"ing the mate"nal death "epo"t& whi%h of the following %o""e%tly %odes this o%%$""en%eQ # F?SISG,=1 )' FHSIS=ED2 C F?SISG,=+ ) F?SISG<=1 5+ Hhe"e sho$ld *$"se @$de0 b"ing the "epo"ting fo"ms if he is in the @?U Fa%ilityQ # 1$"al health offi%e @ F?SIS <ain offi%e C' Pr#8i$"ia+ /!a+t/ #,,i"! ) 1egional health offi%e 5. #fte" b"inging the "epo"ting fo"ms in the "ight fa%ility fo" p"o%essing& *$"se @$de0 0new that the o$tp$t "epo"ts a"e solely p"od$%ed by what offi%eQ # 1$"al health offi%e @ F?SIS <ain offi%e C' Pr#8i$"ia+ /!a+t/ #,,i"! ) 1egional health offi%e 52 <ang 1a$l ente"ed the health %ente" %omplaining of fatig$e and f"e6$ent syn%ope Ao$ assessed <ang 1a$l and fo$nd o$t that he is se/e"ely malno$"ished and anemi% Hhat "e%o"d sho$ld yo$ get fi"st to do%$ment these findingsQ A' Fa6i+ tr!at6!$t r!"#r% @ !a"get Client list C 1epo"ting fo"ms ) O$tp$t "e%o"d 55 !he info"mation abo$t <ang 1a$lKs add"ess& f$ll name& age& symptoms and diagnosis is "e%o"ded in A' Fa6i+ tr!at6!$t r!"#r% @ !a"get Client list C 1epo"ting fo"ms ) O$tp$t "e%o"d 58 #nothe" ent"y is to be made fo" <ang 1a$l be%a$se he is in the ta"get %lientKs list& In what !C' sho$ld <ang 1a$lKs ent"y be do%$mentedQ # !C' ,ligible Pop$lation @ !C' Family Planning C' TCL N0triti#$ ) !C' P"e *atal 59 !he n$"se $ses the F?SIS 1e%o"d system in%o""e%tly when she fo$nd o$t that # She go to the indi/id$al o" F!1 fo" ent"y %onfi"mation in the !allyG1epo"t S$mma"y )' S/! r!,!r t# #t/!r s#0r"!s ,#r "#6*+!ti$1 6#$t/+ a$% 40art!r+ r!*#rts C She "e%o"ds dia""hea in the !ally sheetG1epo"t

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fo"m with a %ode F?SISG<=1 ) She "e%o"ds a Child who ha/e f"e6$ent dia""hea in !C' : Unde" Fi/e 59 !he @?S Is the lowest le/el of "epo"ting $nit in F?SIS # @?S %an be %onside"ed a "epo"ting $nit if all of the following a"e met e-%ept # It "ende"s se"/i%e to + ba"angays @ !he"e is a midwife the "eg$la"ly "ende"s se"/i%e to the a"ea C !he @?S ?a/e no mothe" @?S D' It s/#0+% 7! a sat!++it! )HS 80 )ata s$bmitted to the P?O is p"o%essed $sing what type of te%hnologyQ # Inte"net )' Mi"r#"#6*0t!r C S$pe"%omp$te" ) Se"/e" Inte"lin0 Conne%tions SI!U#!IO* : Comm$nity o"gani(ing is a p"o%ess by whi%h people& health se"/i%es and agen%ies of the %omm$nity a"e b"o$ght togethe" to a%t and sol/e thei" own p"oblems 81 <ang #mbo app"oa%hes yo$ fo" %o$nseling Ao$ a"e an effe%ti/e %o$nselo" if yo$ # Di/e good ad/i%e to <ang #mbo @ Identify <ang #mboKs p"oblems C Con/in%e <ang #mbo to follow yo$" ad/i%e D' H!+* Ma$1 A67# i%!$ti, /is *r#7+!6s 82 #s a newly appointed P?* inst"$%ted to o"gani(e @a"angay @a"itan& Hhi%h of the following is yo$" initial step in o"gani(ing the %omm$nity fo" initial a%tionQ A' St0% t/! )ara$1a H!a+t/ statisti"s a$% r!"#r%s @ <a0e a %o$"tesy %all to the @a"angay Captain C <eet with the @a"angay Captain to ma0e plans ) <a0e a %o$"tesy %all to the <$ni%ipal <ayo" 8+ P"epa"ato"y phase is the fi"st phase in o"gani(ing the %omm$nity Hhi%h of the following is the initial step in the p"epa"ato"y phaseQ A' Ar!a s!+!"ti#$ @ Comm$nity p"ofiling C ,nt"y in the %omm$nity ) Integ"ation with the people 8. the most impo"tant fa%to" in dete"mining the p"ope" a"ea fo" %omm$nity o"gani(ing is that this a"ea sho$ld # @e al"eady adopted by anothe" o"gani(ation @ @e able to finan%e the p"oEe%ts C' Ha8! *r#7+!6s a$% $!!%s assista$"! ) ?a/e people with e-pe"tise to be de/eloped

as leade"s 82 Hhi%h of the following dwelling pla%e sho$ld the *$"se %hoose when integ"ating with the peopleQ # # simple ho$se in the bo"de" of @a"angay @a"itan and San Pablo @ # simple ho$se with fen%ing and gate lo%ated in the %ente" of @a"angay @a"itan C # modest dwelling pla%e whe"e people will not hesitate to ente" D' A 6#%!st %-!++i$1 *+a"! -/!r! *!#*+! -i++ $#t /!sitat! t# !$t!r +#"at!% i$ t/! "!$t!r #, t/! "#660$it 85 In %hoosing a leade" in the %omm$nity d$"ing the O"gani(ational phase& Hhi%h among these people will yo$ %hooseQ # <ig$el Jobel& 20 yea"s old& 1i%h and Famo$s @ 1$stom& 28 yea"s old& #%to" C <ang #mbo& 80& Hilling to wo"0 fo" the desi"ed %hange D' Ri"B , 3? !ars #+%, I$,+0!$tia+ a$% 5i++i$1 t# -#rB ,#r t/! %!sir!% "/a$1! 88 Hhi%h type of leade"ship style sho$ld the leade"s of the %omm$nity p"a%ti%eQ # #$to%"ati% )' D!6#"rati" C 'aisse( Fai"e ) Cons$ltati/e 89 Setting $p Committee on ,d$%ation and !"aining is in what phase of COP#1Q # P"epa"ato"y )' Or1a$i9ati#$a+ C ,d$%ation and !"aining ) Inte"se%to"al Collabo"ation , Phase o$t 89 Comm$nity diagnosis is done to %ome $p with a p"ofile of lo%al health sit$ation that will se"/e as basis of health p"og"ams and se"/i%es !his is done in what phase of COP#1Q # P"epa"ato"y @ O"gani(ational C' E%0"ati#$ a$% Trai$i$1 ) Inte"se%to"al Collabo"ation , Phase o$t 90 !he people named the %omm$nity health wo"0e"s based on the %olle%ti/e de%ision in a%%o"dan%e with the set %"ite"ia @efo"e they %an be t"ained by the *$"se& !he *$"se m$st fi"st # <a0e a lesson plan @ Set lea"ning goals and obEe%ti/e C' Ass!ss t/!ir +!ar$i$1 $!!%s ) 1e/iew mate"ials needed fo" t"aining

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91 *$"se @$de0 w"ote a lette" to PCSO as0ing them fo" assistan%e in thei" feeding p"og"ams fo" the %omm$nityKs n$t"ition and health p"oEe%ts PCSO then app"o/ed the "e6$est and ga/e @$de0 20&000 Pesos and a t"$%0load of "i%e& f"$its and /egetables Hhi%h phase of COP#1 did @$de0 $tili(edQ # P"epa"ato"y @ O"gani(ational C ,d$%ation and !"aining D' I$t!rs!"t#ra+ C#++a7#rati#$ , Phase o$t 92 Ideally& ?ow many yea"s sho$ld the *$"se stay in the %omm$nity befo"e he %an phase o$t and be ass$"ed of a Self 1eliant %omm$nityQ A' 5 !ars @ 10 yea"s C 1 yea" ) 5 months 9+ <aEo" dis%$ssion in %omm$nity o"gani(ation a"e made by # !he n$"se @ !he leade"s of ea%h %ommittee C' T/! !$tir! 1r#0* ) Collabo"ating #gen%ies 9. !he n$"se sho$ld 0now that O"gani(ational plan best s$%%eeds when 1 2 + . People sees its /al$es People thin0 its antagonisti% p"ofessionally It is in%ompatible with thei" pe"sonal beliefs It is %ompatible with thei" pe"sonal beliefs

C D"o$nd Ho"0 ) <obili(ation 98 !he #%t$al e-e"%ise of people powe" o%%$"s d$"ing whenQ # Integ"ation @ So%ial <obili(ation C D"o$nd Ho"0 D' M#7i+i9ati#$ 99 Hhi%h steps in COP#1 t"ains indigeno$s and info"mal leade"sQ # D"o$nd Ho"0 @ <obili(ation C' C#r! Gr#0* ,#r6ati#$ ) Integ"ation 99 #s a P?*& One of yo$" "ole is to o"gani(e the %omm$nity *$"se @$de0 0nows that the p$"poses of %omm$nity o"gani(ing a"e 1 <o/e the %omm$nity to a%t on thei" own p"oblems 2 <a0e people awa"e of thei" own p"oblems + ,nable the n$"se to sol/e the %omm$nity p"oblems . Offe" people means of sol/ing thei" own p"oblems
# 1&2&+ @ 1&2&+&. C 1&2 D' 1,2,4 90 !his is %onside"ed the fi"st a%t of integ"ating with the people !his gi/es an in depth pa"ti%ipation in %omm$nity health p"oblems and needs A' R!si%i$1 i$ t/! ar!a #, assi1$6!$t @ 'isting down the name of pe"son to %onta%t fo" %o$"tesy %all C Dathe"ing initial info"mation abo$t the %omm$nity ) P"epa"ing #genda fo" the fi"st meeting SI!U#!IO* : ?ealth ed$%ation is the p"o%ess whe"eby 0nowledge& attit$de and p"a%ti%e of people a"e %hanged to imp"o/e indi/id$al& family and %omm$nity health 91 Hhi%h of the following is the %o""e%t se6$en%e in health ed$%ationQ 1 Info"mation 2 Comm$ni%ation + ,d$%ation A' 1,2,3 @ +&2&1 C 1&+&2 ) +&1&2 92 !he health stat$s of the people is g"eatly affe%ted and dete"mined by whi%h of the

# 1 and + @ 2 and . C 1 and 2 D' 1 a$% 4 92 *$"se @$de0 made a p"oposal that people sho$ld t$"n thei" ba%0ya"d into small fa"ming lots to plant /egetables and f"$its ?e spe%ified that the obEe%ti/e is to sa/e money in b$ying /egetables and f"$its that tend to ha/e a fl$%t$ating and %y%li%al p"i%e Hhi%h step in Comm$nity o"gani(ing p"o%ess did he $tili(edQ # Fa%t finding @ )ete"mination of needs C' Pr#1ra6 ,#r6ati#$ ) ,d$%ation and Inte"p"etation 95 One of the %"iti%al steps in COP#1 is be%oming one with the people and $nde"standing thei" %$lt$"e and lifestyle Hhi%h %"iti%al step in COP#1 will the *$"se t"y to imme"se himself in the %omm$nityQ A' I$t!1rati#$ @ So%ial <obili(ation

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followingQ # @eha/io"al fa%to"s )' S#"i#!"#$#6i" ,a"t#rs C Politi%al fa%to"s ) Psy%hologi%al fa%to"s 9+ *$"se @$de0 is %ond$%ting a health tea%hing to #gnesia& 20 yea" old b"east %an%e" s$"/i/o" needing "ehabilitati/e meas$"es ?e 0nows that health ed$%ation is effe%ti/e when # #gnesia "e%ites the p"o%ed$"e and inst"$%tions pe"fe%tly )' A1$!sia.s 7!/a8i#r a$% #0t+##B i$ +i,! -as "/a$1!% *#siti8!+ C #gnesia ga/e feedba%0 to @$de0 saying that she $nde"stood the inst"$%tion ) #gnesia "e6$ested a w"itten inst"$%tion f"om @$de0 9. Hhi%h of the following is t"$e abo$t health ed$%ationQ # It helps people attain thei" health th"o$gh the n$"seKs sole effo"ts @ It sho$ld not be fle-ible C It is a fast and m$sh"oom li0e p"o%ess D' It is a s+#- a$% "#$ti$0#0s *r#"!ss 92 Hhi%h of the following fa%to"s least infl$en%e the lea"ning "eadiness of an ad$lt lea"ne"Q A' T/! i$%i8i%0a+s sta1! #, %!8!+#*6!$t @ #bility to %on%ent"ate on info"mation to be lea"ned C !he indi/id$alKs psy%hoso%ial adaptation to his illness ) !he inte"nal imp$lses that d"i/e the pe"son to ta0e a%tion 95 Hhi%h of the following is the most impo"tant %ondition fo" diabeti% patients to lea"n how to %ont"ol thei" dietQ # Use of pamphlets and othe" mate"ials d$"ing

inst"$%tions )' M#ti8ati#$ t# 7! s 6*t#6 ,r!! C #bility of the patient to $nde"stand tea%hing inst"$%tion ) 'ang$age $sed by the n$"se 98 #n impo"tant s0ill that a p"imig"a/ida has to a%6$i"e is the ability to bathe he" newbo"n baby and %lean he" b"east if she de%ides to b"eastfeed he" baby& Hhi%h of the following lea"ning domain will yo$ %lassify the abo/e goalsQ A' Ps "/#6#t#r @ Cogniti/e C #ffe%ti/e ) #ttit$dinal 99 Hhen yo$ p"epa"e yo$" tea%hing plan fo" a g"o$p of hype"tensi/e patients& yo$ fi"st fo"m$late yo$" lea"ning obEe%ti/es Hhi%h of the following steps in the n$"sing p"o%ess %o""esponds to the w"iting of the lea"ning obEe%ti/esQ A' P+a$$i$1 @ Implementing C ,/al$ation C #ssessment 99 1ose& 20 yea"s old and newly diagnosed diabeti% patient m$st lea"n how to inEe%t ins$lin Hhi%h of the following physi%al att"ib$te is not in anyway "elated to he" ability to administe" ins$linQ # St"ength @ Coo"dination C )e-te"ity D' M0s"+! )0i+t 100 #ppea"an%e and disposition of %lients a"e best obse"/ed initially d$"ing whi%h of the following sit$ationQ # !a0ing 7GS )' I$t!r8i!C Implementation of the initial %a"e ) #%t$al Physi%al e-amination

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COMMUNIT( HEALTH NURSING Part 2 1 Hhi%h is the p"ima"y goal of %omm$nity health n$"singQ # !o s$ppo"t and s$pplement the effo"ts of the medi%al p"ofession in the p"omotion of health and p"e/ention of illness @ !o enhan%e the %apa%ity of indi/id$als& families and %omm$nities to %ope with thei" health needs C !o in%"ease the p"od$%ti/ity of the people by p"o/iding them with se"/i%es that will in%"ease thei" le/el of health ) !o %ont"ib$te to national de/elopment th"o$gh p"omotion of family welfa"e& fo%$sing pa"ti%$la"ly on mothe"s and %hild"en A$s-!rE F)G T# !$/a$"! t/! "a*a"it #, i$%i8i%0a+s, ,a6i+i!s a$% "#660$iti!s t# "#*! -it/ t/!ir /!a+t/ $!!%s !o %ont"ib$te to national de/elopment th"o$gh p"omotion of family welfa"e& fo%$sing pa"ti%$la"ly on mothe"s and %hild"en 2 C?* is a %omm$nity=based p"a%ti%e Hhi%h best e-plains this statementQ # !he se"/i%e is p"o/ided in the nat$"al en/i"onment of people @ !he n$"se has to %ond$%t %omm$nity diagnosis to dete"mine n$"sing needs and p"oblems C !he se"/i%es a"e based on the a/ailable "eso$"%es within the %omm$nity ) P"io"ity setting is based on the magnit$de of the health p"oblems identified A$s-!rE F)G T/! $0rs! /as t# "#$%0"t "#660$it %ia1$#sis t# %!t!r6i$! $0rsi$1 $!!%s a$% *r#7+!6s' Comm$nity=based p"a%ti%e means p"o/iding %a"e to people in thei" own nat$"al en/i"onments: the home& s%hool and wo"0pla%e& fo" e-ample + Pop$lation=fo%$sed n$"sing p"a%ti%e "e6$i"es whi%h of the following p"o%essesQ # Comm$nity o"gani(ing @ *$"sing p"o%ess C Comm$nity diagnosis ) ,pidemiologi% p"o%ess A$s-!rE FCG C#660$it %ia1$#sis Pop$lation=fo%$sed n$"sing %a"e means p"o/iding %a"e based on the g"eate" need of the maEo"ity of the pop$lation !he g"eate" need is identified th"o$gh %omm$nity diagnosis . 1 # 102. is also 0nown as the O%%$pational ?ealth #%t #side f"om n$mbe" of employees& what othe" fa%to" m$st be %onside"ed in dete"mining the o%%$pational health p"i/ileges to whi%h the wo"0e"s will be entitledQ # !ype of o%%$pation: ag"i%$lt$"al& %omme"%ial& ind$st"ial

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@ 'o%ation of the wo"0pla%e in "elation to health fa%ilities C Classifi%ation of the b$siness ente"p"ise based on net p"ofit ) Se- and age %omposition of employees A$s-!rE F)G L#"ati#$ #, t/! -#rB*+a"! i$ r!+ati#$ t# /!a+t/ ,a"i+iti!s @ased on 1 # 102.& an o%%$pational n$"se m$st be employed when the"e a"e +0 to 100 employees and the wo"0pla%e is mo"e than 1 0m away f"om the nea"est health %ente" 2 # b$siness fi"m m$st employ an o%%$pational health n$"se when it has at least how many employeesQ # 21 @ 101 C 201 ) +01 A$s-!rE F)G 1?1 #gain& this is based on 1 # 102. 5 Hhen the o%%$pational health n$"se employs e"gonomi% p"in%iples& she is pe"fo"ming whi%h of he" "olesQ # ?ealth %a"e p"o/ide" @ ?ealth ed$%ato" C ?ealth %a"e %oo"dinato" ) ,n/i"onmental manage" A$s-!rE FDG E$8ir#$6!$ta+ 6a$a1!r ,"gonomi%s is imp"o/ing effi%ien%y of wo"0e"s by imp"o/ing the wo"0e"Ks en/i"onment th"o$gh app"op"iately designed f$"nit$"e& fo" e-ample 8 # ga"ment fa%to"y does not ha/e an o%%$pational n$"se Hho shall p"o/ide the o%%$pational health needs of the fa%to"y wo"0e"sQ # O%%$pational health n$"se at the P"o/in%ial ?ealth Offi%e @ Physi%ian employed by the fa%to"y C P$bli% health n$"se of the 1?U of thei" m$ni%ipality ) 1$"al sanita"y inspe%to" of the 1?U of thei" m$ni%ipality A$s-!rE FCG P07+i" /!a+t/ $0rs! #, t/! RHU #, t/!ir 60$i"i*a+it Ao$K"e "ight\ !his 6$estion is based on 1 # 102. 9 SP$bli% health se"/i%es a"e gi/en f"ee of %ha"ge T Is this statement t"$e o" falseQ # !he statement is t"$eW it is the "esponsibility of go/e"nment to p"o/ide basi% se"/i%es @ !he statement is falseW people pay indi"e%tly fo" p$bli% health se"/i%es C !he statement may be t"$e o" false& depending on the spe%ifi% se"/i%e "e6$i"ed ) !he statement may be t"$e o" false& depending on poli%ies of the go/e"nment %on%e"ned

A$s-!rE F)G T/! stat!6!$t is ,a+s!H *!#*+! *a i$%ir!"t+ ,#r *07+i" /!a+t/ s!r8i"!s' Comm$nity health se"/i%es& in%l$ding p$bli% health se"/i%es& a"e p"e=paid se"/i%es& tho$gh ta-ation& fo" e-ample 9 #%%o"ding to C , Hinslow& whi%h of the following is the goal of P$bli% ?ealthQ # Fo" people to attain thei" bi"th"ights of health and longe/ity @ Fo" p"omotion of health and p"e/ention of disease C Fo" people to ha/e a%%ess to basi% health se"/i%es ) Fo" people to be o"gani(ed in thei" health effo"ts A$s-!rE FAG F#r *!#*+! t# attai$ t/!ir 7irt/ri1/ts #, /!a+t/ a$% +#$1!8it #%%o"ding to Hinslow& all p$bli% health effo"ts a"e fo" people to "eali(e thei" bi"th"ights of health and longe/ity 10 He say that a Filipino has attained longe/ity when he is able to "ea%h the a/e"age lifespan of Filipinos Hhat othe" statisti% may be $sed to dete"mine attainment of longe/ityQ # #ge=spe%ifi% mo"tality "ate @ P"opo"tionate mo"tality "ate C Swa"oopKs inde) Case fatality "ate A$s-!rE FCG S-ar##*.s i$%!< Swa"oopKs inde- is the pe"%entage of the deaths aged 20 yea"s o" olde" Its in/e"se "ep"esents the pe"%entage of $ntimely deaths Othose who died yo$nge" than 20 yea"sP 11 Hhi%h of the following is the most p"ominent feat$"e of p$bli% health n$"singQ # It in/ol/es p"o/iding home %a"e to si%0 people who a"e not %onfined in the hospital @ Se"/i%es a"e p"o/ided f"ee of %ha"ge to people within the %at%hment a"ea C !he p$bli% health n$"se f$n%tions as pa"t of a team p"o/iding a p$bli% health n$"sing se"/i%es ) P$bli% health n$"sing fo%$ses on p"e/enti/e& not %$"ati/e& se"/i%es A$s-!rE FDG P07+i" /!a+t/ $0rsi$1 ,#"0s!s #$ *r!8!$ti8!, $#t "0rati8!, s!r8i"!s' !he %at%hment a"ea in P?* %onsists of a "esidential %omm$nity& many of whom a"e well indi/id$als who ha/e g"eate" need fo" p"e/enti/e "athe" than %$"ati/e se"/i%es 12 #%%o"ding to <a"ga"et Shetland& the philosophy of p$bli% health n$"sing is based on whi%h of the followingQ # ?ealth and longe/ity as bi"th"ights @ !he mandate of the state to p"ote%t the bi"th"ights of its %iti(ens C P$bli% health n$"sing as a spe%iali(ed field of n$"sing

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) !he wo"th and dignity of man A$s-!rE FDG T/! -#rt/ a$% %i1$it #, 6a$ !his is a di"e%t 6$ote f"om )" <a"ga"et ShetlandKs statements on P$bli% ?ealth *$"sing 1+ Hhi%h of the following is the mission of the )epa"tment of ?ealthQ # ?ealth fo" all Filipinos @ ,ns$"e the a%%essibility and 6$ality of health %a"e C Imp"o/e the gene"al health stat$s of the pop$lation ) ?ealth in the hands of the Filipino people by the yea" 2020 A$s-!rE F)G E$s0r! t/! a""!ssi7i+it a$% 40a+it #, /!a+t/ "ar! OnoneP 1. 1egion I7 ?ospital is %lassified as what le/el of fa%ilityQ # P"ima"y @ Se%onda"y C Inte"mediate ) !e"tia"y A$s-!rE FDG T!rtiar 1egional hospitals a"e te"tia"y fa%ilities be%a$se they se"/e as t"aining hospitals fo" the "egion 12 Hhi%h is t"$e of p"ima"y fa%ilitiesQ # !hey a"e $s$ally go/e"nment="$n @ !hei" se"/i%es a"e p"o/ided on an o$t=patient basis C !hey a"e t"aining fa%ilities fo" health p"ofessionals ) # %omm$nity hospital is an e-ample of this le/el of health fa%ilities A$s-!rE F)G T/!ir s!r8i"!s ar! *r#8i%!% #$ a$ #0tD*ati!$t 7asis' P"ima"y fa%ilities go/e"nment and non= go/e"nment fa%ilities that p"o/ide basi% o$t= patient se"/i%es 15 Hhi%h is an e-ample of the s%hool n$"seKs health %a"e p"o/ide" f$n%tionsQ # 1e6$esting fo" @CD f"om the 1?U fo" s%hool ent"ant imm$ni(ation @ Cond$%ting "andom %lass"oom inspe%tion d$"ing a measles epidemi% C !a0ing "emedial a%tion on an a%%ident ha(a"d in the s%hool playg"o$nd ) Obse"/ing pla%es in the s%hool whe"e p$pils spend thei" f"ee time A$s-!rE F)G C#$%0"ti$1 ra$%#6 "+assr##6 i$s*!"ti#$ %0ri$1 a 6!as+!s !*i%!6i" 1andom %lass"oom inspe%tion is assessment of p$pilsGst$dents and tea%he"s fo" signs of a health p"oblem p"e/alent in the %omm$nity 18 Hhen the n$"se dete"mines whethe" "eso$"%es we"e ma-imi(ed in implementing

'igtas !igdas& she is e/al$ating # ,ffe%ti/eness @ ,ffi%ien%y C #de6$a%y ) #pp"op"iateness A$s-!rE F)G E,,i"i!$" ,ffi%ien%y is dete"mining whethe" the goals we"e attained at the least possible %ost 19 Ao$ a"e a new @ S * g"ad$ate Ao$ want to be%ome a P$bli% ?ealth *$"se Hhe"e will yo$ applyQ # )epa"tment of ?ealth @ P"o/in%ial ?ealth Offi%e C 1egional ?ealth Offi%e ) 1$"al ?ealth Unit A$s-!rE FDG R0ra+ H!a+t/ U$it 1 # 8150 de/ol/ed basi% health se"/i%es to lo%al go/e"nment $nits O'DUKs P !he p$bli% health n$"se is an employee of the 'DU 19 1 # 8150 mandates de/ol$tion of basi% se"/i%es f"om the national go/e"nment to lo%al go/e"nment $nits Hhi%h of the following is the maEo" goal of de/ol$tionQ # !o st"engthen lo%al go/e"nment $nits @ !o allow g"eate" a$tonomy to lo%al go/e"nment $nits C !o empowe" the people and p"omote thei" self="elian%e ) !o ma0e basi% se"/i%es mo"e a%%essible to the people A$s-!rE FCG T# !6*#-!r t/! *!#*+! a$% *r#6#t! t/!ir s!+,Dr!+ia$"! People empowe"ment is the basi% moti/ation behind de/ol$tion of basi% se"/i%es to 'DUKs 20 Hho is the Chai"man of the <$ni%ipal ?ealth @oa"dQ # <ayo" @ <$ni%ipal ?ealth Offi%e" C P$bli% ?ealth *$"se ) #ny 6$alified physi%ian A$s-!rE FAG Ma #r !he lo%al e-e%$ti/e se"/es as the %hai"man of the <$ni%ipal ?ealth @oa"d 21 Hhi%h le/el of health fa%ility is the $s$al point of ent"y of a %lient into the health %a"e deli/e"y systemQ # P"ima"y @ Se%onda"y C Inte"mediate ) !e"tia"y A$s-!rE FAG Pri6ar !he ent"y of a pe"son into the health %a"e deli/e"y system is $s$ally th"o$gh a %ons$ltation in o$t=patient se"/i%es

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22 !he p$bli% health n$"se is the s$pe"/iso" of "$"al health midwi/es Hhi%h of the following is a s$pe"/iso"y f$n%tion of the p$bli% health n$"seQ # 1efe""ing %ases o" patients to the midwife @ P"o/iding te%hni%al g$idan%e to the midwife C P"o/iding n$"sing %a"e to %ases "efe""ed by the midwife ) Fo"m$lating and implementing t"aining p"og"ams fo" midwi/es A$s-!rE F)G Pr#8i%i$1 t!"/$i"a+ 10i%a$"! t# t/! 6i%-i,! !he n$"se p"o/ides te%hni%al g$idan%e to the midwife in the %a"e of %lients& pa"ti%$la"ly in the implementation of management g$idelines& as in Integ"ated <anagement of Childhood Illness 2+ One of the pa"ti%ipants in a hilot t"aining %lass as0ed yo$ to whom she sho$ld "efe" a patient in labo" who de/elops a %ompli%ation Ao$ will answe"& to the # P$bli% ?ealth *$"se @ 1$"al ?ealth <idwife C <$ni%ipal ?ealth Offi%e" ) #ny of these health p"ofessionals A$s-!rE FCG M0$i"i*a+ H!a+t/ O,,i"!r # p$bli% health n$"se and "$"al health midwife %an p"o/ide %a"e d$"ing no"mal %hildbi"th # physi%ian sho$ld attend to a woman with a %ompli%ation d$"ing labo" 2. Ao$ a"e the p$bli% health n$"se in a m$ni%ipality with a total pop$lation of abo$t 20&000 !he"e a"e + "$"al health midwi/es among the 1?U pe"sonnel ?ow many mo"e midwife items will the 1?U needQ # 1 @ 2 C + ) !he 1?U does not need any mo"e midwife item A$s-!rE FAG 1 ,a%h "$"al health midwife is gi/en a pop$lation assignment of abo$t 2&000 22 If the 1?U needs additional midwife items& yo$ will s$bmit the "e6$est fo" additional midwife items fo" app"o/al to the # 1$"al ?ealth Unit @ )ist"i%t ?ealth Offi%e C P"o/in%ial ?ealth Offi%e ) <$ni%ipal ?ealth @oa"d A$s-!rE FDG M0$i"i*a+ H!a+t/ )#ar% #s mandated by 1 # 8150& basi% health se"/i%es ha/e been de/ol/ed f"om the national go/e"nment to lo%al go/e"nment $nits 25 #s an epidemiologist& the n$"se is "esponsible fo" "epo"ting %ases of notifiable diseases Hhat law mandates "epo"ting of %ases of notifiable diseasesQ

# @ C )

#%t +28+ 1 # +82+ 1 # 102. 1 # 1092

A$s-!rE FAG A"t 35A3 #%t +28+& the 'aw on 1epo"ting of Comm$ni%able )iseases& ena%ted in 1929& mandated the "epo"ting of diseases listed in the law to the nea"est health station 28 #%%o"ding to F"eeman and ?ein"i%h& %omm$nity health n$"sing is a de/elopmental se"/i%e Hhi%h of the following best ill$st"ates this statementQ # !he %omm$nity health n$"se %ontin$o$sly de/elops himself pe"sonally and p"ofessionally @ ?ealth ed$%ation and %omm$nity o"gani(ing a"e ne%essa"y in p"o/iding %omm$nity health se"/i%es C Comm$nity health n$"sing is intended p"ima"ily fo" health p"omotion and p"e/ention and t"eatment of disease ) !he goal of %omm$nity health n$"sing is to p"o/ide n$"sing se"/i%es to people in thei" own pla%es of "esiden%e A$s-!rE F)G H!a+t/ !%0"ati#$ a$% "#660$it #r1a$i9i$1 ar! $!"!ssar i$ *r#8i%i$1 "#660$it /!a+t/ s!r8i"!s' !he %omm$nity health n$"se de/elops the health %apability of people th"o$gh health ed$%ation and %omm$nity o"gani(ing a%ti/ities 29 Hhi%h disease was de%la"ed th"o$gh P"esidential P"o%lamation *o . as a ta"get fo" e"adi%ation in the PhilippinesQ # Poliomyelitis @ <easles C 1abies ) *eonatal tetan$s A$s-!rE F)G M!as+!s P"esidential P"o%lamation *o . is on the 'igtas !igdas P"og"am 29 !he p$bli% health n$"se is "esponsible fo" p"esenting the m$ni%ipal health statisti%s $sing g"aphs and tables !o %ompa"e the f"e6$en%y of the leading %a$ses of mo"tality in the m$ni%ipality& whi%h g"aph will yo$ p"epa"eQ # 'ine @ @a" C Pie ) S%atte" diag"am A$s-!rE F)G )ar # ba" g"aph is $sed to p"esent %ompa"ison of /al$es& a line g"aph fo" t"ends o/e" time o" age& a pie g"aph fo" pop$lation %omposition o" dist"ib$tion& and a s%atte" diag"am fo" %o""elation of two /a"iables +0 Hhi%h step in %omm$nity o"gani(ing in/ol/es t"aining of potential leade"s in the

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%omm$nityQ # Integ"ation @ Comm$nity o"gani(ation C Comm$nity st$dy ) Co"e g"o$p fo"mation A$s-!rE FDG C#r! 1r#0* ,#r6ati#$ In %o"e g"o$p fo"mation& the n$"se is able to t"ansfe" the te%hnology of %omm$nity o"gani(ing to the potential o" info"mal %omm$nity leade"s th"o$gh a t"aining p"og"am +1 In whi%h step a"e plans fo"m$lated fo" sol/ing %omm$nity p"oblemsQ # <obili(ation @ Comm$nity o"gani(ation C Follow=$pGe-tension ) Co"e g"o$p fo"mation A$s-!rE F)G C#660$it #r1a$i9ati#$ Comm$nity o"gani(ation is the step when %omm$nity assemblies ta0e pla%e )$"ing the %omm$nity assembly& the people may opt to fo"mali(e the %omm$nity o"gani(ation and ma0e plans fo" %omm$nity a%tion to "esol/e a %omm$nity health p"oblem +2 !he p$bli% health n$"se ta0es an a%ti/e "ole in %omm$nity pa"ti%ipation Hhat is the p"ima"y goal of %omm$nity o"gani(ingQ # !o ed$%ate the people "ega"ding %omm$nity health p"oblems @ !o mobili(e the people to "esol/e %omm$nity health p"oblems C !o ma-imi(e the %omm$nityKs "eso$"%es in dealing with health p"oblems ) !o ma-imi(e the %omm$nityKs "eso$"%es in dealing with health p"oblems A$s-!rE FDG T# 6a<i6i9! t/! "#660$it .s r!s#0r"!s i$ %!a+i$1 -it/ /!a+t/ *r#7+!6s Comm$nity o"gani(ing is a de/elopmental se"/i%e& with the goal of de/eloping the peopleKs self="elian%e in dealing with %omm$nity health p"oblems #& @ and C a"e obEe%ti/es of %ont"ib$to"y obEe%ti/es to this goal ++ #n indi%ato" of s$%%ess in %omm$nity o"gani(ing is when people a"e able to # Pa"ti%ipate in %omm$nity a%ti/ities fo" the sol$tion of a %omm$nity p"oblem @ Implement a%ti/ities fo" the sol$tion of the %omm$nity p"oblem C Plan a%ti/ities fo" the sol$tion of the %omm$nity p"oblem ) Identify the health p"oblem as a %ommon %on%e"n A$s-!rE FAG Parti"i*at! i$ "#660$it a"ti8iti!s ,#r t/! s#+0ti#$ #, a "#660$it *r#7+!6 Pa"ti%ipation in %omm$nity a%ti/ities in "esol/ing a %omm$nity p"oblem may be in any of the p"o%esses mentioned in the othe" %hoi%es

+. !e"tia"y p"e/ention is needed in whi%h stage of the nat$"al histo"y of diseaseQ # P"e=pathogenesis @ Pathogenesis C P"od"omal ) !e"minal A$s-!rE FDG T!r6i$a+ !e"tia"y p"e/ention in/ol/es "ehabilitation& p"e/ention of pe"manent disability and disability limitation app"op"iate fo" %on/ales%ents& the disabled& %ompli%ated %ases and the te"minally ill Othose in the te"minal stage of a diseaseP +2 Isolation of a %hild with measles belongs to what le/el of p"e/entionQ # P"ima"y @ Se%onda"y C Inte"mediate ) !e"tia"y A$s-!rE FAG Pri6ar !he p$"pose of isolating a %lient with a %omm$ni%able disease is to p"ote%t those who a"e not si%0 Ospe%ifi% disease p"e/entionP +5 On the othe" hand& Ope"ation !imbang is aaaaa p"e/ention # P"ima"y @ Se%onda"y C Inte"mediate ) !e"tia"y A$s-!rE F)G S!"#$%ar Ope"ation !imbang is done to identify membe"s of the s$s%eptible pop$lation who a"e malno$"ished Its p$"pose is ea"ly diagnosis and& s$bse6$ently& p"ompt t"eatment +8 Hhi%h type of family=n$"se %onta%t will p"o/ide yo$ with the best oppo"t$nity to obse"/e family dynami%sQ # Clini% %ons$ltation @ D"o$p %onfe"en%e C ?ome /isit ) H"itten %omm$ni%ation A$s-!rE FCG H#6! 8isit )ynami%s of family "elationships %an best be obse"/ed in the familyKs nat$"al en/i"onment& whi%h is the home +9 !he typology of family n$"sing p"oblems is $sed in the statement of n$"sing diagnosis in the %a"e of families !he yo$ngest %hild of the de los 1eyes family has been diagnosed as mentally "eta"ded !his is %lassified as a # ?ealth th"eat @ ?ealth defi%it C Fo"eseeable %"isis ) St"ess point A$s-!rE F)G H!a+t/ %!,i"it Fail$"e of a family membe" to de/elop

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a%%o"ding to what is e-pe%ted& as in mental "eta"dation& is a health defi%it +9 !he de los 1eyes %o$ple ha/e a 5=yea" old %hild ente"ing s%hool fo" the fi"st time !he de los 1eyes family has a # ?ealth th"eat @ ?ealth defi%it C Fo"eseeable %"isis ) St"ess point A$s-!rE FCG F#r!s!!a7+! "risis ,nt"y of the 5=yea" old into s%hool is an anti%ipated pe"iod of $n$s$al demand on the family .0 Hhi%h of the following is an ad/antage of a home /isitQ # It allows the n$"se to p"o/ide n$"sing %a"e to a g"eate" n$mbe" of people @ It p"o/ides an oppo"t$nity to do fi"st hand app"aisal of the home sit$ation C It allows sha"ing of e-pe"ien%es among people with simila" health p"oblems ) It de/elops the familyKs initiati/e in p"o/iding fo" health needs of its membe"s A$s-!rE F)G It *r#8i%!s a$ #**#rt0$it t# %# ,irst /a$% a**raisa+ #, t/! /#6! sit0ati#$' Choi%e # is not %o""e%t sin%e a home /isit "e6$i"es that the n$"se spend so m$%h time with the family Choi%e C is an ad/antage of a g"o$p %onfe"en%e& while %hoi%e ) is t"$e of a %lini% %ons$ltation .1 Hhi%h is CO*!1#1A to the p"in%iples in planning a home /isitQ # # home /isit sho$ld ha/e a p$"pose o" obEe%ti/e @ !he plan sho$ld "e/ol/e a"o$nd family health needs C # home /isit sho$ld be %ond$%ted in the manne" p"es%"ibed by the 1?U ) Planning of %ontin$ing %a"e sho$ld in/ol/e a "esponsible family membe" A$s-!rE FCG A /#6! 8isit s/#0+% 7! "#$%0"t!% i$ t/! 6a$$!r *r!s"ri7!% 7 t/! RHU' !he home /isit plan sho$ld be fle-ible and p"a%ti%al& depending on fa%to"s& s$%h as the familyKs needs and the "eso$"%es a/ailable to the n$"se and the family .2 !he P?* bag is an impo"tant tool in p"o/iding n$"sing %a"e d$"ing a home /isit !he most impo"tant p"in%iple of bag te%hni6$e states that it # Sho$ld sa/e time and effo"t @ Sho$ld minimi(e if not totally p"e/ent the sp"ead of infe%tion C Sho$ld not o/e"shadow %on%e"n fo" the patient and his family ) <ay be done in a /a"iety of ways depending on the home sit$ation& et%

A$s-!rE F)G S/#0+% 6i$i6i9! i, $#t t#ta++ *r!8!$t t/! s*r!a% #, i$,!"ti#$' @ag te%hni6$e is pe"fo"med befo"e and afte" handling a %lient in the home to p"e/ent t"ansmission of infe%tion to and f"om the %lient .+ !o maintain the %leanliness of the bag and its %ontents& whi%h of the following m$st the n$"se doQ # Hash hisGhe" hands befo"e and afte" p"o/iding n$"sing %a"e to the family membe"s @ In the %a"e of family membe"s& as m$%h as possible& $se only a"ti%les ta0en f"om the bag C P$t on an ap"on to p"ote%t he" $nifo"m and fold it with the "ight side o$t befo"e p$tting it ba%0 into the bag ) #t the end of the /isit& fold the lining on whi%h the bag was pla%ed& ens$"ing that the %ontaminated side is on the o$tside A$s-!rE FAG 5as/ /is=/!r /a$%s 7!,#r! a$% a,t!r *r#8i%i$1 $0rsi$1 "ar! t# t/! ,a6i+ 6!67!rs' Choi%e @ goes against the idea of $tili(ing the familyKs "eso$"%es& whi%h is en%o$"aged in C?* Choi%es C and ) goes against the p"in%iple of asepsis of %onfining the %ontaminated s$"fa%e of obEe%ts .. !he p$bli% health n$"se %ond$%ts a st$dy on the fa%to"s %ont"ib$ting to the high mo"tality "ate d$e to hea"t disease in the m$ni%ipality whe"e she wo"0s Hhi%h b"an%h of epidemiology does the n$"se p"a%ti%e in this sit$ationQ # )es%"ipti/e @ #nalyti%al C !he"ape$ti% ) ,/al$ation A$s-!rE F)G A$a+ ti"a+ #nalyti%al epidemiology is the st$dy of fa%to"s o" dete"minants affe%ting the patte"ns of o%%$""en%e and dist"ib$tion of disease in a %omm$nity .2 Hhi%h of the following is a f$n%tion of epidemiologyQ # Identifying the disease %ondition based on manifestations p"esented by a %lient @ )ete"mining fa%to"s that %ont"ib$ted to the o%%$""en%e of pne$monia in a + yea" old C )ete"mining the effi%a%y of the antibioti% $sed in the t"eatment of the + yea" old %lient with pne$monia ) ,/al$ating the effe%ti/eness of the implementation of the Integ"ated <anagement of Childhood Illness A$s-!rE FDG E8a+0ati$1 t/! !,,!"ti8!$!ss #, t/! i6*+!6!$tati#$ #, t/! I$t!1rat!% Ma$a1!6!$t #, C/i+%/##% I++$!ss ,pidemiology is $sed in the assessment of a %omm$nity o" e/al$ation of inte"/entions in %omm$nity health p"a%ti%e

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.5 Hhi%h of the following is an epidemiologi% f$n%tion of the n$"se d$"ing an epidemi%Q # Cond$%ting assessment of s$spe%ted %ases to dete%t the %omm$ni%able disease @ <onito"ing the %ondition of the %ases affe%ted by the %omm$ni%able disease C Pa"ti%ipating in the in/estigation to dete"mine the so$"%e of the epidemi% ) !ea%hing the %omm$nity on p"e/enti/e meas$"es against the disease A$s-!rE FCG Parti"i*ati$1 i$ t/! i$8!sti1ati#$ t# %!t!r6i$! t/! s#0r"! #, t/! !*i%!6i" ,pidemiology is the st$dy of patte"ns of o%%$""en%e and dist"ib$tion of disease in the %omm$nity& as well as the fa%to"s that affe%t disease patte"ns !he p$"pose of an epidemiologi% in/estigation is to identify the so$"%e of an epidemi%& i e & what b"o$ght abo$t the epidemi% .8 !he p"ima"y p$"pose of %ond$%ting an epidemiologi% in/estigation is to # )elineate the etiology of the epidemi% @ ,n%o$"age %oope"ation and s$ppo"t of the %omm$nity C Identify g"o$ps who a"e at "is0 of %ont"a%ting the disease ) Identify geog"aphi%al lo%ation of %ases of the disease in the %omm$nity A$s-!rE FAG D!+i$!at! t/! !ti#+#1 #, t/! !*i%!6i" )elineating the etiology of an epidemi% is identifying its so$"%e .9 Hhi%h is a %ha"a%te"isti% of pe"son=to=pe"son p"opagated epidemi%sQ # !he"e a"e mo"e %ases of the disease than e-pe%ted @ !he disease m$st ne%essa"ily be t"ansmitted th"o$gh a /e%to" C !he sp"ead of the disease %an be att"ib$ted to a %ommon /ehi%le ) !he"e is a g"ad$al b$ild $p of %ases befo"e the epidemi% be%omes easily noti%eable A$s-!rE FDG T/!r! is a 1ra%0a+ 70i+% 0* #, "as!s 7!,#r! t/! !*i%!6i" 7!"#6!s !asi+ $#ti"!a7+!' # g"ad$al o" insidio$s onset of the epidemi% is $s$ally obse"/able in pe"son=to=pe"son p"opagated epidemi%s .9 In the in/estigation of an epidemi%& yo$ %ompa"e the p"esent f"e6$en%y of the disease with the $s$al f"e6$en%y at this time of the yea" in this %omm$nity !his is done d$"ing whi%h stage of the in/estigationQ # ,stablishing the epidemi% @ !esting the hypothesis C Fo"m$lation of the hypothesis ) #pp"aisal of fa%ts

A$s-!rE FAG Esta7+is/i$1 t/! !*i%!6i" ,stablishing the epidemi% is dete"mining whethe" the"e is an epidemi% o" not !his is done by %ompa"ing the p"esent n$mbe" of %ases with the $s$al n$mbe" of %ases of the disease at the same time of the yea"& as well as establishing the "elatedness of the %ases of the disease 20 !he n$mbe" of %ases of )eng$e fe/e" $s$ally in%"eases towa"ds the end of the "ainy season !his patte"n of o%%$""en%e of )eng$e fe/e" is best des%"ibed as # ,pidemi% o%%$""en%e @ Cy%li%al /a"iation C Spo"adi% o%%$""en%e ) Se%$la" /a"iation A$s-!rE F)G C "+i"a+ 8ariati#$ # %y%li%al /a"iation is a pe"iodi% fl$%t$ation in the n$mbe" of %ases of a disease in the %omm$nity 21 In the yea" 1990& the Ho"ld ?ealth O"gani(ation de%la"ed the Philippines& togethe" with some othe" %o$nt"ies in the Heste"n Pa%ifi% 1egion& Sf"eeT of whi%h diseaseQ # Pne$moni% plag$e @ Poliomyelitis C Small po) #nth"aA$s-!rE FCG S6a++ *#< !he last do%$mented %ase of Small po- was in 1988 at Somalia 22 In the %ens$s of the Philippines in 1992& the"e we"e abo$t +2&299&000 males and abo$t +.&959&000 females Hhat is the se- "atioQ # 99 05:100 @ 100 9.:100 C 20 2+V ) .9 85V A$s-!rE F)G 1??'>4E1?? Se- "atio is the n$mbe" of males fo" e/e"y 100 females in the pop$lation 2+ P"ima"y health %a"e is a total app"oa%h to %omm$nity de/elopment Hhi%h of the following is an indi%ato" of s$%%ess in the $se of the p"ima"y health %a"e app"oa%hQ # ?ealth se"/i%es a"e p"o/ided f"ee of %ha"ge to indi/id$als and families @ 'o%al offi%ials a"e empowe"ed as the maEo" de%ision ma0e"s in matte"s of health C ?ealth wo"0e"s a"e able to p"o/ide %a"e based on identified health needs of the people ) ?ealth p"og"ams a"e s$stained a%%o"ding to the le/el of de/elopment of the %omm$nity A$s-!rE FDG H!a+t/ *r#1ra6s ar! s0stai$!% a""#r%i$1 t# t/! +!8!+ #, %!8!+#*6!$t #, t/! "#660$it ' P"ima"y health %a"e is essential health %a"e that

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%an be s$stained in all stages of de/elopment of the %omm$nity 2. Sp$t$m e-amination is the maEo" s%"eening tool fo" p$lmona"y t$be"%$losis Clients wo$ld sometimes get false negati/e "es$lts in this e-am !his means that the test is not pe"fe%t in te"ms of whi%h %ha"a%te"isti% of a diagnosti% e-aminationQ # ,ffe%ti/eness @ ,ffi%a%y C Spe%ifi%ity ) Sensiti/ity A$s-!rE FDG S!$siti8it Sensiti/ity is the %apa%ity of a diagnosti% e-amination to dete%t %ases of the disease If a test is 100V sensiti/e& all the %ases tested will ha/e a positi/e "es$lt& i e & the"e will be no false negati/e "es$lts 22 Use of app"op"iate te%hnology "e6$i"es 0nowledge of indigeno$s te%hnology Hhi%h medi%inal he"b is gi/en fo" fe/e"& heada%he and %o$ghQ # Sambong @ !saang g$bat C #0ap$l0o ) 'ag$ndi A$s-!rE FDG La10$%i Sambong is $sed as a di$"eti% !saang g$bat is $sed to "elie/e dia""hea #0ap$l0o is $sed fo" its antif$ngal p"ope"ty 25 Hhat law %"eated the Philippine Instit$te of !"aditional and #lte"nati/e ?ealth Ca"eQ # 1 # 9.2+ @ 1 # .92+ C 1 # 2.9+ ) 1 # +.92 A$s-!rE FAG R'A' I423 OnoneP 28 In t"aditional Chinese medi%ine& the yielding& negati/e and feminine fo"%e is te"med # Ain @ Aang C >i ) Chai A$s-!rE FAG (i$ Aang is the male dominating& positi/e and mas%$line fo"%e 29 Hhat is the legal basis fo" P"ima"y ?ealth Ca"e app"oa%h in the PhilippinesQ # #lma #ta )e%la"ation on P?C @ 'ette" of Inst"$%tion *o 9.9 C P"esidential )e%"ee *o 1.8 ) P"esidential )e%"ee 995 A$s-!rE F)G L!tt!r #, I$str0"ti#$ N#' >4> 'ette" of Inst"$%tion 9.9 was iss$ed by then

P"esident Fe"dinand <a"%os& di"e%ting the fo"me"ly %alled <inist"y of ?ealth& now the )epa"tment of ?ealth& to $tili(e P"ima"y ?ealth Ca"e app"oa%h in planning and implementing health p"og"ams 29 Hhi%h of the following demonst"ates inte"se%to"al lin0agesQ # !wo=way "efe""al system @ !eam app"oa%h C ,ndo"sement done by a midwife to anothe" midwife ) Coope"ation between the P?* and p$bli% s%hool tea%he" A$s-!rE FDG C##*!rati#$ 7!t-!!$ t/! PHN a$% *07+i" s"/##+ t!a"/!r Inte"se%to"al lin0ages "efe" to wo"0ing "elationships between the health se%to" and othe" se%to"s in/ol/ed in %omm$nity de/elopment 50 !he m$ni%ipality assigned to yo$ has a pop$lation of abo$t 20&000 ,stimate the n$mbe" of 1=. yea" old %hild"en who will be gi/en 1etinol %aps$le 200&000 I U e/e"y 5 months # 1&200 @ 1&900 C 2&000 ) 2&+00 A$s-!rE FDG 2,3?? @ased on the Philippine pop$lation %omposition& to estimate the n$mbe" of 1=. yea" old %hild"en& m$ltiply total pop$lation by 11 2V 51 ,stimate the n$mbe" of p"egnant women who will be gi/en tetan$s to-oid d$"ing an imm$ni(ation o$t"ea%h a%ti/ity in a ba"angay with a pop$lation of abo$t 1&200 # 252 @ +00 C +82 ) .00 A$s-!rE FAG 2;5 !o estimate the n$mbe" of p"egnant women& m$ltiply the total pop$lation by + 2V 52 !o des%"ibe the se- %omposition of the pop$lation& whi%h demog"aphi% tool may be $sedQ # Se- "atio @ Se- p"opo"tion C Pop$lation py"amid ) #ny of these may be $sed A$s-!rE FDG A$ #, t/!s! 6a 7! 0s!%' Se- "atio and se- p"opo"tion a"e $sed to dete"mine the se- %omposition of a pop$lation # pop$lation py"amid is $sed to p"esent the %omposition of a pop$lation by age and se5+ Hhi%h of the following is a natality "ateQ # C"$de bi"th "ate @ *eonatal mo"tality "ate

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C Infant mo"tality "ate ) Dene"al fe"tility "ate A$s-!rE FAG Cr0%! 7irt/ rat! *atality means bi"th # natality "ate is a bi"th "ate 5. Ao$ a"e %omp$ting the %"$de death "ate of yo$" m$ni%ipality& with a total pop$lation of abo$t 19&000& fo" last yea" !he"e we"e 9. deaths #mong those who died& 20 died be%a$se of diseases of the hea"t and +2 we"e aged 20 yea"s o" olde" Hhat is the %"$de death "ateQ # . 2G1&000 @ 2 2G1&000 C 5 +G1&000 ) 8 +G1&000 A$s-!rE F)G 5'2=1,??? !o %omp$te %"$de death "ate di/ide total n$mbe" of deaths O9.P by total pop$lation O19&000P and m$ltiply by 1&000 52 :nowing that maln$t"ition is a f"e6$ent %omm$nity health p"oblem& yo$ de%ided to %ond$%t n$t"itional assessment Hhat pop$lation is pa"ti%$la"ly s$s%eptible to p"otein ene"gy maln$t"ition OP,<PQ # P"egnant women and the elde"ly @ Unde"=2 yea" old %hild"en C 1=. yea" old %hild"en ) S%hool age %hild"en A$s-!rE FCG 1D4 !ar #+% "/i+%r!$ P"es%hoole"s a"e the most s$s%eptible to P,< be%a$se they ha/e gene"ally been weaned #lso& this is the pop$lation who& $nable to feed themsel/es& a"e often the /i%tims of poo" int"afamilial food dist"ib$tion 55 Hhi%h statisti% %an gi/e the most a%%$"ate "efle%tion of the health stat$s of a %omm$nityQ # 1=. yea" old age=spe%ifi% mo"tality "ate @ Infant mo"tality "ate C Swa"oopKs inde) C"$de death "ate A$s-!rE FCG S-ar##*.s i$%!< Swa"oopKs inde- is the p"opo"tion of deaths aged 20 yea"s and abo/e !he highe" the Swa"oopKs inde- of a pop$lation& the g"eate" the p"opo"tion of the deaths who we"e able to "ea%h the age of at least 20 yea"s& i e & mo"e people g"ew old befo"e they died 58 In the past yea"& @a"angay # had an a/e"age pop$lation of 1522 .5 babies we"e bo"n in that yea"& 2 of whom died less than . wee0s afte" they we"e bo"n !he"e we"e . "e%o"ded stillbi"ths Hhat is the neonatal mo"tality "ateQ # 28 9G1&000 @ .+ 2G1&000 C 95 9G1&000 ) 1+0 .G1&000 A$s-!rE F)G 43'5=1,???

!o %omp$te fo" neonatal mo"tality "ate& di/ide the n$mbe" of babies who died befo"e "ea%hing the age of 29 days by the total n$mbe" of li/e bi"ths& then m$ltiply by 1&000 59 Hhi%h statisti% best "efle%ts the n$t"itional stat$s of a pop$lationQ # 1=. yea" old age=spe%ifi% mo"tality "ate @ P"opo"tionate mo"tality "ate C Infant mo"tality "ate ) Swa"oopKs indeA$s-!rE FAG 1D4 !ar #+% a1!Ds*!"i,i" 6#rta+it rat! Sin%e p"es%hoole"s a"e the most s$s%eptible to the effe%ts of maln$t"ition& a pop$lation with poo" n$t"itional stat$s will most li0ely ha/e a high 1=. yea" old age=spe%ifi% mo"tality "ate& also 0nown as %hild mo"tality "ate 59 Hhat n$me"ato" is $sed in %omp$ting gene"al fe"tility "ateQ # ,stimated midyea" pop$lation @ *$mbe" of "egiste"ed li/e bi"ths C *$mbe" of p"egnan%ies in the yea" ) *$mbe" of females of "ep"od$%ti/e age A$s-!rE F)G N067!r #, r!1ist!r!% +i8! 7irt/s !o %omp$te fo" gene"al o" total fe"tility "ate& di/ide the n$mbe" of "egiste"ed li/e bi"ths by the n$mbe" of females of "ep"od$%ti/e age O12=.2 yea"sP& then m$ltiply by 1&000 80 Ao$ will gathe" data fo" n$t"itional assessment of a p$"o0 Ao$ will gathe" info"mation only f"om families with membe"s who belong to the ta"get pop$lation fo" P,< Hhat method of data gathe"ing is best fo" this p$"poseQ # Cens$s @ S$"/ey C 1e%o"d "e/iew ) 1e/iew of %i/il "egist"y A$s-!rE F)G S0r8! # s$"/ey& also %alled sample s$"/ey& is data gathe"ing abo$t a sample of the pop$lation 81 In the %ond$%t of a %ens$s& the method of pop$lation assignment based on the a%t$al physi%al lo%ation of the people is te"med # )e E$"e @ )e lo%$s C )e fa%to ) )e no/o A$s-!rE FCG D! ,a"t# !he othe" method of pop$lation assignment& de E$"e& is based on the $s$al pla%e of "esiden%e of the people 82 !he Field ?ealth Se"/i%es and Info"mation System OF?SISP is the "e%o"ding and "epo"ting system in p$bli% health %a"e in the Philippines !he <onthly Field ?ealth Se"/i%e #%ti/ity

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1epo"t is a fo"m $sed in whi%h of the %omponents of the F?SISQ # !ally "epo"t @ O$tp$t "epo"t C !a"getG%lient list ) Indi/id$al health "e%o"d A$s-!rE FAG Ta++ r!*#rt # tally "epo"t is p"epa"ed monthly o" 6$a"te"ly by the 1?U pe"sonnel and t"ansmitted to the P"o/in%ial ?ealth Offi%e 8+ !o monito" %lients "egiste"ed in long=te"m "egimens& s$%h as the <$lti=)"$g !he"apy& whi%h %omponent will be most $sef$lQ # !ally "epo"t @ O$tp$t "epo"t C !a"getG%lient list ) Indi/id$al health "e%o"d A$s-!rE FCG Tar1!t="+i!$t +ist !he <)! Client 'ist is a "e%o"d of %lients en"olled in <)! and othe" "ele/ant data& s$%h as dates when %lients %olle%ted thei" monthly s$pply of d"$gs 8. Ci/il "egist"ies a"e impo"tant so$"%es of data Hhi%h law "e6$i"es "egist"ation of bi"ths within +0 days f"om the o%%$""en%e of the bi"thQ # P ) 521 @ #%t +28+ C 1 # +82+ ) 1 # ++82 A$s-!rE FAG P'D' ;51 P ) 521 amended 1 # +82+& "e6$i"ing the "egist"y of bi"ths within +0 days f"om thei" o%%$""en%e 82 Hhi%h of the following p"ofessionals %an sign the bi"th %e"tifi%ateQ # P$bli% health n$"se @ 1$"al health midwife C <$ni%ipal health offi%e" ) #ny of these health p"ofessionals A$s-!rE FDG A$ #, t/!s! /!a+t/ *r#,!ssi#$a+s ) 1 # +82+ states that any bi"th attendant may sign the %e"tifi%ate of li/e bi"th 85 Hhi%h %"ite"ion in p"io"ity setting of health p"oblems is $sed only in %omm$nity health %a"eQ # <odifiability of the p"oblem @ *at$"e of the p"oblem p"esented C <agnit$de of the health p"oblem ) P"e/enti/e potential of the health p"oblem A$s-!rE FCG Ma1$it0%! #, t/! /!a+t/ *r#7+!6 <agnit$de of the p"oblem "efe"s to the pe"%entage of the pop$lation affe%ted by a health p"oblem !he othe" %hoi%es a"e %"ite"ia

%onside"ed in both family and %omm$nity health %a"e 88 !he Sent"ong Sigla <o/ement has been la$n%hed to imp"o/e health se"/i%e deli/e"y Hhi%h of the following isGa"e t"$e of this mo/ementQ # !his is a p"oEe%t spea"headed by lo%al go/e"nment $nits @ It is a basis fo" in%"easing f$nding f"om lo%al go/e"nment $nits C It en%o$"ages health %ente"s to fo%$s on disease p"e/ention and %ont"ol ) Its main st"ategy is %e"tifi%ation of health %ente"s able to %omply with standa"ds A$s-!rE FDG Its 6ai$ strat!1 is "!rti,i"ati#$ #, /!a+t/ "!$t!rs a7+! t# "#6*+ -it/ sta$%ar%s' Sent"ong Sigla <o/ement is a Eoint p"oEe%t of the )O? and lo%al go/e"nment $nits Its main st"ategy is %e"tifi%ation of health %ente"s that a"e able to %omply with standa"ds set by the )O? 89 Hhi%h of the following women sho$ld be %onside"ed as spe%ial ta"gets fo" family planningQ # !hose who ha/e two %hild"en o" mo"e @ !hose with medi%al %onditions s$%h as anemia C !hose yo$nge" than 20 yea"s and olde" than +2 yea"s ) !hose who E$st had a deli/e"y within the past 12 months A$s-!rE FDG T/#s! -/# J0st /a% a %!+i8!r -it/i$ t/! *ast 15 6#$t/s !he ideal bi"th spa%ing is at least two yea"s 12 months pl$s 9 months of p"egnan%y F 2 yea"s 89 F"eedom of %hoi%e is one of the poli%ies of the Family Planning P"og"am of the Philippines Hhi%h of the following ill$st"ates this p"in%ipleQ # Info"mation dissemination abo$t the need fo" family planning @ S$ppo"t of "esea"%h and de/elopment in family planning methods C #de6$ate info"mation fo" %o$ples "ega"ding the diffe"ent methods ) ,n%o$"agement of %o$ples to ta0e family planning as a Eoint "esponsibility A$s-!rE FCG A%!40at! i$,#r6ati#$ ,#r "#0*+!s r!1ar%i$1 t/! %i,,!r!$t 6!t/#%s !o enable the %o$ple to %hoose f"eely among diffe"ent methods of family planning& they m$st be gi/en f$ll info"mation "ega"ding the diffe"ent methods that a"e a/ailable to them& %onside"ing the a/ailability of 6$ality se"/i%es that %an s$ppo"t thei" %hoi%e 90 # woman& 5 months p"egnant& %ame to the %ente" fo" %ons$ltation Hhi%h of the following s$bstan%es is %ont"aindi%atedQ

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# @ C )

!etan$s to-oid 1etinol 200&000 IU Fe""o$s s$lfate 200 mg Potassi$m iodate 200 mg %aps$le

A$s-!rE F)G R!ti$#+ 2??,??? IU 1etinol 200&000 IU is a fo"m of megadose 7itamin # !his may ha/e a te"atogeni% effe%t 91 )$"ing p"enatal %ons$ltation& a %lient as0ed yo$ if she %an ha/e he" deli/e"y at home #fte" histo"y ta0ing and physi%al e-amination& yo$ ad/ised he" against a home deli/e"y Hhi%h of the following findings dis6$alifies he" fo" a home deli/e"yQ # ?e" O@ s%o"e is D2P+ @ She has some palma" pallo" C ?e" blood p"ess$"e is 1+0G90 ) ?e" baby is in %ephali% p"esentation A$s-!rE FAG H!r O) s"#r! is G5P3' Only women with less than 2 p"egnan%ies a"e 6$alified fo" a home deli/e"y It is also ad/isable fo" a p"imig"a/ida to ha/e deli/e"y at a %hildbi"th fa%ility 92 Inade6$ate inta0e by the p"egnant woman of whi%h /itamin may %a$se ne$"al t$be defe%tsQ # *ia%in @ 1ibofla/in C Foli% a%id ) !hiamine A$s-!rE FCG F#+i" a"i% It is estimated that the in%iden%e of ne$"al t$be defe%ts %an be "ed$%ed d"asti%ally if p"egnant women ha/e an ade6$ate inta0e of foli% a%id 9+ Ao$ a"e in a %lientKs home to attend to a deli/e"y Hhi%h of the following will yo$ do fi"stQ # Set $p the ste"ile a"ea @ P$t on a %lean gown o" ap"on C Cleanse the %lientKs /$l/a with soap and wate" ) *ote the inte"/al& d$"ation and intensity of labo" %ont"a%tions A$s-!rE FDG N#t! t/! i$t!r8a+, %0rati#$ a$% i$t!$sit #, +a7#r "#$tra"ti#$s' #ssessment of the woman sho$ld be done fi"st to dete"mine whethe" she is ha/ing t"$e labo" and& if so& what stage of labo" she is in 9. In p"epa"ing a p"imig"a/ida fo" b"eastfeeding& whi%h of the following will yo$ doQ # !ell he" that la%tation begins within a day afte" deli/e"y @ !ea%h he" nipple st"et%hing e-e"%ises if he" nipples a"e e/e"ted C Inst"$%t he" to wash he" nipples befo"e and afte" ea%h b"eastfeeding ) ,-plain to he" that p$tting the baby to b"east will lessen blood loss afte" deli/e"y

A$s-!rE FDG E<*+ai$ t# /!r t/at *0tti$1 t/! 7a7 t# 7r!ast -i++ +!ss!$ 7+##% +#ss a,t!r %!+i8!r ' S$%0ling of the nipple stim$lates the "elease of o-yto%in by the poste"io" pit$ita"y gland& whi%h %a$ses $te"ine %ont"a%tion 'a%tation begins 1 to + days afte" deli/e"y *ipple st"et%hing e-e"%ises a"e done when the nipples a"e flat o" in/e"ted F"e6$ent washing d"ies $p the nipples& ma0ing them p"one to the fo"mation of fiss$"es 92 # p"imig"a/ida is inst"$%ted to offe" he" b"east to the baby fo" the fi"st time within +0 min$tes afte" deli/e"y Hhat is the p$"pose of offe"ing the b"east this ea"lyQ # !o initiate the o%%$""en%e of mil0 letdown @ !o stim$late mil0 p"od$%tion by the mamma"y a%ini C !o ma0e s$"e that the baby is able to get the %olost"$m ) !o allow the woman to p"a%ti%e b"eastfeeding in the p"esen%e of the health wo"0e" A$s-!rE F)G T# sti60+at! 6i+B *r#%0"ti#$ 7 t/! 6a66ar a"i$i S$%0ling of the nipple stim$lates p"ola%tin "efleOthe "elease of p"ola%tin by the ante"io" pit$ita"y glandP& whi%h initiates la%tation 95 In a mothe"sK %lass& yo$ dis%$ss p"ope" b"eastfeeding te%hni6$e Hhi%h is of these is a sign that the baby has Slat%hed onT to the b"east p"ope"lyQ # !he baby ta0es shallow& "apid s$%0s @ !he mothe" does not feel nipple pain C !he babyKs mo$th is only pa"tly open ) Only the mothe"Ks nipple is inside the babyKs mo$th A$s-!rE F)G T/! 6#t/!r %#!s $#t ,!!+ $i**+! *ai$' Hhen the baby has p"ope"ly lat%hed on to the b"east& he ta0es deep& slow s$%0sW his mo$th is wide openW and m$%h of the a"eola is inside his mo$th #nd& yo$K"e "ight\ !he mothe" does not feel nipple pain 98 Ao$ e-plain to a b"eastfeeding mothe" that b"east mil0 is s$ffi%ient fo" all of the babyKs n$t"ient needs only $p to aaaa # + months @ 5 months C 1 yea" ) 2 yea"s A$s-!rE F)G ; 6#$t/s #fte" 5 months& the babyKs n$t"ient needs& espe%ially the babyKs i"on "e6$i"ement& %an no longe" be p"o/ided by mothe"Ks mil0 alone 99 Hhat is gi/en to a woman within a month afte" the deli/e"y of a babyQ # <al$nggay %aps$le @ Fe""o$s s$lfate 100 mg O)

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C 1etinol 200&000 I U & 1 %aps$le ) Potassi$m iodate 200 mg& 1 %aps$le A$s-!rE FCG R!ti$#+ 2??,??? I'U', 1 "a*s0+! # %aps$le of 1etinol 200&000 IU is gi/en within 1 month afte" deli/e"y Potassi$m iodate is gi/en d$"ing p"egnan%yW mal$nggay %aps$le is not "o$tinely administe"ed afte" deli/e"yW and fe""o$s s$lfate is ta0en fo" two months afte" deli/e"y 99 Hhi%h biologi%al $sed in ,-panded P"og"am on Imm$ni(ation O,PIP is sto"ed in the f"ee(e"Q # )P! @ !etan$s to-oid C <easles /a%%ine ) ?epatitis @ /a%%ine A$s-!rE FCG M!as+!s 8a""i$! #mong the biologi%als $sed in the ,-panded P"og"am on Imm$ni(ation& measles /a%%ine and OP7 a"e highly sensiti/e to heat& "e6$i"ing sto"age in the f"ee(e" 90 Un$sed @CD sho$ld be dis%a"ded how many ho$"s afte" "e%onstit$tionQ # 2 @ . C 5 ) #t the end of the day A$s-!rE F)G 4 Hhile the $n$sed po"tion of othe" biologi%als in ,PI may be gi/en $ntil the end of the day& only @CD is dis%a"ded . ho$"s afte" "e%onstit$tion !his is why @CD imm$ni(ation is s%hed$led only in the mo"ning 91 In imm$ni(ing s%hool ent"ants with @CD& yo$ a"e not obliged to se%$"e pa"ental %onsent !his is be%a$se of whi%h legal do%$mentQ # P ) 995 @ 1 # 89.5 C P"esidential P"o%lamation *o 5 ) P"esidential P"o%lamation *o .5 A$s-!rE FAG P'D' >>; P"esidential )e%"ee 995& ena%ted in 1985& made imm$ni(ation in the ,PI %omp$lso"y fo" %hild"en $nde" 9 yea"s of age ?epatitis @ /a%%ination was made %omp$lso"y fo" the same age g"o$p by 1 # 89.5 92 Hhi%h imm$ni(ation p"od$%es a pe"manent s%a"Q # )P! @ @CD C <easles /a%%ination ) ?epatitis @ /a%%ination A$s-!rE F)G )CG @CD %a$ses the fo"mation of a s$pe"fi%ial abs%ess& whi%h begins 2 wee0s afte" imm$ni(ation !he abs%ess heals witho$t

t"eatment& with the fo"mation of a pe"manent s%a" 9+ # .=wee0 old baby was b"o$ght to the health %ente" fo" his fi"st imm$ni(ation Hhi%h %an be gi/en to himQ # )P!1 @ OP71 C Infant @CD ) ?epatitis @ /a%%ine 1 A$s-!rE FCG I$,a$t )CG Infant @CD may be gi/en at bi"th #ll the othe" imm$ni(ations mentioned %an be gi/en at 5 wee0s of age 9. Ao$ will not gi/e )P! 2 if the mothe" says that the infant had # Sei($"es a day afte" )P! 1 @ Fe/e" fo" + days afte" )P! 1 C #bs%ess fo"mation afte" )P! 1 ) 'o%al tende"ness fo" + days afte" )P! 1 A$s-!rE FAG S!i90r!s a %a a,t!r DPT 1' Sei($"es within + days afte" administ"ation of )P! is an indi%ation of hype"sensiti/ity to pe"t$ssis /a%%ine& a %omponent of )P! !his is %onside"ed a spe%ifi% %ont"aindi%ation to s$bse6$ent doses of )P! 92 # 2=month old infant was b"o$ght to the health %ente" fo" imm$ni(ation )$"ing assessment& the infantKs tempe"at$"e "egiste"ed at +9 1RC Hhi%h is the best %o$"se of a%tion that yo$ will ta0eQ # Do on with the infantKs imm$ni(ations @ Di/e Pa"a%etamol and wait fo" his fe/e" to s$bside C 1efe" the infant to the physi%ian fo" f$"the" assessment ) #d/ise the infantKs mothe" to b"ing him ba%0 fo" imm$ni(ation when he is well A$s-!rE FAG G# #$ -it/ t/! i$,a$t.s i660$i9ati#$s' In the ,PI& fe/e" $p to +9 2RC is not a %ont"aindi%ation to imm$ni(ation <ild a%$te "espi"ato"y t"a%t infe%tion& simple dia""hea and maln$t"ition a"e not %ont"aindi%ations eithe" 95 # p"egnant woman had E$st "e%ei/ed he" .th dose of tetan$s to-oid S$bse6$ently& he" baby will ha/e p"ote%tion against tetan$s fo" how longQ # 1 yea" @ + yea"s C 10 yea"s ) 'ifetime A$s-!rE FAG 1 !ar !he baby will ha/e passi/e nat$"al imm$nity by pla%ental t"ansfe" of antibodies !he mothe" will ha/e a%ti/e a"tifi%ial imm$nity lasting fo" abo$t 10 yea"s 2 doses will gi/e the mothe" lifetime p"ote%tion

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98 # .=month old infant was b"o$ght to the health %ente" be%a$se of %o$gh ?e" "espi"ato"y "ate is .2Gmin$te Using the Integ"ated <anagement of Child Illness OI<CIP g$idelines of assessment& he" b"eathing is %onside"ed # Fast @ Slow C *o"mal ) Insignifi%ant A$s-!rE FCG N#r6a+ In I<CI& a "espi"ato"y "ate of 20Gmin$te o" mo"e is fast b"eathing fo" an infant aged 2 to 12 months 99 Hhi%h of the following signs will indi%ate that a yo$ng %hild is s$ffe"ing f"om se/e"e pne$moniaQ # )yspnea @ Hhee(ing C Fast b"eathing ) Chest ind"awing A$s-!rE FDG C/!st i$%ra-i$1 In I<CI& %hest ind"awing is $sed as the positi/e sign of dyspnea& indi%ating se/e"e pne$monia 99 Using I<CI g$idelines& yo$ %lassify a %hild as ha/ing se/e"e pne$monia Hhat is the best management fo" the %hildQ # P"es%"ibe an antibioti% @ 1efe" him $"gently to the hospital C Inst"$%t the mothe" to in%"ease fl$id inta0e ) Inst"$%t the mothe" to %ontin$e b"eastfeeding A$s-!rE F)G R!,!r /i6 0r1!$t+ t# t/! /#s*ita+' Se/e"e pne$monia "e6$i"es $"gent "efe""al to a hospital #nswe"s #& C and ) a"e done fo" a %lient %lassified as ha/ing pne$monia 100 # 2=month old infant was b"o$ght by his mothe" to the health %ente" be%a$se of dia""hea o%%$""ing . to 2 times a day ?is s0in goes ba%0 slowly afte" a s0in pin%h and his eyes a"e s$n0en Using the I<CI g$idelines& yo$ will %lassify this infant in whi%h %atego"yQ # *o signs of dehyd"ation @ Some dehyd"ation C Se/e"e dehyd"ation ) !he data is ins$ffi%ient A$s-!rE F)G S#6! %!/ %rati#$ Using the assessment g$idelines of I<CI& a %hild O2 months to 2 yea"s oldP with dia""hea is %lassified as ha/ing SO<, ),?A)1#!IO* if he shows 2 o" mo"e of the following signs: "estless o" i""itable& s$n0en eyes& the s0in goes ba%0 slow afte" a s0in pin%h 101 @ased on assessment& yo$ %lassified a += month old infant with the %hief %omplaint of dia""hea in the %atego"y of SO<,

),?A)1#!IO* @ased on I<CI management g$idelines& whi%h of the following will yo$ doQ # @"ing the infant to the nea"est fa%ility whe"e I7 fl$ids %an be gi/en @ S$pe"/ise the mothe" in gi/ing 200 to .00 ml of O"esol in . ho$"s C Di/e the infantKs mothe" inst"$%tions on home management ) :eep the infant in yo$" health %ente" fo" %lose obse"/ation A$s-!rE F)G S0*!r8is! t/! 6#t/!r i$ 1i8i$1 2?? t# 4?? 6+' #, Or!s#+ i$ 4 /#0rs' In the I<CI management g$idelines& SO<, ),?A)1#!IO* is t"eated with the administ"ation of O"esol within a pe"iod of . ho$"s !he amo$nt of O"esol is best %omp$ted on the basis of the %hildKs weight O82 mlG0g body weightP If the weight is $n0nown& the amo$nt of O"esol is based on the %hildKs age 102 # mothe" is $sing O"esol in the management of dia""hea of he" +=yea" old %hild She as0ed yo$ what to do if he" %hild /omits Ao$ will tell he" to # @"ing the %hild to the nea"est hospital fo" f$"the" assessment @ @"ing the %hild to the health %ente" fo" int"a/eno$s fl$id the"apy C @"ing the %hild to the health %ente" fo" assessment by the physi%ian ) 'et the %hild "est fo" 10 min$tes then %ontin$e gi/ing O"esol mo"e slowly A$s-!rE FDG L!t t/! "/i+% r!st ,#r 1? 6i$0t!s t/!$ "#$ti$0! 1i8i$1 Or!s#+ 6#r! s+#-+ ' If the %hild /omits pe"sistently& that is& he /omits e/e"ything that he ta0es in& he has to be "efe""ed $"gently to a hospital Othe"wise& /omiting is managed by letting the %hild "est fo" 10 min$tes and then %ontin$ing with O"esol administ"ation !ea%h the mothe" to gi/e O"esol mo"e slowly 10+ # 1 [ yea" old %hild was %lassified as ha/ing +"d deg"ee p"otein ene"gy maln$t"ition& 0washio"0o" Hhi%h of the following signs will be most appa"ent in this %hildQ # 7o"a%io$s appetite @ Hasting C #pathy ) ,dema A$s-!rE FDG E%!6a ,dema& a maEo" sign of 0washio"0o"& is %a$sed by de%"eased %olloidal osmoti% p"ess$"e of the blood b"o$ght abo$t by hypoalb$minemia )e%"eased blood alb$min le/el is d$e a p"otein= defi%ient diet 10. #ssessment of a 2=yea" old %hild "e/ealed Sbaggy pantsT Using the I<CI g$idelines& how will yo$ manage this %hildQ # 1efe" the %hild $"gently to a hospital fo" %onfinement @ Coo"dinate with the so%ial wo"0e" to en"oll the %hild in a feeding p"og"am

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C <a0e a tea%hing plan fo" the mothe"& fo%$sing on men$ planning fo" he" %hild ) #ssess and t"eat the %hild fo" health p"oblems li0e infe%tions and intestinal pa"asitism A$s-!rE FAG R!,!r t/! "/i+% 0r1!$t+ t# a /#s*ita+ ,#r "#$,i$!6!$t' S@aggy pantsT is a sign of se/e"e ma"asm$s !he best management is $"gent "efe""al to a hospital 102 )$"ing the physi%al e-amination of a yo$ng %hild& what is the ea"liest sign of -e"ophthalmia that yo$ may obse"/eQ # :e"atomala%ia @ Co"neal opa%ity C *ight blindness ) ConE$n%ti/al -e"osis A$s-!rE FDG C#$J0$"ti8a+ <!r#sis !he ea"liest sign of 7itamin # defi%ien%y O-e"ophthalmiaP is night blindness ?owe/e"& this is a f$n%tional %hange& whi%h is not obse"/able d$"ing physi%al e-amination !he ea"liest /isible lesion is %onE$n%ti/al -e"osis o" d$llness of the %onE$n%ti/a d$e to inade6$ate tea" p"od$%tion 105 !o p"e/ent -e"ophthalmia& yo$ng %hild"en a"e gi/en 1etinol %aps$le e/e"y 5 months Hhat is the dose gi/en to p"es%hoole"sQ # 10&000 IU @ 20&000 IU C 100&000 IU ) 200&000 IU A$s-!rE FDG 2??,??? IU P"es%hoole"s a"e gi/en 1etinol 200&000 IU e/e"y 5 months 100&000 IU is gi/en on%e to infants aged 5 to 12 months !he dose fo" p"egnant women is 10&000 IU 108 !he maEo" sign of i"on defi%ien%y anemia is pallo" Hhat pa"t is best e-amined fo" pallo"Q # Palms @ *ailbeds C #"o$nd the lips ) 'owe" %onE$n%ti/al sa% A$s-!rE FAG Pa+6s !he anatomi% %ha"a%te"isti%s of the palms allow a "eliable and %on/enient basis fo" e-amination fo" pallo" 109 Food fo"tifi%ation is one of the st"ategies to p"e/ent mi%"on$t"ient defi%ien%y %onditions 1 # 9985 mandates fo"tifi%ation of %e"tain food items Hhi%h of the following is among these food itemsQ # S$ga" @ @"ead C <a"ga"ine ) Filled mil0 A$s-!rE FAG S01ar 1 # 9985 mandates fo"tifi%ation of "i%e& wheat

flo$"& s$ga" and %oo0ing oil with 7itamin #& i"on andGo" iodine 109 Hhat is the best %o$"se of a%tion when the"e is a measles epidemi% in a nea"by m$ni%ipalityQ # Di/e measles /a%%ine to babies aged 5 to 9 months @ Di/e babies aged 5 to 11 months one dose of 100&000 I U of 1etinol C Inst"$%t mothe"s to 0eep thei" babies at home to p"e/ent disease t"ansmission ) Inst"$%t mothe"s to feed thei" babies ade6$ately to enhan%e thei" babiesK "esistan%e A$s-!rE FAG Gi8! 6!as+!s 8a""i$! t# 7a7i!s a1!% ; t# I 6#$t/s' O"dina"ily& measles /a%%ine is gi/en at 9 months of age )$"ing an impending epidemi%& howe/e"& one dose may be gi/en to babies aged 5 to 9 months !he mothe" is inst"$%ted that the baby needs anothe" dose when the baby is 9 months old 110 # mothe" b"o$ght he" da$ghte"& . yea"s old& to the 1?U be%a$se of %o$gh and %olds Following the I<CI assessment g$ide& whi%h of the following is a dange" sign that indi%ates the need fo" $"gent "efe""al to a hospitalQ # Inability to d"in0 @ ?igh g"ade fe/e" C Signs of se/e"e dehyd"ation ) Co$gh fo" mo"e than +0 days A$s-!rE FAG I$a7i+it t# %ri$B # si%0 %hild aged 2 months to 2 yea"s m$st be "efe""ed $"gently to a hospital if heGshe has one o" mo"e of the following signs: not able to feed o" d"in0& /omits e/e"ything& %on/$lsions& abno"mally sleepy o" diffi%$lt to awa0en 111 <anagement of a %hild with measles in%l$des the administ"ation of whi%h of the followingQ # Dentian /iolet on mo$th lesions @ #ntibioti%s to p"e/ent pne$monia C !et"a%y%line eye ointment fo" %o"neal opa%ity ) 1etinol %aps$le "ega"dless of when the last dose was gi/en A$s-!rE FDG R!ti$#+ "a*s0+! r!1ar%+!ss #, -/!$ t/! +ast %#s! -as 1i8!$ #n infant 5 to 12 months %lassified as a %ase of measles is gi/en 1etinol 100&000 IUW a %hild is gi/en 200&000 IU "ega"dless of when the last dose was gi/en 112 # mothe" b"o$ght he" 10 month old infant fo" %ons$ltation be%a$se of fe/e"& whi%h sta"ted . days p"io" to %ons$ltation !o dete"mine mala"ia "is0& what will yo$ doQ # )o a to$"ni6$et test @ #s0 whe"e the family "esides C Det a spe%imen fo" blood smea"

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) #s0 if the fe/e" is p"esent e/e"yday A$s-!rE F)G AsB -/!r! t/! ,a6i+ r!si%!s' @e%a$se mala"ia is endemi%& the fi"st 6$estion to dete"mine mala"ia "is0 is whe"e the %lientKs family "esides If the a"ea of "esiden%e is not a 0nown endemi% a"ea& as0 if the %hild had t"a/eled within the past 5 months& whe"e heGshe was b"o$ght and whethe" heGshe stayed o/e"night in that a"ea 11+ !he following a"e st"ategies implemented by the )epa"tment of ?ealth to p"e/ent mos6$ito=bo"ne diseases Hhi%h of these is most effe%ti/e in the %ont"ol of )eng$e fe/e"Q # St"eam seeding with la"/a=eating fish @ )est"oying b"eeding pla%es of mos6$itoes C Chemop"ophyla-is of non=imm$ne pe"sons going to endemi% a"eas ) !ea%hing people in endemi% a"eas to $se %hemi%ally t"eated mos6$ito nets A$s-!rE F)G D!str# i$1 7r!!%i$1 *+a"!s #, 6#s40it#!s #edes aegypti& the /e%to" of )eng$e fe/e"& b"eeds in stagnant& %lea" wate" Its feeding time is $s$ally d$"ing the daytime It has a %y%li%al patte"n of o%%$""en%e& $nli0e mala"ia whi%h is endemi% in %e"tain pa"ts of the %o$nt"y 11. Se%onda"y p"e/ention fo" mala"ia in%l$des # Planting of neem o" e$%alypt$s t"ees @ 1esid$al sp"aying of inse%ti%ides at night C )ete"mining whethe" a pla%e is endemi% o" not ) D"owing la"/a=eating fish in mos6$ito b"eeding pla%es A$s-!rE FCG D!t!r6i$i$1 -/!t/!r a *+a"! is !$%!6i" #r $#t !his is diagnosti% and the"efo"e se%onda"y le/el p"e/ention !he othe" %hoi%es a"e fo" p"ima"y p"e/ention 112 S%ot%h tape swab is done to %he%0 fo" whi%h intestinal pa"asiteQ # #s%a"is @ Pinwo"m C ?oo0wo"m ) S%histosoma A$s-!rE F)G Pi$-#r6 Pinwo"m o/a a"e deposited a"o$nd the anal o"ifi%e 115 Hhi%h of the following signs indi%ates the need fo" sp$t$m e-amination fo" #F@Q # ?ematemesis @ Fe/e" fo" 1 wee0 C Co$gh fo" + wee0s ) Chest pain fo" 1 wee0 A$s-!rE FCG C#01/ ,#r 3 -!!Bs # %lient is %onside"ed a P!@ s$spe%t when he has %o$gh fo" 2 wee0s o" mo"e& pl$s one o" mo"e

of the following signs: fe/e" fo" 1 month o" mo"eW %hest pain lasting fo" 2 wee0s o" mo"e not att"ib$ted to othe" %onditionsW p"og"essi/e& $ne-plained weight lossW night sweatsW and hemoptysis 118 Hhi%h %lients a"e %onside"ed ta"gets fo" )O!S Catego"y IQ # Sp$t$m negati/e %a/ita"y %ases @ Clients "et$"ning afte" a defa$lt C 1elapses and fail$"es of p"e/io$s P!@ t"eatment "egimens ) Clients diagnosed fo" the fi"st time th"o$gh a positi/e sp$t$m e-am A$s-!rE FDG C+i!$ts %ia1$#s!% ,#r t/! ,irst ti6! t/r#01/ a *#siti8! s*0t06 !<a6 Catego"y I is fo" new %lients diagnosed by sp$t$m e-amination and %lients diagnosed to ha/e a se"io$s fo"m of e-t"ap$lmona"y t$be"%$losis& s$%h as !@ osteomyelitis 119 !o imp"o/e %omplian%e to t"eatment& what inno/ation is being implemented in )O!SQ # ?a/ing the health wo"0e" follow $p the %lient at home @ ?a/ing the health wo"0e" o" a "esponsible family membe" monito" d"$g inta0e C ?a/ing the patient %ome to the health %ente" e/e"y month to get his medi%ations ) ?a/ing a ta"get list to %he%0 on whethe" the patient has %olle%ted his monthly s$pply of d"$gs A$s-!rE F)G Ha8i$1 t/! /!a+t/ -#rB!r #r a r!s*#$si7+! ,a6i+ 6!67!r 6#$it#r %r01 i$taB! )i"e%tly Obse"/ed !"eatment Sho"t Co$"se is so= %alled be%a$se a t"eatment pa"tne"& p"efe"ably a health wo"0e" a%%essible to the %lient& monito"s the %lientKs %omplian%e to the t"eatment 119 )iagnosis of lep"osy is highly dependent on "e%ognition of symptoms Hhi%h of the following is an ea"ly sign of lep"osyQ # <a%$la" lesions @ Inability to %lose eyelids C !hi%0ened painf$l ne"/es ) Sin0ing of the noseb"idge A$s-!rE FCG T/i"B!$!% *ai$,0+ $!r8!s !he lesion of lep"osy is not ma%$la" It is %ha"a%te"i(ed by a %hange in s0in %olo" Oeithe" "eddish o" whitishP and loss of sensation& sweating and hai" g"owth o/e" the lesion Inability to %lose the eyelids OlagophthalmosP and sin0ing of the noseb"idge a"e late symptoms 120 Hhi%h of the following %lients sho$ld be %lassified as a %ase of m$ltiba%illa"y lep"osyQ # + s0in lesions& negati/e slit s0in smea" @ + s0in lesions& positi/e slit s0in smea" C 2 s0in lesions& negati/e slit s0in smea" ) 2 s0in lesions& positi/e slit s0in smea"

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A$s-!rE FDG 5 sBi$ +!si#$s, *#siti8! s+it sBi$ s6!ar # m$ltiba%illa"y lep"osy %ase is one who has a positi/e slit s0in smea" and at least 2 s0in lesions 121 In the Philippines& whi%h %ondition is the most f"e6$ent %a$se of death asso%iated with s%histosomiasisQ # 'i/e" %an%e" @ 'i/e" %i""hosis C @ladde" %an%e" ) Intestinal pe"fo"ation A$s-!rE F)G Li8!r "irr/#sis !he etiologi% agent of s%histosomiasis in the Philippines is S%histosoma Eaponi%$m& whi%h affe%ts the small intestine and the li/e" 'i/e" damage is a %onse6$en%e of fib"oti% "ea%tions to s%histosoma eggs in the li/e" 122 Hhat is the most effe%ti/e way of %ont"olling s%histosomiasis in an endemi% a"eaQ # Use of moll$s%i%ides @ @$ilding of foot b"idges C P"ope" $se of sanita"y toilets ) Use of p"ote%ti/e footwea"& s$%h as "$bbe" boots A$s-!rE FCG Pr#*!r 0s! #, sa$itar t#i+!ts !he o/a of the pa"asite get o$t of the h$man body togethe" with fe%es C$tting the %y%le at this stage is the most effe%ti/e way of p"e/enting the sp"ead of the disease to s$s%eptible hosts 12+ Hhen "esidents obtain wate" f"om an a"tesian well in the neighbo"hood& the le/el of this app"o/ed type of wate" fa%ility is # I @ II C III ) I7 A$s-!rE F)G II # %omm$nal fa$%et o" wate" standpost is %lassified as 'e/el II 12. Fo" p"e/ention of hepatitis #& yo$ de%ided to %ond$%t health ed$%ation a%ti/ities Hhi%h of the following is I11,',7#*!Q # Use of ste"ile sy"inges and needles @ Safe food p"epa"ation and food handling by /endo"s C P"ope" disposal of h$man e-%"eta and pe"sonal hygiene ) Immediate "epo"ting of wate" pipe lea0s and illegal wate" %onne%tions A$s-!rE FAG Us! #, st!ri+! s ri$1!s a$% $!!%+!s ?epatitis # is t"ansmitted th"o$gh the fe%al o"al "o$te ?epatitis @ is t"ansmitted th"o$gh infe%ted body se%"etions li0e blood and semen

125 Hhi%h biologi%al $sed in ,-panded P"og"am on Imm$ni(ation O,PIP sho$ld *O! be sto"ed in the f"ee(e"Q # )P! @ O"al polio /a%%ine C <easles /a%%ine ) <<1 A$s-!rE FAG DPT )P! is sensiti/e to f"ee(ing !he app"op"iate sto"age tempe"at$"e of )P! is 2 to 9R C only OP7 and measles /a%%ine a"e highly sensiti/e to heat and "e6$i"e f"ee(ing <<1 is not an imm$ni(ation in the ,-panded P"og"am on Imm$ni(ation 128 Ao$ will %ond$%t o$t"ea%h imm$ni(ation in a ba"angay with a pop$lation of abo$t 1200 ,stimate the n$mbe" of infants in the ba"angay # .2 @ 20 C 22 ) 50 A$s-!rE FAG 45 !o estimate the n$mbe" of infants& m$ltiply total pop$lation by +V 129 In Integ"ated <anagement of Childhood Illness& se/e"e %onditions gene"ally "e6$i"e $"gent "efe""al to a hospital Hhi%h of the following se/e"e %onditions )O,S *O! always "e6$i"e $"gent "efe""al to a hospitalQ # <astoiditis @ Se/e"e dehyd"ation C Se/e"e pne$monia ) Se/e"e feb"ile disease A$s-!rE F)G S!8!r! %!/ %rati#$ !he o"de" of p"io"ity in the management of se/e"e dehyd"ation is as follows: int"a/eno$s fl$id the"apy& "efe""al to a fa%ility whe"e I7 fl$ids %an be initiated within +0 min$tes& O"esolGnasogast"i% t$be& O"esolGo"em Hhen the fo"egoing meas$"es a"e not possible o" effe%ti/e& tehn $"gent "efe""al to the hospital is done 129 # %lient was diagnosed as ha/ing )eng$e fe/e" Ao$ will say that the"e is slow %apilla"y "efill when the %olo" of the nailbed that yo$ p"essed does not "et$"n within how many se%ondsQ # + @ 2 C 9 ) 10 A$s-!rE FAG 3 #de6$ate blood s$pply to the a"ea allows the "et$"n of the %olo" of the nailbed within + se%onds 1+0 # +=yea" old %hild was b"o$ght by his mothe" to the health %ente" be%a$se of fe/e" of .=day d$"ation !he %hild had a positi/e

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to$"ni6$et test "es$lt In the absen%e of othe" signs& whi%h is the most app"op"iate meas$"e that the P?* may %a""y o$t to p"e/ent )eng$e sho%0 synd"omeQ # Inse"t an *D! and gi/e fl$ids pe" *D! @ Inst"$%t the mothe" to gi/e the %hild O"esol C Sta"t the patient on int"a/eno$s fl$ids S!#! ) 1efe" the %lient to the physi%ian fo" app"op"iate management A$s-!rE F)G I$str0"t t/! 6#t/!r t# 1i8! t/! "/i+% Or!s#+' Sin%e the %hild does not manifest any othe" dange" sign& maintenan%e of fl$id balan%e and "epla%ement of fl$id loss may be done by gi/ing the %lient O"esol 1+1 !he pathognomoni% sign of measles is :opli0Ks spot Ao$ may see :opli0Ks spot by inspe%ting the aaaaa # *asal m$%osa @ @$%%al m$%osa C S0in on the abdomen ) S0in on the ante%$bital s$"fa%e A$s-!rE F)G )0""a+ 60"#sa :opli0Ks spot may be seen on the m$%osa of the mo$th o" the th"oat 1+2 #mong the following diseases& whi%h is ai"bo"neQ # 7i"al %onE$n%ti/itis @ #%$te poliomyelitis C )iphthe"ia ) <easles A$s-!rE FDG M!as+!s 7i"al %onE$n%ti/itis is t"ansmitted by di"e%t o" indi"e%t %onta%t with dis%ha"ges f"om infe%ted eyes #%$te poliomyelitis is sp"ead th"o$gh the fe%al=o"al "o$te and %onta%t with th"oat se%"etions& whe"eas diphthe"ia is th"o$gh di"e%t and indi"e%t %onta%t with "espi"ato"y se%"etions 1++ #mong %hild"en aged 2 months to + yea"s& the most p"e/alent fo"m of meningitis is %a$sed by whi%h mi%"oo"ganismQ # ?emophil$s infl$en(ae @ <o"billi/i"$s C Stepto%o%%$s pne$moniae ) *eisse"ia meningitidis A$s-!rE FAG H!6#*/i+0s i$,+0!$9a! ?emophil$s meningitis is $n$s$al o/e" the age of 2 yea"s In de/eloping %o$nt"ies& the pea0 in%iden%e is in %hild"en less than 5 months of age <o"billi/i"$s is the etiology of measles St"epto%o%%$s pne$moniae and *eisse"ia meningitidis may %a$se meningitis& b$t age dist"ib$tion is not spe%ifi% in yo$ng %hild"en 1+. ?$man beings a"e the maEo" "ese"/oi" of mala"ia Hhi%h of the following st"ategies in mala"ia %ont"ol is based on this fa%tQ # St"eam seeding

@ St"eam %lea"ing C )est"$%tion of b"eeding pla%es ) Joop"ophyla-is A$s-!rE FDG K##*r#*/ +a<is Joop"ophyla-is is done by p$tting animals li0e %attle o" dogs %lose to windows o" doo"ways E$st befo"e nightfall !he #nopheles mos6$ito ta0es his blood meal f"om the animal and goes ba%0 to its b"eeding pla%e& the"eby p"e/enting infe%tion of h$mans 1+2 !he $se of la"/i/o"o$s fish in mala"ia %ont"ol is the basis fo" whi%h st"ategy of mala"ia %ont"olQ # St"eam seeding @ St"eam %lea"ing C )est"$%tion of b"eeding pla%es ) Joop"ophyla-is A$s-!rE FAG Str!a6 s!!%i$1 St"eam seeding is done by p$tting tilapia f"y in st"eams o" othe" bodies of wate" identified as b"eeding pla%es of the #nopheles mos6$ito 1+5 <os6$ito=bo"ne diseases a"e p"e/ented mostly with the $se of mos6$ito %ont"ol meas$"es Hhi%h of the following is *O! app"op"iate fo" mala"ia %ont"olQ # Use of %hemi%ally t"eated mos6$ito nets @ Seeding of b"eeding pla%es with la"/a=eating fish C )est"$%tion of b"eeding pla%es of the mos6$ito /e%to" ) Use of mos6$ito="epelling soaps& s$%h as those with basil o" %it"onella A$s-!rE FCG D!str0"ti#$ #, 7r!!%i$1 *+a"!s #, t/! 6#s40it# 8!"t#r #nopheles mos6$itoes b"eed in slow=mo/ing& %lea" wate"& s$%h as mo$ntain st"eams 1+8 # .=yea" old %lient was b"o$ght to the health %ente" with the %hief %omplaint of se/e"e dia""hea and the passage of S"i%e wate"T stools !he %lient is most p"obably s$ffe"ing f"om whi%h %onditionQ # Dia"diasis @ Chole"a C #mebiasis ) )ysente"y A$s-!rE F)G C/#+!ra Passage of p"of$se wate"y stools is the maEo" symptom of %hole"a @oth amebi% and ba%illa"y dysente"y a"e %ha"a%te"i(ed by the p"esen%e of blood andGo" m$%$s in the stools Dia"diasis is %ha"a%te"i(ed by fat malabso"ption and& the"efo"e& steato""hea 1+9 In the Philippines& whi%h spe%ie of s%histosoma is endemi% in %e"tain "egionsQ # S mansoni @ S Eaponi%$m C S malayensis

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) S haematobi$m A$s-!rE F)G S' Ja*#$i"06 S mansoni is fo$nd mostly in #f"i%a and So$th #me"i%aW S haematobi$m in #f"i%a and the <iddle ,astW and S malayensis only in penins$la" <alaysia 1+9 # +2=yea" old %lient %ame fo" %ons$ltation at the health %ente" with the %hief %omplaint of fe/e" fo" a wee0 #%%ompanying symptoms we"e m$s%le pains and body malaise # wee0 afte" the sta"t of fe/e"& the %lient noted yellowish dis%olo"ation of his s%le"a ?isto"y showed that he waded in flood wate"s abo$t 2 wee0s befo"e the onset of symptoms @ased on his histo"y& whi%h disease %ondition will yo$ s$spe%tQ # ?epatitis # @ ?epatitis @ C !etan$s ) 'eptospi"osis A$s-!rE FDG L!*t#s*ir#sis 'eptospi"osis is t"ansmitted th"o$gh %onta%t with the s0in o" m$%o$s memb"ane with wate" o" moist soil %ontaminated with $"ine of infe%ted animals& li0e "ats 1.0 <HSS p"o/ides wate" to <anila and othe" %ities in <et"o <anila !his is an e-ample of whi%h le/el of wate" fa%ilityQ # I @ II C III ) I7 A$s-!rE FCG III Hate"wo"0s systems& s$%h as <HSS& a"e %lassified as le/el III 1.1 Ao$ a"e the P?* in the %ity health %ente" # %lient $nde"went s%"eening fo" #I)S $sing ,'IS# ?is "es$lt was positi/e Hhat is the best %o$"se of a%tion that yo$ may ta0eQ # Det a tho"o$gh histo"y of the %lient& fo%$sing on the p"a%ti%e of high "is0 beha/io"s @ #s0 the %lient to be a%%ompanied by a signifi%ant pe"son befo"e "e/ealing the "es$lt C 1efe" the %lient to the physi%ian sin%e he is the best pe"son to "e/eal the "es$lt to the %lient ) 1efe" the %lient fo" a s$pplementa"y test& s$%h as Heste"n blot& sin%e the ,'IS# "es$lt may be false A$s-!rE FDG R!,!r t/! "+i!$t ,#r a s0**+!6!$tar t!st, s0"/ as 5!st!r$ 7+#t, si$"! t/! ELISA r!s0+t 6a 7! ,a+s!' # %lient ha/ing a "ea%ti/e ,'IS# "es$lt m$st $nde"go a mo"e spe%ifi% test& s$%h as Heste"n blot # negati/e s$pplementa"y test "es$lt means that the ,'IS# "es$lt was false and that& most p"obably& the %lient is not infe%ted 1.2 Hhi%h is the @,S! %ont"ol meas$"e fo" #I)SQ

# @eing faithf$l to a single se-$al pa"tne" @ Using a %ondom d$"ing ea%h se-$al %onta%t C #/oiding se-$al %onta%t with %omme"%ial sewo"0e"s ) <a0ing s$"e that oneKs se-$al pa"tne" does not ha/e signs of #I)S A$s-!rE FAG )!i$1 ,ait/,0+ t# a si$1+! s!<0a+ *art$!r Se-$al fidelity "$les o$t the possibility of getting the disease by se-$al %onta%t with anothe" infe%ted pe"son !"ansmission o%%$"s mostly th"o$gh se-$al inte"%o$"se and e-pos$"e to blood o" tiss$es
1.+ !he most f"e6$ent %a$ses of death among %lients with #I)S a"e oppo"t$nisti% diseases Hhi%h of the following oppo"t$nisti% infe%tions is %ha"a%te"i(ed by tonsillopha"yngitisQ # 1espi"ato"y %andidiasis @ Infe%tio$s monon$%leosis C Cytomegalo/i"$s disease ) Pne$mo%ystis %a"inii pne$monia A$s-!rE F)G I$,!"ti#0s 6#$#$0"+!#sis Cytomegalo/i"$s disease is an a%$te /i"al disease %ha"a%te"i(ed by fe/e"& so"e th"oat and lymphadenopathy 1.. !o dete"mine possible so$"%es of se-$ally t"ansmitted infe%tions& whi%h is the @,S! method that may be $nde"ta0en by the p$bli% health n$"seQ # @ C ) Conta%t t"a%ing Comm$nity s$"/ey <ass s%"eening tests Inte"/iew of s$spe%ts

A$s-!rE FAG C#$ta"t tra"i$1 Conta%t t"a%ing is the most p"a%ti%al and "eliable method of finding possible so$"%es of pe"son=to= pe"son t"ansmitted infe%tions& s$%h as se-$ally t"ansmitted diseases 1.2 #nti"et"o/i"al agents& s$%h as #J!& a"e $sed in the management of #I)S Hhi%h of the following is *O! an a%tion e-pe%ted of these d"$gs # !hey p"olong the life of the %lient with #I)S @ !hey "ed$%e the "is0 of oppo"t$nisti% infe%tions C !hey sho"ten the pe"iod of %omm$ni%ability of the disease ) !hey a"e able to b"ing abo$t a %$"e of the disease %ondition A$s-!rE FDG T/! ar! a7+! t# 7ri$1 a7#0t a "0r! #, t/! %is!as! "#$%iti#$' !he"e is no 0nown t"eatment fo" #I)S #nti"et"o/i"al agents "ed$%e the "is0 of oppo"t$nisti% infe%tions and p"olong life& b$t does not %$"e the $nde"lying imm$nodefi%ien%y 1.5 # ba"angay had an o$tb"ea0 of De"man measles !o p"e/ent %ongenital "$bella& what is the @,S! ad/i%e that yo$ %an gi/e to women in the fi"st t"imeste" of p"egnan%y in the ba"angayQ # #d/i%e them on the signs of De"man measles @ #/oid %"owded pla%es& s$%h as ma"0ets and mo/ieho$ses

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C Cons$lt at the health %ente" whe"e "$bella /a%%ine may be gi/en ) Cons$lt a physi%ian who may gi/e them "$bella imm$noglob$lin A$s-!rE FDG C#$s0+t a */ si"ia$ -/# 6a 1i8! t/!6 r07!++a i660$#1+#70+i$' 1$bella /a%%ine is made $p of atten$ated De"man measles /i"$ses !his is %ont"aindi%ated in p"egnan%y Imm$ne glob$lin& a spe%ifi% p"ophyla%ti% against De"man measles& may be gi/en to p"egnant women 1.8 Ao$ we"e in/ited to be the "eso$"%e pe"son in a t"aining %lass fo" food handle"s Hhi%h of the following wo$ld yo$ emphasi(e "ega"ding p"e/ention of staphylo%o%%al food poisoningQ # #ll %oo0ing and eating $tensils m$st be tho"o$ghly washed @ Food m$st be %oo0ed p"ope"ly to dest"oy staphylo%o%%al mi%"oo"ganisms C Food handle"s and food se"/e"s m$st ha/e a negati/e stool e-amination "es$lt ) P"ope" handwashing d$"ing food p"epa"ation is the best way of p"e/enting the %ondition A$s-!rE FDG Pr#*!r /a$%-as/i$1 %0ri$1 ,##% *r!*arati#$ is t/! 7!st -a #, *r!8!$ti$1 t/! "#$%iti#$' Symptoms of this food poisoning a"e d$e to staphylo%o%%al ente"oto-in& not the mi%"oo"ganisms themsel/es Contamination is by food handling by pe"sons with staphylo%o%%al s0in o" eye infe%tions

1.9 In a mothe"sK %lass& yo$ dis%$ssed %hildhood diseases s$%h as %hi%0en po- Hhi%h of the following statements abo$t %hi%0en po- is %o""e%tQ # !he olde" one gets& the mo"e s$s%eptible he be%omes to the %ompli%ations of %hi%0en po@ # single atta%0 of %hi%0en po- will p"e/ent f$t$"e episodes& in%l$ding %onditions s$%h as shingles C !o p"e/ent an o$tb"ea0 in the %omm$nity& 6$a"antine may be imposed by health a$tho"ities ) Chi%0en po- /a%%ine is best gi/en when the"e is an impending o$tb"ea0 in the %omm$nity A$s-!rE FAG T/! #+%!r #$! 1!ts, t/! 6#r! s0s"!*ti7+! /! 7!"#6!s t# t/! "#6*+i"ati#$s #, "/i"B!$ *#<' Chi%0en po- is $s$ally mo"e se/e"e in ad$lts than in %hild"en Compli%ations& s$%h as pne$monia& a"e highe" in in%iden%e in ad$lts 1.9 Compli%ations to infe%tio$s pa"otitis Om$mpsP may be se"io$s in whi%h type of %lientsQ # P"egnant women @ ,lde"ly %lients C Ao$ng ad$lt males ) Ao$ng infants A$s-!rE FCG (#0$1 a%0+t 6a+!s ,pididymitis and o"%hitis a"e possible %ompli%ations of m$mps In post=adoles%ent males& bilate"al inflammation of the testes and epididymis may %a$se ste"ility

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MEDICAL SURGICAL NURSING Part 1 1 <"s Ch$a a 89 yea" old %lient is admitted with the diagnosis of mild %h"oni% hea"t fail$"e !he n$"se e-pe%ts to hea" when listening to %lientKs l$ngs indi%ati/e of %h"oni% hea"t fail$"e wo$ld be: a St"ido" b C"a%0les % Hhee(es d F"i%tion "$bs 2 Pat"i%0 who is hospitali(ed following a myo%a"dial infa"%tion as0s the n$"se why he is ta0ing mo"phine !he n$"se e-plains that mo"phine: a )e%"ease an-iety and "estlessness b P"e/ents sho%0 and "elie/es pain % )ilates %o"ona"y blood /essels d ?elps p"e/ent fib"illation of the hea"t + Hhi%h of the following sho$ld the n$"se tea%h the %lient abo$t the signs of digitalis to-i%ityQ a In%"eased appetite b ,le/ated blood p"ess$"e % S0in "ash o/e" the %hest and ba%0 d 7is$al dist$"ban%es s$%h as seeing yellow spots . *$"se !"isha tea%hes a %lient with hea"t fail$"e to ta0e o"al F$"osemide in the mo"ning !he "eason fo" this is to helpM a 1eta"d "apid d"$g abso"ption b ,-%"ete e-%essi/e fl$ids a%%$m$lated at night % P"e/ents sleep dist$"ban%es d$"ing night d P"e/ention of ele%t"olyte imbalan%e 2 Hhat wo$ld be the p"ima"y goal of the"apy fo" a %lient with p$lmona"y edema and hea"t fail$"eQ a ,nhan%e %omfo"t

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b In%"ease %a"dia% o$tp$t % Imp"o/e "espi"ato"y stat$s d Pe"iphe"al edema de%"eased 5 *$"se 'inda is %a"ing fo" a %lient with head inE$"y and monito"ing the %lient with de%e"eb"ate post$"ing Hhi%h of the following is a %ha"a%te"isti% of this type of post$"ingQ a Uppe" e-t"emity fle-ion with lowe" e-t"emity fle-ion b Uppe" e-t"emity fle-ion with lowe" e-t"emity e-tension % ,-tension of the e-t"emities afte" a stim$l$s d Fle-ion of the e-t"emities afte" stim$l$s 8 # female %lient is ta0ing Cas%a"a Sag"ada *$"se @etty info"ms the %lient that the following maybe e-pe"ien%ed as side effe%ts of this medi%ation: a DI bleeding b Pepti% $l%e" disease % #bdominal %"amps d Pa"tial bowel obst"$%tion 9 )" <a"6$e( o"de"s a %ontin$o$s int"a/eno$s nit"ogly%e"in inf$sion fo" the %lient s$ffe"ing f"om myo%a"dial infa"%tion Hhi%h of the following is the most essential n$"sing a%tionQ a <onito"ing $"ine o$tp$t f"e6$ently b <onito"ing blood p"ess$"e e/e"y . ho$"s % Obtaining se"$m potassi$m le/els daily d Obtaining inf$sion p$mp fo" the medi%ation 9 )$"ing the se%ond day of hospitali(ation of the %lient afte" a <yo%a"dial Infa"%tion Hhi%h of the following is an e-pe%ted o$t%omeQ a #ble to pe"fo"m self=%a"e a%ti/ities witho$t pain b Se/e"e %hest pain % Can "e%ogni(e the "is0 fa%to"s of <yo%a"dial Infa"%tion d Can Pa"ti%ipate in %a"dia% "ehabilitation wal0ing p"og"am 10 # 59 yea" old %lient is diagnosed with a "ight=sided b"ain atta%0 and is admitted to the hospital In %a"ing fo" this %lient& the n$"se sho$ld plan to: a #ppli%ation of elasti% sto%0ings to p"e/ent fla%%id by m$s%le b Use hand "oll and e-tend the left $ppe" e-t"emity on a pillow to p"e/ent %ont"a%tions % Use a bed %"adle to p"e/ent do"sifle-ion of feet d )o passi/e "ange of motion e-e"%ise 11 *$"se 'i(a is assigned to %a"e fo" a %lient who has "et$"ned to the n$"sing $nit afte" left neph"e%tomy *$"se 'i(aKs highest p"io"ity wo$ld beM a ?o$"ly $"ine o$tp$t b !empe"at$"e % #ble to t$"n side to side d #ble to sips %lea" li6$id 12 # 5. yea" old male %lient with a long histo"y of %a"dio/as%$la" p"oblem in%l$ding hype"tension and angina is to be s%hed$led fo" %a"dia% %athete"i(ation )$"ing p"e %a"dia% %athete"i(ation tea%hing& *$"se Che""y sho$ld info"m the %lient that the p"ima"y p$"pose of the p"o%ed$"e isM a !o dete"mine the e-isten%e of C?) b !o /is$ali(e the disease p"o%ess in the %o"ona"y a"te"ies % !o obtain the hea"t %hambe"s p"ess$"e d !o meas$"e o-ygen %ontent of diffe"ent hea"t %hambe"s 1+ )$"ing the fi"st se/e"al ho$"s afte" a %a"dia% %athete"i(ation& it wo$ld be most essential fo" n$"se Che""y toM a ,le/ate %lients bed at .2R b Inst"$%t the %lient to %o$gh and deep b"eathe e/e"y 2 ho$"s % F"e6$ently monito" %lientKs api%al p$lse and blood p"ess$"e d <onito" %lients tempe"at$"e e/e"y ho$" 1. :ate who has $nde"gone mit"al /al/e "epla%ement s$ddenly e-pe"ien%es %ontin$o$s bleeding f"om the s$"gi%al in%ision d$"ing postope"ati/e pe"iod Hhi%h of the following pha"ma%e$ti%al agents sho$ld *$"se #i(a p"epa"e to administe" to :ateQ a P"otamine S$lfate b >$inidine S$lfate % 7itamin C d Co$madin 12 In "ed$%ing the "is0 of endo%a"ditis& good dental %a"e is an impo"tant meas$"e !o p"omote good dental %a"e in %lient with mit"al stenosis in tea%hing plan sho$ld in%l$de p"ope" $se ofM a )ental floss b ,le%t"i% toothb"$sh % <an$al toothb"$sh d I""igation de/i%e

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15 #mong the following signs and symptoms& whi%h wo$ld most li0ely be p"esent in a %lient with mit"al g$"gitationQ a #lte"ed le/el of %ons%io$sness b ,-%eptional )yspnea % In%"ease %"eatine phospholinase %on%ent"ation d Chest pain 18 :"is with a histo"y of %h"oni% infe%tion of the $"ina"y system %omplains of $"ina"y f"e6$en%y and b$"ning sensation !o fig$"e o$t whethe" the %$""ent p"oblem is in "enal o"igin& the n$"se sho$ld assess whethe" the %lient has dis%omfo"t o" pain in theM a U"ina"y meat$s b Pain in the 'abi$m % S$p"ap$bi% a"ea d 1ight o" left %osto/e"teb"al angle 19 *$"se Pe""y is e/al$ating the "enal f$n%tion of a male %lient #fte" do%$menting $"ine /ol$me and %ha"a%te"isti%s& *$"se Pe""y assesses whi%h signs as the best indi%ato" of "enal f$n%tion a @lood p"ess$"e b Cons%io$sness % )istension of the bladde" d P$lse "ate 19 Bohn s$ddenly e-pe"ien%es a sei($"e& and *$"se Dina noti%e that Bohn e-hibits $n%ont"ollable Ee"0ing mo/ements *$"se Dina do%$ments that Bohn e-pe"ien%ed whi%h type of sei($"eQ a !oni% sei($"e b #bsen%e sei($"e % <yo%loni% sei($"e d Cloni% sei($"e 20 Smo0ing %essation is %"iti%al st"ategy fo" the %lient with @$"ghe"Ks disease& *$"se Basmin anti%ipates that the male %lient will go home with a p"es%"iption fo" whi%h medi%ationQ a Pa"a%etamol b Ib$p"ofen % *it"ogly%e"in d *i%otine O*i%ot"olP 21 *$"se 'illy has been assigned to a %lient with 1ayna$dKs disease *$"se 'illy "eali(es that the etiology of the disease is $n0nown b$t it is %ha"a%te"i(ed by: a ,pisodi% /asospasti% diso"de" of %apilla"ies b ,pisodi% /asospasti% diso"de" of small /eins % ,pisodi% /asospasti% diso"de" of the ao"ta d ,pisodi% /asospasti% diso"de" of the small a"te"ies 22 *$"se Bamie sho$ld e-plain to male %lient with diabetes that self=monito"ing of blood gl$%ose is p"efe""ed to $"ine gl$%ose testing be%a$seM a <o"e a%%$"ate b Can be done by the %lient % It is easy to pe"fo"m d It is not infl$en%ed by d"$gs 2+ Bessie weighed 210 po$nds on admission to the hospital #fte" 2 days of di$"eti% the"apy& Bessie weighs 202 2 po$nds !he n$"se %o$ld estimate the amo$nt of fl$id Bessie has lostM a 0+' b 12' % 20' d +2' 2. *$"se )onna is awa"e that the shift of body fl$ids asso%iated with Int"a/eno$s administ"ation of alb$min o%%$"s in the p"o%ess of: a Osmosis b )iff$sion % #%ti/e t"anspo"t d Filt"ation 22 <y"na a 22 yea" old %lient with a f"a%t$"ed left tibia has a long leg %ast and she is $sing %"$t%hes to amb$late *$"se Boy assesses fo" whi%h sign and symptom that indi%ates %ompli%ation asso%iated with %"$t%h wal0ingQ a 'eft leg dis%omfo"t b Hea0 bi%eps b"a%hii % !"i%eps m$s%le spasm d Fo"ea"m wea0ness 25 Hhi%h of the following statements sho$ld the n$"se tea%h the ne$t"openi% %lient and his family to a/oidQ a Pe"fo"ming o"al hygiene afte" e/e"y meal b Using s$pposito"ies o" enemas % Pe"fo"ming pe"ineal hygiene afte" ea%h bowel mo/ement

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d Using a filte" mas0 28 # female %lient is e-pe"ien%ing painf$l and "igid abdomen and is diagnosed with pe"fo"ated pepti% $l%e" # s$"ge"y has been s%hed$led and a nasogast"i% t$be is inse"ted !he n$"se sho$ld pla%e the %lient befo"e s$"ge"y in a Sims position b S$pine position % Semi=fowle"s position d )o"sal "e%$mbent position 29 Hhi%h n$"sing inte"/ention ens$"es ade6$ate /entilating e-%hange afte" s$"ge"yQ a 1emo/e the ai"way only when %lient is f$lly %ons%io$s b #ssess fo" hypo/entilation by a$s%$ltating the l$ngs % Position %lient late"ally with the ne%0 e-tended d <aintain h$midified o-ygen /ia nasal %an$la 29 Deo"ge who has $nde"gone tho"a%i% s$"ge"y has %hest t$be %onne%ted to a wate"=seal d"ainage system atta%hed to s$%tion P"esen%e of e-%essi/e b$bbling is identified in wate"=seal %hambe"& the n$"se sho$ldM a SSt"ipT the %hest t$be %athete" b Che%0 the system fo" ai" lea0s % 1e%ogni(e the system is f$n%tioning %o""e%tly d )e%"ease the amo$nt of s$%tion p"ess$"e +0 # %lient who has been diagnosed of hype"tension is being ta$ght to "est"i%t inta0e of sodi$m !he n$"se wo$ld 0now that the tea%hings a"e effe%ti/e if the %lient states thatM a I %an eat %ele"y sti%0s and %a""ots b I %an eat b"oiled s%allops % I %an eat sh"edded wheat %e"eal d I %an eat spaghetti on "ye b"ead +1 # male %lient with a histo"y of %i""hosis and al%oholism is admitted with se/e"e dyspnea "es$lted to as%ites !he n$"se sho$ld be awa"e that the as%ites is most li0ely the "es$lt of in%"easedM a P"ess$"e in the po"tal /ein b P"od$%tion of se"$m alb$min % Se%"etion of bile salts d Inte"stitial osmoti% p"ess$"e +2 # newly admitted %lient is diagnosed with ?odg0inKs disease $nde"goes an e-%isional %e"/i%al lymph node biopsy $nde" lo%al anesthesia Hhat does the n$"se assess fi"st afte" the p"o%ed$"eQ a 7ital signs b In%ision site % #i"way d 'e/el of %ons%io$sness ++ # %lient has 12V blood loss Hhi%h of the following n$"sing assessment findings indi%ates hypo/olemi% sho%0Q a Systoli% blood p"ess$"e less than 90mm ?g b P$pils $ne6$ally dilated % 1espi"ato"y "ate of . b"eathGmin d P$lse "ate less than 50bpm +. *$"se '$%y is planning to gi/e p"e ope"ati/e tea%hing to a %lient who will be $nde"going "hinoplasty Hhi%h of the following sho$ld be in%l$dedQ a 1es$lts of the s$"ge"y will be immediately noti%eable postope"ati/ely b *o"mal saline nose d"ops will need to be administe"ed p"eope"ati/ely % #fte" s$"ge"y& nasal pa%0ing will be in pla%e 9 to 10 days d #spi"in %ontaining medi%ations sho$ld not be ta0en 1. days befo"e s$"ge"y +2 Pa$l is admitted to the hospital d$e to metaboli% a%idosis %a$sed by )iabeti% 0etoa%idosis O):#P !he n$"se p"epa"es whi%h of the following medi%ations as an initial t"eatment fo" this p"oblemQ a 1eg$la" ins$lin b Potassi$m % Sodi$m bi%a"bonate d Cal%i$m gl$%onate +5 )" <a"6$e( tells a %lient that an in%"ease inta0e of foods that a"e "i%h in 7itamin , and beta=%a"otene a"e impo"tant fo" healthie" s0in !he n$"se tea%hes the %lient that e-%ellent food so$"%es of both of these s$bstan%es a"e: a Fish and f"$it Eam b O"anges and g"apef"$it % Ca""ots and potatoes d Spina%h and mangoes +8 # %lient has Dast"oesophageal 1efl$- )isease OD,1)P !he n$"se sho$ld tea%h the %lient that afte" e/e"y meals& the %lient sho$ldM a 1est in sitting position

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b !a0e a sho"t wal0 % )"in0 plenty of wate" d 'ie down at least +0 min$tes #fte" gast"os%opy& an adaptation that indi%ates maEo" %ompli%ation wo$ld be: a *a$sea and /omiting b #bdominal distention % In%"eased DI motility d )iffi%$lty in swallowing # %lient who has $nde"gone a %hole%yste%tomy as0s the n$"se whethe" the"e a"e any dieta"y "est"i%tions that m$st be followed *$"se ?ila"y wo$ld "e%ogni(e that the dieta"y tea%hing was well $nde"stood when the %lient tells a family membe" that: a S<ost people need to eat a high p"otein diet fo" 12 months afte" s$"ge"yT b SI sho$ld not eat those foods that $pset me befo"e the s$"ge"yT % SI sho$ld a/oid fatty foods as long as I li/eT d S<ost people %an tole"ate "eg$la" diet afte" this type of s$"ge"yT *$"se 1a%hel tea%hes a %lient who has been "e%ently diagnosed with hepatitis # abo$t $ntowa"d signs and symptoms "elated to ?epatitis that may de/elop !he one that sho$ld be "epo"ted immediately to the physi%ian is: a 1estlessness b Aellow $"ine % *a$sea d Clay= %olo"ed stools Hhi%h of the following antit$be"%$losis d"$gs %an damage the 9th %"anial ne"/eQ a Isonia(id OI*?P b Pa"aoaminosali%yli% a%id OP#SP % ,thamb$tol hyd"o%hlo"ide Omyamb$tolP d St"eptomy%in !he %lient as0s *$"se #nnie the %a$ses of pepti% $l%e" *$"se #nnie "esponds that "e%ent "esea"%h indi%ates that pepti% $l%e"s a"e the "es$lt of whi%h of the following: a Deneti% defe%t in gast"i% m$%osa b St"ess % )iet high in fat d ?eli%oba%te" pylo"i infe%tion 1yan has $nde"gone s$btotal gast"e%tomy !he n$"se sho$ld e-pe%t that nasogast"i% t$be d"ainage will be what %olo" fo" abo$t 12 to 2. ho$"s afte" s$"ge"yQ a @ile g"een b @"ight "ed % Clo$dy white d )a"0 b"own *$"se Boan is assigned to %ome fo" %lient who has E$st $nde"gone eye s$"ge"y *$"se Boan plans to tea%h the %lient a%ti/ities that a"e pe"mitted d$"ing the post ope"ati/e pe"iod Hhi%h of the following is best "e%ommended fo" the %lientQ a Hat%hing %i"%$s b @ending o/e" % Hat%hing !7 d 'ifting obEe%ts # %lient s$ffe"ed f"om a lowe" leg inE$"y and see0s t"eatment in the eme"gen%y "oom !he"e is a p"ominent defo"mity to the lowe" aspe%t of the leg& and the inE$"ed leg appea"s sho"te" that the othe" leg !he affe%ted leg is painf$l& swollen and beginning to be%ome e%%hymoti% !he n$"se inte"p"ets that the %lient is e-pe"ien%ing: a F"a%t$"e b St"ain % Sp"ain d Cont$sion *$"se Benny is instilling an oti% sol$tion into an ad$lt male %lient left ea" *$"se Benny a/oids doing whi%h of the following as pa"t of the p"o%ed$"e a P$lling the a$"i%le ba%0wa"d and $pwa"d b Ha"ming the sol$tion to "oom tempe"at$"e % Pa%ing the tip of the d"oppe" on the edge of ea" %anal d Pla%ing %lient in side lying position *$"se @ea sho$ld inst"$%t the male %lient with an ileostomy to "epo"t immediately whi%h of the following symptomQ a #bsen%e of d"ainage f"om the ileostomy fo" 5 o" mo"e ho$"s b Passage of li6$id stool in the stoma % O%%asional p"esen%e of $ndigested food d # tempe"at$"e of +8 5 RC

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.9 Be""y has diagnosed with appendi%itis ?e de/elops a fe/e"& hypotension and ta%hy%a"dia !he n$"se s$spe%ts whi%h of the following %ompli%ationsQ a Intestinal obst"$%tion b Pe"itonitis % @owel is%hemia d )efi%ient fl$id /ol$me .9 Hhi%h of the following %ompilations sho$ld the n$"se %a"ef$lly monito"s a %lient with a%$te pan%"eatitis a <yo%a"dial Infa"%tion b Ci""hosis % Pepti% $l%e" d Pne$monia 20 Hhi%h of the following symptoms d$"ing the i%te"i% phase of /i"al hepatitis sho$ld the n$"se e-pe%t the %lient to inhibitQ a Hate"y stool b Aellow s%le"a % !a""y stool d Sho"tness of b"eath

ANS5ERS a$% RATIONALES ,#r MEDICAL SURGICAL NURSING Part 1

1 2 + . 2 5 8 9 9 10 11 12 1+

) 'eft sided hea"t fail$"e %a$ses fl$id a%%$m$lation in the %apilla"y netwo"0 of the l$ng Fl$id e/ent$ally ente"s al/eola" spa%es and %a$ses %"a%0ling so$nds at the end of inspi"ation ) <o"phine is a %ent"al ne"/o$s system dep"essant $sed to "elie/e the pain asso%iated with myo%a"dial infa"%tion& it also de%"eases app"ehension and p"e/ents %a"diogeni% sho%0 D Seeing yellow spots and %olo"ed /ision a"e %ommon symptoms of digitalis to-i%ity C Hhen di$"eti%s a"e ta0en in the mo"ning& %lient will /oid f"e6$ently d$"ing daytime and will not need to /oid f"e6$ently at night ) !he p"ima"y goal of the"apy fo" the %lient with p$lmona"y edema o" hea"t fail$"e is in%"easing %a"dia% o$tp$t P$lmona"y edema is an a%$te medi%al eme"gen%y "e6$i"ing immediate inte"/ention C )e%e"eb"ate post$"ing is the e-tension of the e-t"emities afte" a stim$l$s& whi%h may o%%$" with $ppe" b"ain stem inE$"y C !he most f"e6$ent side effe%ts of Cas%a"a Sag"ada O'a-ati/eP is abdominal %"amps and na$sea D #dminist"ation of Int"a/eno$s *it"ogly%e"in inf$sion "e6$i"es p$mp fo" a%%$"ate %ont"ol of medi%ation A @y the 2nd day of hospitali(ation afte" s$ffe"ing a <yo%a"dial Infa"%tion& Clients a"e able to pe"fo"m %a"e witho$t %hest pain ) !he left side of the body will be affe%ted in a "ight=sided b"ain atta%0 A #fte" neph"e%tomy& it is ne%essa"y to meas$"e $"ine o$tp$t ho$"ly !his is done to assess the effe%ti/eness of the "emaining 0idney also to dete%t "enal fail$"e ea"ly ) !he l$men of the a"te"ies %an be assessed by %a"dia% %athete"i(ation #ngina is $s$ally %a$sed by na""owing of the %o"ona"y a"te"ies C @lood p"ess$"e is monito"ed to dete%t hypotension whi%h may indi%ate sho%0 o" hemo""hage #pi%al p$lse is ta0en to dete%t dys"hythmias "elated to %a"dia% i""itability

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1. A P"otamine S$lfate is $sed to p"e/ent %ontin$o$s bleeding in %lient who has $nde"gone open hea"t
s$"ge"y

12 C !he $se of ele%t"oni% toothb"$sh& i""igation de/i%e o" dental floss may %a$se bleeding of g$ms&
allowing ba%te"ia to ente" and in%"easing the "is0 of endo%a"ditis

15 ) Height gain d$e to "etention of fl$ids and wo"sening hea"t fail$"e %a$ses e-e"tional dyspnea in %lients 18 19 19 20 21 22 2+ 2. 22 25 28 29 29 +0 +1 +2 ++ +. +2 +5 +8 +9 +9 .0 .1 .2 .+ .. .2 .5
with mit"al "eg$"gitation D )is%omfo"t o" pain is a p"oblem that o"iginates in the 0idney It is felt at the %osto/e"teb"al angle on the affe%ted side A Pe"f$sion %an be best estimated by blood p"ess$"e& whi%h is an indi"e%t "efle%tion of the ade6$a%y of %a"dia% o$tp$t C <yo%loni% sei($"e is %ha"a%te"i(ed by s$dden $n%ont"ollable Ee"0ing mo/ements of a single o" m$ltiple m$s%le g"o$p D *i%otine O*i%ot"olP is gi/en in %ont"olled and de%"easing doses fo" the management of ni%otine withd"awal synd"ome D 1ayna$dKs disease is %ha"a%te"i(ed by /asospasms of the small %$taneo$s a"te"ies that in/ol/es finge"s and toes A U"ine testing p"o/ides an indi"e%t meas$"e that maybe infl$en%ed by 0idney f$n%tion while blood gl$%ose testing is a mo"e di"e%t and a%%$"ate meas$"e C One lite" of fl$id app"o-imately weighs 2 2 po$nds # . 2 po$nd weight loss e6$als to app"o-imately 2' A Osmosis is the mo/ement of fl$id f"om an a"ea of lesse" sol$te %on%ent"ation to an a"ea of g"eate" sol$te %on%ent"ation D Fo"ea"m m$s%le wea0ness is a p"obable sign of "adial ne"/e inE$"y %a$sed by %"$t%h p"ess$"e on the a-illae ) *e$t"openi% %lient is at "is0 fo" infe%tion espe%ially ba%te"ial infe%tion of the gast"ointestinal and "espi"ato"y t"a%t C Semi=fowle"s position will lo%ali(e the spilled stoma%h %ontents in the lowe" pa"t of the abdominal %a/ity C Positioning the %lient late"ally with the ne%0 e-tended does not obst"$%t the ai"way so that d"ainage of se%"etions and o-ygen and %a"bon dio-ide e-%hange %an o%%$" ) ,-%essi/e b$bbling indi%ates an ai" lea0 whi%h m$st be eliminated to pe"mit l$ng e-pansion C Hheat %e"eal has a low sodi$m %ontent A ,nla"ged %i""hoti% li/e" impinges the po"tal system %a$sing in%"eased hyd"ostati% p"ess$"e "es$lting to as%ites C #ssessing fo" an open ai"way is the p"io"ity !he p"o%ed$"e in/ol/es the ne%0& the anesthesia may ha/e affe%ted the swallowing "efle- o" the inflammation may ha/e %losed in on the ai"way leading to ineffe%ti/e ai" e-%hange A !ypi%al signs and symptoms of hypo/olemi% sho%0 in%l$des systoli% blood p"ess$"e of less than 90 mm ?g D #spi"in %ontaining medi%ations sho$ld not be ta0en 1. days befo"e s$"ge"y to de%"ease the "is0 of bleeding A <etaboli% a%idosis is anae"obi% metabolism %a$sed by la%0 of ability of the body to $se %i"%$lating gl$%ose #dminist"ation of ins$lin %o""e%ts this p"oblem D @eta=%a"otene and 7itamin , a"e antio-idants whi%h help to inhibit o-idation 7itamin , is fo$nd in the following foods: wheat ge"m& %o"n& n$ts& seeds& oli/es& s*i$a"/& aspa"ag$s and othe" g"een leafy /egetables Food so$"%es of beta=%a"otene in%l$de da"0 g"een /egetables& %a""ots& 6a$1#!s and tomatoes A D"a/ity speeds $p digestion and p"e/ents "efl$- of stoma%h %ontents into the esophag$s ) #bdominal distension may be asso%iated with pain& may indi%ate pe"fo"ation& a %ompli%ation that %o$ld lead to pe"itonitis D It may ta0e . to 5 months to eat anything& b$t most people %an eat anything they want D Clay %olo"ed stools a"e indi%ati/e of hepati% obst"$%tion D St"eptomy%in is an aminogly%oside and damage on the 9th %"anial ne"/e Oototo-i%ityP is a %ommon side effe%t of aminogly%osides D <ost pepti% $l%e" is %a$sed by ?eli%opte" pylo"i whi%h is a g"am negati/e ba%te"i$m D 12 to 2. ho$"s afte" s$btotal gast"e%tomy gast"i% d"ainage is no"mally b"own& whi%h indi%ates digested food C Hat%hing !7 is pe"missible be%a$se the eye does not need to mo/e "apidly with this a%ti/ity& and it does not in%"ease int"ao%$la" p"ess$"e A Common signs and symptoms of f"a%t$"e in%l$de pain& defo"mity& sho"tening of the e-t"emity& %"epit$s and swelling C !he d"oppe" sho$ld not to$%h any obEe%t o" any pa"t of the %lientKs ea"

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.8 A S$dden de%"ease in d"ainage o" onset of se/e"e abdominal pain sho$ld be "epo"ted immediately to the
physi%ian be%a$se it %o$ld mean that obst"$%tion has been de/eloped

.9 ) Compli%ations of a%$te appendi%itis a"e pe"itonitis& pe"fo"ation and abs%ess de/elopment .9 D # %lient with a%$te pan%"eatitis is p"one to %ompli%ations asso%iated with "espi"ato"y system 20 ) 'i/e" inflammation and obst"$%tion blo%0 the no"mal flow of bile ,-%ess bili"$bin t$"ns the s0in and
s%le"a yellow and the $"ine da"0 and f"othy

MEDICAL SURGICAL NURSING Part 2 1 # %lient is s%hed$led fo" inse"tion of an infe"io" /ena %a/a OI7CP filte" *$"se Pat"i%ia %ons$lts the physi%ian abo$t withholding whi%h "eg$la"ly s%hed$led medi%ation on the day befo"e the s$"ge"yQ a Potassi$m Chlo"ide b Ha"fa"in Sodi$m % F$"osemide d )o%$sate 2 # n$"se is planning to assess the %o"neal "efle- on $n%ons%io$s %lient Hhi%h of the following is the safest stim$l$s to to$%h the %lientKs %o"neaQ a Cotton b$ds b Ste"ile glo/e % Ste"ile tong$e dep"esso" d Hisp of %otton + # female %lient de/elops an infe%tion at the %athete" inse"tion site !he n$"se in %ha"ge $ses the te"m Siat"ogeni%T when des%"ibing the infe%tion be%a$se it "es$lted f"om: a ClientKs de/elopmental le/el b !he"ape$ti% p"o%ed$"e % Poo" hygiene d Inade6$ate dieta"y patte"ns . *$"se Ca"ol is assessing a %lient with Pa"0insonKs disease !he n$"se "e%ogni(e b"ady0inesia when the %lient e-hibits:

COMPREHENSIVE NURSING REVIEW by R. C. REA

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a Intentional t"emo" b Pa"alysis of limbs % <$s%le spasm d 'a%0 of spontaneo$s mo/ement 2 # %lient who s$ffe"ed f"om a$tomobile a%%ident %omplains of seeing f"e6$ent flashes of light !he n$"se sho$ld e-pe%t: a <yopia b )eta%hed "etina % Dla$%oma d S%le"ode"ma 5 :ate with se/e"e head inE$"y is being monito"ed by the n$"se fo" in%"easing int"a%"anial p"ess$"e OICPP Hhi%h finding sho$ld be most indi%ati/e sign of in%"easing int"a%"anial p"ess$"eQ a Inte"mittent ta%hy%a"dia b Polydipsia % !a%hypnea d In%"eased "estlessness 8 # hospitali(ed %lient had a toni%=%loni% sei($"e while wal0ing in the hall )$"ing the sei($"e the n$"se p"io"ity sho$ld be: a ?old the %lients a"ms and leg fi"mly b Pla%e the %lient immediately to soft s$"fa%e % P"ote%ts the %lientKs head f"om inE$"y d #ttempt to inse"t a tong$e dep"esso" between the %lientKs teeth 9 # %lient has $nde"gone "ight pne$mone%tomy Hhen t$"ning the %lient& the n$"se sho$ld plan to position the %lient eithe": a 1ight side=lying position o" s$pine b ?igh fowle"s % 1ight o" left side lying position d 'ow fowle"Ks position 9 *$"se Benny sho$ld %a$tion a female %lient who is se-$ally a%ti/e in ta0ing Isonia(id OI*?P be%a$se the d"$g has whi%h of the following side effe%tsQ a P"e/ents o/$lation b ?as a m$tageni% effe%t on o/a % )e%"eases the effe%ti/eness of o"al %ont"a%epti/es d In%"eases the "is0 of /aginal infe%tion 10 # %lient has $nde"gone gast"e%tomy *$"se Bo/y is awa"e that the best position fo" the %lient is: a 'eft side lying b 'ow fowle"Ks % P"one d S$pine 11 )$"ing the initial postope"ati/e pe"iod of the %lientKs stoma !he n$"se e/al$ates whi%h of the following obse"/ations sho$ld be "epo"ted immediately to the physi%ianQ a Stoma is da"0 "ed to p$"ple b Stoma is oo(es a small amo$nt of blood % Stoma is lightly edemato$s d Stoma does not e-pel stool 12 :ate whi%h has diagnosed with $l%e"ati/e %olitis is following physi%ianKs o"de" fo" bed "est with bath"oom p"i/ileges Hhat is the "ationale fo" this a%ti/ity "est"i%tionQ a P"e/ent inE$"y b P"omote "est and %omfo"t % 1ed$%e intestinal pe"istalsis d Conse"/e ene"gy 1+ *$"se :C sho$ld "eg$la"ly assess the %lientKs ability to metaboli(e the total pa"ente"al n$t"ition O!P*P sol$tion ade6$ately by monito"ing the %lient fo" whi%h of the following signs: a ?ype"gly%emia b ?ypogly%emia % ?ype"tension d ,le/ate blood $"ea nit"ogen %on%ent"ation 1. # female %lient has an a%$te pan%"eatitis Hhi%h of the following signs and symptoms the n$"se wo$ld e-pe%t to seeQ a Constipation b ?ype"tension % #s%ites d Ba$ndi%e 12 # %lient is s$spe%ted to de/elop tetany afte" a s$btotal thy"oide%tomy Hhi%h of the following symptoms might indi%ate tetanyQ

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15

18

19

19

20

21

22

2+

2.

22

25

a !ingling in the finge"s b Pain in hands and feet % !ension on the s$t$"e lines d @leeding on the ba%0 of the d"essing # 29 yea" old woman has newly diagnosed with hypothy"oidism !he n$"se is awa"e that the signs and symptoms of hypothy"oidism in%l$de: a )ia""hea b 7omiting % !a%hy%a"dia d Height gain # %lient has $nde"gone fo" an ileal %ond$it& the n$"se in %ha"ge sho$ld %losely monito" the %lient fo" o%%$""en%e of whi%h of the following %ompli%ations "elated to pel/i% s$"ge"yQ a #s%ites b !h"ombophlebitis % Ing$inal he"nia d Pe"itonitis )" <a"6$e( is abo$t to defib"illate a %lient in /ent"i%$la" fib"illation and says in a lo$d /oi%e S%lea"T Hhat sho$ld be the a%tion of the n$"seQ a Pla%es %ond$%ti/e gel pads fo" defib"illation on the %lientKs %hest b !$"n off the me%hani%al /entilato" % Sh$ts off the %lientKs I7 inf$sion d Steps away f"om the bed and ma0e s$"e all othe"s ha/e done the same # %lient has been diagnosed with glome"$loneph"itis %omplains of thi"st !he n$"se sho$ld offe": a B$i%e b Dinge" ale % <il0 sha0e d ?a"d %andy # %lient with a%$te "enal fail$"e is awa"e that the most se"io$s %ompli%ation of this %ondition is: a Constipation b #nemia % Infe%tion d Platelet dysf$n%tion *$"se :a"en is %a"ing fo" %lients in the O1 !he n$"se is awa"e that the last physiologi% f$n%tion that the %lient loss d$"ing the ind$%tion of anesthesia is: a Cons%io$sness b Dag "efle% 1espi"ato"y mo/ement d Co"neal "efle!he n$"se is assessing a %lient with ple$"al eff$sion !he n$"se e-pe%t to find: a )e/iation of the t"a%hea towa"ds the in/ol/ed side b 1ed$%ed o" absent of b"eath so$nds at the base of the l$ng % <oist %"a%0les at the poste"io" of the l$ngs d In%"eased "esonan%e with pe"%$ssion of the in/ol/ed a"ea # %lient admitted with newly diagnosed with ?odg0inKs disease Hhi%h of the following wo$ld the n$"se e-pe%t the %lient to "epo"tQ a 'ymph node pain b Height gain % *ight sweats d ?eada%he # %lient has s$ffe"ed f"om fall and s$stained a leg inE$"y Hhi%h app"op"iate 6$estion wo$ld the n$"se as0 the %lient to help dete"mine if the inE$"y %a$sed f"a%t$"eQ a SIs the pain sha"p and %ontin$o$sQT b SIs the pain d$ll a%heQT % S)oes the dis%omfo"t feel li0e a %"ampQT d S)oes the pain feel li0e the m$s%le was st"et%hedQT !he *$"se is assessing the %lientKs %asted e-t"emity fo" signs of infe%tion Hhi%h of the following findings is indi%ati/e of infe%tionQ a ,dema b Hea0 distal p$lse % Coolness of the s0in d P"esen%e of Shot spotT on the %ast *$"se 1hia is pe"fo"ming an otos%opi% e-amination on a female %lient with a s$spe%ted diagnosis of mastoiditis *$"se 1hia wo$ld e-pe%t to note whi%h of the following if this diso"de" is p"esentQ a !"anspa"ent tympani% memb"ane b !hi%0 and immobile tympani% memb"ane

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28

29

29

+0

+1

+2

++

+.

+2

+5

+8

+9

% Pea"ly %olo"ed tympani% memb"ane d <obile tympani% memb"ane *$"se Bo%elyn is %a"ing fo" a %lient with nasogast"i% t$be that is atta%hed to low s$%tion *$"se Bo%elyn assesses the %lient fo" symptoms of whi%h a%id=base diso"de"Q a 1espi"ato"y al0alosis b 1espi"ato"y a%idosis % <etaboli% a%idosis d <etaboli% al0alosis # male ad$lt %lient has $nde"gone a l$mba" p$n%t$"e to obtain %e"eb"ospinal fl$id OCSFP fo" analysis Hhi%h of the following /al$es sho$ld be negati/e if the CSF is no"malQ a 1ed blood %ells b Hhite blood %ells % Ins$lin d P"otein # %lient is s$spe%ted of de/eloping diabetes insipid$s Hhi%h of the following is the most effe%ti/e assessmentQ a !a0ing /ital signs e/e"y . ho$"s b <onito"ing blood gl$%ose % #ssessing #@D /al$es e/e"y othe" day d <eas$"ing $"ine o$tp$t ho$"ly # 29 yea" old %lient is s$ffe"ing f"om a%$te phase of "he$matoid a"th"itis Hhi%h of the following wo$ld the n$"se in %ha"ge identify as the lowest p"io"ity of the plan of %a"eQ a P"e/ent Eoint defo"mity b <aintaining $s$al ways of a%%omplishing tas0 % 1elie/ing pain d P"ese"/ing Eoint f$n%tion #mong the following& whi%h %lient is a$tot"ansf$sion possibleQ a Client with #I)S b Client with "$pt$"ed bowel % Client who is in dange" of %a"dia% a""est d Client with wo$nd infe%tion Hhi%h of the following is not a sign of th"omboembolismQ a ,dema b Swelling % 1edness d Coolness *$"se @e%0y is %a"ing fo" %lient who begins to e-pe"ien%e sei($"e while in bed Hhi%h a%tion sho$ld the n$"se implement to p"e/ent aspi"ationQ a Position the %lient on the side with head fle-ed fo"wa"d b ,le/ate the head % Use tong$e dep"esso" between teeth d 'oosen "est"i%ti/e %lothing # %lient has $nde"gone bone biopsy Hhi%h n$"sing a%tion sho$ld the n$"se p"o/ide afte" the p"o%ed$"eQ a #dministe" analgesi%s /ia I< b <onito" /ital signs % <onito" the site fo" bleeding& swelling and hematoma fo"mation d :eep a"ea in ne$t"al position # %lient is s$ffe"ing f"om low ba%0 pain Hhi%h of the following e-e"%ises will st"engthen the lowe" ba%0 m$s%le of the %lientQ a !ennis b @as0etball % )i/ing d Swimming # %lient with pepti% $l%e" is being assessed by the n$"se fo" gast"ointestinal pe"fo"ation !he n$"se sho$ld monito" fo": a OIP g$aia% stool test b Slow& st"ong p$lse % S$dden& se/e"e abdominal pain d In%"eased bowel so$nds # %lient has $nde"gone s$"ge"y fo" "etinal deta%hment Hhi%h of the following goal sho$ld be p"io"iti(edQ a P"e/ent an in%"ease int"ao%$la" p"ess$"e b #lle/iate pain % <aintain da"0ened "oom d P"omote low=sodi$m diet # Client with gla$%oma has been p"es%"ibed with mioti%s !he n$"se is awa"e that mioti%s is fo":

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+9

.0

.1

.2

.+

..

.2

.5

.8

.9

.9

a Const"i%ting p$pil b 1ela-ing %ilia"y m$s%le % Const"i%ting int"ao%$la" /essel d Pa"aly(ing %ilia"y m$s%le Hhen s$%tioning an $n%ons%io$s %lient& whi%h n$"sing inte"/ention sho$ld the n$"se p"io"iti(e in maintaining %e"eb"al pe"f$sionQ a #dministe" di$"eti%s b #dministe" analgesi%s % P"o/ide hygiene d ?ype"o-ygenate befo"e and afte" s$%tioning Hhen dis%$ssing b"eathing e-e"%ises with a postope"ati/e %lient& *$"se ?a(el sho$ld in%l$de whi%h of the following tea%hingQ a Sho"t f"e6$ent b"eaths b ,-hale with mo$th open % ,-e"%ise twi%e a day d Pla%e hand on the abdomen and feel it "ise 'o$ie& with b$"ns o/e" +2V of the body& %omplains of %hilling In p"omoting the %lientKs %omfo"t& the n$"se sho$ld: a <aintain "oom h$midity below .0V b Pla%e top sheet on the %lient % 'imit the o%%$""en%e of d"afts d :eep "oom tempe"at$"e at 90 deg"ees *$"se !"ish is awa"e that tempo"a"y hete"og"aft Opig s0inP is $sed to t"eat b$"ns be%a$se this g"aft will: a 1elie/e pain and p"omote "apid epitheliali(ation b @e s$t$"ed in pla%e fo" bette" adhe"en%e % )eb"ide ne%"oti% epitheli$m d Con%$""ently $sed with topi%al antimi%"obials <a"0 has m$ltiple ab"asions and a la%e"ation to the t"$n0 and all fo$" e-t"emities says& SI %anKt eat all this foodT !he food that the n$"se sho$ld s$ggest to be eaten fi"st sho$ld be: a <eat loaf and %offee b <eat loaf and st"awbe""ies % !omato so$p and apple pie d !omato so$p and b$tte"ed b"ead !ony "et$"ns fo"m s$"ge"y with pe"manent %olostomy )$"ing the fi"st 2. ho$"s the %olostomy does not d"ain !he n$"se sho$ld be awa"e that: a P"ope" f$n%tioning of nasogast"i% s$%tion b P"es$"gi%al de%"ease in fl$id inta0e % #bsen%e of gast"ointestinal motility d Intestinal edema following s$"ge"y Hhen tea%hing a %lient abo$t the signs of %olo"e%tal %an%e"& *$"se !"ish st"esses that the most %ommon %omplaint of pe"sons with %olo"e%tal %an%e" is: a #bdominal pain b ?emo""hoids % Change in %alibe" of stools d Change in bowel habits 'o$is de/elops pe"itonitis and sepsis afte" s$"gi%al "epai" of "$pt$"es di/e"ti%$l$m !he n$"se in %ha"ge sho$ld e-pe%t an assessment of the %lient to "e/eal: a !a%hy%a"dia b #bdominal "igidity % @"ady%a"dia d In%"eased bowel so$nds Immediately afte" li/e" biopsy& the %lient is pla%ed on the "ight side& the n$"se is awa"e that that this position sho$ld be maintained be%a$se it will: a ?elp stop bleeding if any o%%$"s b 1ed$%e the fl$id t"apped in the bilia"y d$%ts % Position with g"eatest %omfo"t d P"omote %i"%$lating blood /ol$me !ony has diagnosed with hepatitis # !he info"mation f"om the health histo"y that is most li0ely lin0ed to hepatitis # is: a ,-posed with a"seni% %ompo$nds at wo"0 b Ho"0ing as lo%al pl$mbe" % Ho"0ing at hemodialysis %lini% d )ish washe" in "esta$"ants *$"se !"ish is awa"e that the labo"ato"y test "es$lt that most li0ely wo$ld indi%ate a%$te pan%"eatitis is an ele/ated:

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a Se"$m bili"$bin le/el b Se"$m amylase le/el % Potassi$m le/el d Sodi$m le/el 20 )" <a"6$e( o"de"s se"$m ele%t"olytes !o dete"mine the effe%t of pe"sistent /omiting& *$"se !"ish sho$ld be most %on%e"ned with monito"ing the: a Chlo"ide and sodi$m le/els b Phosphate and %al%i$m le/els % P"otein and magnesi$m le/els d S$lfate and bi%a"bonate le/els

ANS5ERS a$% RATIONALES ,#r MEDICAL SURGICAL NURSING Part 2 1 ) In p"eope"ati/e pe"iod& the n$"se sho$ld %ons$lt with the physi%ian abo$t withholding Ha"fa"in Sodi$m to a/oid o%%$""en%e of hemo""hage 2 D # %lient who is $n%ons%io$s is at g"eate" "is0 fo" %o"neal ab"asion Fo" this "eason& the safest way to test the %o"nel "efle- is by to$%hing the %o"nea lightly with a wisp of %otton + ) Iat"ogeni% infe%tion is %a$sed by the heath %a"e p"o/ide" o" is ind$%ed inad/e"tently by medi%al t"eatment o" p"o%ed$"es . D @"ady0inesia is slowing down f"om the initiation and e-e%$tion of mo/ement 2 ) !his symptom is %a$sed by stim$lation of "etinal %ells by o%$la" mo/ement 5 D 1estlessness indi%ates a la%0 of o-ygen to the b"ain stem whi%h impai"s the "eti%$la" a%ti/ating system 8 C 1hythmi% %ont"a%tion and "ela-ation asso%iated with toni%=%loni% sei($"e %an %a$se "epeated banging of head 9 A 1ight side lying position o" s$pine position pe"mits /entilation of the "emaining l$ng and p"e/ent fl$id f"om d"aining into s$t$"ed b"on%hial st$mp 9 C Isonia(id OI*?P inte"fe"es in the effe%ti/eness of o"al %ont"a%epti/es and %lients of %hildbea"ing age sho$ld be %o$nseled to $se an alte"nati/e fo"m of bi"th %ont"ol while ta0ing this d"$g 10 ) # %lient who has had abdominal s$"ge"y is best pla%ed in a low fowle"Ks position !his "ela-es abdominal m$s%les and p"o/ides ma-im$m "espi"ato"y and %a"dio/as%$la" f$n%tion 11 A )a"0 "ed to p$"ple stoma indi%ates inade6$ate blood s$pply 12 C !he "ationale fo" a%ti/ity "est"i%tion is to help "ed$%e the hype"motility of the %olon

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1+ A )$"ing !otal Pa"ente"al *$t"ition O!P*P administ"ation& the %lient sho$ld be monito"ed "eg$la"ly fo" hype"gly%emia 1. D Ba$ndi%e may be p"esent in a%$te pan%"eatitis owing to obst"$%tion of the bilia"y d$%t 12 A !etany may o%%$" afte" thy"oide%tomy if the pa"athy"oid glands a"e a%%identally inE$"ed o" "emo/ed 15 D !ypi%al signs of hypothy"oidism in%l$des weight gain& fatig$e& de%"eased ene"gy& apathy& b"ittle nails& d"y s0in& %old intole"an%e& %onstipation and n$mbness 18 ) #fte" a pel/i% s$"ge"y& the"e is an in%"eased %han%e of th"ombophlebitits owing to the pel/i% manip$lation that %an inte"fe"e with %i"%$lation and p"omote /eno$s stasis 19 D Fo" the safety of all pe"sonnel& if the defib"illato" paddles a"e being dis%ha"ged& all pe"sonnel m$st stand ba%0 and be %lea" of all the %onta%t with the %lient o" the %lientKs bed 19 D ?a"d %andy will "elie/e thi"st and in%"ease %a"bohyd"ates b$t does not s$pply e-t"a fl$id 20 C Infe%tion is "esponsible fo" one thi"d of the t"a$mati% o" s$"gi%ally ind$%ed death of %lients with "enal fail$"e as well as medi%al ind$%ed a%$te "enal fail$"e O#1FP 21 C !he"e is no "espi"ato"y mo/ement in stage . of anesthesia& p"io" to this stage& "espi"ation is dep"essed b$t p"esent 22 ) Comp"ession of the l$ng by fl$id that a%%$m$lates at the base of the l$ngs "ed$%es e-pansion and ai" e-%hange 2+ C #ssessment of a %lient with ?odg0inKs disease most often "e/eals enla"ged& painless lymph node& fe/e"& malaise and night sweats 2. A F"a%t$"ed pain is gene"ally des%"ibed as sha"p& %ontin$o$s& and in%"easing in f"e6$en%y 22 D Signs and symptoms of infe%tion $nde" a %asted a"ea in%l$de odo" o" p$"$lent d"ainage and the p"esen%e of Shot spotT whi%h a"e a"eas on the %ast that a"e wa"me" than the othe"s 25 ) Otos%opi% e-amnation in a %lient with mastoiditis "e/eals a d$ll& "ed& thi%0 and immobile tymphani% memb"ane with o" witho$t pe"fo"ation 28 D 'oss of gast"i% fl$id /ia nasogast"i% s$%tion o" /omiting %a$ses metaboli% al0alosis be%a$se of the loss of hyd"o%hlo"i% a%id whi%h is a potent a%id in the body 29 A !he ad$lt with no"mal %e"eb"ospinal fl$id has no "ed blood %ells 29 D <eas$"ing the $"ine o$tp$t to dete%t e-%ess amo$nt and %he%0ing the spe%ifi% g"a/ity of $"ine samples to dete"mine $"ine %on%ent"ation a"e app"op"iate meas$"es to dete"mine the onset of diabetes insipid$s +0 ) !he n$"se sho$ld fo%$s mo"e on de/eloping less st"essf$l ways of a%%omplishing "o$tine tas0 +1 C #$tot"ansf$sion is a%%eptable fo" the %lient who is in dange" of %a"dia% a""est +2 D !he %lient with th"omboembolism does not ha/e %oolness ++ A Positioning the %lient on one side with head fle-ed fo"wa"d allows the tong$e to fall fo"wa"d and fa%ilitates d"ainage se%"etions the"efo"e p"e/ents aspi"ation +. C *$"sing %a"e afte" bone biopsy in%l$des %lose monito"ing of the p$n%t$"ed site fo" bleeding& swelling and hematoma fo"mation +2 D Hal0ing and swimming a"e /e"y helpf$l in st"engthening ba%0 m$s%les fo" the %lient s$ffe"ing f"om lowe" ba%0 pain +5 C S$dden& se/e"e abdominal pain is the most indi%ati/e sign of pe"fo"ation Hhen pe"fo"ation of an $l%e" o%%$"s& the n$"se maybe $nable to hea" bowel so$nds at all +8 A #fte" s$"ge"y to %o""e%t a deta%hed "etina& p"e/ention of in%"eased int"ao%$la" p"ess$"e is the p"io"ity goal +9 A <ioti% agent %onst"i%ts the p$pil and %ont"a%ts %ilia"y m$s%le !hese effe%ts widen the filt"ation angle and pe"mit in%"eased o$t flow of a6$eo$s h$mo" +9 D It is a p"io"ity to hype"o-ygenate the %lient befo"e and afte" s$%tioning to p"e/ent hypo-ia and to maintain %e"eb"al pe"f$sion .0 D #bdominal b"eathing imp"o/es l$ngs e-pansion .1 C # Client with b$"ns is /e"y sensiti/e to tempe"at$"e %hanges be%a$se heat is loss in the b$"n a"eas .2 A !he g"aft %o/e"s the ne"/e endings& whi%h "ed$%es pain and p"o/ides f"amewo"0 fo" g"an$lation .+ ) <eat p"o/ides p"oteins and the f"$it p"oteins /itamin C that both p"omote wo$nd healing .. C !his is p"ima"ily %a$sed by the t"a$ma of intestinal manip$lation and the dep"essi/e effe%ts anestheti%s and analgesi%s .2 D Constipation& dia""hea& andGo" %onstipation alte"nating with dia""hea a"e the most %ommon symptoms of %olo"e%tal %an%e" .5 ) Hith in%"eased int"aabdominal p"ess$"e& the abdominal wall will be%ome tende" and "igid .8 A P"ess$"e applied in the p$n%t$"e site indi%ates that a bilia"y /essel was p$n%t$"e whi%h is a %ommon %ompli%ation afte" li/e" biopsy .9 ) ?epatitis # is p"ima"ily sp"ead /ia fe%al=o"al "o$te Sewage poll$ted wate" may ha"bo" the /i"$s .9 ) #mylase %on%ent"ation is high in the pan%"eas and is ele/ated in the se"$m when the pan%"eas be%omes a%$tely inflamed and also it disting$ishes pan%"eatitis f"om othe" a%$te abdominal p"oblems 20 A Sodi$m& whi%h is %on%e"ned with the "eg$lation of e-t"a%ell$la" fl$id /ol$me& it is lost with /omiting Chlo"ide& whi%h balan%es %ations in the e-t"a%ell$la" %ompa"tments& is also lost with /omiting& be%a$se sodi$m and %hlo"ide a"e pa"allel ele%t"olytes& hyponat"emia will a%%ompany

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MEDICAL SURGICAL NURSING Part 3 1 <a"%o who was diagnosed with b"ain t$mo" was s%hed$led fo" %"aniotomy In p"e/enting the de/elopment of %e"eb"al edema afte" s$"ge"y& the n$"se sho$ld e-pe%t the $se of: a )i$"eti%s b #ntihype"tensi/e % Ste"oids d #nti%on/$lsants 2 ?alfway th"o$gh the administ"ation of blood& the female %lient %omplains of l$mba" pain #fte" stopping the inf$sion *$"se ?a(el sho$ld: a In%"ease the flow of no"mal saline b #ssess the pain f$"the" % *otify the blood ban0 d Obtain /ital signs + *$"se <a$"een 0nows that the positi/e diagnosis fo" ?I7 infe%tion is made based on whi%h of the following: a # histo"y of high "is0 se-$al beha/io"s b Positi/e ,'IS# and weste"n blot tests % Identifi%ation of an asso%iated oppo"t$nisti% infe%tion d ,/iden%e of e-t"eme weight loss and high fe/e" . *$"se <a$"een is awa"e that a %lient who has been diagnosed with %h"oni% "enal fail$"e "e%ogni(es an ade6$ate amo$nt of high=biologi%=/al$e p"otein when the food the %lient sele%ted f"om the men$ was: a 1aw %a""ots

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b #pple E$i%e % Hhole wheat b"ead d Cottage %heese 2 :enneth who has diagnosed with $"emi% synd"ome has the potential to de/elop %ompli%ations Hhi%h among the following %ompli%ations sho$ld the n$"se anti%ipates: a Flapping hand t"emo"s b #n ele/ated hemato%"it le/el % ?ypotension d ?ypo0alemia 5 # %lient is admitted to the hospital with benign p"ostati% hype"plasia& the n$"se most "ele/ant assessment wo$ld be: a Flan0 pain "adiating in the g"oin b )istention of the lowe" abdomen % Pe"ineal edema d U"eth"al dis%ha"ge 8 # %lient has $nde"gone with penile implant #fte" 2. h"s of s$"ge"y& the %lientKs s%"ot$m was edemato$s and painf$l !he n$"se sho$ld: a #ssist the %lient with sit( bath b #pply wa" soa0s in the s%"ot$m % ,le/ate the s%"ot$m $sing a soft s$ppo"t d P"epa"e fo" a possible in%ision and d"ainage 9 *$"se ha(el "e%ei/es eme"gen%y labo"ato"y "es$lts fo" a %lient with %hest pain and immediately info"ms the physi%ian #n in%"eased myoglobin le/el s$ggests whi%h of the followingQ a 'i/e" disease b <yo%a"dial damage % ?ype"tension d Can%e" 9 *$"se <a$"een wo$ld e-pe%t the a %lient with mit"al stenosis wo$ld demonst"ate symptoms asso%iated with %ongestion in the: a 1ight at"i$m b S$pe"io" /ena %a/a % #o"ta d P$lmona"y 10 # %lient has been diagnosed with hype"tension !he n$"se p"io"ity n$"sing diagnosis wo$ld be: a Ineffe%ti/e health maintenan%e b Impai"ed s0in integ"ity % )efi%ient fl$id /ol$me d Pain 11 *$"se ?a(el tea%hes the %lient with angina abo$t %ommon e-pe%ted side effe%ts of nit"ogly%e"in in%l$ding: a high blood p"ess$"e b stoma%h %"amps % heada%he d sho"tness of b"eath 12 !he following a"e lipid abno"malities Hhi%h of the following is a "is0 fa%to" fo" the de/elopment of athe"os%le"osis and P7)Q a ?igh le/els of low density lipid O')'P %holeste"ol b ?igh le/els of high density lipid O?)'P %holeste"ol % 'ow %on%ent"ation t"igly%e"ides d 'ow le/els of ')' %holeste"ol 1+ Hhi%h of the following "ep"esents a signifi%ant "is0 immediately afte" s$"ge"y fo" "epai" of ao"ti% ane$"ysmQ a Potential wo$nd infe%tion b Potential ineffe%ti/e %oping % Potential ele%t"olyte balan%e d Potential alte"ation in "enal pe"f$sion 1. *$"se Bosie sho$ld inst"$%t the %lient to eat whi%h of the following foods to obtain the best s$pply of 7itamin @12Q a dai"y p"od$%ts b /egetables % D"ains d @"o%%oli 12 :a"en has been diagnosed with aplasti% anemia !he n$"se monito"s fo" %hanges in whi%h of the following physiologi% f$n%tionsQ a @owel f$n%tion b Pe"iphe"al sensation % @leeding tenden%ies

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d Inta0e and o$t p$t 15 'ydia is s%hed$led fo" ele%ti/e splene%tomy @efo"e the %lients goes to s$"ge"y& the n$"se in %ha"ge final assessment wo$ld be: a signed %onsent b /ital signs % name band d empty bladde" 18 Hhat is the pea0 age "ange in a%6$i"ing a%$te lympho%yti% le$0emia O#''PQ a . to 12 yea"s b 20 to +0 yea"s % .0 to 20 yea"s d 50 50 80 yea"s 19 <a"ie with a%$te lympho%yti% le$0emia s$ffe"s f"om na$sea and heada%he !hese %lini%al manifestations may indi%ate all of the following e-%ept a effe%ts of "adiation b %hemothe"apy side effe%ts % meningeal i""itation d gast"i% distension 19 # %lient has been diagnosed with )isseminated Int"a/as%$la" Coag$lation O)ICP Hhi%h of the following is %ont"aindi%ated with the %lientQ a #dministe"ing ?epa"in b #dministe"ing Co$madin % !"eating the $nde"lying %a$se d 1epla%ing depleted blood p"od$%ts 20 Hhi%h of the following findings is the best indi%ation that fl$id "epla%ement fo" the %lient with hypo/olemi% sho%0 is ade6$ateQ a U"ine o$tp$t g"eate" than +0mlGh" b 1espi"ato"y "ate of 21 b"eathsGmin$te % )iastoli% blood p"ess$"e g"eate" than 90 mmhg d Systoli% blood p"ess$"e g"eate" than 110 mmhg 21 Hhi%h of the following signs and symptoms wo$ld *$"se <a$"een in%l$de in tea%hing plan as an ea"ly manifestation of la"yngeal %an%e"Q a Stomatitis b #i"way obst"$%tion % ?oa"seness d )ysphagia 22 :a"ina a %lient with myasthenia g"a/is is to "e%ei/e imm$nos$pp"essi/e the"apy !he n$"se $nde"stands that this the"apy is effe%ti/e be%a$se it: a P"omotes the "emo/al of antibodies that impai" the t"ansmission of imp$lses b Stim$lates the p"od$%tion of a%etyl%holine at the ne$"om$s%$la" E$n%tion % )e%"eases the p"od$%tion of a$toantibodies that atta%0 the a%etyl%holine "e%epto"s d Inhibits the b"ea0down of a%etyl%holine at the ne$"om$s%$la" E$n%tion 2+ # female %lient is "e%ei/ing I7 <annitol #n assessment spe%ifi% to safe administ"ation of the said d"$g is: a 7ital signs 6.h b Heighing daily % U"ine o$tp$t ho$"ly d 'e/el of %ons%io$sness 6.h 2. Pat"i%ia a 20 yea" old %ollege st$dent with diabetes mellit$s "e6$ests additional info"mation abo$t the ad/antages of $sing a pen li0e ins$lin deli/e"y de/i%es !he n$"se e-plains that the ad/antages of these de/i%es o/e" sy"inges in%l$des: a #%%$"ate dose deli/e"y b Sho"te" inEe%tion time % 'owe" %ost with "e$sable ins$lin %a"t"idges d Use of smalle" ga$ge needle 22 # male %lientKs left tibia was f"a%t$"ed in an a$tomobile a%%ident& and a %ast is applied !o assess fo" damage to maEo" blood /essels f"om the f"a%t$"e tibia& the n$"se in %ha"ge sho$ld monito" the %lient fo": a Swelling of the left thigh b In%"eased s0in tempe"at$"e of the foot % P"olonged "epe"f$sion of the toes afte" blan%hing d In%"eased blood p"ess$"e 25 #fte" a long leg %ast is "emo/ed& the male %lient sho$ld: a Cleanse the leg by s%"$bbing with a b"is0 motion b P$t leg th"o$gh f$ll "ange of motion twi%e daily % 1epo"t any dis%omfo"t o" stiffness to the physi%ian d ,le/ate the leg when sitting fo" long pe"iods of time

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28 Hhile pe"fo"ming a physi%al assessment of a male %lient with go$t of the g"eat toe& *$"se 7i/ian sho$ld assess fo" additional tophi O$"ate depositsP on the: a @$tto%0s b ,a"s % Fa%e d #bdomen 29 *$"se :at"ina wo$ld "e%ogni(e that the demonst"ation of %"$t%h wal0ing with t"ipod gait was $nde"stood when the %lient pla%es weight on the: a Palms of the hands and a-illa"y "egions b Palms of the hand % #-illa"y "egions d Feet& whi%h a"e set apa"t 29 <ang Bose with "he$matoid a"th"itis states& Sthe only time I am witho$t pain is when I lie in bed pe"fe%tly stillT )$"ing the %on/ales%ent stage& the n$"se in %ha"ge with <ang Bose sho$ld en%o$"age: a #%ti/e Eoint fle-ion and e-tension b Contin$ed immobility $ntil pain s$bsides % 1ange of motion e-e"%ises twi%e daily d Fle-ion e-e"%ises th"ee times daily +0 # male %lient has $nde"gone spinal s$"ge"y& the n$"se sho$ld: a Obse"/e the %lientKs bowel mo/ement and /oiding patte"ns b 'og="oll the %lient to p"one position % #ssess the %lientKs feet fo" sensation and %i"%$lation d ,n%o$"age %lient to d"in0 plenty of fl$ids +1 <a"ina with a%$te "enal fail$"e mo/es into the di$"eti% phase afte" one wee0 of the"apy )$"ing this phase the %lient m$st be assessed fo" signs of de/eloping: a ?ypo/olemia b "enal fail$"e % metaboli% a%idosis d hype"0alemia +2 *$"se B$dith obtains a spe%imen of %lea" nasal d"ainage f"om a %lient with a head inE$"y Hhi%h of the following tests diffe"entiates m$%$s f"om %e"eb"ospinal fl$id OCSFPQ a P"otein b Spe%ifi% g"a/ity % Dl$%ose d <i%"oo"ganism ++ # 22 yea" old %lient s$ffe"ed f"om his fi"st toni%=%loni% sei($"e Upon awa0ening the %lient as0s the n$"se& SHhat %a$sed me to ha/e a sei($"eQ Hhi%h of the following wo$ld the n$"se in%l$de in the p"ima"y %a$se of toni% %loni% sei($"es in ad$lts mo"e the 20 yea"sQ a ,le%t"olyte imbalan%e b ?ead t"a$ma % ,pilepsy d Congenital defe%t +. Hhat is the p"io"ity n$"sing assessment in the fi"st 2. ho$"s afte" admission of the %lient with th"omboti% C7#Q a P$pil si(e and papilla"y "esponse b %holeste"ol le/el % ,%ho%a"diog"am d @owel so$nds +2 *$"se 'inda is p"epa"ing a %lient with m$ltiple s%le"osis fo" dis%ha"ge f"om the hospital to home Hhi%h of the following inst"$%tion is most app"op"iateQ a SP"a%ti%e $sing the me%hani%al aids that yo$ will need when f$t$"e disabilities a"iseT b SFollow good health habits to %hange the %o$"se of the diseaseT % S:eep a%ti/e& $se st"ess "ed$%tion st"ategies& and a/oid fatig$e d SAo$ will need to a%%ept the ne%essity fo" a 6$iet and ina%ti/e lifestyleT +5 !he n$"se is awa"e the ea"ly indi%ato" of hypo-ia in the $n%ons%io$s %lient is: a Cyanosis b In%"eased "espi"ations % ?ype"tension d 1estlessness +8 # %lient is e-pe"ien%ing spinal sho%0 *$"se <y"na sho$ld e-pe%t the f$n%tion of the bladde" to be whi%h of the followingQ a *o"mal b #toni% % Spasti% d Un%ont"olled

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+9 Hhi%h of the following stage the %a"%inogen is i""e/e"sibleQ a P"og"ession stage b Initiation stage % 1eg"ession stage d P"omotion stage +9 #mong the following %omponents tho"o$gh pain assessment& whi%h is the most signifi%antQ a ,ffe%t b Ca$se % Ca$sing fa%to"s d Intensity .0 # 52 yea" old female is e-pe"ien%ing fla"e $p of p"$"it$s Hhi%h of the %lientKs a%tion %o$ld agg"a/ate the %a$se of fla"e $psQ a Sleeping in %ool and h$midified en/i"onment b )aily baths with f"ag"ant soap % Using %lothes made f"om 100V %otton d In%"easing fl$id inta0e .1 #t"opine s$lfate O#t"opineP is %ont"aindi%ated in all b$t one of the following %lientQ a # %lient with high blood b # %lient with bowel obst"$%tion % # %lient with gla$%oma d # %lient with U ! I .2 #mong the following %lients& whi%h among them is high "is0 fo" potential ha(a"ds f"om the s$"gi%al e-pe"ien%eQ a 58=yea"=old %lient b .9=yea"=old %lient % ++=yea"=old %lient d 12=yea"=old %lient .+ *$"se Bon assesses /ital signs on a %lient $nde"gone epid$"al anesthesia Hhi%h of the following wo$ld the n$"se assess ne-tQ a ?eada%he b @ladde" distension % )i((iness d #bility to mo/e legs .. *$"se :at"ina sho$ld anti%ipate that all of the following d"$gs may be $sed in the attempt to %ont"ol the symptoms of <enie"eKs disease e-%ept: a #ntiemeti%s b )i$"eti%s % #ntihistamines d Dl$%o%o"ti%oids .2 Hhi%h of the following %ompli%ations asso%iated with t"a%heostomy t$beQ a In%"eased %a"dia% o$tp$t b #%$te "espi"ato"y dist"ess synd"ome O#1)SP % In%"eased blood p"ess$"e d )amage to la"yngeal ne"/es .5 *$"se Faith sho$ld "e%ogni(e that fl$id shift in an %lient with b$"n inE$"y "es$lts f"om in%"ease in the: a !otal /ol$me of %i"%$lating whole blood b !otal /ol$me of int"a/as%$la" plasma % Pe"meability of %apilla"y walls d Pe"meability of 0idney t$b$les .8 #n 9+=yea"=old woman has se/e"al e%%hymoti% a"eas on he" "ight a"m !he b"$ises a"e p"obably %a$sed by: a in%"eased %apilla"y f"agility and pe"meability b in%"eased blood s$pply to the s0in % self infli%ted inE$"y d elde" ab$se .9 *$"se #nna is awa"e that ea"ly adaptation of %lient with "enal %a"%inoma is: a *a$sea and /omiting b flan0 pain % weight gain d inte"mittent hemat$"ia .9 # male %lient with t$be"%$losis as0s *$"se @"ian how long the %hemothe"apy m$st be %ontin$ed *$"se @"ianKs a%%$"ate "eply wo$ld be: a 1 to + wee0s b 5 to 12 months % + to 2 months d + yea"s and mo"e

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20 # %lient has $nde"gone la"ynge%tomy !he immediate n$"sing p"io"ity wo$ld be: a :eep t"a%hea f"ee of se%"etions b <onito" fo" signs of infe%tion % P"o/ide emotional s$ppo"t d P"omote means of %omm$ni%ation

ANS5ERS a$% RATIONALES ,#r MEDICAL SURGICAL NURSING Part 3 1 C Dl$%o%o"ti%oids Oste"oidsP a"e $sed fo" thei" anti=inflammato"y a%tion& whi%h de%"eases the de/elopment of edema 2 A !he blood m$st be stopped at on%e& and then no"mal saline sho$ld be inf$sed to 0eep the line patent and maintain blood /ol$me + ) !hese tests %onfi"m the p"esen%e of ?I7 antibodies that o%%$" in "esponse to the p"esen%e of the h$man imm$nodefi%ien%y /i"$s O?I7P . D One %$p of %ottage %heese %ontains app"o-imately 222 %alo"ies& 28 g of p"otein& 9 g of fat& +0 mg %holeste"ol& and 5 g of %a"bohyd"ate P"oteins of high biologi% /al$e O?@7P %ontain optimal le/els of amino a%ids essential fo" life 2 A ,le/ation of $"emi% waste p"od$%ts %a$ses i""itation of the ne"/es& "es$lting in flapping hand t"emo"s 5 ) !his indi%ates that the bladde" is distended with $"ine& the"efo"e palpable 8 C ,le/ation in%"eases lymphati% d"ainage& "ed$%ing edema and pain 9 ) )ete%tion of myoglobin is a diagnosti% tool to dete"mine whethe" myo%a"dial damage has o%%$""ed 9 D Hhen mit"al stenosis is p"esent& the left at"i$m has diffi%$lty emptying its %ontents into the left /ent"i%le be%a$se the"e is no /al/e to p"e/ent ba%0 wa"d flow into the p$lmona"y /ein& the p$lmona"y %i"%$lation is $nde" p"ess$"e 10 A <anaging hype"tension is the p"io"ity fo" the %lient with hype"tension Clients with hype"tension f"e6$ently do not e-pe"ien%e pain& defi%ient /ol$me& o" impai"ed s0in integ"ity It is the asymptomati% nat$"e of hype"tension that ma0es it so diffi%$lt to t"eat 11 C @e%a$se of its widesp"ead /asodilating effe%ts& nit"ogly%e"in often p"od$%es side effe%ts s$%h as heada%he& hypotension and di((iness

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12 A #n in%"eased in ')' %holeste"ol %on%ent"ation has been do%$mented at "is0 fa%to" fo" the de/elopment of athe"os%le"osis ')' %holeste"ol is not b"o0en down into the li/e" b$t is deposited into the wall of the blood /essels 1+ D !he"e is a potential alte"ation in "enal pe"f$sion manifested by de%"eased $"ine o$tp$t !he alte"ed "enal pe"f$sion may be "elated to "enal a"te"y embolism& p"olonged hypotension& o" p"olonged ao"ti% %"oss= %lamping d$"ing the s$"ge"y 1. A Dood so$"%e of /itamin @12 a"e dai"y p"od$%ts and meats 12 C #plasti% anemia de%"eases the bone ma""ow p"od$%tion of 1@CKs& white blood %ells& and platelets !he %lient is at "is0 fo" b"$ising and bleeding tenden%ies 15 )' #n ele%ti/e p"o%ed$"e is s%hed$led in ad/an%e so that all p"epa"ations %an be %ompleted ahead of time !he /ital signs a"e the final %he%0 that m$st be %ompleted befo"e the %lient lea/es the "oom so that %ontin$ity of %a"e and assessment is p"o/ided fo" 18 A !he pea0 in%iden%e of #%$te 'ympho%yti% 'e$0emia O#''P is . yea"s of age It is $n%ommon afte" 12 yea"s of age 19 D #%$te 'ympho%yti% 'e$0emia O#''P does not %a$se gast"i% distention It does in/ade the %ent"al ne"/o$s system& and %lients e-pe"ien%e heada%hes and /omiting f"om meningeal i""itation 19 ) )isseminated Int"a/as%$la" Coag$lation O)ICP has not been fo$nd to "espond to o"al anti%oag$lants s$%h as Co$madin 20 A U"ine o$tp$t p"o/ides the most sensiti/e indi%ation of the %lientKs "esponse to the"apy fo" hypo/olemi% sho%0 U"ine o$tp$t sho$ld be %onsistently g"eate" than +0 to +2 m'Gh" 21 C ,a"ly wa"ning signs of la"yngeal %an%e" %an /a"y depending on t$mo" lo%ation ?oa"seness lasting 2 wee0s sho$ld be e/al$ated be%a$se it is one of the most %ommon wa"ning signs 22 C Ste"oids de%"ease the bodyKs imm$ne "esponse th$s de%"easing the p"od$%tion of antibodies that atta%0 the a%etyl%holine "e%epto"s at the ne$"om$s%$la" E$n%tion 2+ C !he osmoti% di$"eti% mannitol is %ont"aindi%ated in the p"esen%e of inade6$ate "enal f$n%tion o" hea"t fail$"e be%a$se it in%"eases the int"a/as%$la" /ol$me that m$st be filte"ed and e-%"eted by the 0idney 2. A !hese de/i%es a"e mo"e a%%$"ate be%a$se they a"e easily to $sed and ha/e imp"o/ed adhe"en%e in ins$lin "egimens by yo$ng people be%a$se the medi%ation %an be administe"ed dis%"eetly 22 C )amage to blood /essels may de%"ease the %i"%$lato"y pe"f$sion of the toes& this wo$ld indi%ate the la%0 of blood s$pply to the e-t"emity 25 D' ,le/ation will help %ont"ol the edema that $s$ally o%%$"s 28 )' U"i% a%id has a low sol$bility& it tends to p"e%ipitate and fo"m deposits at /a"io$s sites whe"e blood flow is least a%ti/e& in%l$ding %a"tilagino$s tiss$e s$%h as the ea"s 29 ) !he palms sho$ld bea" the %lientKs weight to a/oid damage to the ne"/es in the a-illa 29 A #%ti/e e-e"%ises& alte"nating e-tension& fle-ion& abd$%tion& and add$%tion& mobili(e e-$dates in the Eoints "elie/es stiffness and pain +0 C' #lte"ation in sensation and %i"%$lation indi%ates damage to the spinal %o"d& if these o%%$"s notify physi%ian immediately +1 A In the di$"eti% phase fl$id "etained d$"ing the olig$"i% phase is e-%"eted and may "ea%h + to 2 lite"s daily& hypo/olemia may o%%$" and fl$ids sho$ld be "epla%ed +2 C !he %onstit$ents of CSF a"e simila" to those of blood plasma #n e-amination fo" gl$%ose %ontent is done to dete"mine whethe" a body fl$id is a m$%$s o" a CSF # CSF no"mally %ontains gl$%ose ++ ) !"a$ma is one of the p"ima"y %a$se of b"ain damage and sei($"e a%ti/ity in ad$lts Othe" %ommon %a$ses of sei($"e a%ti/ity in ad$lts in%l$de neoplasms& withd"awal f"om d"$gs and al%ohol& and /as%$la" disease +. A It is %"$%ial to monito" the p$pil si(e and papilla"y "esponse to indi%ate %hanges a"o$nd the %"anial ne"/es +2 C !he n$"se most positi/e app"oa%h is to en%o$"age the %lient with m$ltiple s%le"osis to stay a%ti/e& $se st"ess "ed$%tion te%hni6$es and a/oid fatig$e be%a$se it is impo"tant to s$ppo"t the imm$ne system while "emaining a%ti/e +5 D 1estlessness is an ea"ly indi%ato" of hypo-ia !he n$"se sho$ld s$spe%t hypo-ia in $n%ons%io$s %lient who s$ddenly be%omes "estless +8 ) In spinal sho%0& the bladde" be%omes %ompletely atoni% and will %ontin$e to fill $nless the %lient is %athete"i(ed +9 A P"og"ession stage is the %hange of t$mo" f"om the p"eneoplasti% state o" low deg"ee of malignan%y to a fast g"owing t$mo" that %annot be "e/e"sed +9 D Intensity is the maEo" indi%ati/e of se/e"ity of pain and it is impo"tant fo" the e/al$ation of the t"eatment .0 )' !he $se of f"ag"ant soap is /e"y d"ying to s0in hen%e %a$sing the p"$"it$s .1 C' #t"opine s$lfate is %ont"aindi%ated with gla$%oma patients be%a$se it in%"eases int"ao%$la" p"ess$"e .2 A # 58 yea" old %lient is g"eate" "is0 be%a$se the olde" ad$lt %lient is mo"e li0ely to ha/e a less=effe%ti/e imm$ne system .+ ) !he last a"ea to "et$"n sensation is in the pe"ineal a"ea& and the n$"se in %ha"ge sho$ld monito" the %lient fo" distended bladde" .. D Dl$%o%o"ti%oids play no signifi%ant "ole in disease t"eatment .2 D !"a%heostomy t$be has se/e"al potential %ompli%ations in%l$ding bleeding& infe%tion and la"yngeal ne"/e damage

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.5 C In b$"n& the %apilla"ies and small /essels dilate& and %ell damage %a$se the "elease of a histamine=li0e s$bstan%e !he s$bstan%e %a$ses the %apilla"y walls to be%ome mo"e pe"meable and signifi%ant 6$antities of fl$id a"e lost .8 A #ging p"o%ess in/ol/es in%"eased %apilla"y f"agility and pe"meability Olde" ad$lts ha/e a de%"eased amo$nt of s$b%$taneo$s fat and %a$se an in%"eased in%iden%e of b"$ise li0e lesions %a$sed by %olle%tion of e-t"a/as%$la" blood in loosely st"$%t$"ed de"mis .9 D Inte"mittent pain is the %lassi% sign of "enal %a"%inoma It is p"ima"ily d$e to %apilla"y e"osion by the %an%e"o$s g"owth .9 )' !$be"%le ba%ill$s is a d"$g "esistant o"ganism and ta0es a long time to be e"adi%ated Us$ally a %ombination of th"ee d"$gs is $sed fo" minim$m of 5 months and at least si- months beyond %$lt$"e %on/e"sion 20 A' Patent ai"way is the most p"io"ityW the"efo"e "emo/al of se%"etions is ne%essa"y

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PS(CHIATRIC NURSING Part 1 1 <a"%o app"oa%hed *$"se !"ish as0ing fo" ad/i%e on how to deal with his al%ohol addi%tion *$"se !"ish sho$ld tell the %lient that the only effe%ti/e t"eatment fo" al%oholism is: a Psy%hothe"apy b #l%oholi%s anonymo$s O# # P % !otal abstinen%e d #/e"sion !he"apy 2 *$"se ?a(el is %a"ing fo" a male %lient who e-pe"ien%e false senso"y pe"%eptions with no basis in "eality !his pe"%eption is 0nown as: a ?all$%inations b )el$sions % 'oose asso%iations d *eologisms + *$"se <onet is %a"ing fo" a female %lient who has s$i%idal tenden%y Hhen a%%ompanying the %lient to the "est"oom& *$"se <onet sho$ldM a Di/e he" p"i/a%y b #llow he" to $"inate % Open the window and allow he" to get some f"esh ai" d Obse"/e he" . *$"se <a$"een is de/eloping a plan of %a"e fo" a female %lient with ano"e-ia ne"/osa Hhi%h a%tion sho$ld the n$"se in%l$de in the planQ

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a P"o/ide p"i/a%y d$"ing meals b Set=$p a st"i%t eating plan fo" the %lient % ,n%o$"age %lient to e-e"%ise to "ed$%e an-iety d 1est"i%t /isits with the family 2 # %lient is e-pe"ien%ing an-iety atta%0 !he most app"op"iate n$"sing inte"/ention sho$ld in%l$deQ a !$"ning on the tele/ision b 'ea/ing the %lient alone % Staying with the %lient and spea0ing in sho"t senten%es d #s0 the %lient to play with othe" %lients 5 # female %lient is admitted with a diagnosis of del$sions of D1#*),U1 !his diagnosis "efle%ts a belief that one is: a @eing :illed b ?ighly famo$s and impo"tant % 1esponsible fo" e/il wo"ld d Conne%ted to %lient $n"elated to oneself 8 # 20 yea" old %lient was diagnosed with dependent pe"sonality diso"de" Hhi%h beha/io" is not most li0ely to be e/iden%e of ineffe%ti/e indi/id$al %opingQ a 1e%$""ent self=dest"$%ti/e beha/io" b #/oiding "elationship % Showing inte"est in solita"y a%ti/ities d Inability to ma0e %hoi%es and de%ision witho$t ad/ise 9 # male %lient is diagnosed with s%hi(otypal pe"sonality diso"de" Hhi%h signs wo$ld this %lient e-hibit d$"ing so%ial sit$ationQ a Pa"anoid tho$ghts b ,motional affe%t % Independen%e need d #gg"essi/e beha/io" 9 *$"se Clai"e is %a"ing fo" a %lient diagnosed with b$limia !he most app"op"iate initial goal fo" a %lient diagnosed with b$limia isQ a ,n%o$"age to a/oid foods b Identify an-iety %a$sing sit$ations % ,at only th"ee meals a day d #/oid shopping plenty of g"o%e"ies 10 *$"se !ony was %a"ing fo" a .1 yea" old female %lient Hhi%h beha/io" by the %lient indi%ates ad$lt %ogniti/e de/elopmentQ a Dene"ates new le/els of awa"eness b #ss$mes "esponsibility fo" he" a%tions % ?as ma-im$m ability to sol/e p"oblems and lea"n new s0ills d ?e" pe"%eption a"e based on "eality 11 # ne$"om$s%$la" blo%0ing agent is administe"ed to a %lient befo"e ,C! the"apy !he *$"se sho$ld %a"ef$lly obse"/e the %lient fo"Q a 1espi"ato"y diffi%$lties b *a$sea and /omiting % )i((iness d Sei($"es 12 # 82 yea" old %lient is admitted to the hospital with the diagnosis of dementia of the #l(heime"Ks type and dep"ession !he symptom that is $n"elated to dep"ession wo$ld beQ a #patheti% "esponse to the en/i"onment b SI donKt 0nowT answe" to 6$estions % Shallow of labile effe%t d *egle%t of pe"sonal hygiene 1+ *$"se !"ish is wo"0ing in a mental health fa%ilityW the n$"se p"io"ity n$"sing inte"/ention fo" a newly admitted %lient with b$limia ne"/osa wo$ld be toQ a !ea%h %lient to meas$"e I N O b In/ol/e %lient in planning daily meal % Obse"/e %lient d$"ing meals d <onito" %lient %ontin$o$sly 1. *$"se Pat"i%ia is awa"e that the maEo" health %ompli%ation asso%iated with int"a%table ano"e-ia ne"/osa wo$ld beQ a Ca"dia% dys"hythmias "es$lting to %a"dia% a""est b Dl$%ose intole"an%e "es$lting in p"ot"a%ted hypogly%emia % ,ndo%"ine imbalan%e %a$sing %old ameno""hea d )e%"eased metabolism %a$sing %old intole"an%e 12 *$"se #nna %an minimi(e agitation in a dist$"bed %lient byQ a In%"easing stim$lation

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b limiting $nne%essa"y inte"a%tion % in%"easing app"op"iate senso"y pe"%eption d ens$"ing %onstant %lient and staff %onta%t 15 # +9 yea" old mothe" with obsessi/e=%omp$lsi/e diso"de" has be%ome immobili(ed by he" elabo"ate hand washing and wal0ing "it$als *$"se !"ish "e%ogni(es that the basis of O C diso"de" is often: a P"oblems with being too %ons%ientio$s b P"oblems with ange" and "emo"se % Feelings of g$ilt and inade6$a%y d Feeling of $nwo"thiness and hopelessness 18 <a"io is %omplaining to othe" %lients abo$t not being allowed by staff to 0eep food in his "oom Hhi%h of the following inte"/entions wo$ld be most app"op"iateQ a #llowing a sna%0 to be 0ept in his "oom b 1ep"imanding the %lient % Igno"ing the %lients beha/io" d Setting limits on the beha/io" 19 Conney with bo"de"line pe"sonality diso"de" who is to be dis%ha"ge soon th"eatens to Sdo somethingT to he"self if dis%ha"ged Hhi%h of the following a%tions by the n$"se wo$ld be most impo"tantQ a #s0 a family membe" to stay with the %lient at home tempo"a"ily b )is%$ss the meaning of the %lientKs statement with he" % 1e6$est an immediate e-tension fo" the %lient d Igno"e the %lients statement be%a$se itKs a sign of manip$lation 19 Boey a %lient with antiso%ial pe"sonality diso"de" bel%hes lo$dly # staff membe" as0s Boey& S)o yo$ 0now why people find yo$ "ep$lsi/eQT this statement most li0ely wo$ld eli%it whi%h of the following %lient "ea%tionQ a )epensi/eness b ,mba""assment % Shame d 1emo"sef$lness 20 Hhi%h of the following app"oa%hes wo$ld be most app"op"iate to $se with a %lient s$ffe"ing f"om na"%issisti% pe"sonality diso"de" when dis%"epan%ies e-ist between what the %lient states and what a%t$ally e-istQ a 1ationali(ation b S$ppo"ti/e %onf"ontation % 'imit setting d Consisten%y 21 Cely is e-pe"ien%ing al%ohol withd"awal e-hibits t"emo"s& diapho"esis and hype"a%ti/ity @lood p"ess$"e is 190G98 mmhg and p$lse is 92 bpm Hhi%h of the medi%ations wo$ld the n$"se e-pe%t to administe"Q a *alo-one O*a"%anP b @en(l"opine OCogentinP % 'o"a(epam O#ti/anP d ?alope"idol O?aldolP 22 Hhi%h of the following foods wo$ld the n$"se !"ish eliminate f"om the diet of a %lient in al%ohol withd"awalQ a <il0 b O"ange B$i%e % Soda d 1eg$la" Coffee 2+ Hhi%h of the following wo$ld *$"se ?a(el e-pe%t to assess fo" a %lient who is e-hibiting late signs of he"oin withd"awalQ a Aawning N diapho"esis b 1estlessness N I""itability % Constipation N steato""hea d 7omiting and )ia""hea 2. !o establish open and t"$sting "elationship with a female %lient who has been hospitali(ed with se/e"e an-iety& the n$"se in %ha"ge sho$ldQ a ,n%o$"age the staff to ha/e f"e6$ent inte"a%tion with the %lient b Sha"e an a%ti/ity with the %lient % Di/e %lient feedba%0 abo$t beha/io" d 1espe%t %lientKs need fo" pe"sonal spa%e 22 *$"se <onette "e%ogni(es that the fo%$s of en/i"onmental O<I'I,UP the"apy is to: a <anip$late the en/i"onment to b"ing abo$t positi/e %hanges in beha/io" b #llow the %lientKs f"eedom to dete"mine whethe" o" not they will be in/ol/ed in a%ti/ities % 1ole play life e/ents to meet indi/id$al needs d Use nat$"al "emedies "athe" than d"$gs to %ont"ol beha/io" 25 *$"se !"ish wo$ld e-pe%t a %hild with a diagnosis of "ea%ti/e atta%hment diso"de" to:

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a ?a/e mo"e positi/e "elation with the fathe" than the mothe" b Cling to mothe" N %"y on sepa"ation % @e able to de/elop only s$pe"fi%ial "elation with the othe"s d ?a/e been physi%ally ab$se 28 Hhen tea%hing pa"ents abo$t %hildhood dep"ession *$"se !"ina sho$ld sayQ a It may appea" a%ting o$t beha/io" b )oes not "espond to %on/entional t"eatment % Is sho"t in d$"ation N "esol/es easily d 'oo0s almost identi%al to ad$lt dep"ession 29 *$"se Pe""y is awa"e that lang$age de/elopment in a$tisti% %hild "esembles: a S%anning spee%h b Spee%h lag % Sh$tte"ing d ,%holalia 29 # 50 yea" old female %lient who li/es alone tells the n$"se at the %omm$nity health %ente" SI "eally donKt need anyone to tal0 toT !he !7 is my best f"iend !he n$"se "e%ogni(es that the %lient is $sing the defense me%hanism 0nown asQ a )ispla%ement b P"oEe%tion % S$blimation d )enial +0 Hhen wo"0ing with a male %lient s$ffe"ing phobia abo$t bla%0 %ats& *$"se !"ish sho$ld anti%ipate that a p"oblem fo" this %lient wo$ld beQ a #n-iety when dis%$ssing phobia b #nge" towa"d the fea"ed obEe%t % )enying that the phobia e-ist d )isto"tion of "eality when %ompleting daily "o$tines +1 'inda is pa%ing the floo" and appea"s e-t"emely an-io$s !he d$ty n$"se app"oa%hes in an attempt to alle/iate 'indaKs an-iety !he most the"ape$ti% 6$estion by the n$"se wo$ld beQ a Ho$ld yo$ li0e to wat%h !7Q b Ho$ld yo$ li0e me to tal0 with yo$Q % #"e yo$ feeling $pset nowQ d Igno"e the %lient +2 *$"se Penny is awa"e that the symptoms that disting$ish post t"a$mati% st"ess diso"de" f"om othe" an-iety diso"de" wo$ld be: a #/oidan%e of sit$ation N %e"tain a%ti/ities that "esemble the st"ess b )ep"ession and a bl$nted affe%t when dis%$ssing the t"a$mati% sit$ation % 'a%0 of inte"est in family N othe"s d 1e=e-pe"ien%ing the t"a$ma in d"eams o" flashba%0 ++ *$"se @enEie is %omm$ni%ating with a male %lient with s$bstan%e=ind$%ed pe"sisting dementiaW the %lient %annot "emembe" fa%ts and fills in the gaps with imagina"y info"mation *$"se @enEie is awa"e that this is typi%al ofQ a Flight of ideas b #sso%iati/e looseness % Confab$lation d Con%"etism +. *$"se Boey is awa"e that the signs N symptoms that wo$ld be most spe%ifi% fo" diagnosis ano"e-ia a"eQ a ,-%essi/e weight loss& ameno""hea N abdominal distension b Slow p$lse& 10V weight loss N alope%ia % Comp$lsi/e beha/io"& e-%essi/e fea"s N na$sea d ,-%essi/e a%ti/ity& memo"y lapses N an in%"eased p$lse +2 # %ha"a%te"isti% that wo$ld s$ggest to *$"se #nne that an adoles%ent may ha/e b$limia wo$ld be: a F"e6$ent "eg$"gitation N "e=swallowing of food b P"e/io$s histo"y of gast"itis % @adly stained teeth d Positi/e body image +5 *$"se <onette is awa"e that e-t"emely dep"essed %lients seem to do best in settings whe"e they ha/e: a <$ltiple stim$li b 1o$tine #%ti/ities % <inimal de%ision ma0ing d 7a"ied #%ti/ities +8 !o f$"the" assess a %lientKs s$i%idal potential *$"se :at"ina sho$ld be espe%ially ale"t to the %lient e-p"ession of: a F"$st"ation N fea" of death b #nge" N "esentment

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% #n-iety N loneliness d ?elplessness N hopelessness +9 # n$"sing %a"e plan fo" a male %lient with bipola" I diso"de" sho$ld in%l$de: a P"o/iding a st"$%t$"ed en/i"onment b )esigning a%ti/ities that will "e6$i"e the %lient to maintain %onta%t with "eality % ,ngaging the %lient in %on/e"sing abo$t %$""ent affai"s d !o$%hing the %lient p"o/ide ass$"an%e +9 Hhen planning %a"e fo" a female %lient $sing "it$alisti% beha/io"& *$"se Dina m$st "e%ogni(e that the "it$al: a ?elps the %lient fo%$s on the inability to deal with "eality b ?elps the %lient %ont"ol the an-iety % Is $nde" the %lientKs %ons%io$s %ont"ol d Is $sed by the %lient p"ima"ily fo" se%onda"y gains .0 # +2 yea" old male g"ad$ate st$dent& who has be%ome in%"easingly withd"awn and negle%tf$l of his wo"0 and pe"sonal hygiene& is b"o$ght to the psy%hiat"i% hospital by his pa"ents #fte" detailed assessment& a diagnosis of s%hi(oph"enia is made It is $nli0ely that the %lient will demonst"ate: a 'ow self esteem b Con%"ete thin0ing % ,ffe%ti/e self bo$nda"ies d Hea0 ego .1 # 2+ yea" old %lient has been admitted with a diagnosis of s%hi(oph"enia says to the n$"se SAes& its ma"%h& <a"%h is little womanT !hatKs lite"al yo$ 0nowT !hese statement ill$st"ate: a *eologisms b ,%holalia % Flight of ideas d 'oosening of asso%iation .2 # long te"m goal fo" a pa"anoid male %lient who has $nE$stifiably a%%$sed his wife of ha/ing many e-t"ama"ital affai"s wo$ld be to help the %lient de/elop: a Insight into his beha/io" b @ette" self %ont"ol % Feeling of self wo"th d Faith in his wife .+ # male %lient who is e-pe"ien%ing diso"de"ed thin0ing abo$t food being poisoned is admitted to the mental health $nit !he n$"se $ses whi%h %omm$ni%ation te%hni6$e to en%o$"age the %lient to eat dinne"Q a Fo%$sing on self=dis%los$"e of own food p"efe"en%e b Using open ended 6$estion and silen%e % Offe"ing opinion abo$t the need to eat d 7e"bali(ing "easons that the %lient may not %hoose to eat .. *$"se *ina is assigned to %a"e fo" a %lient diagnosed with Catatoni% St$po" Hhen *$"se *ina ente"s the %lientKs "oom& the %lient is fo$nd lying on the bed with a body p$lled into a fetal position *$"se *ina sho$ldQ a #s0 the %lient di"e%t 6$estions to en%o$"age tal0ing b 1a0e the %lient into the day"oom to be with othe" %lients % Sit beside the %lient in silen%e and o%%asionally as0 open=ended 6$estion d 'ea/e the %lient alone and %ontin$e with p"o/iding %a"e to the othe" %lients .2 *$"se !ina is %a"ing fo" a %lient with deli"i$m and states that Sloo0 at the spide"s on the wallT Hhat sho$ld the n$"se "espond to the %lientQ a SAo$K"e ha/ing hall$%ination& the"e a"e no spide"s in this "oom at allT b SI %an see the spide"s on the wall& b$t they a"e not going to h$"t yo$T % SHo$ld yo$ li0e me to 0ill the spide"sT d SI 0now yo$ a"e f"ightened& b$t I do not see spide"s on the wallT .5 *$"se Bonel is p"o/iding info"mation to a %omm$nity g"o$p abo$t /iolen%e in the family Hhi%h statement by a g"o$p membe" wo$ld indi%ate a need to p"o/ide additional info"mationQ a S#b$se o%%$"s mo"e in low=in%ome familiesT b S#b$se" #"e often Eealo$s o" self=%ente"edT % S#b$se" $se fea" and intimidationT d S#b$se" $s$ally ha/e poo" self=esteemT .8 )$"ing ele%t"o%on/$lsi/e the"apy O,C!P the %lient "e%ei/es o-ygen by mas0 /ia positi/e p"ess$"e /entilation !he n$"se assisting with this p"o%ed$"e 0nows that positi/e p"ess$"e /entilation is ne%essa"y be%a$seQ a #nesthesia is administe"ed d$"ing the p"o%ed$"e b )e%"ease o-ygen to the b"ain in%"eases %onf$sion and diso"ientation % D"and mal sei($"e a%ti/ity dep"esses "espi"ations d <$s%le "ela-ations gi/en to p"e/ent inE$"y d$"ing sei($"e a%ti/ity dep"ess "espi"ations

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.9 Hhen planning the dis%ha"ge of a %lient with %h"oni% an-iety& *$"se Ch"is e/al$ates a%hie/ement of the dis%ha"ge maintenan%e goals Hhi%h goal wo$ld be most app"op"iately ha/ing been in%l$ded in the plan of %a"e "e6$i"ing e/al$ationQ a !he %lient eliminates all an-iety f"om daily sit$ations b !he %lient igno"es feelings of an-iety % !he %lient identifies an-iety p"od$%ing sit$ations d !he %lient maintains %onta%t with a %"isis %o$nselo" .9 *$"se !ina is %a"ing fo" a %lient with dep"ession who has not "esponded to antidep"essant medi%ation !he n$"se anti%ipates that what t"eatment p"o%ed$"e may be p"es%"ibedQ a *e$"olepti% medi%ation b Sho"t te"m se%l$sion % Psy%hos$"ge"y d ,le%t"o%on/$lsi/e the"apy 20 <a"io is admitted to the eme"gen%y "oom with d"$g=in%l$ded an-iety "elated to o/e" ingestion of p"es%"ibed antipsy%hoti% medi%ation !he most impo"tant pie%e of info"mation the n$"se in %ha"ge sho$ld obtain initially is the: a 'ength of time on the med b *ame of the ingested medi%ation N the amo$nt ingested % 1eason fo" the s$i%ide attempt d *ame of the nea"est "elati/e N thei" phone n$mbe"

ANS5ERS a$% RATIONALES ,#r PS(CHIATRIC NURSING Part 1 1 C !otal abstinen%e is the only effe%ti/e t"eatment fo" al%oholism 2 A ?all$%inations a"e /is$al& a$dito"y& g$stato"y& ta%tile o" olfa%to"y pe"%eptions that ha/e no basis in "eality + D !he *$"se has a "esponsibility to obse"/e %ontin$o$sly the a%$tely s$i%idal %lient !he *$"se sho$ld wat%h fo" %l$es& s$%h as %omm$ni%ating s$i%idal tho$ghts& and messagesW hoa"ding medi%ations and tal0ing abo$t death . )' ,stablishing a %onsistent eating plan and monito"ing %lientKs weight a"e impo"tant to this diso"de" 2 C #pp"op"iate n$"sing inte"/entions fo" an an-iety atta%0 in%l$de $sing sho"t senten%es& staying with the %lient& de%"easing stim$li& "emaining %alm and medi%ating as needed 5 ) )el$sion of g"ande$" is a false belief that one is highly famo$s and impo"tant 8 D Indi/id$al with dependent pe"sonality diso"de" typi%ally shows inde%isi/eness s$bmissi/eness and %linging beha/io" so that othe"s will ma0e de%isions with them 9 A Clients with s%hi(otypal pe"sonality diso"de" e-pe"ien%e e-%essi/e so%ial an-iety that %an lead to pa"anoid tho$ghts 9 ) @$limia diso"de" gene"ally is a maladapti/e %oping "esponse to st"ess and $nde"lying iss$es !he %lient sho$ld identify an-iety %a$sing sit$ation that stim$late the b$limi% beha/io" and then lea"n new ways of %oping with the an-iety 10 A #n ad$lt age +1 to .2 gene"ates new le/el of awa"eness 11 A *e$"om$s%$la" @lo%0e"& s$%h as SUCCI*A'C?O'I*, O#ne%tineP p"od$%es "espi"ato"y dep"ession be%a$se it inhibits %ont"a%tions of "espi"ato"y m$s%les

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12 C Hith dep"ession& the"e is little o" no emotional in/ol/ement the"efo"e little alte"ation in affe%t 1+ D !hese %lients often hide food o" fo"%e /omitingW the"efo"e they m$st be %a"ef$lly monito"ed 1. A !hese %lients ha/e se/e"ely depleted le/els of sodi$m and potassi$m be%a$se of thei" sta"/ation diet and ene"gy e-pendit$"e& these ele%t"olytes a"e ne%essa"y fo" %a"dia% f$n%tioning 12 ) 'imiting $nne%essa"y inte"a%tion will de%"ease stim$lation and agitation 15 C 1it$alisti% beha/io" seen in this diso"de" is aimed at %ont"olling g$ilt and inade6$a%y by maintaining an absol$te set patte"n of beha/io" 18 D !he n$"se needs to set limits in the %lientKs manip$lati/e beha/io" to help the %lient %ont"ol dysf$n%tional beha/io" # %onsistent app"oa%h by the staff is ne%essa"y to de%"ease manip$lation 19 ) #ny s$i%idal statement m$st be assessed by the n$"se !he n$"se sho$ld dis%$ss the %lientKs statement with he" to dete"mine its meaning in te"ms of s$i%ide 19 A Hhen the staff membe" as0 the %lient if he wonde"s why othe"s find him "ep$lsi/e& the %lient is li0ely to feel defensi/e be%a$se the 6$estion is belittling !he nat$"al tenden%y is to %o$nte"atta%0 the th"eat to self image 20 ) !he n$"se wo$ld spe%ifi%ally $se s$ppo"ti/e %onf"ontation with the %lient to point o$t dis%"epan%ies between what the %lient states and what a%t$ally e-ists to in%"ease "esponsibility fo" self 21 C !he n$"se wo$ld most li0ely administe" ben(odia(epine& s$%h as lo"a(epan Oati/anP to the %lient who is e-pe"ien%ing symptom: !he %lientKs e-pe"ien%es symptoms of withd"awal be%a$se of the "ebo$nd phenomenon when the sedation of the C*S f"om al%ohol begins to de%"ease 22 D 1eg$la" %offee %ontains %affeine whi%h a%ts as psy%homoto" stim$lants and leads to feelings of an-iety and agitation Se"/ing %offee top the %lient may add to t"emo"s o" wa0ef$lness 2+ D 7omiting and dia""hea a"e $s$ally the late signs of he"oin withd"awal& along with m$s%le spasm& fe/e"& na$sea& "epetiti/e& abdominal %"amps and ba%0a%he 2. D <o/ing to a %lientKs pe"sonal spa%e in%"eases the feeling of th"eat& whi%h in%"eases an-iety 22 A ,n/i"onmental O<I'I,UP the"apy aims at ha/ing e/e"ything in the %lientKs s$""o$nding a"ea towa"d helping the %lient 25 C Child"en who ha/e e-pe"ien%ed atta%hment diffi%$lties with p"ima"y %a"egi/e" a"e not able to t"$st othe"s and the"efo"e "elate s$pe"fi%ially 28 A Child"en ha/e diffi%$lty /e"bally e-p"essing thei" feelings& a%ting o$t beha/io"& s$%h as tempe" tant"$ms& may indi%ate $nde"lying dep"ession 29 D !he a$tisti% %hild "epeat so$nds o" wo"ds spo0en by othe"s 29 D !he %lient statement is an e-ample of the $se of denial& a defense that blo%0s p"oblem by $n%ons%io$s "ef$sing to admit they e-ist +0 A )is%$ssion of the fea"ed obEe%t t"igge"s an emotional "esponse to the obEe%t +1 ) !he n$"se p"esen%e may p"o/ide the %lient with s$ppo"t N feeling of %ont"ol +2 D ,-pe"ien%ing the a%t$al t"a$ma in d"eams o" flashba%0 is the maEo" symptom that disting$ishes post t"a$mati% st"ess diso"de" f"om othe" an-iety diso"de" ++ C Confab$lation o" the filling in of memo"y gaps with imagina"y fa%ts is a defense me%hanism $sed by people e-pe"ien%ing memo"y defi%its +. A !hese a"e the maEo" signs of ano"e-ia ne"/osa Height loss is e-%essi/e O12V of e-pe%ted weightP +2 C )ental enamel e"osion o%%$"s f"om "epeated self=ind$%ed /omiting +5 ) )ep"ession $s$ally is both emotional N physi%al # simple daily "o$tine is the best& least st"essf$l and least an-iety p"od$%ing +8 D !he e-p"ession of these feeling may indi%ate that this %lient is $nable to %ontin$e the st"$ggle of life +9 A St"$%t$"e tends to de%"ease agitation and an-iety and to in%"ease the %lientKs feeling of se%$"ity +9 ) !he "it$als $sed by a %lient with obsessi/e %omp$lsi/e diso"de" help %ont"ol the an-iety le/el by maintaining a set patte"n of a%tion .0 C # pe"son with this diso"de" wo$ld not ha/e ade6$ate self=bo$nda"ies .1 D 'oose asso%iations a"e tho$ghts that a"e p"esented witho$t the logi%al %onne%tions $s$ally ne%essa"y fo" the listening to inte"p"et the message .2 C ?elping the %lient to de/elop feeling of self wo"th wo$ld "ed$%e the %lientKs need to $se pathologi% defenses .+ ) Open ended 6$estions and silen%e a"e st"ategies $sed to en%o$"age %lients to dis%$ss thei" p"oblem in des%"ipti/e manne" .. C Clients who a"e withd"awn may be immobile and m$te& and "e6$i"e %onsistent& "epeated inte"/entions Comm$ni%ation with withd"awn %lients "e6$i"es m$%h patien%e f"om the n$"se !he n$"se fa%ilitates %omm$ni%ation with the %lient by sitting in silen%e& as0ing open=ended 6$estion and pa$sing to p"o/ide oppo"t$nities fo" the %lient to "espond .2 D Hhen hall$%ination is p"esent& the n$"se sho$ld "einfo"%e "eality with the %lient .5 A Pe"sonal %ha"a%te"isti%s of ab$se" in%l$de low self=esteem& immat$"ity& dependen%e& inse%$"ity and Eealo$sy .8 D # sho"t a%ting s0eletal m$s%le "ela-ant s$%h as s$%%inyl%holine O#ne%tineP is administe"ed d$"ing this p"o%ed$"e to p"e/ent inE$"ies d$"ing sei($"e .9 C 1e%ogni(ing sit$ations that p"od$%e an-iety allows the %lient to p"epa"e to %ope with an-iety o" a/oid spe%ifi% stim$l$s

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.9 D ,le%t"o%on/$lsi/e the"apy is an effe%ti/e t"eatment fo" dep"ession that has not "esponded to medi%ation 20 ) In an eme"gen%y& li/es sa/ing fa%ts a"e obtained fi"st !he name and the amo$nt of medi%ation ingested a"e of o$tmost impo"tant in t"eating this potentially life th"eatening sit$ation

PS(CHIATRIC NURSING Part 2 1 *$"se !ony sho$ld fi"st dis%$ss te"minating the n$"se=%lient "elationship with a %lient d$"ing the: a !e"mination phase when dis%ha"ge plans a"e being made b Ho"0ing phase when the %lient shows some p"og"ess % O"ientation phase when a %ont"a%t is established d Ho"0ing phase when the %lient b"ings it $p 2 <alo$ is diagnosed with maEo" dep"ession spends maEo"ity of the day lying in bed with the sheet p$lled o/e" his head Hhi%h of the following app"oa%hes by the n$"se wo$ld be the most the"ape$ti%Q a >$estion the %lient $ntil he "esponds b Initiate %onta%t with the %lient f"e6$ently % Sit o$tside the %lients "oom d Hait fo" the %lient to begin the %on/e"sation + Boe who is /e"y dep"essed e-hibits psy%homoto" "eta"dation& a flat affe%t and apathy !he n$"se in %ha"ge obse"/es Boe to be in need of g"ooming and hygiene Hhi%h of the following n$"sing a%tions wo$ld be most app"op"iateQ a Haiting $ntil the %lientKs family %an pa"ti%ipate in the %lientKs %a"e b #s0ing the %lient if he is "eady to ta0e showe" % ,-plaining the impo"tan%e of hygiene to the %lient d Stating to the %lient that itKs time fo" him to ta0e a showe"

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. Hhen tea%hing <a"io with a typi%al dep"ession abo$t foods to a/oid while ta0ing phenel(ineO*a"dilP& whi%h of the following wo$ld the n$"se in %ha"ge in%l$deQ a 1oasted %hi%0en b F"esh fish % Salami d ?amb$"ge" 2 Hhen assessing a female %lient who is "e%ei/ing t"i%y%li% antidep"essant the"apy& whi%h of the following wo$ld ale"t the n$"se to the possibility that the %lient is e-pe"ien%ing anti%holine"gi% effe%tsQ a U"ine "etention and bl$""ed /ision b 1espi"ato"y dep"ession and %on/$lsion % )eli"i$m and Sedation d !"emo"s and %a"dia% a""hythmias 5 Fo" a male %lient with dysthymi% diso"de"& whi%h of the following app"oa%hes wo$ld the n$"se e-pe%t to implementQ a ,C! b Psy%hothe"ape$ti% app"oa%h % Psy%hoanalysis d #ntidep"essant the"apy 8 )anny who is diagnosed with bipola" diso"de" and a%$te mania& states the n$"se& SHhe"e is my da$ghte"Q I lo/e 'o$is 1ain& "ain go away )ogs eat di"t T !he n$"se inte"p"ets these statements as indi%ating whi%h of the followingQ a ,%holalia b *eologism % Clang asso%iations d Flight of ideas 9 !e""y with mania is s0ipping $p and down the hallway p"a%ti%ally "$nning into othe" %lients Hhi%h of the following a%ti/ities wo$ld the n$"se in %ha"ge e-pe%t to in%l$de in !e""yKs plan of %a"eQ a Hat%hing !7 b Cleaning day"oom tables % 'eading g"o$p a%ti/ity d 1eading a boo0 9 Hhen assessing a male %lient fo" s$i%idal "is0& whi%h of the following methods of s$i%ide wo$ld the n$"se identify as most lethalQ a H"ist %$tting b ?ead banging % Use of g$n d #spi"in o/e"dose 10 B$n has been hospitali(ed fo" maEo" dep"ession and s$i%idal ideation Hhi%h of the following statements indi%ates to the n$"se that the %lient is imp"o/ingQ a SIKm of no $se to anyone anymo"e T b SI 0now my 0ids donKt need me anymo"e sin%e theyK"e g"own T % SI %o$ldnKt 0ill myself be%a$se I donKt want to go to hell T d SI donKt thin0 abo$t 0illing myself as m$%h as I $sed to T 11 Hhi%h of the following a%ti/ities wo$ld *$"se !"ish "e%ommend to the %lient who be%omes /e"y an-io$s when tho$ghts of s$i%ide o%%$"Q a Using e-e"%ise bi%y%le b <editating % Hat%hing !7 d 1eading %omi%s 12 Hhen de/eloping the plan of %a"e fo" a %lient "e%ei/ing halope"idol& whi%h of the following medi%ations wo$ld n$"se <onet anti%ipate administe"ing if the %lient de/eloped e-t"a py"amidal side effe%tsQ a Olan(apine OJyp"e-aP b Pa"o-etine OPa-ilP % @en(t"opine mesylate OCogentinP d 'o"a(epam O#ti/anP 1+ Bon a s$spi%io$s %lient states that SI 0now yo$ n$"ses a"e sp"aying my food with poison as yo$ ta0e it o$t of the %a"t T Hhi%h of the following wo$ld be the best "esponse of the n$"seQ a Di/ing the %lient %anned s$pplements $ntil the del$sion s$bsides b #s0ing what 0ind of poison the %lient s$spe%ts is being $sed % Se"/ing foods that %ome in sealed pa%0ages d #llowing the %lient to be the fi"st to open the %a"t and get a t"ay 1. # %lient is s$ffe"ing f"om %atatoni% beha/io"s Hhi%h of the following wo$ld the n$"se $se to dete"mine that the medi%ation administe"ed P1* ha/e been most effe%ti/eQ a !he %lient "esponds to /e"bal di"e%tions to eat b !he %lient initiates simple a%ti/ities witho$t di"e%tion

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15

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19

19

20

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22

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% !he %lient wal0s with the n$"se to he" "oom d !he %lient is able to mo/e all e-t"emities o%%asionally *$"se ?a(el in/ites new %lientKs pa"ents to attend the psy%ho ed$%ational p"og"am fo" families of the %h"oni%ally mentally ill !he p"og"am wo$ld be most li0ely to help the family with whi%h of the following iss$esQ a )e/eloping a s$ppo"t netwo"0 with othe" families b Feeling mo"e g$ilty abo$t the %lientKs illness % 1e%ogni(ing the %lientKs wea0ness d <anaging thei" finan%ial %on%e"n and p"oblems Hhen planning %a"e fo" )o"y with s%hi(otypal pe"sonality diso"de"& whi%h of the following wo$ld help the %lient be%ome in/ol/ed with othe"sQ a #ttending an a%ti/ity with the n$"se b 'eading a sing a long in the afte"noon % Pa"ti%ipating solely in g"o$p a%ti/ities d @eing in/ol/ed with p"ima"ily one to one a%ti/ities Hhi%h statement abo$t an indi/id$al with a pe"sonality diso"de" is t"$eQ a Psy%hoti% beha/io" is %ommon d$"ing a%$te episodes b P"ognosis fo" "e%o/e"y is good with the"ape$ti% inte"/ention % !he indi/id$al typi%ally "emains in the mainst"eam of so%iety& altho$gh he has p"oblems in so%ial and o%%$pational "oles d !he indi/id$al $s$ally see0s t"eatment willingly fo" symptoms that a"e pe"sonally dist"essf$l *$"se Bohn is tal0ing with a %lient who has been diagnosed with antiso%ial pe"sonality abo$t how to so%iali(e d$"ing a%ti/ities witho$t being sed$%ti/e *$"se Bohn wo$ld fo%$s the dis%$ssion on whi%h of the following a"easQ a )is%$ssing his "elationship with his mothe" b #s0ing him to e-plain "easons fo" his sed$%ti/e beha/io" % S$ggesting to apologi(e to othe"s fo" his beha/io" d ,-plaining the negati/e "ea%tions of othe"s towa"d his beha/io" !ina with a hist"ioni% pe"sonality diso"de" is melod"amati% and "esponds to othe"s and sit$ations in an e-agge"ated manne" *$"se !"ish wo$ld "e%ommend whi%h of the following a%ti/ities fo" !inaQ a @a0ing %lass b 1ole playing % S%"ap boo0 ma0ing d <$si% g"o$p Boy has ente"ed the %hemi%al dependen%y $nit fo" t"eatment of al%ohol dependen%y Hhi%h of the following %lientKs possession will the n$"se most li0ely pla%e in a lo%0ed a"eaQ a !oothpaste b Shampoo % #ntisepti% wash d <oist$"i(e" Hhi%h of the following assessment wo$ld p"o/ide the best info"mation abo$t the %lientKs physiologi% "esponse and the effe%ti/eness of the medi%ation p"es%"ibed spe%ifi%ally fo" al%ohol withd"awalQ a Sleeping patte"n b <ental ale"tness % *$t"itional stat$s d 7ital signs #fte" administe"ing nalo-one O*a"%anP& an opioid antagonist& *$"se 1onald sho$ld monito" the female %lient %a"ef$lly fo" whi%h of the followingQ a 1espi"ato"y dep"ession b ,pilepsy % :idney fail$"e d Ce"eb"al edema Hhi%h of the following wo$ld n$"se 1onald $se as the best meas$"e to dete"mine a %lientKs p"og"ess in "ehabilitationQ a !he way he gets along with his pa"ents b !he n$mbe" of d"$g=f"ee days he has % !he 0inds of f"iends he ma0es d !he amo$nt of "esponsibility his Eob entails # female %lient is b"o$ght by amb$lan%e to the hospital eme"gen%y "oom afte" ta0ing an o/e"dose of ba"bit$"ates is %omatose *$"se !"ish wo$ld be espe%ially ale"t fo" whi%h of the followingQ a ,pilepsy b <yo%a"dial Infa"%tion % 1enal fail$"e d 1espi"ato"y fail$"e

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22 Boey who has a %h"oni% $se" of %o%aine "epo"ts that he feels li0e he has %o%0"oa%hes %"awling $nde" his s0in ?is a"ms a"e "ed be%a$se of s%"at%hing !he n$"se in %ha"ge inte"p"ets these findings as possibly indi%ating whi%h of the followingQ a )el$sion b Fo"mi%ation % Flash ba%0 d Conf$sion 25 Bose is diagnosed with amphetamine psy%hosis and was admitted in the eme"gen%y "oom *$"se 1onald wo$ld most li0ely p"epa"e to administe" whi%h of the following medi%ationQ a 'ib"i$m b 7ali$m % #ti/an d ?aldol 28 Hhi%h of the following li6$ids wo$ld n$"se 'eng administe" to a female %lient who is into-i%ated with phen%y%lidine OPCPP to hasten e-%"etion of the %hemi%alQ a Sha0e b !ea % C"anbe""y B$i%e d D"ape E$i%e 29 Hhen de/eloping a plan of %a"e fo" a female %lient with a%$te st"ess diso"de" who lost he" siste" in a %a" a%%ident Hhi%h of the following wo$ld the n$"se e-pe%t to initiateQ a Fa%ilitating p"og"essi/e "e/iew of the a%%ident and its %onse6$en%es b Postponing dis%$ssion of the a%%ident $ntil the %lient b"ings it $p % !elling the %lient to a/oid details of the a%%ident d ?elping the %lient to e/al$ate he" siste"Ks beha/io" 29 !he n$"sing assistant tells n$"se 1onald that the %lient is not in the dining "oom fo" l$n%h *$"se 1onald wo$ld di"e%t the n$"sing assistant to do whi%h of the followingQ a !ell the %lient heKll need to wait $ntil s$ppe" to eat if he misses l$n%h b In/ite the %lient to l$n%h and a%%ompany him to the dining "oom % Info"m the %lient that he has 10 min$tes to get to the dining "oom fo" l$n%h d !a0e the %lient a l$n%h t"ay and let the %lient eat in his "oom +0 !he initial n$"sing inte"/ention fo" the signifi%ant=othe"s d$"ing sho%0 phase of a g"ief "ea%tion sho$ld be fo%$sed on: a P"esenting f$ll "eality of the loss of the indi/id$als b )i"e%ting the indi/id$alKs a%ti/ities at this time % Staying with the indi/id$als in/ol/ed d <obili(ing the indi/id$alKs s$ppo"t system +1 BoyKs st"eam of %ons%io$sness is o%%$pied e-%l$si/ely with tho$ghts of he" fathe"Ks death *$"se 1onald sho$ld plan to help Boy th"o$gh this stage of g"ie/ing& whi%h is 0nown as: a Sho%0 and disbelief b )e/eloping awa"eness % 1esol/ing the loss d 1estit$tion +2 Hhen ta0ing a health histo"y f"om a female %lient who has a mode"ate le/el of %ogniti/e impai"ment d$e to dementia& the n$"se wo$ld e-pe%t to note the p"esen%e of: a #%%ent$ated p"emo"bid t"aits b ,nhan%e intelligen%e % In%"eased inhibitions d ?ype" /igilan%e ++ Hhat is the p"io"ity %a"e fo" a %lient with a dementia "es$lting f"om #I)SQ a Planning fo" "emoti/ational the"apy b #""anging fo" long te"m %$stodial %a"e % P"o/iding basi% intelle%t$al stim$lation d #ssessing pain f"e6$ently +. Be"ome who has eating diso"de" often e-hibits simila" symptoms *$"se 'hey wo$ld e-pe%t an adoles%ent %lient with ano"e-ia to e-hibit: a #ffe%ti/e instability b )ishe"ed& $n0empt physi%al appea"an%e % )epe"sonali(ation and de"eali(ation d 1epetiti/e moto" me%hanisms +2 !he p"ima"y n$"sing diagnosis fo" a female %lient with a medi%al diagnosis of maEo" dep"ession wo$ld be: a Sit$ational low self=esteem "elated to alte"ed "ole b Powe"lessness "elated to the loss of ideali(ed self % Spi"it$al dist"ess "elated to dep"ession d Impai"ed /e"bal %omm$ni%ation "elated to dep"ession

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+5 Hhen de/eloping an initial n$"sing %a"e plan fo" a male %lient with a @ipola" I diso"de" Omani% episodeP n$"se 1on sho$ld plan toQ a Isolate his gym time b ,n%o$"age his a%ti/e pa"ti%ipation in $nit p"og"ams % P"o/ide foods& fl$ids and "est d ,n%o$"age his pa"ti%ipation in p"og"ams +8 D"a%e is e-hibiting withd"awn patte"ns of beha/io" *$"se Bohnny is awa"e that this type of beha/io" e/ent$ally p"od$%es feeling of: a 1ep"ession b 'oneliness % #nge" d Pa"anoia +9 One mo"ning a female %lient on the inpatient psy%hiat"i% se"/i%e %omplains to n$"se ?a(el that she has been waiting fo" o/e" an ho$" fo" someone to a%%ompany he" to a%ti/ities *$"se ?a(el "eplies to the %lient SHeK"e doing the best we %an !he"e a"e a lot of othe" people on the $nit who needs attention too T !his statement shows that the n$"seKs $se of: a )efensi/e beha/io" b 1eality "einfo"%ement % 'imit=setting beha/io" d Imp$lse %ont"ol +9 # n$"sing diagnosis fo" a male %lient with a diagnosed m$ltiple pe"sonality diso"de" is %h"oni% low self= esteem p"obably "elated to %hildhood ab$se !he most app"op"iate sho"t te"m %lient o$t%ome wo$ld be: a 7e"bali(ing the need fo" an-iety medi%ations b 1e%ogni(ing ea%h e-isting pe"sonality % ,ngaging in obEe%t=o"iented a%ti/ities d ,liminating defense me%hanisms and phobia .0 # 22 yea" old male is admitted to a mental health fa%ility be%a$se of inapp"op"iate beha/io" !he %lient has been hea"ing /oi%es& "esponding to imagina"y %ompanions and withd"awing to his "oom fo" se/e"al days at a time *$"se <onette $nde"stands that the withd"awal is a defense against the %lientKs fea" of: a Phobia b Powe"lessness % P$nishment d 1eEe%tion .1 Hhen as0ing the pa"ents abo$t the onset of p"oblems in yo$ng %lient with the diagnosis of s%hi(oph"enia& *$"se 'inda wo$ld e-pe%t that they wo$ld "elate the %lientKs diffi%$lties began in: a ,a"ly %hildhood b 'ate %hildhood % #doles%en%e d P$be"ty .2 Bose who has been hospitali(ed with s%hi(oph"enia tells *$"se 1on& S<y hea"t has stopped and my /eins ha/e t$"ned to glass\T *$"se 1on is awa"e that this is an e-ample of: a Somati% del$sions b )epe"sonali(ation % ?ypo%hond"iasis d ,%holalia .+ In "e%ogni(ing %ommon beha/io"s e-hibited by male %lient who has a diagnosis of s%hi(oph"enia& n$"se Bosie %an anti%ipate: a Sl$mped post$"e& pessimisti% o$t loo0 and flight of ideas b D"andiosity& a""ogan%e and dist"a%tibility % Hithd"awal& "eg"essed beha/io" and la%0 of so%ial s0ills d )iso"ientation& fo"getf$lness and an-iety .. One mo"ning& n$"se )iane finds a dist$"bed %lient %$"led $p in the fetal position in the %o"ne" of the day"oom !he most a%%$"ate initial e/al$ation of the beha/io" wo$ld be that the %lient is: a Physi%ally ill and e-pe"ien%ing abdominal dis%omfo"t b !i"ed and p"obably did not sleep well last night % #ttempting to hide f"om the n$"se d Feeling mo"e an-io$s today .2 *$"se @ea noti%es a female %lient sitting alone in the %o"ne" smiling and tal0ing to he"self 1eali(ing that the %lient is hall$%inating *$"se @ea sho$ld: a In/ite the %lient to help de%o"ate the day"oom b 'ea/e the %lient alone $ntil he stops tal0ing % #s0 the %lient why he is smiling and tal0ing d !ell the %lient it is not good fo" him to tal0 to himself .5 Hhen being admitted to a mental health fa%ility& a yo$ng female ad$lt tells *$"se <ylene that the /oi%es she hea"s f"ighten he" *$"se <ylene $nde"stands that the %lient tends to hall$%inate mo"e /i/idly:

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.8

.9

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20

a Hhile wat%hing !7 b )$"ing meal time % )$"ing g"o$p a%ti/ities d #fte" going to bed *$"se Bohn "e%ogni(es that pa"anoid del$sions $s$ally a"e "elated to the defense me%hanism of: a P"oEe%tion b Identifi%ation % 1ep"ession d 1eg"ession Hhen planning %a"e fo" a male %lient $sing pa"anoid ideation& n$"se Basmin sho$ld "eali(e the impo"tan%e of: a Di/ing the %lient diffi%$lt tas0s to p"o/ide stim$lation b P"o/iding the %lient with a%ti/ities in whi%h s$%%ess %an be a%hie/ed % 1emo/ing st"ess so that the %lient %an "elad *ot pla%ing any demands on the %lient *$"se De""y is awa"e that the defense me%hanism %ommonly $sed by %lients who a"e al%oholi%s is: a )ispla%ement b )enial % P"oEe%tion d Compensation Hithin a few ho$"s of al%ohol withd"awal& n$"se Bohn sho$ld assess the male %lient fo" the p"esen%e of: a )iso"ientation& pa"anoia& ta%hy%a"dia b !"emo"s& fe/e"& p"of$se diapho"esis % I""itability& heightened ale"tness& Ee"0y mo/ements d Aawning& an-iety& %on/$lsions

ANS5ERS a$% RATIONALES ,#r PS(CHIATRIC NURSING Pa"t 2

C Hhen the n$"se and %lient ag"ee to wo"0 togethe"& a %ont"a%t sho$ld be established& the length of the "elationship sho$ld be dis%$ssed in te"ms of its $ltimate te"mination 2 ) !he n$"se sho$ld initiate b"ief& f"e6$ent %onta%ts th"o$gho$t the day to let the %lient 0now that he is impo"tant to the n$"se !his will positi/ely affe%t the %lientKs self=esteem + D !he %lient with dep"ession is p"eo%%$pied& has de%"eased ene"gy& and is $nable to ma0e de%isions !he n$"se p"esents the sit$ation& SItKs time fo" a showe"T& and assists the %lient with pe"sonal hygiene to p"ese"/e his dignity and self=esteem . C Foods high in ty"amine& those that a"e fe"mented& pi%0led& aged& o" smo0ed m$st be a/oided be%a$se when they a"e ingested in %ombination with <#OIs a hype"tensi/e %"isis will o%%$" 2 A #nti%holine"gi% effe%ts& whi%h "es$lt f"om blo%0age of the pa"asympatheti% O%"aniosa%"alP ne"/o$s system in%l$ding $"ine "etention& bl$""ed /ision& d"y mo$th N %onstipation 5 ) )ysthymia is a less se/e"e& %h"oni% dep"ession diagnosed when a %lient has had a dep"essed mood fo" mo"e days than not o/e" a pe"iod of at least 2 yea"s Client with dysthymi% diso"de" benefit f"om psy%hothe"ape$ti% app"oa%hes that assist the %lient in "e/e"sing the negati/e self image& negati/e feelings abo$t the f$t$"e 8 D Flight of ideas is spee%h patte"n of "apid t"ansition f"om topi% to topi%& often witho$t finishing one idea It is %ommon in mania

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) !he %lient with mania is /e"y a%ti/e N needs to ha/e this ene"gy %hanneled in a %onst"$%ti/e tas0 s$%h as %leaning o" tidying the "oom 9 C # %"$%ial fa%to" is dete"mining the lethality of a method is the amo$nt of time that o%%$"s between initiating the method N the deli/e"y of the lethal impa%t of the method 10 D !he statement SI donKt thin0 abo$t 0illing myself as m$%h as I $sed to T Indi%ates a lessening of s$i%idal ideation and imp"o/ement in the %lientKs %ondition 11 A Using e-e"%ise bi%y%le is app"op"iate fo" the %lient who be%omes /e"y an-io$s when tho$ghts of s$i%idal o%%$" 12 C !he d"$g of %hoi%e fo" a %lient e-pe"ien%ing e-t"a py"amidal side effe%ts f"om halope"idol O?aldolP is ben(t"opine mesylate O%ogentinP be%a$se of its anti %holine"gi% p"ope"ties 1+ D #llowing the %lient to be the fi"st to open the %a"t N ta0e a t"ay p"esents the %lient with the "eality that the n$"ses a"e not to$%hing the food N t"ay& the"eby dispelling the del$sion 1. ) #ltho$gh all the a%tions indi%ate imp"o/ement& the ability to initiate simple a%ti/ities witho$t di"e%tions indi%ates the most imp"o/ement in the %atatoni% beha/io"s 12 A Psy%hoed$%ational g"o$ps fo" families de/elop a s$ppo"t netwo"0 !hey p"o/ide ed$%ation abo$t the bio%hemi%al etiology of psy%hiat"i% disease to "ed$%e& not in%"ease family g$ilt 15 C #ttending a%ti/ity with the n$"se assists the %lient to be%ome in/ol/ed with othe"s slowly !he %lient with s%hi(otypal pe"sonality diso"de" needs s$ppo"t& 0indness N gentle s$ggestion to imp"o/e so%ial s0ills N inte"pe"sonal "elationship 18 C #n indi/id$al with pe"sonality diso"de" $s$ally is not hospitali(ed $nless a %oe-isting #-is I psy%hiat"i% diso"de" is p"esent Dene"ally& these indi/id$als ma0e ma"ginal adE$stments and "emain in so%iety& altho$gh they typi%ally e-pe"ien%e "elationship and o%%$pational p"oblems "elated to thei" infle-ible beha/io"s Pe"sonality diso"de"s a"e %h"oni% lifelong patte"ns of beha/io"W a%$te episodes do not o%%$" Psy%hoti% beha/io" is $s$ally not %ommon& altho$gh it %an o%%$" in eithe" s%hi(otypal pe"sonality diso"de" o" bo"de"line pe"sonality diso"de" @e%a$se these diso"de"s a"e end$"ing and e/asi/e and the indi/id$al is infle-ible& p"ognosis fo" "e%o/e"y is $nfa/o"able Dene"ally& the indi/id$al does not see0 t"eatment be%a$se he does not pe"%ei/e p"oblems with his own beha/io" )ist"ess %an o%%$" based on othe" peopleKs "ea%tion to the indi/id$alKs beha/io" 19 D !he n$"se wo$ld e-plain the negati/e "ea%tions of othe"s towa"ds the %lientKs beha/io"s to ma0e the %lients awa"e of the impa%t of his sed$%ti/e beha/io"s on othe"s 19 ) !he n$"se wo$ld $se "ole=playing to tea%h the %lient app"op"iate "esponses to othe"s and in /a"io$s sit$ations !his %lient d"amati(es e/ents& d"awn attention to self& and is $nawa"e of and does not deal with feelings !he n$"se wo"0s to help the %lient %la"ify t"$e feelings N lea"n to e-p"ess them app"op"iately 20 C #ntisepti% mo$thwash often %ontains al%ohol N sho$ld be 0ept in lo%0ed a"ea& $nless labeling %lea"ly indi%ates that the p"od$%t does not %ontain al%ohol 21 D <onito"ing of /ital signs p"o/ides the best info"mation abo$t the %lientKs o/e"all physiologi% stat$s d$"ing al%ohol withd"awal N the physiologi% "esponse to the medi%ation $sed 22 A #fte" administe"ing nalo-one O*a"%anP the n$"se sho$ld monito" the %lientKs "espi"ato"y stat$s %a"ef$lly& be%a$se the d"$g is sho"t a%ting N "espi"ato"y dep"ession may "e%$" afte" its effe%ts wea" off 2+ ) !he best meas$"e to dete"mine a %lientKs p"og"ess in "ehabilitation is the n$mbe" of d"$g= f"ee days he has !he longe" the %lient is f"ee of d"$gs& the bette" the p"ognosis is 2. D @a"bit$"ates a"e C*S dep"essantsW the n$"se wo$ld be espe%ially ale"t fo" the possibility of "espi"ato"y fail$"e 1espi"ato"y fail$"e is the most li0ely %a$se of death f"om ba"bit$"ate o/e" dose 22 ) !he feeling of b$gs %"awling $nde" the s0in is te"med as fo"mi%ation& and is asso%iated with %o%aine $se 25 D !he n$"se wo$ld p"epa"e to administe" an antipsy%hoti% medi%ation s$%h as ?aldol to a %lient e-pe"ien%ing amphetamine psy%hosis to de%"ease agitation N psy%hoti% symptoms& in%l$ding del$sions& hall$%inations N %ogniti/e impai"ment 28 C #n a%id en/i"onment aids in the e-%"etion of PCP !he n$"se will definitely gi/e the %lient with PCP into-i%ation %"anbe""y E$i%e to a%idify the $"ine to a ph of 2 2 N a%%ele"ate e-%"etion 29 A !he n$"se wo$ld fa%ilitate p"og"essi/e "e/iew of the a%%ident and its %onse6$en%e to help the %lient integ"ate feelings N memo"ies and to begin the g"ie/ing p"o%ess 29 ) !he n$"se inst"$%ts the n$"sing assistant to in/ite the %lient to l$n%h N a%%ompany him to the dinning "oom to de%"ease manip$lation& se%onda"y gain& dependen%y and "einfo"%ement of negati/e beha/io" while maintaining the %lientKs wo"th +0 C !his p"o/ides s$ppo"t $ntil the indi/id$als %oping me%hanisms and pe"sonal s$ppo"t systems %an be immobili(ed +1 C 1esol/ing a loss is a slow& painf$l& %ontin$o$s p"o%ess $ntil a mental image of the dead pe"son& almost de/oid of negati/e o" $ndesi"able feat$"es eme"ges +2 A # mode"ate le/el of %ogniti/e impai"ment d$e to dementia is %ha"a%te"i(ed by in%"easing dependen%e on en/i"onment N so%ial st"$%t$"e and by in%"easing psy%hologi% "igidity with a%%ent$ated p"e/io$s t"aits N beha/io"s

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C !his a%tion maintains fo" as long as possible& the %lients intelle%t$al f$n%tions by p"o/iding an oppo"t$nity to $se them +. A Indi/id$als with ano"e-ia often display i""itability& hospitality& and a dep"essed mood +2 D )ep"essed %lients demonst"ate de%"eased %omm$ni%ation be%a$se of la%0 of psy%hi% o" physi%al ene"gy +5 C !he %lient in a mani% episode of the illness often negle%ts basi% needs& these needs a"e a p"io"ity to ens$"e ade6$ate n$t"ition& fl$id& and "est +8 ) !he withd"awn patte"n of beha/io" p"esents the indi/id$al f"om "ea%hing o$t to othe"s fo" sha"ing the isolation p"od$%es feeling of loneliness +9 A !he n$"seKs "esponse is not the"ape$ti% be%a$se it does not "e%ogni(e the %lientKs needs b$t t"ies to ma0e the %lient feel g$ilty fo" being demanding +9 ) !he %lient m$st "e%ogni(e the e-isten%e of the s$b pe"sonalities so that inte"p"etation %an o%%$" .0 D #n aloof& deta%hed& withd"awn post$"e is a means of p"ote%ting the self by withd"awing and maintaining a safe& emotional distan%e .1 C !he $s$al age of onset of s%hi(oph"enia is adoles%en%e o" ea"ly %hildhood .2 A Somati% del$sion is a fi-ed false belief abo$t oneKs body .+ C !hese a"e the %lassi% beha/io"s e-hibited by %lients with a diagnosis of s%hi(oph"enia .. D !he fetal position "ep"esents "eg"essed beha/io" 1eg"ession is a way of "esponding to o/e"whelming an-iety .2 ) !his p"o/ides a stim$l$s that %ompetes with and "ed$%es hall$%ination .5 D #$dito"y hall$%inations a"e most t"o$blesome when en/i"onmental stim$li a"e diminished and the"e a"e few %ompeting dist"a%tions .8 A P"oEe%tion is a me%hanism in whi%h inne" tho$ghts and feelings a"e p"oEe%ted onto the en/i"onment& seeming to %ome f"om o$tside the self "athe" than f"om within .9 ) !his will help the %lient de/elop self=esteem and "ed$%e the $se of pa"anoid ideation .9 ) )enial is a method of "esol/ing %onfli%t o" es%aping $npleasant "ealities by igno"ing thei" e-isten%e 20 C #l%ohol is a %ent"al ne"/o$s system dep"essant !hese symptoms a"e the bodyKs ne$"ologi% adaptation to the withd"awal of al%ohol

PS(CHIATRIC NURSING Part 3 1 F"an%is who is addi%ted to %o%aine withd"aws f"om the d"$g *$"se 1on sho$ld e-pe%t to obse"/e: a ?ype"a%ti/ity b )ep"ession % S$spi%ion d )eli"i$m 2 *$"se Bohn is awa"e that a se"io$s effe%t of inhaling %o%aine isQ a )ete"io"ation of nasal sept$m b #%$te fl$id and ele%t"olyte imbalan%es % ,-t"a py"amidal t"a%t symptoms d ,sophageal /a"i%es + # tentati/e diagnosis of opiate addi%tion& *$"se Candy sho$ld assess a "e%ently hospitali(ed %lient fo" signs of opiate withd"awal !hese signs wo$ld in%l$de:

COMPREHENSIVE NURSING REVIEW by R. C. REA

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a 1hino""hea& %on/$lsions& s$bno"mal tempe"at$"e b *a$sea& dilated p$pils& %onstipation % 'a%"imation& /omiting& d"owsiness d <$s%le a%hes& papilla"y %onst"i%tion& yawning . # .9 yea" old male %lient is b"o$ght to the psy%hiat"i% eme"gen%y "oom afte" attempting to E$mp off a b"idge !he %lientKs wife states that he lost his Eob se/e"al months ago and has been $nable to find anothe" Eob !he p"ima"y n$"sing inte"/ention at this time wo$ld be to assess fo": a # past histo"y of dep"ession b C$""ent plans to %ommit s$i%ide % !he p"esen%e of ma"ital diffi%$lties d Feelings of e-%essi/e fail$"e 2 @efo"e helping a male %lient who has been se-$ally assa$lted& n$"se <a$"een sho$ld "e%ogni(e that the "apist is moti/ated by feelings of: a ?ostility b Inade6$a%y % In%ompeten%e d Passion 5 Hhen wo"0ing with %hild"en who ha/e been se-$ally ab$sed by a family membe" it is impo"tant fo" the n$"se to $nde"stand that these /i%tims $s$ally a"e o/e"whelmed with feelings of: a ?$miliation b Conf$sion % Self blame d ?at"ed 8 Boy who has E$st e-pe"ien%ed he" se%ond spontaneo$s abo"tion e-p"esses ange" towa"ds he" physi%ian& the hospital and the S"otten n$"sing %a"eT Hhen assessing the sit$ation& the n$"se "e%ogni(es that the %lient may be $sing the %oping me%hanism of: a P"oEe%tion b )ispla%ement % )enial d 1ea%tion fo"mation 9 !he most %"iti%al fa%to" fo" n$"se 'inda to dete"mine d$"ing %"isis inte"/ention wo$ld be the %lientKs: a #/ailable sit$ational s$ppo"ts b Hillingness to "est"$%t$"e the pe"sonality % )e/elopmental theo"y d Unde"lying $n%ons%io$s %onfli%t 9 *$"se !"ish s$ggests a %"isis inte"/ention g"o$p to a %lient e-pe"ien%ing a de/elopmental %"isis !hese g"o$ps a"e s$%%essf$l be%a$se the: a C"isis inte"/ention wo"0e" is a psy%hologist and $nde"stands beha/io" patte"ns b C"isis g"o$p s$pplies a wo"0able sol$tion to the %lientKs p"oblem % Client is en%o$"aged to tal0 abo$t pe"sonal p"oblems d Client is assisted to in/estigate alte"nati/e app"oa%hes to sol/ing the identified p"oblem 10 *$"se 1onald %o$ld e/al$ate that the staffKs app"oa%h to setting limits fo" a demanding& ang"y %lient was effe%ti/e if the %lient: a #pologi(es fo" dis"$pting the $nitKs "o$tine when something is needed b Unde"stands the "eason why f"e6$ent %alls to the staff we"e made % )is%$ss %on%e"ns "ega"ding the emotional %ondition that "e6$i"ed hospitali(ations d *o longe" %alls the n$"sing staff fo" assistan%e 11 *$"se Bohn is awa"e that the the"apy that has the highest s$%%ess "ate fo" people with phobias wo$ld be: a Psy%hothe"apy aimed at "ea""anging maladapti/e tho$ght p"o%ess b Psy%hoanalyti%al e-plo"ation of "ep"essed %onfli%ts of an ea"lie" de/elopment phase % Systemati% desensiti(ation $sing "ela-ation te%hni6$e d Insight the"apy to dete"mine the o"igin of the an-iety and fea" 12 Hhen n$"se ?a(el %onside"s a %lientKs pla%ement on the %ontin$$m of an-iety& a 0ey in dete"mining the deg"ee of an-iety being e-pe"ien%ed is the %lientKs: a Pe"%ept$al field b )el$sional system % <emo"y state d C"eati/ity le/el 1+ In the diagnosis of a possible pe"/asi/e de/elopmental a$tisti% diso"de" !he n$"se wo$ld find it most $n$s$al fo" a + yea" old %hild to demonst"ate: a #n inte"est in m$si% b #n atta%hment to odd obEe%ts % 1it$alisti% beha/io" d 1esponsi/eness to the pa"ents

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 1+.

1. <alo$ with s%hi(oph"enia tells *$"se <elinda& S<y intestines a"e "otted f"om wo"ms %hewing on them T !his statement indi%ates a: a Bealo$s del$sion b Somati% del$sion % )el$sion of g"ande$" d )el$sion of pe"se%$tion 12 #ndy is admitted to the psy%hiat"i% $nit with a diagnosis of bo"de"line pe"sonality diso"de" *$"se ?ila"y sho$ld e-pe%ts the assessment to "e/eal: a Coldness& deta%hment and la%0 of tende" feelings b Somati% symptoms % Inability to f$n%tion as "esponsible pa"ent d Unp"edi%table beha/io" and intense inte"pe"sonal "elationships 15 P1OP1#*O'O' OInde"alP is $sed in the mental health setting to manage whi%h of the following %onditionsQ a #ntipsy%hoti% X ind$%ed a0athisia and an-iety b Obsessi/e X %omp$lsi/e diso"de" OOC)P to "ed$%e "it$alisti% beha/io" % )el$sions fo" %lients s$ffe"ing f"om s%hi(oph"enia d !he mani% phase of bipola" illness as a mood stabili(e" 18 Hhi%h medi%ation %an %ont"ol the e-t"a py"amidal effe%ts asso%iated with antipsy%hoti% agentsQ a Clo"a(epate O!"an-eneP b #mantadine OSymmet"elP % )o-epin OSine6$anP d Pe"phena(ine O!"ilafonP 19 Hhi%h of the following statements sho$ld be in%l$ded when tea%hing %lients abo$t monoamine o-idase inhibito" O<#OIP antidep"essantsQ a )onKt ta0e aspi"in o" nonste"oidal anti=inflammato"y d"$gs O*S#I)sP b ?a/e blood le/els s%"eened wee0ly fo" le$%openia % #/oid st"en$o$s a%ti/ity be%a$se of the %a"dia% effe%ts of the d"$g d )onKt ta0e p"es%"ibed o" o/e" the %o$nte" medi%ations witho$t %ons$lting the physi%ian 19 :"is pe"iodi%ally has a%$te pani% atta%0s !hese atta%0s a"e $np"edi%table and ha/e no appa"ent asso%iation with a spe%ifi% obEe%t o" sit$ation )$"ing an a%$te pani% atta%0& :"is may e-pe"ien%e: a ?eightened %on%ent"ation b )e%"eased pe"%ept$al field % )e%"eased %a"dia% "ate d )e%"eased "espi"ato"y "ate 20 Initial inte"/entions fo" <a"%o with a%$te an-iety in%l$de all e-%ept whi%h of the followingQ a !o$%hing the %lient in an attempt to %omfo"t him b #pp"oa%hing the %lient in %alm& %onfident manne" % ,n%o$"aging the %lient to /e"bali(e feelings and %on%e"ns d P"o/iding the %lient with a safe& 6$iet and p"i/ate pla%e 21 *$"se Bessie is assessing a %lient s$ffe"ing f"om st"ess and an-iety # %ommon physiologi%al "esponse to st"ess and an-iety is: a Uti%a"ia b 7e"tigo % Sedation d )ia""hea 22 Hhen pe"fo"ming a physi%al e-amination on a female an-io$s %lient& n$"se *elli wo$ld e-pe%t to find whi%h of the following effe%ts p"od$%ed by the pa"asympatheti% systemQ a <$s%le tension b ?ype"a%ti/e bowel so$nds % )e%"eased $"ine o$tp$t d Constipation 2+ Hhi%h of the following d"$gs ha/e been 0nown to be effe%ti/e in t"eating obsessi/e=%omp$lsi/e diso"de" OOC)PQ a )i/alp"oe- Odepa0oteP and 'ithi$m OlithobidP b Chlo"dia(epo-ide O'ib"i$mP and dia(epam O/ali$mP % Fl$/o-amine O'$/o-P and %lomip"amine Oanaf"anilP d @en(t"opine OCogentinP and diphenhyd"amine Obenad"ylP 2. !ony with ago"aphobia has been symptom=f"ee fo" . months Classi% signs and symptoms of phobia in%l$de: a Se/e"e an-iety and fea" b Hithd"awal and fail$"e to disting$ish "eality f"om fantasy % )ep"ession and weight loss d Insomnia and inability to %on%ent"ate 22 Hhi%h n$"sing a%tion is most app"op"iate when t"ying to diff$se a %lientKs impending /iolent beha/io"Q a Pla%e the %lient in se%l$sion b 'ea/ing the %lient alone $ntil he %an tal0 abo$t his feelings

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 1+2

25

28

29

+0

+1

+2

++

+.

+2

+5

% In/ol/ing the %lient in a 6$iet a%ti/ity to di/e"t attention d ?elping the %lient identify and e-p"ess feelings of an-iety and ange" 1osana is in the se%ond stage of #l(heime"Ks disease who appea"s to be in pain Hhi%h 6$estion by *$"se Benny wo$ld best eli%it info"mation abo$t the painQ a SHhe"e is yo$" pain lo%atedQT b S)o yo$ h$"tQ Opa$seP S)o yo$ h$"tQT % SCan yo$ des%"ibe yo$" painQT d SHhe"e do yo$ h$"tQT *$"sing p"epa"ation fo" a %lient $nde"going ele%t"o%on/$lsi/e the"apy O,C!P "esemble those $sed fo": a Dene"al anesthesia b Ca"dia% st"ess testing % *e$"ologi% e-amination d Physi%al the"apy Bose who is "e%ei/ing monoamine o-idase inhibito" antidep"essant sho$ld a/oid ty"amine& a %ompo$nd fo$nd in whi%h of the following foodsQ a Figs and %"eam %heese b F"$its and yellow /egetables % #ged %heese and Chianti wine d D"een leafy /egetables 29 ,"linda& age 92& with maEo" dep"ession $nde"goes a si-th ele%t"o%on/$lsi/e the"apy O,C!P t"eatment Hhen assessing the %lient immediately afte" ,C!& the n$"se e-pe%ts to find: a Pe"manent sho"t=te"m memo"y loss and hype"tension b Pe"manent long=te"m memo"y loss and hypomania % !"ansito"y sho"t=te"m memo"y loss and pe"manent long=te"m memo"y loss d !"ansito"y sho"t and long te"m memo"y loss and %onf$sion @a"ba"a with bipola" diso"de" is being t"eated with lithi$m fo" the fi"st time *$"se Clint sho$ld obse"/e the %lient fo" whi%h %ommon ad/e"se effe%t of lithi$mQ a Poly$"ia b Sei($"es % Constipation d Se-$al dysf$n%tion *$"se F"ed is assessing a %lient who has E$st been admitted to the ,1 depa"tment Hhi%h signs wo$ld s$ggest an o/e"dose of an antian-iety agentQ a S$spi%io$sness& dilated p$pils and in%omplete @P b #gitation& hype"a%ti/ity and g"andiose ideation % Combati/eness& sweating and %onf$sion d ,motional lability& e$pho"ia and impai"ed memo"y )is%ha"ge inst"$%tions fo" a male %lient "e%ei/ing t"i%y%li% antidep"essants in%l$de whi%h of the following info"mationQ a 1est"i%t fl$ids and sodi$m inta0e b )onKt %ons$me al%ohol % )is%ontin$e if d"y mo$th and bl$""ed /ision o%%$" d 1est"i%t fl$id and sodi$m inta0e Impo"tant tea%hing fo" women in thei" %hildbea"ing yea"s who a"e "e%ei/ing antipsy%hoti% medi%ations in%l$des whi%h of the followingQ a In%"eased in%iden%e of dysmeno""hea while ta0ing the d"$g b O%%$""en%e of in%omplete libido d$e to medi%ation ad/e"se effe%ts % Contin$ing p"e/io$s $se of %ont"a%eption d$"ing pe"iods of ameno""hea d Inst"$%tion that ameno""hea is i""e/e"sible # %lient "ef$ses to "emain on psy%hot"opi% medi%ations afte" dis%ha"ge f"om an inpatient psy%hiat"i% $nit Hhi%h info"mation sho$ld the %omm$nity health n$"se assess fi"st d$"ing the initial follow=$p with this %lientQ a In%ome le/el and li/ing a""angements b In/ol/ement of family and s$ppo"t systems % 1eason fo" inpatient admission d 1eason fo" "ef$sal to ta0e medi%ations !he n$"se $nde"stands that the the"ape$ti% effe%ts of typi%al antipsy%hoti% medi%ations a"e asso%iated with whi%h ne$"ot"ansmitte" %hangeQ a )e%"eased dopamine le/el b In%"eased a%etyl%holine le/el % Stabili(ation of se"otonin d Stim$lation of D#@# Hhi%h of the following best e-plains why t"i%y%li% antidep"essants a"e $sed with %a$tion in elde"ly patientsQ a Cent"al *e"/o$s System effe%ts b Ca"dio/as%$la" system effe%ts

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 1+5

+8

+9

+9

.0

.1

.2

.+

..

.2

.5

.8

% Dast"ointestinal system effe%ts d Se"otonin synd"ome effe%ts # %lient with dep"essi/e symptoms is gi/en p"es%"ibed medi%ations and tal0s with his the"apist abo$t his belief that he is wo"thless and $nable to %ope with life Psy%hiat"i% %a"e in this t"eatment plan is based on whi%h f"amewo"0Q a @eha/io"al f"amewo"0 b Cogniti/e f"amewo"0 % Inte"pe"sonal f"amewo"0 d Psy%hodynami% f"amewo"0 # n$"se who e-plains that a %lientKs psy%hoti% beha/io" is $n%ons%io$sly moti/ated $nde"stands that the %lientKs diso"de"ed beha/io" a"ises f"om whi%h of the followingQ a #bno"mal thin0ing b #lte"ed ne$"ot"ansmitte"s % Inte"nal needs d 1esponse to stim$li # %lient with dep"ession has been hospitali(ed fo" t"eatment afte" ta0ing a lea/e of absen%e f"om wo"0 !he %lientKs employe" e-pe%ts the %lient to "et$"n to wo"0 following inpatient t"eatment !he %lient tells the n$"se& SIKm no good IKm a fail$"eT #%%o"ding to %ogniti/e theo"y& these statements "efle%t: a 'ea"ned beha/io" b P$niti/e s$pe"ego and de%"eased self=esteem % Fa$lty tho$ght p"o%esses that go/e"n beha/io" d ,/iden%e of diffi%$lt "elationships in the wo"0 en/i"onment !he n$"se des%"ibes a %lient as an-io$s Hhi%h of the following statement abo$t an-iety is t"$eQ a #n-iety is $s$ally pathologi%al b #n-iety is di"e%tly obse"/able % #n-iety is $s$ally ha"mf$l d #n-iety is a "esponse to a th"eat # %lient with a phobi% diso"de" is t"eated by systemati% desensiti(ation !he n$"se $nde"stands that this app"oa%h will do whi%h of the followingQ a ?elp the %lient e-e%$te a%tions that a"e fea"ed b ?elp the %lient de/elop insight into i""ational fea"s % ?elp the %lient s$bstit$tes one fea" fo" anothe" d ?elp the %lient de%"ease an-iety Hhi%h %lient o$t%ome wo$ld best indi%ate s$%%essf$l t"eatment fo" a %lient with an antiso%ial pe"sonality diso"de"Q a !he %lient e-hibits %ha"ming beha/io" when a"o$nd a$tho"ity fig$"es b !he %lient has de%"eased episodes of imp$lsi/e beha/io"s % !he %lient ma0es statements of self=satisfa%tion d !he %lientKs statements indi%ate no "emo"se fo" beha/io"s !he n$"se is %a"ing fo" a %lient with an a$toimm$ne diso"de" at a medi%al %lini%& whe"e alte"nati/e medi%ine is $sed as an adE$n%t to t"aditional the"apies Hhi%h info"mation sho$ld the n$"se tea%h the %lient to help foste" a sense of %ont"ol o/e" his symptomsQ a Pathophysiology of disease p"o%ess b P"in%iples of good n$t"ition % Side effe%ts of medi%ations d St"ess management te%hni6$es Hhi%h of the following is the most disting$ishing feat$"e of a %lient with an antiso%ial pe"sonality diso"de"Q a #ttention to detail and o"de" b @i(a""e manne"isms and tho$ghts % S$bmissi/e and dependent beha/io" d )is"ega"d fo" so%ial and legal no"ms Hhi%h n$"sing diagnosis is most app"op"iate fo" a %lient with ano"e-ia ne"/osa who e-p"esses feelings of g$ilt abo$t not meeting family e-pe%tationsQ a #n-iety b )ist$"bed body image % )efensi/e %oping d Powe"lessness # n$"se is e/al$ating the"apy with the family of a %lient with ano"e-ia ne"/osa Hhi%h of the following wo$ld indi%ate that the the"apy was s$%%essf$lQ a !he pa"ents "einfo"%ed in%"eased de%ision ma0ing by the %lient b !he pa"ents %lea"ly /e"bali(e thei" e-pe%tations fo" the %lient % !he %lient /e"bali(es that family meals a"e now enEoyable d !he %lient tells he" pa"ents abo$t feelings of low=self esteem # %lient with dysthymi% diso"de" "epo"ts to a n$"se that his life is hopeless and will ne/e" imp"o/e in the f$t$"e ?ow %an the n$"se best "espond $sing a %ogniti/e app"oa%hQ

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 1+8

a #g"ee with the %lientKs painf$l feelings b Challenge the a%%$"a%y of the %lientKs belief % )eny that the sit$ation is hopeless d P"esent a %hee"f$l attit$de .9 # %lient with maEo" dep"ession has not /e"bali(ed p"oblem a"eas to staff o" pee"s sin%e admission to a psy%hiat"i% $nit Hhi%h a%ti/ity sho$ld the n$"se "e%ommend to help this %lient e-p"ess himselfQ a #"t the"apy in a small g"o$p b @as0etball game with pee"s on the $nit % 1eading a self=help boo0 on dep"ession d Hat%hing mo/ie with the pee" g"o$p .9 !he home health psy%hiat"i% n$"se /isits a %lient with %h"oni% s%hi(oph"enia who was "e%ently dis%ha"ged afte" a p"olong stay in a state hospital !he %lient li/es in a boa"ding home& "epo"ts no family in/ol/ement& and has little so%ial inte"a%tion !he n$"se plan to "efe" the %lient to a day t"eatment p"og"am in o"de" to help him with: a <anaging his hall$%inations b <edi%ation tea%hing % So%ial s0ills t"aining d 7o%ational t"aining 20 Hhi%h a%ti/ity wo$ld be most app"op"iate fo" a se/e"ely withd"awn %lientQ a #"t a%ti/ity with a staff membe" b @oa"d game with a small g"o$p of %lients % !eam spo"t in the gym d Hat%hing !7 in the day"oom

ANS5ERS a$% RATIONALES ,#r PS(CHIATRIC NURSING Pa"t +

) !he"e is no set of symptoms asso%iated with %o%aine withd"awal& only the dep"ession that follows the high %a$sed by the d"$g 2 A Co%aine is a %hemi%al that when inhaled& %a$ses dest"$%tion of the m$%o$s memb"anes of the nose + D !hese adaptations a"e asso%iated with opiate withd"awal whi%h o%%$"s afte" %essation o" "ed$%tion of p"olonged mode"ate o" hea/y $se of opiates . ) Hhethe" the"e is a s$i%ide plan is a %"ite"ion when assessing the %lientKs dete"mination to ma0e anothe" attempt 2 A 1apists a"e belie/ed to ha"bo" and a%t o$t hostile feelings towa"d all women th"o$gh the a%t of "ape 5 C !hese %hild"en often ha/e nonse-$al needs met by indi/id$al and a"e powe"less to "ef$se #mbi/alen%e "es$lts in self=blame and also g$ilt 8 ) !he %lientKs ange" o/e" the abo"tion is shifted to the staff and the hospital be%a$se she is $nable to deal with the abo"tion at this time

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 1+9

A Pe"sonal inte"nal st"ength and s$ppo"ti/e indi/id$als a"e %"iti%al fa%to"s that %an be employed to assist the indi/id$al to %ope with a %"isis 9 D C"isis inte"/ention g"o$p helps %lient "eestablish psy%hologi% e6$ilib"i$m by assisting them to e-plo"e new alte"nati/es fo" %oping It %onside"s "ealisti% sit$ations $sing "ational and fle-ible p"oblem sol/ing methods 10 C !his wo$ld do%$ment that the %lient feels %omfo"table eno$gh to dis%$ss the p"oblems that ha/e moti/ated the beha/io" 11 C !he most s$%%essf$l the"apy fo" people with phobias in/ol/es beha/io" modifi%ation te%hni6$es $sing desensiti(ation 12 A Pe"%ept$al field is a 0ey indi%ato" of an-iety le/el be%a$se the pe"%ept$al fields na""ow as an-iety in%"eases 1+ D One of the symptoms of a$tisti% %hild displays a la%0 of "esponsi/eness to othe"s !he"e is little o" no e-tension to the e-te"nal en/i"onment 1. ) Somati% del$sions fo%$s on bodily f$n%tions o" systems and %ommonly in%l$de del$sion abo$t fo$l odo" emissions& inse%t manifestations& inte"nal pa"asites and misshapen pa"ts 12 D # %lient with bo"de"line pe"sonality displays a pe"/asi/e patte"n of $np"edi%table beha/io"& mood and self image Inte"pe"sonal "elationships may be intense and $nstable and beha/io" may be inapp"op"iate and imp$lsi/e 15 A P"op"anolol is a potent beta ad"ene"gi% blo%0e" and p"od$%ing a sedating effe%t& the"efo"e it is $sed to t"eat antipsy%hoti% ind$%ed a0athisia and an-iety 18 ) #mantadine is an anti%holine"gi% d"$g $sed to "eli/e d"$g=ind$%ed e-t"a py"amidal ad/e"se effe%ts s$%h as m$s%le wea0ness& in/ol$nta"y m$s%le mo/ements& pse$dopa"0insonism and ta" di/e dys0inesia 19 C <#OI antidep"essants when %ombined with a n$mbe" of d"$gs %an %a$se life=th"eatening hype"tensi/e %"isis ItKs impe"ati/e that a %lient %he%0s with his physi%ian and pha"ma%ist befo"e ta0ing any othe" medi%ations 19 ) Pani% is the most se/e"e le/el of an-iety )$"ing pani% atta%0& the %lient e-pe"ien%es a de%"ease in the pe"%ept$al field& be%oming mo"e fo%$sed on self& less awa"e of s$""o$ndings and $nable to p"o%ess info"mation f"om the en/i"onment !he de%"eased pe"%ept$al field %ont"ib$tes to impai"ed attention and inability to %on%ent"ate 20 A !he eme"gen%y n$"se m$st establish "appo"t and t"$st with the an-io$s %lient befo"e $sing the"ape$ti% to$%h !o$%hing an an-io$s %lient may a%t$ally in%"ease an-iety 21 D )ia""hea is a %ommon physiologi%al "esponse to st"ess and an-iety 22 ) !he pa"asympatheti% ne"/o$s system wo$ld p"od$%e in%omplete D I motility "es$lting in hype"a%ti/e bowel so$nds& possibly leading to dia""hea 2+ C !he antidep"essants fl$/o-amine and %lomip"amine ha/e been effe%ti/e in the t"eatment of OC) 2. A Phobias %a$se se/e"e an-iety Os$%h as pani% atta%0P that is o$t of p"opo"tion to the th"eat of the fea"ed obEe%t o" sit$ation Physi%al signs and symptoms of phobias in%l$de p"of$se sweating& poo" moto" %ont"ol& ta%hy%a"dia and ele/ated @ P 22 D In many instan%es& the n$"se %an diff$se impending /iolen%e by helping the %lient identify and e-p"ess feelings of ange" and an-iety S$%h statement as SHhat happened to get yo$ this ang"yQT may help the %lient /e"bali(es feelings "athe" than a%t on them 25 ) Hhen spea0ing to a %lient with #l(heime"Ks disease& the n$"se sho$ld $se %lose=ended 6$estions !hose that the %lient %an answe" with SyesT o" SnoT whene/e" possible and a/oid 6$estions that "e6$i"e the %lient to ma0e %hoi%es 1epeating the 6$estion aids %omp"ehension 28 A !he n$"se sho$ld p"epa"e a %lient fo" ,C! in a manne" simila" to that fo" gene"al anesthesia 29 C #ged %heese and Chianti wine %ontain high %on%ent"ations of ty"amine 29 D ,C! %ommonly %a$ses t"ansito"y sho"t and long te"m memo"y loss and %onf$sion& espe%ially in ge"iat"i% %lients It "a"ely "es$lts in pe"manent sho"t and long te"m memo"y loss +0 A Poly$"ia %ommonly o%%$"s ea"ly in the t"eatment with lithi$m and %o$ld "es$lt in fl$id /ol$me defi%it +1 D Signs of an-iety agent o/e"dose in%l$de emotional lability& e$pho"ia and impai"ed memo"y +2 ) )"in0ing al%ohol %an potentiate the sedating a%tion of t"i%y%li% antidep"essants )"y mo$th and bl$""ed /ision a"e no"mal ad/e"se effe%ts of t"i%y%li% antidep"essants ++ C Homen may e-pe"ien%e ameno""hea& whi%h is "e/e"sible& while ta0ing antipsy%hoti%s #meno""hea doesnKt indi%ate %essation of o/$lation th$s& the %lient %an still be p"egnant +. D !he fi"st a"e fo" assessment wo$ld be the %lientKs "eason fo" "ef$sing medi%ation !he %lient may not $nde"stand the p$"pose fo" the medi%ation& may be e-pe"ien%ing dist"essing side effe%ts& o" may be %on%e"ned abo$t the %ost of medi%ine In any %ase& the n$"se %annot p"o/ide app"op"iate inte"/ention befo"e assessing the %lientKs p"oblem with the medi%ation !he patientKs in%ome le/el& li/ing a""angements& and in/ol/ement of family and s$ppo"t systems a"e "ele/ant iss$es following dete"mination of the %lientKs "eason fo" "ef$sing medi%ation !he n$"se p"o/iding follow=$p %a"e wo$ld ha/e a%%ess to the %lientKs medi%al "e%o"d and sho$ld al"eady 0now the "eason fo" inpatient admission

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 1+9

+2 A ,-%ess dopamine is tho$ght to be the %hemi%al %a$se fo" psy%hoti% thin0ing !he typi%al antipsy%hoti%s
a%t to blo%0 dopamine "e%epto"s and the"efo"e de%"ease the amo$nt of ne$"ot"ansmitte" at the synapses !he typi%al antipsy%hoti%s do not in%"ease a%etyl%holine& stabili(e se"otonin& stim$late D#@# +5 ) !he !C#s affe%t no"epineph"ine as well as othe" ne$"ot"ansmitte"s& and th$s ha/e signifi%ant %a"dio/as%$la" side effe%ts !he"efo"e& they a"e $sed with %a$tion in elde"ly %lients who may ha/e in%"eased "is0 fa%to"s fo" %a"dia% p"oblems be%a$se of thei" age and othe" medi%al %onditions !he "emaining side effe%ts wo$ld apply to any %lient ta0ing a !C# and a"e not pa"ti%$la" to an elde"ly pe"son +8 ) Cogniti/e thin0ing the"apy fo%$ses on the %lientKs mispe"%eptions abo$t self& othe"s and the wo"ld that impa%t f$n%tioning and %ont"ib$te to symptoms Using medi%ations to alte" ne$"ot"ansmitte" a%ti/ity is a psy%hobiologi% app"oa%h to t"eatment !he othe" answe" %hoi%es a"e f"amewo"0s fo" %a"e& b$t hey a"e not appli%able to this sit$ation +9 C !he %on%ept that beha/io" is moti/ated and has meaning %omes f"om the psy%hodynami% f"amewo"0 #%%o"ding to this pe"spe%ti/e& beha/io" a"ises f"om inte"nal wishes o" needs <$%h of what moti/ates beha/io" %omes f"om the $n%ons%io$s !he "emaining "esponses do not add"ess the inte"nal fo"%es tho$ght to moti/ate beha/io" +9 C !he %lient is demonst"ating fa$lty tho$ght p"o%esses that a"e negati/e and that go/e"n his beha/io" in his wo"0 sit$ation X iss$es that a"e typi%ally e-amined $sing a %ogniti/e theo"y app"oa%h Iss$es in/ol/ing lea"ned beha/io" a"e best e-plo"ed th"o$gh beha/io" theo"y& not %ogniti/e theo"y Iss$es in/ol/ing ego de/elopment a"e the fo%$s of psy%hoanalyti% theo"y Option . is in%o""e%t be%a$se the"e is no e/iden%e in this sit$ation that the %lient has %onfli%t$al "elationships in the wo"0 en/i"onment .0 D #n-iety is a "esponse to a th"eat a"ising f"om inte"nal o" e-te"nal stim$li .1 A Systemati% desensiti(ation is a beha/io"al the"apy te%hni6$e that helps %lients with i""ational fea"s and a/oidan%e beha/io" to fa%e the thing they fea"& witho$t e-pe"ien%ing an-iety !he"e is no attempt to p"omote insight with this p"o%ed$"e& and the %lient will not be ta$ght to s$bstit$te one fea" fo" anothe" #ltho$gh the %lientKs an-iety may de%"ease with s$%%essf$l %onf"ontation of i""ational fea"s& the p$"pose of the p"o%ed$"e is spe%ifi%ally "elated to pe"fo"ming a%ti/ities that typi%ally a"e a/oided as pa"t of the phobi% "esponse .2 ) # %lient with antiso%ial pe"sonality diso"de" typi%ally has f"e6$ent episodes of a%ting imp$lsi/ely with poo" ability to delay self=g"atifi%ation !he"efo"e& de%"eased f"e6$en%y of imp$lsi/e beha/io"s wo$ld be e/iden%e of imp"o/ement Cha"ming beha/io" when a"o$nd a$tho"ity fig$"es and statements indi%ating no "emo"se a"e e-amples of symptoms typi%al of someone with this diso"de" and wo$ld not indi%ate s$%%essf$l t"eatment Self=satisfa%tion wo$ld be /iewed as a positi/e %hange if the %lient e-p"esses low self=esteemW howe/e" this is not a %ha"a%te"isti% of a %lient with antiso%ial pe"sonality diso"de" .+ D In a$toimm$ne diso"de"s& st"ess and the "esponse to st"ess %an e-a%e"bate symptoms St"ess management te%hni6$es %an help the %lient "ed$%e the psy%hologi%al "esponse to st"ess& whi%h in t$"n will help "ed$%e the physiologi% st"ess "esponse !his will affo"d the %lient an in%"eased sense of %ont"ol o/e" his symptoms !he n$"se %an add"ess the "emaining answe" %hoi%es in he" tea%hing abo$t the %lientKs disease and t"eatmentW howe/e"& 0nowledge alone will not help the %lient to manage his st"ess effe%ti/ely eno$gh to %ont"ol symptoms .. D )is"ega"d fo" established "$les of so%iety is the most %ommon %ha"a%te"isti% of a %lient with antiso%ial pe"sonality diso"de" #ttention to detail and o"de" is %ha"a%te"isti% of someone with obsessi/e %omp$lsi/e diso"de" @i(a""e manne"isms and tho$ghts a"e %ha"a%te"isti%s of a %lient with s%hi(oid o" s%hi(otypal diso"de" S$bmissi/e and dependent beha/io"s a"e %ha"a%te"isti% of someone with a dependent pe"sonality .2 D !he %lient with ano"e-ia typi%ally feels powe"less& with a sense of ha/ing little %ont"ol o/e" any aspe%t of life besides eating beha/io" Often& pa"ental e-pe%tations and standa"ds a"e 6$ite high and lead to the %lientsK sense of g$ilt o/e" not meas$"ing $p .5 A One of the %o"e iss$es %on%e"ning the family of a %lient with ano"e-ia is %ont"ol !he familyKs a%%eptan%e of the %lientKs ability to ma0e independent de%isions is 0ey to s$%%essf$l family inte"/ention #ltho$gh the "emaining options may o%%$" d$"ing the p"o%ess of the"apy& they wo$ld not ne%essa"ily indi%ate a s$%%essf$l o$t%omeW the %ent"al family iss$es of dependen%e and independen%e a"e not add"esses on these "esponses .8 ) Use of %ogniti/e te%hni6$es allows the n$"se to help the %lient "e%ogni(e that this negati/e beliefs may be disto"tions and that& by %hanging his thin0ing& he %an adopt mo"e positi/e beliefs that a"e "ealisti% and hopef$l #g"eeing with the %lientKs feelings and p"esenting a %hee"f$l attit$de a"e not %onsistent with a %ogniti/e app"oa%h and wo$ld not be helpf$l in this sit$ation )enying the %lientKs feelings is belittling and may %on/ey that the n$"se does not $nde"stand the depth of the %lientKs dist"ess .9 A' #"t the"apy p"o/ides a nonth"eatening /ehi%le fo" the e-p"ession of feelings& and $se of a small g"o$p will help the %lient be%ome %omfo"table with pee"s in a g"o$p setting @as0etball is a %ompetiti/e game that "e6$i"es ene"gyW the %lient with maEo" dep"ession is not li0ely to pa"ti%ipate in this a%ti/ity 1e%ommending that the %lient "ead a self=help boo0 may in%"ease& not de%"ease his isolation Hat%hing mo/ie with a pee" g"o$p does not g$a"antee that inte"a%tion will o%%$"W the"efo"e& the %lient may "emain isolated .9 C' )ay t"eatment p"og"ams p"o/ide %lients with %h"oni%& pe"sistent mental illness t"aining in so%ial s0ills& s$%h as meeting and g"eeting people& as0ing 6$estions o" di"e%tions& pla%ing an o"de" in a "esta$"ant& ta0ing t$"ns in a g"o$p setting a%ti/ity #ltho$gh management of hall$%inations and medi%ation tea%hing may also be pa"t of the p"og"am offe"ed in a day t"eatment& the n$"se is "efe""ing the %lient in this sit$ation be%a$se of his

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 1.0

need fo" so%iali(ation s0ills 7o%ational t"aining gene"ally ta0es pla%e in a "ehabilitation fa%ilityW the %lient des%"ibed in this sit$ation wo$ld not be a %andidate fo" this se"/i%e 20 A' !he best app"oa%h with a withd"awn %lient is to initiate b"ief& nondemanding a%ti/ities on a one=to=one basis !his app"oa%h gi/es the n$"se an oppo"t$nity to establish a t"$sting "elationship with the %lient # boa"d game with a g"o$p %lients o" playing a team spo"t in the gym may o/e"whelm a se/e"ely withd"awn %lient Hat%hing !7 is a solita"y a%ti/ity that will "einfo"%e the %lientKs withd"awal f"om othe"s

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 1.1

PROFESSIONAL ADLUSTMENT

1 # n$"se who wo$ld li0e to p"a%ti%e n$"sing in the Philippines %an obtain a li%ense to p"a%ti%e by:
# Paying the p"ofessional ta- afte" ta0ing the boa"d e-ams @ Passing the boa"d e-ams and ta0ing the oath of p"ofessionals C Paying the e-amination fee befo"e ta0ing the boa"d e-ams

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 1.2

) Unde"going the inte"/iew %ond$%ted by the @oa"d of *$"sing and ta0ing the boa"d e-ams #nswe": O@P Passing the boa"d e-ams and ta0ing the oath of p"ofessionals Fo" a n$"se to obtain a li%ense to p"a%ti%e n$"sing in the Philippines& sGhe m$st pass the boa"d e-aminations and then ta0e the oath of p"ofessionals befo"e the @oa"d of *$"sing

2 1e%ip"o%ity of li%ense to p"a%ti%e "e6$i"es that the %o$nt"y of o"igin of the inte"ested fo"eign n$"se %omplies
with the following %onditions: # !he %o$nt"y of o"igin has simila" p"epa"ation fo" a n$"se and has laws allowing Filipino n$"ses to p"a%ti%e in thei" %o$nt"y @ !he Philippines is "e%ogni(ed by the %o$nt"y of o"igin as one that has high 6$ality of n$"sing ed$%ation C !he %o$nt"y of o"igin "e6$i"es Filipinos to ta0e thei" own boa"d e-amination ) !he %o$nt"y of o"igin e-empts Filipinos f"om passing thei" li%ens$"e e-amination #nswe": O#P !he %o$nt"y of o"igin has simila" p"epa"ation fo" a n$"se and has laws allowing Filipino n$"ses to p"a%ti%e in thei" %o$nt"y #%%o"ding to the Philippine *$"ses #%t of 2002& fo"eign n$"ses wanting to p"a%ti%e in the Philippines m$st show p"oof that hisGhe" %o$nt"y of o"igin meets the two essential %onditions: aP the "e6$i"ements fo" "egist"ation between the two %o$nt"ies a"e s$bstantially the sameW and bP the %o$nt"y of o"igin of the fo"eign n$"se has laws allowing the Filipino n$"se to p"a%ti%e in hisGhe" %o$nt"y E$st li0e its own %iti(ens

+ *$"ses p"a%ti%ing the p"ofession in the Philippines and a"e employed in go/e"nment hospitals a"e "e6$i"ed to
pay ta-es s$%h as: # @oth in%ome ta- and p"ofessional ta@ In%ome ta- only sin%e they a"e e-empt f"om paying p"ofessional taC P"ofessional ta- whi%h is paid by all n$"ses employed in both go/e"nment and p"i/ate hospitals ) In%ome ta- whi%h paid e/e"y <a"%h 12 and p"ofessional ta- whi%h is paid e/e"y Ban$a"y +1 #nswe": O@P In%ome ta- only sin%e they a"e e-empt f"om paying p"ofessional ta#%%o"ding to the <agna Ca"ta fo" P$bli% ?ealth Ho"0e"s& go/e"nment n$"ses a"e e-empted f"om paying p"ofessional ta- ?en%e& as an employee in the go/e"nment& sGhe will pay only the in%ome ta-

. #%%o"ding to 1# 918+ Philippine *$"sing #%t of 2002& a g"ad$ate n$"se who wants to ta0e m$st li%ens$"e
e-amination m$st %omply with the following 6$alifi%ations: # #t least 21 yea"s old& g"ad$ate of @S* f"om a "e%ogni(ed s%hool& and of good mo"al %ha"a%te" @ #t least 19 yea"s old& g"ad$ate of @S* f"om a "e%ogni(ed s%hool and of good mo"al %ha"a%te" C #t least 19 yea"s old& p"o/ided that when sGhe passes the boa"d e-ams& sGhe m$st be at least 21 yea"s oldW @S* g"ad$ate of a "e%ogni(ed s%hool& and of good mo"al %ha"a%te" ) Filipino %iti(en o" a %iti(en of a %o$nt"y whe"e we ha/e "e%ip"o%ityW g"ad$ate of @S* f"om a "e%ogni(ed s%hool and of good mo"al %ha"a%te" #nswe": O)P Filipino %iti(en o" a %iti(en of a %o$nt"y whe"e we ha/e "e%ip"o%ityW g"ad$ate of @S* f"om a "e%ogni(ed s%hool and of good mo"al %ha"a%te" 1# 918+ se%tion 1+ states that the 6$alifi%ations to ta0e the boa"d e-ams a"e: Filipino %iti(en o" %iti(en of a %o$nt"y whe"e the Philippines has "e%ip"o%ityW of good mo"al %ha"a%te" and g"ad$ate of @S* f"om a "e%ogni(ed s%hool of n$"sing !he"e is no e-pli%it p"o/ision abo$t the age "e6$i"ement in 1# 918+ $nli0e in 1#815. Oold

lawP 2 Hhi%h of the following is !1U, abo$t membe"ship to the Philippine *$"ses #sso%iation OP*#PQ
# <embe"ship to P*# is mandato"y and is stip$lated in the Philippine *$"sing #%t of 2002 @ <embe"ship to P*# is %omp$lso"y fo" newly "egiste"ed n$"ses wanting to ente" the p"a%ti%e of n$"sing in the %o$nt"y C <embe"ship to P*# is /ol$nta"y and is en%o$"aged by the P1C Code of ,thi%s fo" *$"ses ) <embe"ship to P*# is "e6$i"ed by go/e"nment hospitals p"io" to employment #nswe": OCP <embe"ship to P*# is /ol$nta"y and is en%o$"aged by the P1C Code of ,thi%s fo" *$"ses <embe"ship to any o"gani(ation& in%l$ding the P*#& is only /ol$nta"y and this "ight to Eoin any o"gani(ation is g$a"anteed in the 1998 %onstit$tion of the Philippines ?owe/e"& the P1C Code of ,thi%s states that one of the ethi%al obligations of the p"ofessional n$"se towa"ds the p"ofession is to be an a%ti/e membe" of the a%%"edited p"ofessional o"gani(ation

5 Hhen the li%ense of the n$"se is "e/o0ed& it means that the n$"se:
# Is no longe" allowed to p"a%ti%e the p"ofession fo" the "est of he" life @ Hill ne/e" ha/e he"Ghis li%ense "e=iss$ed sin%e it has been "e/o0ed

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 1.+

C <ay apply fo" "e=iss$an%e of hisGhe" li%ense based on %e"tain %onditions stip$lated in 1# 918+ ) Hill "emain $nable to p"a%ti%e p"ofessional n$"sing #nswe": OCP <ay apply fo" "e=iss$an%e of hisGhe" li%ense based on %e"tain %onditions stip$lated in 1# 918+ 1# 918+ se% 2. states that fo" e6$ity and E$sti%e& a "e/o0ed li%ense maybe "e=iss$ed p"o/ided that the following %onditions a"e met: aP the %a$se fo" "e/o%ation of li%ense has al"eady been %o""e%ted o" "emo/edW and& bP at least fo$" yea"s has elapsed sin%e the li%ense has been "e/o0ed

8 #%%o"ding to the %$""ent n$"sing law& the minim$m ed$%ational 6$alifi%ation fo" a fa%$lty membe" of a %ollege
of n$"sing is: # Only a <aste" of #"ts in *$"sing is a%%eptable @ <aste"s deg"ee in *$"sing o" in the "elated fields C #t least a do%to"ate in n$"sing ) #t least 19 $nits in the <aste" of #"ts in *$"sing P"og"am #nswe": O@P <aste"s deg"ee in *$"sing o" in the "elated fields #%%o"ding to 1# 918+ se% 28& the ed$%ational 6$alifi%ation of a fa%$lty membe" tea%hing in a %ollege of n$"sing m$st be maste"s deg"ee whi%h maybe in n$"sing o" "elated fields li0e ed$%ation& allied health p"ofessions& psy%hology

9 !he ed$%ational 6$alifi%ation of a n$"se to be%ome a s$pe"/iso" in a hospital is:


# @ C ) @S* with at least 9 $nits of post g"ad$ate st$dies in n$"sing administ"ation <aste" of #"ts in *$"sing maEo" in administ"ation #t least 2 yea"s e-pe"ien%e as a headn$"se #t least 19 $nits of post g"ad$ate st$dies in n$"sing administ"ation

#nswe": O#P @S* with at least 9 $nits of post g"ad$ate st$dies in n$"sing administ"ation #%%o"ding to 1# 918+ se% 29& the ed$%ational 6$alifi%ation to be a s$pe"/iso" in a hospital is at least 9 $nits of postg"ad$ate st$dies in n$"sing administ"ation # maste"s deg"ee in n$"sing is "e6$i"ed fo" the %hief n$"se of a se%onda"y o" te"tia"y hospital

9 !he @oa"d of *$"sing has 6$asi=E$di%ial powe" #n e-ample of this powe" is:
# @ C ) !he @oa"d %an iss$e "$les and "eg$lations that will go/e"n the p"a%ti%e of n$"sing !he @oa"d %an in/estigate /iolations of the n$"sing law and %ode of ethi%s !he @oa"d %an /isit a s%hool applying fo" a pe"mit in %ollabo"ation with C?,) !he @oa"d p"epa"es the boa"d e-aminations

#nswe": O@P !he @oa"d %an in/estigate /iolations of the n$"sing law and %ode of ethi%s >$asi=E$di%ial powe" means that the @oa"d of *$"sing has the a$tho"ity to in/estigate /iolations of the n$"sing law and %an iss$e s$mmons& s$bpoena o" s$bpoena d$%es te%$m as needed

10 Hhen a n$"se %a$ses an inE$"y to the patient and the inE$"y %a$sed be%omes the p"oof of the negligent a%t& the
p"esen%e of the inE$"y is said to e-emplify the p"in%iple of: # Fo"%e maEe$"e @ 1espondeat s$pe"io" C 1es ipsa lo6$it$" ) ?oldo/e" do%t"ine #nswe": OCP 1es ipsa lo6$it$" 1es ipsa lo6$it$" lite"ally means the thing spea0s fo" itself !his means in ope"ational te"ms that the inE$"y %a$sed is the p"oof that the"e was a negligent a%t

11 ,ns$"ing that the"e is an info"med %onsent on the pa"t of the patient befo"e a s$"ge"y is done& ill$st"ates the
bioethi%al p"in%iple of: # @enefi%en%e @ #$tonomy C !"$th tellingG/e"a%ity ) *on=malefi%en%e #nswe": O@P #$tonomy Info"med %onsent means that the patient f$lly $nde"stands what will be the s$"ge"y to be done& the "is0s in/ol/ed and the alte"nati/e sol$tions so that when sGhe gi/e %onsent it is done with f$ll 0nowledge and is gi/en f"eely !he a%tion of allowing the patient to de%ide whethe" a s$"ge"y is to be done o" not e-emplifies the bioethi%al p"in%iple

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of a$tonomy

12 Hhen a n$"se is p"o/iding %a"e to he"Ghis patient& sGhe m$st "emembe" that she is d$ty bo$nd not to do doing
any a%tion that will %a$se the patient ha"m !his is the meaning of the bioethi%al p"in%iple: # *on=malefi%en%e @ @enefi%en%e C B$sti%e ) Solida"ity #nswe": O#P *on=malefi%en%e *on=malefi%en%e means do not %a$se ha"m o" do any a%tion that will %a$se any ha"m to the patientG%lient !o do good is "efe""ed as benefi%en%e

1+ Hhen the patient is as0ed to testify in %o$"t& sGhe m$st abide by the ethi%al p"in%iple of:
# @ C ) P"i/ileged %omm$ni%ation Info"med %onsent Solida"ity #$tonomy

#nswe": O#P P"i/ileged %omm$ni%ation #ll %onfidential info"mation that %omes to the 0nowledge of the n$"se in the %a"e of he"Ghis patients is %onside"ed p"i/ileged %omm$ni%ations ?en%e& sGhe is not allowed to E$st "e/eal the %onfidential info"mation a"bit"a"ily SGhe may only be allowed to b"ea0 the seal of se%"e%y in %e"tain %onditions One s$%h %ondition is when the %o$"t o"de"s the n$"se to testify in a %"iminal o" medi%o=legal %ase

1. Hhen the do%to" o"de"s Sdo not "es$s%itateT& this means that
# @ C ) !he n$"se need not gi/e d$e %a"e to the patient sin%e sGhe is te"minally ill !he patient need not be gi/en food and wate" afte" all sGhe is dying !he n$"ses and the attending physi%ian sho$ld not do any he"oi% o" e-t"ao"dina"y meas$"es fo" the patient !he patient need not be gi/en o"dina"y %a"e so that he"Ghis dying p"o%ess is hastened

#nswe": OCP !he n$"ses and the attending physi%ian sho$ld not do any he"oi% o" e-t"ao"dina"y meas$"es fo" the patient )o not "es$s%itateT is a medi%al o"de" whi%h is w"itten on the %ha"t afte" the do%to" has %ons$lted the family and this means that the membe"s of the health team a"e not "e6$i"ed to gi/e e-t"ao"dina"y meas$"es b$t %annot withhold the basi% needs li0e food& wate"& and ai" It also means that the n$"se is still d$ty bo$nd to gi/e the basi% n$"sing %a"e to the te"minally ill patient and ens$"e that the spi"it$al needs of the patient is ta0en %a"ed of

12 Hhi%h of the following statements is !1U, of abo"tion in the PhilippinesQ


# Ind$%ed abo"tion is allowed in %ases of "ape and in%est @ Ind$%ed abo"tion is both a %"iminal a%t and an $nethi%al a%t fo" the n$"se C #bo"tion maybe %onside"ed a%%eptable if the mothe" is $np"epa"ed fo" the p"egnan%y ) # n$"se who pe"fo"ms ind$%ed abo"tion will ha/e no legal a%%o$ntability if the mothe" "e6$ested that the abo"tion done on he" #nswe": O@P Ind$%ed abo"tion is both a %"iminal a%t and an $nethi%al a%t fo" the n$"se Ind$%ed abo"tion is %onside"ed a %"iminal a%t whi%h is p$nishable by imp"isonment whi%h maybe $p to a ma-im$m of 12 yea"s if the n$"se gets paid fo" it #lso& the P1C Code of ,thi%s states that the n$"se m$st "espe%t life and m$st not do any a%tion that will dest"oy life #bo"tion is an a%t that dest"oys life albeit at the beginning

of life

LEADERSHIP a$% MANAGEMENT 1 <s Cast"o is newly=p"omoted to a patient %a"e manage" position She $pdates he" 0nowledge on the theo"ies in management and leade"ship in o"de" to be%ome effe%ti/e in he" new "ole She lea"ns that some manage"s ha/e low %on%e"n fo" se"/i%es and high %on%e"n fo" staff Hhi%h style of management "efe"s to thisQ

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# @ C )

O"gani(ation <an Impo/e"ished <anagement Co$nt"y Cl$b <anagement !eam <anagement

#nswe": OCP Co$nt"y Cl$b <anagement Co$nt"y %l$b management style p$ts %on%e"n fo" the staff as n$mbe" one p"io"ity at the e-pense of the deli/e"y of se"/i%es ?eGshe "$ns the depa"tment E$st li0e a %o$nt"y %l$b whe"e e/e"y one is happy in%l$ding the manage" 2 ?e" fo"me" manage" demonst"ated passion fo" se"/ing he" staff "athe" than being se"/ed She ta0es time to listen& p"efe"s to be a tea%he" fi"st befo"e being a leade"& whi%h is %ha"a%te"isti% of # !"ansfo"mational leade" @ !"ansa%tional leade" C Se"/ant leade" ) Cha"ismati% leade" #nswe": OCP Se"/ant leade" Se"/ant leade"s a"e open=minded& listen deeply& t"y to f$lly $nde"stand othe"s and not being E$dgmental + On the othe" hand& <s Cast"o noti%es that the Chief *$"se ,-e%$ti/e has %ha"ismati% leade"ship style Hhi%h of the following beha/io"s best des%"ibes this styleQ # Possesses inspi"ational 6$ality that ma0es followe"s gets att"a%ted of him and "ega"ds him with "e/e"en%e @ #%ts as he does be%a$se he e-pe%ts that his beha/io" will yield positi/e "es$lts C Uses /isioning as the %o"e of his leade"ship ) <at%hes his leade"ship style to the sit$ation at hand #nswe": O#P Possesses inspi"ational 6$ality that ma0es followe"s gets att"a%ted of him and "ega"ds him with "e/e"en%e Cha"ismati% leade"s ma0e the followe"s feel at ease in thei" p"esen%e !hey feel that they a"e in good hands whene/e" the leade" is a"o$nd . Hhi%h of the following %on%l$sions of <s Cast"o abo$t leade"ship %ha"a%te"isti%s is !1U,Q # !he"e is a high %o""elation between the %omm$ni%ation s0ills of a leade" and the ability to get the Eob done @ # manage" is effe%ti/e when he has the ability to plan well C #ssessment of pe"sonal t"aits is a "eliable tool fo" p"edi%ting a manage"Ks potential ) !he"e is good e/iden%e that %e"tain pe"sonal 6$alities fa/o" s$%%ess in manage"ial "ole #nswe": OCP #ssessment of pe"sonal t"aits is a "eliable tool fo" p"edi%ting a manage"Ks potential It is not %on%l$si/e that %e"tain 6$alities of a pe"son wo$ld ma0e him be%ome a good manage" It %an only p"edi%t a manage"Ks potential of be%oming a good one 2 She "eads abo$t Path Doal theo"y Hhi%h of the following beha/io"s is manifested by the leade" who $ses this theo"yQ # 1e%ogni(es staff fo" going beyond e-pe%tations by gi/ing them %itations @ Challenges the staff to ta0e indi/id$al a%%o$ntability fo" thei" own p"a%ti%e C #dmonishes staff fo" being lagga"ds ) 1eminds staff abo$t the san%tions fo" non pe"fo"man%e #nswe": O#P 1e%ogni(es staff fo" going beyond e-pe%tations by gi/ing them %itations Path Doal theo"y a%%o"ding to ?o$se and asso%iates "ewa"ds good pe"fo"man%e so that othe"s wo$ld do the same 5 One leade"ship theo"y states that Sleade"s a"e bo"n and not made&T whi%h "efe"s to whi%h of the following theo"iesQ # !"ait @ Cha"ismati% C D"eat <an ) Sit$ational #nswe": OCP D"eat <an 'eade"s be%ome leade"s be%a$se of thei" bi"th "ight !his is also %alled Deneti% theo"y o" the #"istotelian theo"y 8 She %ame a%"oss a theo"y whi%h states that the leade"ship style is effe%ti/e dependent on the sit$ation Hhi%h of the following styles best fits a sit$ation when the followe"s a"e self=di"e%ted& e-pe"ts and a"emat$"ed indi/id$alsQ # )emo%"ati% @ #$tho"ita"ian

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C 'aisse( fai"e ) @$"ea$%"ati% #nswe": OCP 'aisse( fai"e 'aisse( fai"e leade"ship is p"efe""ed when the followe"s 0now what to do and a"e e-pe"ts in the field !his leade"ship style is "elationship=o"iented "athe" than tas0=%ente"ed 9 She s$"fs the inte"net fo" mo"e info"mation abo$t leade"ship styles She "eads abo$t sha"ed leade"ship as a p"a%ti%e in some magnet hospitals Hhi%h of the following des%"ibes this style of leade"shipQ # 'eade"ship beha/io" is gene"ally dete"mined by the "elationship between the leade"Ks pe"sonality and the spe%ifi% sit$ation @ 'eade"s belie/e that people a"e basi%ally good and need not be %losely %ont"olled C 'eade"s "ely hea/ily on /isioning and inspi"e membe"s to a%hie/e "es$lts ) 'eade"ship is sha"ed at the point of %a"e #nswe": O)P 'eade"ship is sha"ed at the point of %a"e Sha"ed go/e"nan%e allows the staff n$"ses to ha/e the a$tho"ity& "esponsibility and a%%o$ntability fo" thei" own p"a%ti%e 9 <s Cast"o lea"ns that some leade"s a"e t"ansa%tional leade"s Hhi%h of the following does *O! %ha"a%te"i(e a t"ansa%tional leade"Q # Fo%$ses on management tas0s @ Is a %a"eta0e" C Uses t"ade=offs to meet goals ) Inspi"es othe"s with /ision #nswe": O)P Inspi"es othe"s with /ision Inspi"es othe"s with a /ision is %ha"a%te"isti% of a t"ansfo"mational leade" ?e is fo%$sed mo"e on the day=to=day ope"ations of the depa"tmentG$nit 10 She finds o$t that some manage"s ha/e bene/olent=a$tho"itati/e style of management Hhi%h of the following beha/io"s will she e-hibit most li0elyQ # ?a/e %ondes%ending t"$st and %onfiden%e in thei" s$bo"dinates @ Di/es e%onomi% o" ego awa"ds C Comm$ni%ates downwa"d to the staff ) #llows de%ision ma0ing among s$bo"dinates #nswe": O#P ?a/e %ondes%ending t"$st and %onfiden%e in thei" s$bo"dinates @ene/olent=a$tho"itati/e manage"s p"etentio$sly show thei" t"$st and %onfiden%e to thei" followe"s 11 ?a""y is a Unit <anage" I the <edi%al Unit ?e is not satisfied with the way things a"e going in his $nit Patient satisfa%tion "ate is 50V fo" two %onse%$ti/e months and staff mo"ale is at its lowest ?e de%ides to plan and initiate %hanges that will p$sh fo" a t$"na"o$nd in the %ondition of the $nit Hhi%h of the following a%tions is a p"io"ity fo" ?a""yQ # Call fo" a staff meeting and ta0e this $p in the agenda @ See0 help f"om he" manage" C )e/elop a st"ategi% a%tion on how to deal with these %on%e"ns ) Igno"e the iss$es sin%e these will be "esol/ed nat$"ally #nswe": O#P Call fo" a staff meeting and ta0e this $p in the agenda !his will allow fo" the pa"ti%ipation of e/e"y staff in the $nit If they %ont"ib$te to the sol$tions of the p"oblem& they will own the sol$tionsW hen%e the %han%e fo" %omplian%e wo$ld be g"eate" 12 She 0nows that the"e a"e e-te"nal fo"%es that infl$en%e %hanges in his $nit Hhi%h of the following is *O! an e-te"nal fo"%eQ # <emo f"om the C,O to %$t down on ele%t"i%al %ons$mption @ )emands of the labo" se%to" to in%"ease wages C 'ow mo"ale of staff in he" $nit ) ,-a%ting "eg$lato"y and a%%"editation standa"ds #nswe": OCP 'ow mo"ale of staff in he" $nit 'ow mo"ale of staff is an inte"nal fa%to" that affe%ts only the $nit #ll the "est of the options emanate f"om the top e-e%$ti/e o" f"om o$tside the instit$tion

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1+ #fte" dis%$ssing the possible effe%ts of the low patient satisfa%tion "ate& the staff sta"ted to list down possible st"ategies to sol/e the p"oblems head=on Sho$ld they de%ide to /ote on the best %hange st"ategy& whi%h of the following st"ategies is "efe""ed to thisQ # Collabo"ation @ <aEo"ity "$le C )ominan%e ) Comp"omise #nswe": O@P <aEo"ity "$le <aEo"ity "$le in/ol/es di/iding the ho$se and the highest /ote wins 1G2 I 1 is a maEo"ity 1. One staff s$ggests that they "e/iew the patte"n of n$"sing %a"e that they a"e $sing& whi%h is des%"ibed as a # Eob des%"iption @ system $sed to deli/e" %a"e C man$al of p"o%ed$"e ) "$les to be followed #nswe": O@P system $sed to deli/e" %a"e # system $sed to deli/e" %a"e In the 80Ks it was te"med as methods of patient assignmentW in the ea"ly 90Ks it was %alled modalities of patient %a"e then patte"ns of n$"sing %a"e in the 90Ks $ntil "e%ently a$tho"s %alled it n$"sing %a"e systems 12 Hhi%h of the following is !1U, abo$t f$n%tional n$"singQ # Con%ent"ates on tas0s and a%ti/ities @ ,mphasi(es $se of g"o$p %ollabo"ation C One=to=one n$"se=patient "atio ) P"o/ides %ontin$o$s& %oo"dinated and %omp"ehensi/e n$"sing se"/i%es #nswe": O#P Con%ent"ates on tas0s and a%ti/ities F$n%tional n$"sing is fo%$sed on tas0s and a%ti/ities and not on the holisti% %a"e of the patients 15 F$n%tional n$"sing has some ad/antages& whi%h one is an ,;C,P!IO*Q # Psy%hologi%al and so%iologi%al needs a"e emphasi(ed @ D"eat %ont"ol of wo"0 a%ti/ities C <ost e%onomi%al way of deli/e"ing n$"sing se"/i%es ) Ho"0e"s feel se%$"e in dependent "ole #nswe": O#P Psy%hologi%al and so%iologi%al needs a"e emphasi(ed Hhen the f$n%tional method is $sed& the psy%hologi%al and so%iologi%al needs of the patients a"e negle%tedW the patients a"e "ega"ded as ^tas0s to be done ^ 18 ?e "aised the iss$e on gi/ing p"io"ity to patient needs Hhi%h of the following offe"s the best way fo" setting p"io"ityQ # #ssessing n$"sing needs and p"oblems @ Di/ing inst"$%tions on how n$"sing %a"e needs a"e to be met C Cont"olling and e/al$ating the deli/e"y of n$"sing %a"e ) #ssigning safe n$"se: patient "atio #nswe": O#P #ssessing n$"sing needs and p"oblems !his option follows the f"amewo"0 of the n$"sing p"o%ess at the same time applies the management p"o%ess of planning& o"gani(ing& di"e%ting and %ont"olling 19 Hhi%h of the following is the best g$a"antee that the patientKs p"io"ity needs a"e metQ # Che%0ing with the "elati/e of the patient @ P"epa"ing a n$"sing %a"e plan in %ollabo"ation with the patient C Cons$lting with the physi%ian ) Coo"dinating with othe" membe"s of the team #nswe": O@P P"epa"ing a n$"sing %a"e plan in %ollabo"ation with the patient !he best so$"%e of info"mation abo$t the p"io"ity needs of the patient is the patient himself ?en%e $sing a n$"sing %a"e plan based on his e-p"essed p"io"ity needs wo$ld ens$"e meeting his needs effe%ti/ely 19 Hhen ?a""y $ses team n$"sing as a %a"e deli/e"y system& he and his team need to assess the p"io"ity of %a"e fo" a g"o$p of patients& whi%h of the following sho$ld be a p"io"ityQ # ,a%h patient as listed on the wo"0sheet @ Patients who needs least %a"e

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C <edi%ations and t"eatments "e6$i"ed fo" all patients ) Patients who need the most %a"e #nswe": O)P Patients who need the most %a"e In setting p"io"ities fo" a g"o$p of patients& those who need the most %a"e sho$ld be n$mbe"=one p"io"ity to ens$"e that thei" %"iti%al needs a"e met ade6$ately !he needs of othe" patients who need less %a"e %a be attended to late" o" e/en delegated to assisti/e pe"sonnel a%%o"ding to "$les on delegation 20 She is hopef$l that he" $nit will ma0e a big t$"na"o$nd in the s$%%eeding months Hhi%h of the following a%tions of ?a""y demonst"ates that he has "ea%hed the thi"d stage of %hangeQ # Honde"s why things a"e not what it $sed to be @ Finds sol$tions to the p"oblems C Integ"ate the sol$tions to his day=to=day a%ti/ities ) Sele%ts the best %hange st"ategy #nswe": OCP Integ"ate the sol$tions to his day=to=day a%ti/ities Integ"ate the sol$tions to his day=to=day a%ti/ities is a e-pe%ted to happen d$"ing the thi"d stage of %hange when the %hange agent in%o"po"ate the sele%ted sol$tions to his system and begins to %"eate a %hange 21 B$li$s is a newly=appointed n$"se manage" of !he Dood Shephe"d <edi%al Cente"& a te"tia"y hospital lo%ated within the hea"t of the met"opolis ?e thin0s of s%hed$ling planning wo"0shop with his staff in o"de" to ens$"e an effe%ti/e and effi%ient management of the depa"tment Sho$ld he de%ide to %ond$%t a st"ategi% planning wo"0shop& whi%h of the following is *O! a %ha"a%te"isti% of this a%ti/ityQ # 'ong=te"m goal=setting @ ,-tends to +=2 yea"s in the f$t$"e C Fo%$ses on "o$tine tas0s ) )ete"mines di"e%tions of the o"gani(ation #nswe": OCP Fo%$ses on "o$tine tas0s St"ategi% planning in/ol/es options #& @ and ) e-%ept C whi%h is att"ib$ted to ope"ational planning 22 Hhi%h of the following statements "efe" to the /ision of the hospitalQ # !he Dood Shephe"d <edi%al Cente" is a t"endsette" in te"tia"y health %a"e in the Philippines in the ne-t fi/e yea"s @ !he offi%e"s and staff of !he Dood Shephe"d <edi%al Cente" belie/e in the $ni6$e nat$"e of the h$man pe"son C #ll the n$"ses shall $nde"go %ontin$ing %ompeten%y t"aining p"og"am ) !he Dood Shephe"d <edi%al Cente" aims to p"o/ide a patient=%ente"ed %a"e in a total healing en/i"onment #nswe": O#P !he Dood Shephe"d <edi%al Cente" is a t"endsette" in te"tia"y health %a"e in the Philippines in the ne-t fi/e yea"s # /ision "efe"s to what the instit$tion wants to be%ome within a pa"ti%$la" pe"iod of time 2+ !he statement& S!he Dood Shephe"d <edi%al Cente" aims to p"o/ide patient=%ente"ed %a"e in a total healing en/i"onmentT "efe"s to whi%h of the followingQ # 7ision @ Doal C Philosophy

) <ission #nswe": O@P Doal


2. B$li$s plans to "e/isit the o"gani(ational %ha"t of the depa"tment ?e plans to %"eate a new position of a Patient ,d$%ato" who has a %oo"dinating "elationship with the head n$"se in the $nit Hhi%h of the following will li0ely depi%t this o"gani(ational "elationshipQ # @o@ Solid line C @"o0en line ) )otted line #nswe": OCP @"o0en line !his is a staff "elationship hen%e it is depi%ted by a b"o0en line in the o"gani(ational st"$%t$"e 22 ?e li0ewise st"esses the need fo" all the employees to follow o"de"s and inst"$%tions f"om him and not f"om anyone else Hhi%h of the following p"in%iples does he "efe" toQ # S%ala" %hain @ )is%ipline

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C Unity of %ommand ) O"de" #nswe": OCP Unity of %ommand !he p"in%iple of $nity of %ommand means that employees sho$ld "e%ei/e o"de"s %oming f"om only one manage" and not f"om two manage"s !his a/e"ts the possibility of sowing %onf$sion among the membe"s of the o"gani(ation 25 B$li$s o"ients his staff on the patte"ns of "epo"ting "elationship th"o$gho$t the o"gani(ation Hhi%h of the following p"in%iples "efe" to thisQ # Span of %ont"ol @ ?ie"a"%hy C ,sp"it dK %o"ps ) Unity of di"e%tion #nswe": O@P ?ie"a"%hy ?ie"a"%hy "efe"s to the patte"n of "epo"ting o" the fo"mal line of a$tho"ity in an o"gani(ational st"$%t$"e 28 ?e emphasi(es to the team that they need to p$t thei" effo"ts togethe" towa"ds the attainment of the goals of the p"og"am Hhi%h of the following p"in%iples "efe"s to thisQ # Span of %ont"ol @ Unity of di"e%tion C Unity of %ommand ) Command "esponsibility #nswe": O@P Unity of di"e%tion Unity of di"e%tion means ha/ing one goal o" one obEe%ti/e fo" the team to p$"s$eW hen%e all membe"s of the o"gani(ation sho$ld p$t thei" effo"ts togethe" towa"ds the attainment of thei" %ommon goal o" obEe%ti/e 29 B$li$s st"esses the impo"tan%e of p"omoting ^esp"it d %o"psK among the membe"s of the $nit Hhi%h of the following "ema"0s of the staff indi%ates that they $nde"stand what he pointed o$tQ # S'etKs wo"0 togethe" in ha"monyW we need to be s$ppo"ti/e of one anothe"T @ SIn o"de" that we a%hie/e the same "es$ltsW we m$st all follow the di"e%ti/es of B$li$s and not f"om othe" manage"s T C SHe will ens$"e that all the "eso$"%es we need a"e a/ailable when needed T ) SHe need to p$t o$" effo"ts togethe" in o"de" to "aise the ba" of e-%ellen%e in the %a"e we p"o/ide to all o$" patients T #nswe": O#P S'etKs wo"0 togethe" in ha"monyW we need to be s$ppo"ti/e of one anothe"T !he p"in%iple of ^esp"it dK %o"psK "efe"s to p"omoting ha"mony in the wo"0pla%e& whi%h is essential in maintaining a %limate %ond$%i/e to wo"0 29 ?e dis%$sses the goal of the depa"tment Hhi%h of the following statements is a goalQ # In%"ease the patient satisfa%tion "ate @ ,liminate the in%iden%e of delayed administ"ation of medi%ations C ,stablish "appo"t with patients ) 1ed$%e "esponse time to two min$tes #nswe": O#P In%"ease the patient satisfa%tion "ate Doal is a desi"ed "es$lt towa"ds whi%h effo"ts a"e di"e%ted Options #@& C and ) a"e all obEe%ti/es whi%h a"e aimed at spe%ifi% end +0 ?e wants to infl$en%e the %$stoma"y way of thin0ing and beha/ing that is sha"ed by the membe"s of the depa"tment Hhi%h of the following te"ms "efe" to thisQ # O"gani(ational %ha"t @ C$lt$"al netwo"0 C O"gani(ational st"$%t$"e ) O"gani(ational %$lt$"e #nswe": O)P O"gani(ational %$lt$"e #n o"gani(ational %$lt$"e "efe"s to the way the membe"s of the o"gani(ation thin0 togethe" and do things a"o$nd them togethe" ItKs thei" way of life in that o"gani(ation +1 ?e asse"ts the impo"tan%e of p"omoting a positi/e o"gani(ational %$lt$"e in thei" $nit Hhi%h of the following beha/io"s indi%ate that this is attained by the g"o$pQ

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# @ C )

P"oa%ti/e and %a"ing with one anothe" Competiti/e and pe"fe%tionist Powe"f$l and oppositional Obedient and $n%omplaining

#nswe": O#P P"oa%ti/e and %a"ing with one anothe" Positi/e %$lt$"e is based on h$manism and affiliati/e no"ms +2 Stephanie is a new Staff ,d$%ato" of a p"i/ate te"tia"y hospital She %ond$%ts o"ientation among new staff n$"ses in he" depa"tment Boseph& one of the new staff n$"ses& wants to $nde"stand the %hannel of %omm$ni%ation& span of %ont"ol and lines of %omm$ni%ation Hhi%h of the following will p"o/ide this info"mationQ # O"gani(ational st"$%t$"e @ Poli%y C Bob des%"iption ) <an$al of p"o%ed$"es #nswe": O#P O"gani(ational st"$%t$"e O"gani(ational st"$%t$"e p"o/ides info"mation on the %hannel of a$tho"ity& i e & who "epo"ts to whom and with what a$tho"ityW the n$mbe" of people who di"e%tly "epo"ts to the /a"io$s le/els of hie"a"%hy and the lines of %omm$ni%ation whethe" line o" staff ++ Stephanie is often seen inte"a%ting with the medi%al inte"n d$"ing %offee b"ea0s and afte" d$ty ho$"s Hhat type of o"gani(ational st"$%t$"e is thisQ # Fo"mal @ Info"mal C Staff ) 'ine #nswe": O@P Info"mal !his is $s$ally not p$blished and oftentimes %on%ealed +. She ta0es p"ide in saying that the hospital has a de%ent"ali(ed st"$%t$"e Hhi%h of the following is *O! %ompatible with this type of modelQ # Flat o"gani(ation @ Pa"ti%ipato"y app"oa%h C Sha"ed go/e"nan%e ) !all o"gani(ation #nswe": O)P !all o"gani(ation !all o"gani(ations a"e highly %ent"ali(ed o"gani(ations whe"e de%ision ma0ing is %ente"ed on one a$tho"ity le/el +2 Cent"ali(ed o"gani(ations ha/e some ad/antages Hhi%h of the following statements a"e !1U,Q 1 ?ighly %ost=effe%ti/e 2 <a0es management easie" + 1efle%ts the inte"est of the wo"0e" . #llows 6$i%0 de%isions o" a%tions # @ C ) 1N2 2N. 2& +N . 1& 2& N .

#nswe": O#P 1 N 2 Cent"ali(ed o"gani(ations a"e needs only a few manage"s hen%e they a"e less e-pensi/e and easie" to manage +5 Stephanie delegates effe%ti/ely if she has a$tho"ity to a%t& whi%h is @,S! defined as: # ha/ing "esponsibility to di"e%t othe"s @ being a%%o$ntable to the o"gani(ation C ha/ing legitimate "ight to a%t ) telling othe"s what to do #nswe": OCP ha/ing legitimate "ight to a%t #$tho"ity is a legitimate o" offi%ial "ight to gi/e %ommand !his is an offi%ially san%tioned "esponsibility +8 1ega"dless of the si(e of a wo"0 g"o$p& eno$gh staff m$st be a/ailable at all times to a%%omplish %e"tain

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p$"poses Hhi%h of these p$"poses in *O! in%l$dedQ # <eet the needs of patients @ P"o/ide a pai" of hands to othe" $nits as needed C Co/e" all time pe"iods ade6$ately ) #llow fo" g"owth and de/elopment of n$"sing staff #nswe": O@P P"o/ide a pai" of hands to othe" $nits as needed P"o/iding a pai" of hands fo" othe" $nits is not a p$"pose in doing an effe%ti/e staffing p"o%ess !his is a f$n%tion of a staffing %oo"dinato" at a %ent"ali(ed model +9 Hhi%h of the following g$idelines sho$ld be least %onside"ed in fo"m$lating obEe%ti/es fo" n$"sing %a"eQ # H"itten n$"sing %a"e plan @ ?olisti% app"oa%h C P"es%"ibed standa"ds ) Staff p"efe"en%es #nswe": O)P Staff p"efe"en%es Staff p"efe"en%es sho$ld be the least p"io"ity in fo"m$lating obEe%ti/es of n$"sing %a"e Indi/id$al p"efe"en%es sho$ld be s$bo"dinate to the inte"est of the patients

+9 Stephanie %onside"s shifting to t"ansfo"mational leade"ship Hhi%h of the following statements best des%"ibes
this type of leade"shipQ # Uses /isioning as the essen%e of leade"ship @ Se"/es the followe"s "athe" than being se"/ed C <aintains f$ll t"$st and %onfiden%e in the s$bo"dinates ) Possesses innate %ha"isma that ma0es othe"s feel good in his p"esen%e #nswe": O#P Uses /isioning as the essen%e of leade"ship !"ansfo"mational leade"ship "elies hea/ily on /isioning as the %o"e of leade"ship

.0 #s a manage"& she fo%$ses he" ene"gy on both the 6$ality of se"/i%es "ende"ed to the patients as well as the
welfa"e of the staff of he" $nit Hhi%h of the following management styles does she adoptQ # Co$nt"y %l$b management @ O"gani(ation man management C !eam management ) #$tho"ity=obedien%e management #nswe": OCP !eam management !eam management has a high %on%e"n fo" se"/i%es and high %on%e"n fo" staff

.1 :athe"ine is a yo$ng Unit <anage" of the Pediat"i% Ha"d <ost of he" staff n$"ses a"e senio" to he"& /e"y
a"ti%$late& %onfident and sometimes agg"essi/e :athe"ine feels $n%omfo"table belie/ing that she is the s%apegoat of e/e"ything that goes w"ong in he" depa"tment Hhi%h of the following is the best a%tion that she m$st ta0eQ # Identify the so$"%e of the %onfli%t and $nde"stand the points of f"i%tion @ )is"ega"d what she feels and %ontin$e to wo"0 independently C See0 help f"om the )i"e%to" of *$"sing ) >$it he" Eob and loo0 fo" anothe" employment #nswe": O#P Identify the so$"%e of the %onfli%t and $nde"stand the points of f"i%tion !his in/ol/es a p"oblem sol/ing app"oa%h& whi%h add"esses the "oot %a$se of the p"oblem

.2 #s a yo$ng manage"& she 0nows that %onfli%t o%%$"s in any o"gani(ation Hhi%h of the following statements
"ega"ding %onfli%t is *O! t"$eQ # Can be dest"$%ti/e if the le/el is too high @ Is not benefi%ialW hen%e it sho$ld be p"e/ented at all times C <ay "es$lt in poo" pe"fo"man%e ) <ay %"eate leade"s #nswe": O@P Is not benefi%ialW hen%e it sho$ld be p"e/ented at all times Confli%ts a"e benefi%ial be%a$se it s$"fa%es o$t iss$es in the open and %an be sol/ed "ight away 'i0ewise& membe"s of the team be%ome mo"e %ons%ientio$s with thei" wo"0 when they a"e awa"e that othe" membe"s of the

team a"e wat%hing them

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.+ :athe"ine tells one of the staff& SI donKt ha/e time to dis%$ss the matte" with yo$ now See me in my offi%e
late"T when the latte" as0s if they %an tal0 abo$t an iss$e Hhi%h of the following %onfli%t "esol$tion st"ategies did she $seQ # Smoothing @ Comp"omise C #/oidan%e ) 1est"i%tion #nswe": OCP #/oidan%e !his st"ategy sh$ns dis%$ssing the iss$e head=on and p"efe"s to postpone it to a late" time In effe%t the p"oblem "emains $nsol/ed and both pa"ties a"e in a lose=lose sit$ation

.. :athleen 0nows that one of he" staff is e-pe"ien%ing b$"no$t Hhi%h of the following is the best thing fo" he"
to doQ # #d/ise he" staff to go on /a%ation @ Igno"e he" obse"/ationsW it will be "esol/ed e/en witho$t inte"/ention C 1emind he" to show loyalty to the instit$tion ) 'et the staff /entilate he" feelings and as0 how she %an be of help #nswe": O)P 'et the staff /entilate he" feelings and as0 how she %an be of help 1ea%hing o$t and helping the staff is the most effe%ti/e st"ategy in dealing with b$"n o$t :nowing that someone is "eady to help ma0es the staff feel impo"tantW hen%e he" self=wo"th is enhan%ed

.2 She 0nows that pe"fo"man%e app"aisal %onsists of all the following a%ti/ities ,;C,P!:
# @ C ) Setting spe%ifi% standa"ds and a%ti/ities fo" indi/id$al pe"fo"man%e Using agen%y standa"ds as a g$ide )ete"mine a"eas of st"ength and wea0nesses Fo%$sing a%ti/ity on the %o""e%tion of identified beha/io"

#nswe": O)P Fo%$sing a%ti/ity on the %o""e%tion of identified beha/io" Pe"fo"man%e app"aisal deal with both positi/e and negati/e pe"fo"man%eW is not meant to be a fa$lt=finding a%ti/ity

.5 Hhi%h of the following statements is *O! t"$e abo$t pe"fo"man%e app"aisalQ


# @ C ) Info"ming the staff abo$t the spe%ifi% imp"essions of thei" wo"0 help imp"o/e thei" pe"fo"man%e # /e"bal app"aisal is an a%%eptable s$bstit$te fo" a w"itten "epo"t Patients a"e the best so$"%e of info"mation "ega"ding pe"sonnel app"aisal !he o$t%ome of pe"fo"man%e app"aisal "ests p"ima"ily with the staff

#nswe": OCP Patients a"e the best so$"%e of info"mation "ega"ding pe"sonnel app"aisal !he patient %an be a so$"%e of info"mation abo$t the pe"fo"man%e of the staff b$t it is ne/e" the best so$"%e )i"e%tly obse"/ing the staff is the best so$"%e of info"mation fo" pe"sonnel app"aisal

.8 !he"e a"e times when :athe"ine e/al$ates he" staff as she ma0es he" daily "o$nds Hhi%h of the following is
*O! a benefit of %ond$%ting an info"mal app"aisalQ # !he staff membe" is obse"/ed in nat$"al setting @ In%idental %onf"ontation and %ollabo"ation is allowed C !he e/al$ation is fo%$sed on obEe%ti/e data systemati%ally ) !he e/al$ation may p"o/ide /alid info"mation fo" %ompilation of a fo"mal "epo"t #nswe": OCP !he e/al$ation is fo%$sed on obEe%ti/e data systemati%ally Colle%ting obEe%ti/e data systemati%ally %an not be a%hie/ed in an info"mal app"aisal It is fo%$sed on what a%t$ally happens in the nat$"al wo"0 setting

.9 She %ond$%ts a 5=month pe"fo"man%e "e/iew session with a staff membe" Hhi%h of the following a%tions is
app"op"iateQ # She as0s anothe" n$"se to attest the session as a witness @ She info"ms the staff that she may as0 anothe" n$"se to "ead the app"aisal befo"e the session is o/e" C She tells the staff that the session is manage"=%ente"ed ) !he session is p"i/ate between the two membe"s #nswe": O)P !he session is p"i/ate between the two membe"s !he session is p"i/ate between the manage" and the staff and "emains to be so when the two pa"ties do not di/$lge

the info"mation to othe"s

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.9 #le-and"a is tas0ed to o"gani(e the new wing of the hospital She was gi/en the a$tho"ity to do as she deems fit She is awa"e that the di"e%to" of n$"sing has s$bstantial t"$st and %onfiden%e in he" %apabilities&
%omm$ni%ates th"o$gh downwa"d and $pwa"d %hannels and $s$ally $ses the ideas and opinions of he" staff Hhi%h of the following is he" style of managementQ # @ene/olent Xa$tho"itati/e @ Cons$ltati/e C ,-ploiti/e=a$tho"itati/e ) Pa"ti%ipati/e #nswe": O@P Cons$ltati/e # %ons$ltati/e manage" is almost li0e a pa"ti%ipati/e manage" !he pa"ti%ipati/e manage" has %omplete t"$st and %onfiden%e in the s$bo"dinate& always $ses the opinions and ideas of s$bo"dinates and %omm$ni%ates in all di"e%tions 22 She de%ides to ill$st"ate the o"gani(ational st"$%t$"e Hhi%h of the following elements is *O! in%l$dedQ # 'e/el of a$tho"ity @ 'ines of %omm$ni%ation C Span of %ont"ol ) Unity of di"e%tion #nswe": O)P Unity of di"e%tion Unity of di"e%tion is a management p"in%iple& not an element of an o"gani(ational st"$%t$"e

21 She plans of assigning %ompetent people to fill the "oles designed in the hie"a"%hy Hhi%h p"o%ess "efe"s to
thisQ # Staffing @ S%hed$ling C 1e%"$itment ) Ind$%tion #nswe": O#P Staffing Staffing is a management f$n%tion in/ol/ing p$tting the best people to a%%omplish tas0s and a%ti/ities to attain the goals of the o"gani(ation

22 She %he%0s the do%$menta"y "e6$i"ements fo" the appli%ants fo" staff n$"se position Hhi%h one is *O!
ne%essa"yQ # Ce"tifi%ate of p"e/io$s employment @ 1e%o"d of "elated lea"ning e-pe"ien%e O1',P C <embe"ship to a%%"edited p"ofessional o"gani(ation ) P"ofessional identifi%ation %a"d #nswe": O@P 1e%o"d of "elated lea"ning e-pe"ien%e O1',P 1e%o"d of 1', is not "e6$i"ed fo" employment p$"poses b$t it is "e6$i"ed fo" the n$"seKs li%ens$"e e-amination

2+ Hhi%h phase of the employment p"o%ess in%l$des getting on the pay"oll and %ompleting do%$menta"y
"e6$i"ementsQ # O"ientation @ Ind$%tion C Sele%tion ) 1e%"$itment #nswe": O@P Ind$%tion !his step in the "e%"$itment p"o%ess gi/es time fo" the staff to s$bmit all the do%$menta"y "e6$i"ements fo"

employment 2. She t"ies to design an o"gani(ational st"$%t$"e that allows %omm$ni%ation to flow in all di"e%tions and in/ol/e
wo"0e"s in de%ision ma0ing Hhi%h fo"m of o"gani(ational st"$%t$"e is thisQ # Cent"ali(ed @ )e%ent"ali(ed C <at"i) Info"mal

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#nswe": O@P )e%ent"ali(ed )e%ent"ali(ed st"$%t$"es allow the staff to ma0e de%isions on matte"s pe"taining to thei" p"a%ti%e and %omm$ni%ate in downwa"d& $pwa"d& late"al and diagonal flow

22 In a ho"i(ontal %ha"t& the lowest le/el wo"0e" is lo%ated at the


# @ C ) 'eftmost bo<iddle 1ightmost bo@ottom

#nswe": OCP 1ightmost bo!he leftmost bo- is o%%$pied by the highest a$tho"ity while the lowest le/el wo"0e" o%%$pies the "ightmost bo-

25 She de%ides to ha/e a de%ent"ali(ed staffing system Hhi%h of the following is an ad/antage of this system of
staffingQ # g"eate" %ont"ol of a%ti/ities @ Conse"/es time C Compatible with %omp$te"i(ation ) P"omotes bette" inte"pe"sonal "elationship #nswe": O)P P"omotes bette" inte"pe"sonal "elationship )e%ent"ali(ed st"$%t$"es allow the staff to sol/e de%isions by themsel/es& in/ol/e them in de%ision ma0ingW hen%e they a"e always gi/en oppo"t$nities to inte"a%t with one anothe"

28 #$b"ey thin0s abo$t p"ima"y n$"sing as a system to deli/e" %a"e Hhi%h of the following a%ti/ities is *O!
done by a p"ima"y n$"seQ # Collabo"ates with the physi%ian @ P"o/ides %a"e to a g"o$p of patients togethe" with a g"o$p of n$"ses C P"o/ides %a"e fo" 2=5 patients d$"ing thei" hospital stay ) Pe"fo"ms %omp"ehensi/e initial assessment #nswe": O@P P"o/ides %a"e to a g"o$p of patients togethe" with a g"o$p of n$"ses !his f$n%tion is done in team n$"sing whe"e the n$"se is a membe" of a team that p"o/ides %a"e fo" a g"o$p of patients

29 Hhi%h patte"n of n$"sing %a"e in/ol/es the %a"e gi/en by a g"o$p of pa"ap"ofessional wo"0e"s led by a
p"ofessional n$"se who ta0e %a"e of patients with the same disease %onditions and a"e lo%ated geog"aphi%ally nea" ea%h othe"Q # Case method @ <od$la" n$"sing C *$"sing %ase management ) !eam n$"sing #nswe": O@P <od$la" n$"sing <od$la" n$"sing is a /a"iant of team n$"sing !he diffe"en%e lies in the fa%t that the membe"s in mod$la" n$"sing a"e pa"ap"ofessional wo"0e"s

29 St 1aphael <edi%al Cente" E$st opened its new Pe"fo"man%e Imp"o/ement )epa"tment <s 7alen%ia is
appointed as the >$ality Cont"ol Offi%e" She %ommits he"self to he" new "ole and plans he" st"ategies to "eali(e the goals and obEe%ti/es of the depa"tment Hhi%h of the following is a p"ima"y tas0 that they sho$ld pe"fo"m to ha/e an effe%ti/e %ont"ol systemQ # <a0e an inte"p"etation abo$t st"engths and wea0nesses @ Identify the /al$es of the depa"tment C Identify st"$%t$"e& p"o%ess& o$t%ome standa"ds N %"ite"ia ) <eas$"e a%t$al pe"fo"man%es #nswe": O@P Identify the /al$es of the depa"tment Identify the /al$es of the depa"tment will set the g$iding p"in%iples within whi%h the depa"tment will ope"ate its

a%ti/ities 50 <s 7alen%ia de/elops the standa"ds to be followed #mong the following standa"ds& whi%h is %onside"ed as a
st"$%t$"e standa"dQ # !he patients /e"bali(ed satisfa%tion of the n$"sing %a"e "e%ei/ed @ 1otation of d$ty will be done e/e"y fo$" wee0s fo" all patient %a"e pe"sonnel

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C #ll patients shall ha/e thei" weights ta0en "e%o"ded ) Patients shall answe" the e/al$ation fo"m befo"e dis%ha"ge #nswe": O@P 1otation of d$ty will be done e/e"y fo$" wee0s fo" all patient %a"e pe"sonnel St"$%t$"e standa"ds in%l$de management system& fa%ilities& e6$ipment& mate"ials needed to deli/e" %a"e to patients 1otation of d$ty is a management system

51 Hhen she p"esents the n$"sing p"o%ed$"es to be followed& she "efe"s to what type of standa"dsQ
# @ C ) P"o%ess O$t%ome St"$%t$"e C"ite"ia

#nswe": O#P P"o%ess P"o%ess standa"ds in%l$de %a"e plans& n$"sing p"o%ed$"e to be done to add"ess the needs of the patients

52 !he following a"e basi% steps in the %ont"olling p"o%ess of the depa"tment Hhi%h of the following is *O!
in%l$dedQ # <eas$"e a%t$al pe"fo"man%e @ Set n$"sing standa"ds and %"ite"ia C Compa"e "es$lts of pe"fo"man%e to standa"ds and obEe%ti/es ) Identify possible %o$"ses of a%tion #nswe": O)P Identify possible %o$"ses of a%tion !his is a step in a 6$ality %ont"ol p"o%ess and not a basi% step in the %ont"ol p"o%ess

5+ Hhi%h of the following statements "efe"s to %"ite"iaQ


# @ C ) #g"eed on le/el of n$"sing %a"e Cha"a%te"isti%s $sed to meas$"e the le/el of n$"sing %a"e Step=by=step g$idelines Statement whi%h g$ide the g"o$p in de%ision ma0ing and p"oblem sol/ing

#nswe": O@P Cha"a%te"isti%s $sed to meas$"e the le/el of n$"sing %a"e C"ite"ia a"e spe%ifi% %ha"a%te"isti%s $sed to meas$"e the standa"d of %a"e

5. She wants to ens$"e that e/e"y tas0 is %a""ied o$t as planned Hhi%h of the following tas0s is *O! in%l$ded in
the %ont"olling p"o%essQ # Inst"$%ting the membe"s of the standa"ds %ommittee to p"epa"e poli%ies @ 1e/iewing the e-isting poli%ies of the hospital C ,/al$ating the %"edentials of all n$"sing staff ) Che%0ing if a%ti/ities %onfo"m to s%hed$le #nswe": O#P Inst"$%ting the membe"s of the standa"ds %ommittee to p"epa"e poli%ies Inst"$%ting the membe"s in/ol/es a di"e%ting f$n%tion

52 <s 7alen%ia p"epa"es the p"o%ess standa"ds Hhi%h of the following is *O! a p"o%ess standa"dQ
# @ C ) Initial assessment shall be done to all patients within twenty fo$" ho$"s $pon admission Info"med %onsent shall be se%$"ed p"io" to any in/asi/e p"o%ed$"e PatientsK "epo"ts 92V satisfa%tion "ate p"io" to dis%ha"ge f"om the hospital Patient ed$%ation abo$t thei" illness and t"eatment shall be p"o/ided fo" all patients and thei" families

#nswe": OCP PatientsK "epo"ts 92V satisfa%tion "ate p"io" to dis%ha"ge f"om the hospital !his "efe"s to an o$t%ome standa"d& whi%h is a "es$lt of the %a"e that is "ende"ed to the patient

55 Hhi%h of the following is e/iden%e that the %ont"olling p"o%ess is effe%ti/eQ


# @ C ) !he things that we"e planned a"e done Physi%ians do not %omplain ,mployees a"e %ontended !he"e is an in%"ease in %$stome" satisfa%tion "ate

#nswe": O#P !he things that we"e planned a"e done Cont"olling is defined as seeing to it that what is planned is done

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58 <s 7alen%ia is "esponsible to the n$mbe" of pe"sonnel "epo"ting to he" !his p"in%iple "efe"s to:
# @ C ) Span of %ont"ol Unity of %ommand Ca""ot and sti%0 p"in%iple ,sp"it dK %o"ps

#nswe": O#P Span of %ont"ol Span of %ont"ol "efe"s to the n$mbe" of wo"0e"s who "epo"t di"e%tly to a manage"

59 She notes that the"e is an in%"easing $n"est of the staff d$e to fatig$e b"o$ght abo$t by sho"tage of staff
Hhi%h a%tion is a p"io"ityQ # ,/al$ate the o/e"all "es$lt of the $n"est @ Initiate a g"o$p inte"a%tion C )e/elop a plan and implement it ) Identify e-te"nal and inte"nal fo"%es #nswe": O@P Initiate a g"o$p inte"a%tion Initiate a g"o$p inte"a%tion will be an oppo"t$nity to dis%$ss the p"oblem in the open

NURSING RESEARCH Part 1

1 :e/in is a membe" of the *$"sing 1esea"%h Co$n%il of the hospital ?is fi"st assignment is to dete"mine the
le/el of patient satisfa%tion on the %a"e they "e%ei/ed f"om the hospital ?e plans to in%l$de all ad$lt patients admitted f"om #p"il to <ay& with a/e"age length of stay of +=. days& fi"st admission& and with no %ompli%ations Hhi%h of the following is an e-t"aneo$s /a"iable of the st$dyQ # )ate of admission

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@ 'ength of stay C #ge of patients ) #bsen%e of %ompli%ations #nswe": OCP #ge of patients #n e-t"aneo$s /a"iable is not the p"ima"y %on%e"n of the "esea"%he" b$t has an effe%t on the "es$lts of the st$dy #d$lt patients may be yo$ng& middle o" late ad$lt 2 ?e thin0s of an app"op"iate theo"eti%al f"amewo"0 Hhose theo"y add"esses the fo$" modes of adaptationQ # <a"tha 1oge"s @ S" Callista 1oy C Flo"en%e *ightingale ) Bean Hatson #nswe": O@P S" Callista 1oy S" Callista 1oy de/eloped the #daptation <odel whi%h in/ol/es the physiologi% mode& self=%on%ept mode& "ole f$n%tion mode and dependen%e mode + ?e opts to $se a self="epo"t method Hhi%h of the following is *O! !1U, abo$t this methodQ # <ost di"e%t means of gathe"ing info"mation @ 7e"satile in te"ms of %ontent %o/e"age C <ost a%%$"ate and /alid method of data gathe"ing ) Aields info"mation that wo$ld be diffi%$lt to gathe" by anothe" method #nswe": OCP <ost a%%$"ate and /alid method of data gathe"ing !he most se"io$s disad/antage of this method is a%%$"a%y and /alidity of info"mation gathe"ed . Hhi%h of the following a"ti%les wo$ld :e/in least %onside" fo" his "e/iew of lite"at$"eQ # SSto"y=!elling and #n-iety 1ed$%tion #mong Pediat"i% PatientsT @ S!$"na"o$nd !ime in ,me"gen%y 1oomsT C SO$t%ome Standa"ds in !e"tia"y ?ealth Ca"e Instit$tionsT ) S,n/i"onmental <anip$lation and Client O$t%omesT #nswe": O@P S!$"na"o$nd !ime in ,me"gen%y 1oomsT !he a"ti%le is fo" pediat"i% patients and may not be "ele/ant fo" ad$lt patients 2 Hhi%h of the following /a"iables will he li0ely ,;C'U), in his st$dyQ # Competen%e of n$"ses @ Ca"ing attit$de of n$"ses C Sala"y of n$"ses ) 1esponsi/eness of staff #nswe": OCP Sala"y of n$"ses Sala"y of staff n$"ses is not an indi%ato" of patient satisfa%tion& hen%e need not be in%l$ded as a /a"iable in the st$dy 5 ?e plans to $se a 'i0e"t S%ale to dete"mine # deg"ee of ag"eement and disag"eement @ %omplian%e to e-pe%ted standa"ds C le/el of satisfa%tion ) deg"ee of a%%eptan%e #nswe": O#P deg"ee of ag"eement and disag"eement 'i0e"t s%ale is a 2=point s$mmated s%ale $sed to dete"mine the deg"ee of ag"eement o" disag"eement of the "espondents to a statement in a st$dy

8 ?e %he%0s if his inst"$ments meet the %"ite"ia fo" e/al$ation Hhi%h of the following %"ite"ia "efe"s to the
%onsisten%y o" the ability to yield the same "esponse $pon its "epeated administ"ationQ # 7alidity @ 1eliability C Sensiti/ity ) ObEe%ti/ity #nswe": O@P 1eliability

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1eliability is "epeatability of the inst"$mentW it %an eli%it the same "esponses e/en with /a"ied administ"ation of

the inst"$ment
9 Hhi%h %"ite"ia "efe" to the ability of the inst"$ment to dete%t fine diffe"en%es among the s$bEe%ts being st$diedQ # Sensiti/ity @ 1eliability C 7alidity ) ObEe%ti/ity #nswe": O#P Sensiti/ity Sensiti/ity is an att"ib$te of the inst"$ment that allow the "espondents to disting$ish diffe"en%es of the options

whe"e to %hoose f"om


9 Hhi%h of the following te"ms "efe" to the deg"ee to whi%h an inst"$ment meas$"es what it is s$pposed to be meas$"eQ # 7alidity @ 1eliability C <eaningf$lness ) Sensiti/ity #nswe": O#P 7alidity 7alidity is ens$"ing that the inst"$ment %ontains app"op"iate 6$estions abo$t the "esea"%h topi%

10 ?e plans fo" his sampling method Hhi%h sampling method gi/es e6$al %han%e to all $nits in the pop$lation to
get pi%0edQ # 1andom @ #%%idental C >$ota ) B$dgment #nswe": O#P 1andom 1andom sampling gi/es e6$al %han%e fo" all the elements in the pop$lation to be pi%0ed as pa"t of the sample

11 1aphael is inte"ested to lea"n mo"e abo$t t"ans%$lt$"al n$"sing be%a$se he is assigned at the family s$ites
whe"e most patients %ome f"om diffe"ent %$lt$"es and %o$nt"ies Hhi%h of the following designs is app"op"iate fo" this st$dyQ # D"o$nded theo"y @ ,thnog"aphy C Case st$dy ) Phenomenology #nswe": O@P ,thnog"aphy ,thnog"aphy is fo%$sed on patte"ns of beha/io" of sele%ted people within a %$lt$"e

12 !he n$"sing theo"ist who de/eloped t"ans%$lt$"al n$"sing theo"y is


# @ C ) )o"othea O"em <adeleine 'eininge" @etty *ewman S" Callista 1oy

#nswe": O@P <adeleine 'eininge" <adeleine 'eininge" de/eloped the theo"y on t"ans%$lt$"al theo"y based on he" obse"/ations on the beha/io" of sele%ted people within a %$lt$"e

1+ Hhi%h of the following statements best des%"ibes a phenomenologi%al st$dyQ


# @ C ) In/ol/es the des%"iption and inte"p"etation of %$lt$"al beha/io" Fo%$ses on the meaning of e-pe"ien%es as those who e-pe"ien%e it In/ol/es an in=depth st$dy of an indi/id$al o" g"o$p In/ol/es %olle%ting and analy(ing data that aims to de/elop theo"ies g"o$nded in "eal=wo"ld obse"/ations

#nswe": O@P Fo%$ses on the meaning of e-pe"ien%es as those who e-pe"ien%e it Phenomenologi%al st$dy in/ol/es $nde"standing the meaning of e-pe"ien%es as those who e-pe"ien%ed the

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phenomenon 1. ?e systemati%ally plans his sampling plan Sho$ld he de%ides to in%l$de whoe/e" patients a"e admitted d$"ing
the st$dy he $ses what sampling methodQ # B$dgment @ #%%idental C 1andom ) >$ota #nswe": O@P #%%idental #%%idental sampling is a non=p"obability sampling method whi%h in%l$des those who a"e at the site d$"ing data

%olle%tion 12 ?e finally de%ides to $se E$dgment sampling Hhi%h of the following a%tions of 1aphael is %o""e%tQ
# Plans to in%l$de whoe/e" is the"e d$"ing his st$dy @ )ete"mines the diffe"ent nationality of patients f"e6$ently admitted and de%ides to get "ep"esentations samples f"om ea%h C #ssigns n$mbe"s fo" ea%h of the patients& pla%e these in a fishbowl and d"aw 10 f"om it ) )e%ides to get 20 samples f"om the admitted patients #nswe": O@P )ete"mines the diffe"ent nationality of patients f"e6$ently admitted and de%ides to get "ep"esentations samples f"om ea%h B$dgment sampling in/ol/es in%l$ding samples a%%o"ding to the 0nowledge of the in/estigato" abo$t the pa"ti%ipants in the st$dy

15 ?e 0nows that %e"tain patients who a"e in a spe%iali(ed "esea"%h setting tend to "espond psy%hologi%ally to the
%onditions of the st$dy !his is "efe""ed to as # @ias @ ?awtho"ne effe%t C ?alo effe%t ) ?o"ns effe%t #nswe": O@P ?awtho"ne effe%t ?awtho"ne effe%t is based on the st$dy of ,lton <ayo and %ompany abo$t the effe%t of an inte"/ention done to imp"o/e the wo"0ing %onditions of the wo"0e"s on thei" p"od$%ti/ity It "es$lted to an in%"eased p"od$%ti/ity b$t not d$e to the inte"/ention b$t d$e to the psy%hologi%al effe%ts of being obse"/ed !hey pe"fo"med diffe"ently be%a$se they we"e $nde" obse"/ation

18 Hhi%h of the following items "efe" to the sense of %los$"e that 1aphael e-pe"ien%es when data %olle%tion
%eases to yield any new info"mationQ # Sat$"ation @ P"e%ision C 'imitation ) 1ele/an%e #nswe": O#P Sat$"ation Sat$"ation is a%hie/ed when the in/estigato" %an not e-t"a%t new "esponses f"om the info"mants& b$t instead& gets the same "esponses "epeatedly

19 In 6$alitati/e "esea"%h the a%t$al analysis of data begins with:


# @ C ) sea"%h fo" themes /alidation of themati% analysis wea/e the themati% st"ands togethe" 6$asi statisti%s

#nswe": O#P sea"%h fo" themes !he in/estigato" sta"ts data analysis by loo0ing fo" themes f"om the /e"batim "esponses of the info"mants

19 1aphael is also inte"ested to 0now the %oping abilities of patients who a"e newly diagnosed to ha/e te"minal
%an%e" Hhi%h of the following types of "esea"%h is app"op"iateQ # Phenomenologi%al @ ,thnog"aphi% C D"o$nded !heo"y

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) Case St$dy #nswe": OCP D"o$nded !heo"y D"o$nded theo"y ind$%ti/ely de/elops a theo"y based on the obse"/ed p"o%esses in/ol/ing sele%ted people

20 Hhi%h of the following titles of the st$dy is app"op"iate fo" this st$dyQ
# @ C ) 'i/ed ,-pe"ien%es of !e"minally=Ill Can%e" Patients Coping S0ills of !e"minally=Ill Can%e" Patients in a Sele%ted ?ospital !wo Case St$dies of !e"minally=Ill Patients in <anila @eliefs N P"a%ti%es of Patients with !e"minal Can%e"

#nswe": O@P Coping S0ills of !e"minally=Ill Can%e" Patients in a Sele%ted ?ospital !he title has a spe%ifi% phenomenon& sample and "esea"%h lo%ale

21 <s <ontana plans to %ond$%t a "esea"%h on the $se of a new method of pain assessment s%ale Hhi%h of the
following is the se%ond step in the %on%ept$ali(ing phase of the "esea"%h p"o%essQ # Fo"m$lating the "esea"%h hypothesis @ 1e/iew "elated lite"at$"e C Fo"m$lating and delimiting the "esea"%h p"oblem ) )esign the theo"eti%al and %on%ept$al f"amewo"0 #nswe": O@P 1e/iew "elated lite"at$"e #fte" fo"m$lating and delimiting the "esea"%h p"oblem& the "esea"%he" %ond$%ts a "e/iew of "elated lite"at$"e to dete"mine the e-tent of what has been done on the st$dy by p"e/io$s "esea"%he"s

22 Hhi%h of the following %odes of "esea"%h ethi%s "e6$i"es info"med %onsent in all %ases go/e"ning h$man
s$bEe%tsQ # ?elsin0i )e%la"ation @ *$"embe"g Code C @elmont 1epo"t ) IC* Code of ,thi%s #nswe": O#P ?elsin0i )e%la"ation ?elsin0i )e%la"ation is the fi"st inte"national attempt to set $p ethi%al standa"ds in "esea"%h in/ol/ing h$man

"esea"%h s$bEe%ts 2+ Hhi%h of the following ethi%al p"in%iples was *O! a"ti%$lated in the @elmont 1epo"tQ
# @ C ) @enefi%en%e 1espe%t fo" h$man dignity B$sti%e *on=malefi%en%e

#nswe": O)P *on=malefi%en%e *on=malefi%en%e is not a"ti%$lated in the @elmont 1epo"t It only in%l$des benefi%en%e& "espe%t fo" h$man dignity and E$sti%e

2. Hhi%h one of the following %"ite"ia sho$ld be %onside"ed as a top p"io"ity in n$"sing %a"eQ
# @ C ) #/oidan%e of dest"$%ti/e %hanges P"ese"/ation of life #ss$"an%e of safety P"ese"/ation of integ"ity

#nswe": O@P P"ese"/ation of life !he p"ese"/ation of life at all %ost is a p"ima"y "esponsibility of the n$"se !his is embodied in the Code of ,thi%s fo" "egiste"ed n$"ses O @O* 1esol$tion 220 s 200.P

22 Hhi%h of the following p"o%ed$"es ens$"es that the in/estigato" has f$lly des%"ibed to p"ospe%ti/e s$bEe%ts the
nat$"e of the st$dy and the s$bEe%tCs "ightsQ # )eb"iefing @ F$ll dis%los$"e C Info"med %onsent ) Co/e" data %olle%tion

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#nswe": O@P F$ll dis%los$"e F$ll dis%los$"e is gi/ing the s$bEe%ts of the "esea"%h info"mation that they dese"/e to 0now p"io" to the %ond$%t

of the st$dy 25 #fte" the "e/iew session has been %ompleted& :a"en and the staff signed the do%$ment Hhi%h of the
following is the p$"pose of thisQ # #g"ee abo$t the %ontent of the e/al$ation @ Signify disag"eement of the %ontent of the e/al$ation C )o%$ment that :a"en and the staff "e/iewed the e/al$ation ) Se"/e as basis fo" f$t$"e e/al$ation #nswe": OCP )o%$ment that :a"en and the staff "e/iewed the e/al$ation Signing the do%$ment is done to se"/e as a p"oof that pe"fo"man%e "e/iew was %ond$%ted d$"ing that date and time

28 Hhi%h of the following is *O! t"$e abo$t a hypothesisQ ?ypothesis is:


# @ C ) testable p"o/en stated in a fo"m that it %an be a%%epted o" "eEe%ted states a "elationship between /a"iables

#nswe": O@P p"o/en ?ypothesis is not p"o/enW it is eithe" a%%epted o" "eEe%ted ?ypothesis is testable and is defined as a statement that p"edi%ts the "elationship between /a"iables

29 Hhi%h of the following meas$"es will best p"e/ent manip$lation of /$lne"able g"o$psQ
# @ C ) Se%$"e info"med %onsent Payment of stipends fo" s$bEe%ts P"ote%t p"i/a%y of patient ,ns$"e %onfidentiality of data

#nswe": O#P Se%$"e info"med %onsent Se%$"ing info"med %onsent will f"ee the "esea"%he" f"om being a%%$sed of manip$lating the s$bEe%ts be%a$se by so doing heGshe gi/es ample oppo"t$nity fo" the s$bEe%ts to weigh the ad/antagesGdisad/antages of being in%l$ded in the st$dy p"io" to gi/ing his %onsent !his is done witho$t any element of fo"%e& %oe"%ion& th"eat o" e/en

ind$%ement
29 Hhi%h of the following p"o%ed$"es ens$"es that <s <ontana has f$lly des%"ibed to p"ospe%ti/e s$bEe%ts the nat$"e of the st$dy and the s$bEe%tKs "ightsQ # )eb"iefing @ F$ll dis%los$"e C Info"med %onsent ) Co/e"t data %olle%tion #nswe": O@P F$ll dis%los$"e F$ll dis%los$"e is gi/ing the s$bEe%ts of the "esea"%h info"mation that they dese"/e to 0now p"io" to the %ond$%t

of the st$dy
+0 !his te%hni6$e "efe"s to the $se of m$ltiple "efe"ents to d"aw %on%l$sions abo$t what %onstit$tes the t"$th # !"iang$lation @ ,-pe"iment C <eta=analysis ) )elphi te%hni6$e #nswe": O#P !"iang$lation !"iang$lation ma0es $se of diffe"ent so$"%es of info"mation s$%h as t"iang$lation in design& "esea"%he" and inst"$ment

+1 !he statement& S*inety pe"%ent O90VP of the "espondents a"e female staff n$"ses /alidates p"e/io$s "esea"%h
findings OSantos& 2001W 1eyes& 2002P that the n$"sing p"ofession is la"gely a female dominated p"ofession is an e-ample of # impli%ation @ inte"p"etation

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C analysis ) %on%l$sion #nswe": O@P inte"p"etation Inte"p"etation in%l$des the infe"en%es of the "esea"%he" abo$t the findings of the st$dy

+2 !he st$dy is said to be %ompleted when <s <ontana a%hie/ed whi%h of the following a%ti/itiesQ
# @ C ) P$blished the "es$lts in a n$"sing Eo$"nal P"esented the st$dy in a "esea"%h fo"$m !he "es$lts of the st$dy is $sed by the n$"ses in the hospital S$bmitted the "esea"%h "epo"t to the C,O

#nswe": OCP !he "es$lts of the st$dy is $sed by the n$"ses in the hospital !he last step in the "esea"%h p"o%ess is the $tili(ation of the "esea"%h findings

++ Sit$ation: Stephanie is a n$"se "esea"%he" of the Patient Ca"e Se"/i%es )i/ision She plans to %ond$%t a
lite"at$"e sea"%h fo" he" st$dy Hhi%h of the following is the fi"st step in sele%ting app"op"iate mate"ials fo" he" "e/iewQ # !"a%0 down most of the "ele/ant "eso$"%es @ Copy "ele/ant mate"ials C O"gani(e mate"ials a%%o"ding to f$n%tion ) Synthesi(e lite"at$"e gathe"ed #nswe": O#P !"a%0 down most of the "ele/ant "eso$"%es !he fi"st step in the "e/iew of "elated lite"at$"e is to t"a%0 down "ele/ant so$"%es befo"e %opying these !he last step is to synthesi(e the lite"at$"e gathe"ed

+. She 0nows that the most impo"tant %atego"ies of info"mation in lite"at$"e "e/iew is the:
# @ C ) "esea"%h findings theo"eti%al f"amewo"0 methodology opinions

#nswe": O#P "esea"%h findings !he "esea"%h findings is the most impo"tant %atego"y of info"mation that the "esea"%he" sho$ld %opy be%a$se this will gi/e he" /al$able info"mation as to what has been dis%o/e"ed in past st$dies abo$t the same topi%

+2 She also %onside"s a%%essing ele%t"oni% data bases fo" he" lite"at$"e "e/iew Hhi%h of the following is the most
$sef$l ele%t"oni% database fo" n$"sesQ # CI*#?' @ <,)'I*, C ?ealthS!#1 ) ,<@#S, #nswe": O#P CI*#?' !his "efe"s to C$m$lati/e Inde- to *$"sing and #llied ?ealth 'ite"at$"e whi%h is a "i%h so$"%e fo" lite"at$"e "e/iew fo" n$"ses !he "est of the sites a"e fo" medi%ine& pha"ma%y and othe" health="elated sites

+5 Hhile "e/iewing Eo$"nal a"ti%les& Stephanie got inte"ested in "eading the b"ief s$mma"y of the a"ti%le pla%ed at
the beginning of the Eo$"nal "epo"t Hhi%h of the following "efe"s to thisQ # Int"od$%tion @ P"efa%e C #bst"a%t ) @a%0g"o$nd #nswe": OCP #bst"a%t #bst"a%t %ontains %on%ise des%"iption of the ba%0g"o$nd of the st$dy& "esea"%h 6$estions& "esea"%h obEe%ti/es& methods& findings& impli%ations to n$"sing p"a%ti%e as well as 0eywo"ds $sed in the st$dy

+8 She notes down ideas that we"e de"i/ed f"om the des%"iption of an in/estigation w"itten by the pe"son who
%ond$%ted it Hhi%h type of "efe"en%e so$"%e "efe"s to thisQ # Footnote @ @ibliog"aphy

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C P"ima"y so$"%e ) ,ndnotes

#nswe": OCP P"ima"y so$"%e


!his "efe"s to a p"ima"y so$"%e whi%h is a di"e%t a%%o$nt of the in/estigation done by the in/estigato" In %ont"ast to this is a se%onda"y so$"%e& whi%h is w"itten by someone othe" than the o"iginal "esea"%he"

+9 She %ame a%"oss a st$dy whi%h is "efe""ed to as meta=analysis Hhi%h of the following statements best defines
this type of st$dyQ # !"eats the findings f"om one st$dy as a single pie%e of data @ Findings f"om m$ltiple st$dies a"e %ombined to yield a data set whi%h is analy(ed as indi/id$al data C 1ep"esents an appli%ation of statisti%al p"o%ed$"es to findings f"om ea%h "epo"t ) !e%hni6$e fo" 6$antitati/ely %ombining and th$s integ"ating the "es$lts of m$ltiple st$dies on a gi/en topi% #nswe": O)P !e%hni6$e fo" 6$antitati/ely %ombining and th$s integ"ating the "es$lts of m$ltiple st$dies on a gi/en topi% !ho$gh all the options a"e %o""e%t& the best definition is option ) be%a$se it %ombines 6$antitati/ely the "es$lts and at the same time it integ"ates the "es$lts of the diffe"ent st$dies as one finding

+9 !his 0ind of "esea"%h gathe"s data in detail abo$t a indi/id$al o" g"o$ps and p"esented in na""ati/e fo"m&
whi%h is # Case st$dy @ ?isto"i%al C #nalyti%al ) ,-pe"imental #nswe": O#P Case st$dy Case st$dy fo%$ses on in=depth in/estigations of single entity o" small n$mbe" of entities It attempts to analy(e and $nde"stand iss$es of impo"tan%e to histo"y& de/elopment o" %i"%$mstan%es of the pe"son o" entity $nde" st$dy

.0 Stephanie is finished with the steps in the %on%ept$al phase when she has %ond$%ted the '#S! step& whi%h is
# @ C ) fo"m$lating and delimiting the p"oblem "e/iew of "elated lite"at$"e de/elop a theo"eti%al f"amewo"0 fo"m$late a hypothesis

#nswe": O)P fo"m$late a hypothesis !he last step in the %on%ept$ali(ing phase of the "esea"%h p"o%ess is fo"m$lating a hypothesis !he "est a"e the fi"st th"ee steps in this phase

.1 She states the hypothesis of the st$dy Hhi%h of the following is a n$ll hypothesisQ
# @ C ) Infants who a"e b"eastfed ha/e the same weight as those who a"e bottle fed @ottle=fed infants ha/e lowe" weight than b"east=fed infants C$ddled infants sleep longe" than those who a"e left by themsel/es to sleep Child"en of absentee pa"ents a"e mo"e p"one to e-pe"ien%e dep"ession than those who li/e with both pa"ents

#nswe": O#P Infants who a"e b"eastfed ha/e the same weight as those who a"e bottle fed *$ll hypothesis p"edi%ts that the"e is no %hange& no diffe"en%e o" no "elationship between the /a"iables in the st$dy

.2 She notes that the dependent /a"iable in the hypothesis S)$"ation of sleep of %$ddled infants is longe" than
those infants who a"e not %$ddled by mothe"sT is # C$ddled infants @ )$"ation of sleep C Infants ) #bsen%e of %$ddling #nswe": O@P )$"ation of sleep )$"ation of sleep is the ^effe%tK Odependent /a"iableP of %$ddling ^%a$seK Oindependent /a"iableP

.+ Sit$ation: #"etha is a n$"se "esea"%he" in a te"tia"y hospital She is tas0ed to %ond$%t a "esea"%h on the effe%ts
of st"$%t$"ed dis%ha"ge plan fo" post=open hea"t s$"ge"y patients She states the signifi%an%e of the "esea"%h p"oblem Hhi%h of the following statements is the <OS! signifi%ant

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fo" this st$dyQ # Imp"o/ement in patient %a"e @ )e/elopment of a theo"eti%al basis fo" n$"sing C In%"ease the a%%o$ntability of n$"ses ) Imp"o/es the image of n$"sing #nswe": O#P Imp"o/ement in patient %a"e !he $ltimate goal of %ond$%ting "esea"%h is to imp"o/e patient %a"e whi%h is a%hie/ed by enhan%ing the p"a%ti%e of n$"ses when they $tili(e "esea"%h "es$lts in thei" p"a%ti%e

.. 1ega"dless of the signifi%an%e of the st$dy& the feasibility of the st$dy needs to be %onside"ed Hhi%h of the
following is %onside"ed a p"io"ityQ # #/ailability of "esea"%h s$bEe%ts @ @$dgeta"y allo%ation C !ime f"ame ) ,-pe"ien%e of the "esea"%he" #nswe": O#P #/ailability of "esea"%h s$bEe%ts #/ailability is the most impo"tant %"ite"ia to be %onside"ed by the "esea"%he" in dete"mining whethe" the st$dy is feasible o" not *o matte" how signifi%ant the st$dy may be if the"e a"e no a/ailable s$bEe%tsG"espondents& the st$dy %an not p$sh th"o$gh

.5 #"etha 0nows that a good "esea"%h p"oblem e-hibits the following %ha"a%te"isti%sW whi%h one is *O!
in%l$dedQ # Clea"ly identified the /a"iablesGphenomenon $nde" %onside"ation @ Spe%ifies the pop$lation being st$died C Implies the feasibility of empi"i%al testing ) Indi%ates the hypothesis to be tested #nswe": O)P Indi%ates the hypothesis to be tested *ot all st$dies "e6$i"e a hypothesis s$%h as 6$alitati/e st$dies& whi%h does not deal with /a"iables b$t with phenomenon o" %on%epts

.8 She states the p$"poses of the st$dy Hhi%h of the following des%"ibe the p$"pose of a st$dyQ
1 ,stablishes the gene"al di"e%tion of a st$dy 2 Capt$"es the essen%e of the st$dy + Fo"mally a"ti%$lates the goals of the st$dy . Sometimes wo"ded as an intent # 1& 2& + @ 2& +& . C 1& +& . ) 1& 2& +& . #nswe": O)P 1& 2& +& . !he p$"poses of a "esea"%h st$dy %o/e"s all the options indi%ated

.9 She opts to $se inte"/iews in data %olle%tion In addition to /alidity& what is the othe" <OS! se"io$s wea0ness
of this methodQ # #%%$"a%y @ Sensiti/ity C ObEe%ti/ity ) 1eliability #nswe": O#P #%%$"a%y #%%$"a%y and /alidity a"e the most se"io$s wea0nesses of the self="epo"t data !his is d$e to the fa%t that the "espondents sometimes do not want to tell the t"$th fo" fea" of being "eEe%ted o" in o"de" to please the

inte"/iewe" .9 She plans to s$bEe%t he" inst"$ment to p"etesting Hhi%h of the following is *O! a%hie/ed in doing
p"etestingQ # )ete"mines how m$%h time it ta0es to administe" the inst"$ment pa%0age @ Identify pa"ts that a"e diffi%$lt to "ead o" $nde"stand C )ete"mine the b$dgeta"y allo%ation fo" the st$dy

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) )ete"mine if the meas$"es yield data with s$ffi%ient /a"iability #nswe": OCP )ete"mine the b$dgeta"y allo%ation fo" the st$dy )ete"mining b$dgeta"y allo%ation fo" the st$dy is not a p$"pose of doing a p"etesting of the inst"$ments !his is done at an ea"lie" stage of the design and planning phase

20 She tests the inst"$ment whethe" it loo0s as tho$gh it is meas$"ing app"op"iate %onst"$%ts Hhi%h of the
following "efe"s to thisQ # Fa%e /alidity @ Content /alidity C Const"$%t 7alidity ) C"ite"ion="elated /alidity #nswe": O#P Fa%e /alidity Fa%e /alidity meas$"es whethe" the inst"$ment appea"s to be meas$"ing the app"op"iate %onst"$%t It is the easiest type of /alidity testing

21 Hhi%h of the following 6$estions wo$ld dete"mine the %onst"$%t /alidity of the inst"$mentQ
# @ C ) SHhat is this inst"$ment "eally meas$"ingQT S?ow "ep"esentati/e a"e the 6$estions on this test of the $ni/e"se of 6$estions on this topi%QT S)oes the 6$estion as0ed loo0s as tho$gh it is meas$"ing the app"op"iate %onst"$%tQT S)oes the inst"$ment %o""elate highly with an e-te"nal %"ite"ionQ

#nswe": O#P SHhat is this inst"$ment "eally meas$"ingQT Const"$%t /alidity aims to /alidate what the inst"$ment is "eally meas$"ing !he mo"e abst"a%t the %on%ept& the mo"e diffi%$lt to meas$"e the %onst"$%t

22 Hhi%h of the following e-pe"imental "esea"%h designs wo$ld be app"op"iate fo" this st$dy if she wants to find
o$t a %a$se and effe%t "elationship between the st"$%t$"ed dis%ha"ge plan and %omplian%e to home %a"e "egimen among the s$bEe%tsQ # !"$e e-pe"iment @ >$asi e-pe"iment C Post=test only design ) Solomon fo$"=g"o$p #nswe": OCP Post=test only design Post= !est only design is app"op"iate be%a$se it is impossible to meas$"e the %omplian%e to home %a"e "egimen /a"iable p"io" to the dis%ha"ge of the patient f"om the hospital

2+ One hypothesis that she fo"m$lated is SComplian%e to home %a"e "egimen is g"eate" among patients who
"e%ei/ed the st"$%t$"ed dis%ha"ge plan than those who "e%ei/ed /e"bal dis%ha"ge inst"$%tions K Hhi%h is the independent /a"iable in this st$dyQ # St"$%t$"ed dis%ha"ge plan @ Complian%e to home %a"e "egimen C Post=open hea"t s$"ge"y patients ) D"eate" %omplian%e #nswe": O#P St"$%t$"ed dis%ha"ge plan St"$%t$"ed dis%ha"ge plan is the inte"/ention o" the ^%a$seK in the st$dy that "es$lts to an ^effe%tK& whi%h is %omplian%e to home %a"e "egimen o" the dependent /a"iable

2. Sit$ation : #lyssa plans to %ond$%t a st$dy abo$t n$"sing p"a%ti%e in the %o$nt"y She de%ides to "ef"esh he"
0nowledge abo$t the diffe"ent types of "esea"%h in o"de" to %hoose the most app"op"iate design fo" he" st$dy

22 She %ame a%"oss s$"/eys& li0e the So%ial Heathe" Station and P$lse #sia S$"/ey Hhi%h of the following is
the p$"pose of this 0ind of "esea"%hQ # Obtains info"mation "ega"ding the p"e/alen%e& dist"ib$tion and inte""elationships of /a"iables within a pop$lation at a pa"ti%$la" time @ Det an a%%$"ate and %omplete data abo$t a phenomenon C )e/elop a tool fo" data gathe"ing ) Fo"m$late a f"amewo"0 fo" the st$dy #nswe": O#P Obtains info"mation "ega"ding the p"e/alen%e& dist"ib$tion and inte""elationships of /a"iables within a pop$lation at a pa"ti%$la" time

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S$"/eys a"e done to gathe" info"mation on peopleKs a%tions& 0nowledge& intentions& opinions and attit$des

25 She will li0ely $se self="epo"t method Hhi%h of the following self="epo"t methods is the most "espe%ted
method $sed in s$"/eysQ # Pe"sonal inte"/iews @ >$estionnai"es C !elephone inte"/iews ) 1ating S%ale #nswe": O#P Pe"sonal inte"/iews Pe"sonal inte"/iews is the best method of %olle%ting s$"/ey data be%a$se the 6$ality of info"mation they yield is highe" than othe" methods and be%a$se "elati/ely few people "ef$se to be inte"/iewed in pe"son

28 #lyssa "eads abo$t e-plo"ato"y "esea"%h Hhi%h of the following is the p$"pose of doing this type of "esea"%hQ
# @ C ) Ind$%ti/ely de/elops a theo"y based on obse"/ations abo$t p"o%esses in/ol/ing sele%ted people <a0es new 0nowledge $sef$l and p"a%ti%al Identifies the /a"iables in the st$dy Finds o$t the %a$se and effe%t "elationship between /a"iables

#nswe": OCP Identifies the /a"iables in the st$dy ,-plo"ato"y "esea"%h is the fi"st le/el of in/estigation and it deals with identifying the /a"iables in the st$dy

29 She "e/iews 6$alitati/e design of "esea"%h Hhi%h of the following is t"$e abo$t ethnog"aphi% st$dyQ
# @ C ) )e/elops theo"ies that in%"ease the 0nowledge abo$t a %e"tain phenomenon Fo%$ses on the meanings of life e-pe"ien%es of people )eals with patte"ns and e-pe"ien%es of a defined %$lt$"al g"o$p in a holisti% fashion In=depth in/estigation of a single entity

#nswe": OCP )eals with patte"ns and e-pe"ien%es of a defined %$lt$"al g"o$p in a holisti% fashion ,thnog"aphi% "esea"%h deals with the %$lt$"al patte"ns and beliefs of %e"tain %$lt$"e g"o$ps

29 She 0nows that the p$"pose of doing ethnog"aphi% st$dy is to:


# @ C ) Unde"stand the wo"ld/iew of a %$lt$"al g"o$p St$dy the life e-pe"ien%es of people )ete"mine the "elationship between /a"iables In/estigate intensi/ely a single entity

#nswe": O#P Unde"stand the wo"ld/iew of a %$lt$"al g"o$p !he aim of ethnog"aphe"s is to lea"n f"om the membe"s of a %$lt$"al g"o$p by $nde"standing thei" way of life as they pe"%ei/e and li/e it

50 #lyssa wants to lea"n mo"e abo$t e-pe"imental design Hhi%h is the p$"pose of this "esea"%hQ
# !est the %a$se and effe%t "elationship among the /a"iable $nde" a %ont"olled sit$ation @ Identify the /a"iables in the st$dy C P"edi%ts the f$t$"e based on %$""ent inte"/ention ) )es%"ibe the %ha"a%te"isti%s& opinions& attit$des o" beha/io"s of %e"tain pop$lation abo$t a %$""ent iss$e o" e/ent #nswe": O#P !est the %a$se and effe%t "elationship among the /a"iable $nde" a %ont"olled sit$ation ,-pe"imental "esea"%h is a 'e/el III in/estigation whi%h dete"mines the %a$se and effe%t "elationship between

/a"iables 51 She 0nows that the"e a"e th"ee elements of e-pe"imental "esea"%h Hhi%h is *O! in%l$dedQ
# @ C ) <anip$lation 1andomi(ation Cont"ol !"ial

#nswe": O)P !"ial !"ial is not an element of e-pe"imental "esea"%h <anip$lation of /a"iables& "andomi(ation and %ont"ol a"e the th"ee elements of this type of "esea"%h

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52 #lyssa 0nows that the"e a"e times when only manip$lation of st$dy /a"iables is possible and the elements of
%ont"ol o" "andomi(ation a"e not attendant Hhi%h type of "esea"%h is "efe""ed to thisQ # Field st$dy @ >$asi=e-pe"iment C Solomon=Fo$" g"o$p design ) Post=test only design #nswe": O@P >$asi=e-pe"iment >$asi=e-pe"iment is done when "andomi(ation and %ont"ol of the /a"iables a"e not possible

5+ One of the "elated st$dies that she "eads is a phenomenologi%al "esea"%h Hhi%h of the following 6$estions is
answe"ed by this type of 6$alitati/e "esea"%hQ # T Hhat is the way of life of this %$lt$"al g"o$pQT @ SHhat is the effe%t of the inte"/ention to the dependent /a"iableQT C SHhat the essen%e of the phenomenon is as e-pe"ien%ed by these peopleQT ) SHhat is the %o"e %atego"y that is %ent"al in e-plaining what is going on in that so%ial s%eneQT #nswe": OCP SHhat the essen%e of the phenomenon is as e-pe"ien%ed by these peopleQT Phenomenologi%al "esea"%h deals with the meaning of e-pe"ien%es as those who e-pe"ien%ed the phenomenon $nde"stand it

5. Othe" st$dies a"e %atego"i(ed a%%o"ding to the time f"ame Hhi%h of the following "efe"s to a st$dy of
/a"iables in the p"esent whi%h is lin0ed to a /a"iable that o%%$""ed in the pastQ # P"ospe%ti/e design @ 1et"ospe%ti/e design C C"oss se%tional st$dy ) 'ongit$dinal st$dy #nswe": O@P 1et"ospe%ti/e design 1et"ospe%ti/e st$dies a"e done in o"de" to establish a %o""elation between p"esent /a"iables and the ante%edent fa%to"s that ha/e %a$sed it

52 Sit$ation : ?a""y a new "esea"%h staff of the 1esea"%h and )e/elopment )epa"tment of a te"tia"y hospital is
tas0ed to %ond$%t a "esea"%h st$dy abo$t the in%"eased in%iden%e of noso%omial infe%tion in the hospital Hhi%h of the following ethi%al iss$es sho$ld he %onside" in the %ond$%t of his st$dyQ 1 Confidentiality of info"mation gi/en to him by the s$bEe%ts 2 Self=dete"mination whi%h in%l$des the "ight to withd"aw f"om the st$dy g"o$p + P"i/a%y o" the "ight not to be e-posed p$bli%ly . F$ll dis%los$"e abo$t the st$dy to be %ond$%ted # 1& 2& + @ 1& +& . C 2& +& . ) 1& 2& +& . #nswe": O)P 1& 2& +& . !his in%l$des all the options as these a"e the fo$" basi% "ights of s$bEe%ts fo" "esea"%h

55 Hhi%h of the following is the best tool fo" data gathe"ingQ


# @ C ) Inte"/iew s%hed$le >$estionnai"e Use of labo"ato"y data Obse"/ation

#nswe": OCP Use of labo"ato"y data In%iden%e of noso%omial infe%tion is best %olle%ted th"o$gh the $se of biophysiologi% meas$"es& pa"ti%$la"ly in /it"o meas$"ements& hen%e labo"ato"y data is essential

58 )$"ing data %olle%tion& ?a""y en%o$nte"s a patient who "ef$ses to tal0 to him Hhi%h of the following is a
limitation of the st$dyQ # PatientKs "ef$sal to f$lly di/$lge info"mation @ Patients with histo"y of fe/e" and %o$gh C Patients admitted o" who see0s %ons$ltation at the ,1 and do%to"s offi%es

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) Conta%ts of patients with histo"y of fe/e" and %o$gh #nswe": O#P PatientKs "ef$sal to f$lly di/$lge info"mation PatientKs "ef$sal to di/$lge info"mation is a limitation be%a$se it is beyond the %ont"ol of ?a""y

59 Hhat type of "esea"%h is app"op"iate fo" this st$dyQ


# @ C ) )es%"ipti/e= %o""elational ,-pe"iment >$asi=e-pe"iment ?isto"i%al

#nswe": O#P )es%"ipti/e= %o""elational )es%"ipti/e= %o""elational st$dy is the most app"op"iate fo" this st$dy be%a$se it st$dies the /a"iables that %o$ld be the ante%edents of the in%"eased in%iden%e of noso%omial infe%tion

59 In the statement& SF"e6$ent hand washing of health wo"0e"s de%"eases the in%iden%e of noso%omial infe%tions
among post=s$"ge"y patientsT& the dependent /a"iable is # in%iden%e of noso%omial infe%tions @ de%"eases C f"e6$ent hand washing ) post=s$"ge"y patients #nswe": O#P in%iden%e of noso%omial infe%tions !he dependent /a"iable is the in%iden%e of noso%omial infe%tion& whi%h is the o$t%ome o" effe%t of the independent /a"iable& f"e6$ent hand washing

80 ?a""y 0nows that he has to p"ote%t the "ights of h$man "esea"%h s$bEe%ts Hhi%h of the following a%tions of
?a""y ens$"es anonymityQ # :eep the identities of the s$bEe%t se%"et @ Obtain info"med %onsent C P"o/ide e6$al t"eatment to all the s$bEe%ts of the st$dy ) 1elease findings only to the pa"ti%ipants of the st$dy #nswe": O#P :eep the identities of the s$bEe%t se%"et :eeping the identities of the "esea"%h s$bEe%t se%"et will ens$"e anonymity be%a$se this will hinde" p"o/iding lin0 between the info"mation gi/en to whoe/e" is its so$"%e

81 ?e is o"iented to the $se of ele%t"oni% databases fo" n$"sing "esea"%h Hhi%h of the following will she li0ely
a%%essQ # <,)'I*, @ *ational Instit$te of *$"sing 1esea"%h C #me"i%an Bo$"nal of *$"sing ) Inte"national Co$n%il of *$"ses #nswe": O@P *ational Instit$te of *$"sing 1esea"%h *ational Instit$te fo" *$"sing 1esea"%h is a $sef$l so$"%e of info"mation fo" n$"sing "esea"%h !he "est of the options may be helpf$l b$t *I*1 is the most $sef$l site fo" n$"ses

82 ?e de/elops methods fo" data gathe"ing Hhi%h of the following %"ite"ia of a good inst"$ment "efe"s to the
ability of the inst"$ment to yield the same "es$lts $pon its "epeated administ"ationQ # 7alidity @ Spe%ifi%ity C Sensiti/ity ) 1eliability #nswe": O)P 1eliability 1eliability is %onsisten%y of the "esea"%h inst"$ment It "efe"s to the "epeatability of the inst"$ment in e-t"a%ting the same "esponses $pon its "epeated administ"ation

8+ ?a""y is awa"e of the impo"tan%e of %ont"olling th"eats to inte"nal /alidity fo" e-pe"imental "esea"%h& whi%h
in%l$de the following e-amples ,;C,P!: # ?isto"y @ <at$"ation C #tt"ition

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) )esign #nswe": O)P )esign )esign is not a th"eat to inte"nal /alidity of the inst"$ment E$st li0e the othe" options

8. ?is %olleag$e as0s abo$t the e-te"nal /alidity of the "esea"%h findings Hhi%h of the "esponses of ?a""y is
app"op"iateQ !he "esea"%h findings %an be # gene"ali(ed to othe" settings o" samples @ shown to "es$lt only f"om the effe%t of the independent /a"iable C "efle%ted as "es$lts of e-t"aneo$s /a"iables ) f"ee of sele%tion biases #nswe": O#P gene"ali(ed to othe" settings o" samples ,-te"nal /alidity "efe"s to the gene"ali(ability of "esea"%h findings to othe" settings o" samples !his is an iss$e of impo"tan%e to e/iden%e=based n$"sing p"a%ti%e

NURSING RESEARCH Part 2


Sit0ati#$ 1E Ao$ a"e fo"t$nate to be %hosen as pa"t of the "esea"%h team in the hospital # "e/iew of the following I<PO1!#*! n$"sing %on%epts was made:

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1 # p"ofessional n$"se %an do "esea"%h fo" /a"ied "easons e-%ept: a b % d P"ofessional ad/an%ement th"o$gh "esea"%h pa"ti%ipation !o /alidate "es$lts of new n$"sing modalities Fo" finan%ial gains !o imp"o/e n$"sing %a"e

a b % d

<ode 7a"ian%e Standa"d de/iation 1ange

9 In the /al$es: 98& 92& 99& 92& 90& what is the meanQ a b % d 99 2 99 . 98 90

2 ,a%h n$"se pa"ti%ipant was as0ed to identify a p"oblem #fte" the identifi%ation of the "esea"%h p"oblem& whi%h of the following sho$ld be doneQ a b % d <ethodology 1e/iew of "elated lite"at$"e #%0nowledgement Fo"m$late hypothesis

9 In the /al$es: 90& 90& 90& 92& 92& 90& 90& 100& what is the modeQ a b % d 90 92 90 92 2

+ Hhi%h of the following %omm$ni%ate the "es$lts of the "esea"%h to the "eade"s !hey fa%ilitate the des%"iption of the data a b % d ?ypothesis Statisti%s 1esea"%h p"oblem !ables and g"aphs

10 In the /al$es: 90& 90& 10& 10& 22& 52& 100& 200& what is the medianQ a b % d 81 22 22 2 10 and 22 82 2

. In 6$antitati/e data& whi%h of the following is des%"ibed as the distan%e in the s%o"ing $nits of the /a"iable f"om the highest to the lowe"Q a b % d F"e6$en%y <ean <edian 1ange

11 )"aw lots& lotte"y& table of "andom n$mbe"s o" a sampling that ens$"es that ea%h element of the pop$lation has an e6$al and independent %han%e of being %hosen is %alled: a b % d Cl$ste" Simple St"atified Systemati%

2 !his e-p"esses the /a"iability of the data in "efe"en%e to the mean It p"o/ides as with a n$me"i%al estimate of how fa"& on the a/e"age the sepa"ate obse"/ation a"e f"om the mean: a b % d <ode Standa"d de/iation <edian F"e6$en%y

12 #n in/estigato" wants to dete"mine some of the p"oblems e-pe"ien%ed by diabeti% %lients when $sing ins$lin p$mp !he in/estigato" went to a %lini% whe"e he pe"sonally 0nows se/e"al diabeti% %lients ha/ing p"oblem with ins$lin p$mp !he type of sampling done by the in/estigato" is %alled: a b % d P"obability P$"posi/e Snowball In%idental

Sit0ati#$ 2E S$"/ey and statisti%s a"e impo"tant pa"t if "esea"%h that is ne%essa"y to e-plain the %ha"a%te"isti%s of the pop$lation 5 #%%o"ding to H?O statisti%s on the homeless pop$lation a"o$nd the wo"ld& whi%h of the following g"o$ps of people in the wo"ld disp"opo"tionately "ep"esents the homeless pop$lationQ a b % d ?ispani%s #sians #f"i%an #me"i%ans Ca$%asians

1+ If the "esea"%he" implemented a new st"$%t$"ed %o$nseling p"og"am with a "andomi(ed g"o$p of s$bEe%t and a "o$tine %o$nseling p"og"am with anothe" "andomi(ed g"o$p of s$bEe%t& the "esea"%h is $tili(ing whi%h designQ a b % d >$asi e-pe"imental ,-pe"imental Compa"ati/e <ethodologi%al

8 #ll b$t one of the following in not a meas$"e of %ent"al tenden%y:

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1. Hhi%h of the following is not t"$e abo$t a p$"e e-pe"imental "esea"%hQ a b % d !he"e is a %ont"ol g"o$p !he"e is an e-pe"imental g"o$p Sele%tion of s$bEe%ts in the %ont"ol g"o$p is "andomi(ed !he"e is a %a"ef$l sele%tion of s$bEe%ts in the e-pe"imental g"o$p

19 Ao$ wo$ld li0e to %ompa"e the s$ppo"t system of patients with %h"oni% illness to those with a%$te illness Conside"ing that the hypothesis was: SClients with %h"oni% illness ha/e lesse" s$ppo"t system than %lients with a%$te illness T Hhat type of "esea"%h is thisQ a b % d )es%"ipti/e Co""elational& non e-pe"imental ,-pe"imental >$asi e-pe"imental

12 !he "esea"%he" implemented a medi%ation "egimen $sing a new type of %ombination d"$gs to mani% patients while anothe" g"o$p of mani% patients "e%ei/es the "o$tine d"$gs !he "esea"%he" howe/e" handpi%0ed the e-pe"imental g"o$p fo" they a"e the %lients with m$ltiple episodes if bipola" diso"de" !he "esea"%he" $tili(ed whi%h "esea"%h designQ a b % d >$asi e-pe"imental P$"e e-pe"imental Phenomenologi%al 'ongit$dinal

19 In any "esea"%h st$dy whe"e indi/id$al pe"sons a"e in/ol/ed& it is impo"tant that an info"med %onsent of the st$dy is obtained !he following a"e essential info"mation abo$t the %onsent that yo$ sho$ld dis%lose to the p"ospe%ti/e s$bEe%ts e-%ept: a b % d Consent to in%omplete dis%los$"e )es%"iption of benefits& "is0s& and dis%omfo"ts ,-planation of p"o%ed$"e #ss$"an%e of anonymity and %onfidentiality

Sit0ati#$ 3E #s a n$"se& yo$ a"e e-pe%ted to pa"ti%ipate in initiating o" pa"ti%ipating in the %ond$%t of "esea"%h st$dies to imp"o/e n$"sing p"a%ti%e Ao$ ha/e to be $pdated on the latest t"ends and iss$es affe%ting the p"ofession and the best p"a%ti%es a""i/ed at by the p"ofession 15 Ao$ a"e inte"ested to st$dy the effe%ts of mediation and "ela-ation on the pain e-pe"ien%ed by %an%e" patients Hhat type of /a"iable is painQ a b % d )ependent Co""elational Independent )emog"aphi%

20 In the hypothesis: S!he $tili(ation of te%hnology in tea%hing imp"o/es the "etention and attention of the n$"sing st$dents&T whi%h is the dependent /a"iableQ a b % d Utili(ation of te%hnology Imp"o/ement in the "etention and attention *$"sing st$dents !ea%hing

Sit0ati#$ 4E Ao$ a"e an a%ti/ely p"a%ti%ing n$"se who has E$st finished yo$" g"ad$ate st$dies Ao$ lea"ned the /al$e of "esea"%h and wo$ld li0e to $tili(e the 0nowledge and s0ills gained in the appli%ation of "esea"%h to the n$"sing se"/i%e !he following 6$estions apply to "esea"%h 21 Hhi%h type of "esea"%h in6$i"y in/estigates the iss$es of h$man %omple-ity Oe g $nde"standing the h$man e-pe"tisePQ a b % d 'ogi%al position *at$"alisti% in6$i"y Positi/ism >$antitati/e 1esea"%h

18 Ao$ wo$ld li0e to %ompa"e the s$ppo"t system of patient with %h"oni% illness and those with a%$te illness ?ow will yo$ best state yo$" p"oblemQ a # des%"ipti/e st$dy to %ompa"e the s$ppo"t systems of patients with %h"oni% illness and those with a%$te illness in te"ms of demog"aphi% data and 0nowledge abo$t inte"/ention !he effe%ts of the types of s$ppo"t system of patients with %h"oni% illness and those with a%$te illness # %ompa"ati/e analysis of the s$ppo"t system of patients with %h"oni% illness and those with a%$te illness # st$dy to %ompa"e the s$ppo"t system of patients with %h"oni% illness and those with a%$te illness Hhat a"e the diffe"en%es of the s$ppo"t system being "e%ei/ed by patient with %h"oni% illness and patients with a%$te illnessQ

b % d e

22 Hhi%h of the following st$dies is based on 6$antitati/e "esea"%hQ a b % d # st$dy e-amining the be"ea/ement p"o%ess in spo$ses of %lients with te"minal %an%e" # st$dy e-plo"ing fa%to"s infl$en%ing weight %ont"ol beha/io" # st$dy meas$"ing the effe%ts of sleep dep"i/ation on wo$nd healing # st$dy e-amining %lientKs feeling befo"e& d$"ing and afte" a bone ma""ow aspi"ation

2+ Hhi%h of the following st$dies is based on 6$alitati/e "esea"%hQ

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a b % d

# st$dy e-amining %lients "ea%tions to st"ess afte" open hea"t s$"ge"y # st$dy meas$"ing n$t"ition and weight lossGgain in %lients with %an%e" # st$dy e-amining o-ygen le/els afte" endot"a%heal s$%tioning # st$dy meas$"ing diffe"en%es in blood p"ess$"e befo"e& d$"ing and afte" a p"o%ed$"e

a b % d

Compa"ati/e Co""elational ,-pe"imental >$alitati/e

29 Faye "esea"%hed in the de/elopment of a new way to meas$"e intelligen%e by %"eating a 100=item 6$estionnai"e that will assess the %ogniti/e s0ills of an indi/id$al !he design best s$ited fo" this st$dy is: a b % d ?isto"i%al <ethodologi%al S$"/ey Case st$dy

2. #n 92 yea" old %lient in a n$"sing home tells a n$"se& SI signed the pape"s fo" that "esea"%h st$dy be%a$se the do%to" was so insistent and I want him to %ontin$e ta0ing %a"e of meT Hhi%h %lient "ight is being /iolatedQ a b % d 1ight of self dete"mination 1ight to p"i/a%y and %onfidentiality 1ight to f$ll dis%los$"e 1ight not to be ha"med

+0 Bay ,mman$elle is %ond$%ting a "esea"%h st$dy on how 1alph& an #I)S %lient li/es his life # design s$ited fo" this is: a b % d ?isto"i%al Case st$dy Phenomenologi%al ,thnog"aphi%

22 S# s$pposition o" system of ideas that is p"oposed to e-plain a gi/en phenomenonT& best defines: a b % d # pa"adigm # %on%ept # theo"y # %on%ept$al f"amewo"0

+1 <ae%ee is to pe"fo"m a st$dy abo$t how n$"ses pe"fo"m s$"gi%al asepsis d$"ing Ho"ld Ha" II # design best fo" this st$dy is: a b % d ?isto"i%al Case st$dy Phenomenologi%al ,thnog"aphi%

Sit0ati#$ 5E <aste"y of "esea"%h design dete"mination is essential in passing the *', 25 <onette wants to 0now if the length of time she will st$dy fo" the boa"d e-amination is p"opo"tional to he" boa"d "ating )$"ing the )e%embe" 2008 boa"d e-amination& she st$died fo" si- months and gained 59V On B$ne 2009 boa"d e-am& she st$died fo" 5 months again fo" a total of one yea" and gained 8.V On *o/embe" 2009& she st$died fo" 5 months fo" a total of one and a half yea" and gained 92V !he "esea"%h design she $sed is: a b % d Compa"ati/e Co""elational ,-pe"imental >$alitati/e

+2 <edel %ond$%ts sampling at @a"angay <aligaya ?e %olle%ted 100 "andom indi/id$als and dete"mine who is thei" fa/o"ite a%to" 20V said Piolo& 20V said Bohn 'loyd& while some answe"ed Sam& )ingdong& 1i%ha"d& and )e"e0 <edel %ond$%ted what type of "esea"%h st$dyQ a b % d Phenomenologi%al Case st$dy *on e-pe"imental S$"/ey

28 1od"igo was always eating high fat diet Ao$ want to dete"mine if what will be the effe%t of high %holeste"ol food to 1od"igo in the ne-t 10 yea"s Ao$ will $se: a b % d Compa"ati/e Co""elational ?isto"i%al 'ongit$dinal

++ <a"0 and !obe"ts /isited a t"ibe lo%ated somewhe"e in China& it is %alled Shin Bea t"ibe !hey st$died the way of life& t"adition& and the so%ietal st"$%t$"e of these people !hey will best $se whi%h "esea"%h designQ a b % d ?isto"i%al Case st$dy Phenomenologi%al ,thnog"aphi%

29 Comm$nity # was sele%ted "andomly as well as Comm$nity @& n$"se C"ystal %ond$%ted tea%hing to Comm$nity # and assessed if Comm$nity # will ha/e a bette" stat$s than Comm$nity @ !his is an e-ample of:

+. Be((a and Benny "esea"%hed abo$t !@ X its t"ansmission& %a$sati/e agent and fa%to"s& t"eatment& signs and symptoms& as well as medi%ation and all othe" in=depth info"mation abo$t t$be"%$losis !his st$dy is best s$ited fo" whi%h "esea"%h designQ a ?isto"i%al

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b % d

Case st$dy Phenomenologi%al ,thnog"aphi%

+8 Hhi%h of the following $s$ally "efe"s to the independent /a"iables in doing "esea"%hQ a b % d 1es$lt Ca$se O$tp$t ,ffe%t

&'# )iana& #"lene& and Sally a"e to %ond$%t a st$dy abo$t "elationship of the n$mbe" of family membe"s in the ho$sehold and the ele%t"i%ity bill& whi%h of the following is the best "esea"%h design s$ited fo" this st$dyQ 1 2 + . 2 5 a b % d e )es%"ipti/e ,-plo"ato"y ,-planato"y Co""elational Compa"ati/e ,-pe"imental 1 and . 2 and 2 + and 5 1 and 2 2 and .

+9 !he "e%ipients of e-pe"imental t"eatment in an e-pe"imental design o" the indi/id$als to be obse"/ed in a non=e-pe"imental design a"e %alled: a b % d Setting S$bEe%ts !"eatment Sample

+9 !he de/i%e o" te%hni6$es that 7in( employs to %olle%t data is %alled: a b % d Sample Inst"$ment ?ypothesis Con%ept

Sit0ati#$ ;E #s a n$"se "esea"%he"& 7in( m$st ha/e a /e"y good $nde"standing of the %ommon te"ms of %on%ept $sed in "esea"%h +5 !he info"mation that an in/estigato" li0e 7in( %olle%ts f"om the s$bEe%ts o" pa"ti%ipants in a "esea"%h st$dy is $s$ally %alled: a b % d ?ypothesis )ata 7a"iable Con%ept

.0 !he $se of anothe" pe"sonKs ideas o" wo"dings witho$t gi/ing app"op"iate %"edit "es$lts f"om ina%%$"ate o" in%omplete att"ib$tion of mate"ials to its "eso$"%es Hhi%h of the following is "efe""ed to when anothe" pe"sonKs idea is inapp"op"iately %"edited as oneKs ownQ a b % d Plagia"ism >$otation #ss$mption Pa"aph"ase

Suggested Answer ey C@))@ @#@#) @@@)# #,##@ @C##C @)C@C #))@) @@@@#

COMPREHENSIVE EXAMINATION Part 1


1 # woman in a %hild bea"ing age "e%ei/es a "$bella /a%%ination *$"se Boy wo$ld gi/e he" whi%h of the following inst"$%tionsQ

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a 1ef"ain f"om eating eggs o" egg p"od$%ts fo" 2. ho$"s b #/oid ha/ing se-$al inte"%o$"se % )onKt get p"egnant at least + months d #/oid e-pos$"e to s$n 2 Bonas who is diagnosed with en%ephalitis is $nde" the t"eatment of <annitol Hhi%h of the following patient o$t%omes indi%ate to *$"se 1onald that the t"eatment of <annitol has been effe%ti/e fo" a patient that has in%"eased int"a%"anial p"ess$"eQ a In%"eased $"ina"y o$tp$t b )e%"eased 11 % Slowed papilla"y "esponse d )e%"eased le/el of %ons%io$sness + <a"y as0ed *$"se <a$"een abo$t the in%$bation pe"iod of "abies Hhi%h statement by the *$"se <a$"een is app"op"iateQ a In%$bation pe"iod is 5 months b In%$bation pe"iod is 1 wee0 % In%$bation pe"iod is 1 month d In%$bation pe"iod /a"ies depending on the site of the bite . Hhi%h of the following sho$ld *$"se Che""y do fi"st in ta0ing %a"e of a male %lient with "abiesQ a ,n%o$"age the patient to ta0e a bath b Co/e" I7 bottle with b"own pape" bag % Pla%e the patient nea" the %omfo"t "oom d Pla%e the patient nea" the doo" 2 Hhi%h of the following is the s%"eening test fo" deng$e hemo""hagi% fe/e"Q a Complete blood %o$nt b ,'IS# % 1$mpel=leeds test d Sedimentation "ate 5 <" )ela 1osa is s$spe%ted to ha/e mala"ia afte" a b$siness t"ip in Palawan !he most impo"tant diagnosti% test in mala"ia is: a H@C %o$nt b U"inalysis % ,'IS# d Pe"iphe"al blood smea" 8 !he *$"se s$pe"/iso" is planning fo" patientKs assignment fo" the #< shift !he n$"se s$pe"/iso" a/oids assigning whi%h of the following staff membe"s to a %lient with he"pes (oste"Q a *$"se who ne/e" had %hi%0en pob *$"se who ne/e" had "oseola % *$"se who ne/e" had ge"man measles d *$"se who ne/e" had m$mps 9 Cla"issa is 8 wee0s p"egnant F$"the" e-amination "e/ealed that she is s$s%eptible to "$bella Hhen wo$ld be the most app"op"iate fo" he" to "e%ei/e "$bella imm$ni(ationQ a #t on%e b )$"ing 2nd t"imeste" % )$"ing +"d t"imeste" d #fte" the deli/e"y of the baby 9 # female %hild with "$bella sho$ld be isolated f"om a: a 21 yea" old male %o$sin li/ing in the same ho$se b 19 yea" old siste" who "e%ently got ma""ied % 11 yea" old siste" who had "$beola d$"ing %hildhood d . yea" old gi"l who li/es ne-t doo" 10 Hhat is the p"ima"y p"e/ention of lep"osyQ a *$t"ition b 7itamins % @CD /a%%ination d )P! /a%%ination 11 # ba%te"ia whi%h %a$ses diphthe"ia is also 0nown asQ a #moeba b Chole"a % :lebs=loeffle" ba%ill$s d Spi"o%hete 12 *$"se 1on pe"fo"med manto$- s0in test today O<ondayP to a male ad$lt %lient Hhi%h statement by the %lient indi%ates that he $nde"stood the inst"$%tion wellQ a I will %ome ba%0 late" b I will %ome ba%0 ne-t month % I will %ome ba%0 on F"iday

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d I will %ome ba%0 on Hednesday& same time& to "ead the "es$lt 1+ # male %lient had $nde"gone <anto$- s0in test *$"se 1onald notes an 9mm a"ea of ind$"ations at the site of the s0in test !he n$"se inte"p"ets the "es$lt as: a *egati/e b Un%e"tain and needs to be "epeated % Positi/e d In%on%l$si/e 1. !ony will sta"t a 5 month the"apy with Isonia(id OI*?P *$"se !"ish plans to tea%h the %lient to: a Use al%ohol mode"ately b #/oid /itamin s$pplements while o the"apy % In%omplete inta0e of dai"y p"od$%ts d <ay be dis%ontin$ed if symptoms s$bsides 12 Hhi%h is the p"ima"y %ha"a%te"isti% lesion of syphilisQ a So"e eyes b So"e th"oat % Chan%"oid d Chan%"e 15 Hhat is the fast b"eathing of Bana who is + wee0s oldQ a 50 b"eaths pe" min$te b .0 b"eaths pe" min$te % 10 b"eaths pe" min$te d 20 b"eaths pe" min$te 18 Hhi%h of the following signs and symptoms indi%ate some dehyd"ationQ a )"in0s eage"ly b 1estless and i""itable % Un%ons%io$s d # and @ 19 Hhat is the fi"st line fo" dysente"yQ a #mo-i%illin b !et"a%y%line % Cefale-in d Co=t"imo-a(ole 19 In home made o"esol& what is the "atio of salt and s$ga" if yo$ want to p"epa"e with 1 lite" of wate"Q a 1 tbsp salt and 9 tbsp s$ga" b 1 tbsp salt and 9 tsp s$ga" % 1 tsp salt and 9 tsp s$ga" d 9 tsp salt and 9 tsp s$ga" 20 Dentian 7iolet is $sed fo": a Ho$nd b Umbili%al infe%tions % ,a" infe%tions d @$"n 21 Hhi%h of the following is a li/e atten$ated ba%te"ial /a%%ineQ a @CD b OP7 % <easles d *one of the abo/e 22 ,PI is based onQ a @asi% health se"/i%es b S%ope of %omm$nity affe%ted % ,pidemiologi%al sit$ation d 1esea"%h st$dies 2+ !!+ p"o/ides how many pe"%entage of p"ote%tion against tetan$sQ a 100 b 99 % 90 d 90 2. !empe"at$"e of "ef"ige"ato" to maintain poten%y of measles and OP7 /a%%ine is: a =2 0C to =9 0C b =12 0C to =22 0C % I12 0C to I22 0C d I2 0C to I9 0C 22 )ipthe"ia /a%%ine is a: a @a%te"ial to-in b :illed ba%te"ia

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% 'i/e atten$ated d Plasma de"i/ati/es 25 @$dgeting is $nde" in whi%h pa"t of management p"o%essQ a )i"e%ting b Cont"olling % O"gani(ing d Planning 28 !ime table showing planned wo"0 days and shifts of n$"sing pe"sonnel is: a Staffing b S%hed$le % S%hed$ling d Planning 29 # fo"%e within an indi/id$al that infl$en%es the st"ength of beha/io"Q a <oti/ation b ,n/y % 1ewa"d d Self=esteem 29 S!o be the leading hospital in the PhilippinesT is best ill$st"ate in: a <ission b Philosophy % 7ision d ObEe%ti/e +0 It is the p"ofessionally desi"ed no"ms against whi%h a staff pe"fo"man%e will be %ompa"edQ a Bob des%"iptions b S$"/ey % Flow %ha"t d Standa"ds +1 1ep"imanding a staff n$"se fo" wo"0 that is done in%o""e%tly is an e-ample of what type of "einfo"%ementQ a Feedba%0 b Positi/e "einfo"%ement % Pe"fo"man%e app"aisal d *egati/e "einfo"%ement +2 >$estions that a"e answe"able only by %hoosing an option f"om a set of gi/en alte"nati/es a"e 0nown asQ a S$"/ey b Close ended % >$estionnai"e d )emog"aphi% ++ # "esea"%he" that ma0es a gene"ali(ation based on obse"/ations of an indi/id$alKs beha/io" is said to be whi%h type of "easoning: a Ind$%ti/e b 'ogi%al % Illogi%al d )ed$%ti/e +. !he balan%e of a "esea"%hKs benefit /s its "is0s to the s$bEe%t is: a #nalysis b 1is0=benefit "atio % Pe"%entile d <a-im$m "is0 +2 #n indi/id$alGobEe%t that belongs to a gene"al pop$lation is aGan: a ,lement b S$bEe%t % 1espondent d #$tho" +5 #n ill$st"ation that shows how the membe"s of an o"gani(ation a"e %onne%ted: a Flow%ha"t b @a" g"aph % O"gani(ational %ha"t d 'ine g"aph +8 !he fi"st %ollege of n$"sing that was established in the Philippines is: a Fatima Uni/e"sity b Fa" ,aste"n Uni/e"sity % Uni/e"sity of the ,ast d Uni/e"sity of Sto !omas

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+9 Flo"en%e nightingale is bo"n on: a F"an%e b @"itain % US d Italy +9 ObEe%ti/e data is also %alled: a Co/e"t b O/e"t % Infe"en%e d ,/al$ation .0 #n e-ample of s$bEe%ti/e data is: a Si(e of wo$nds b 7S % 'etha"gy d !he statement of patient S<y hand is painf$lT .1 Hhat is the best position in palpating the b"eastQ a !"endelenb$"g b Side lying % S$pine d 'ithotomy .2 Hhen is the best time in pe"fo"ming b"east self e-aminationQ a 8 days afte" menst"$al pe"iod b 8 days befo"e menst"$al pe"iod % 2 days afte" menst"$al pe"iod d 2 days befo"e menst"$al pe"iod .+ Hhi%h of the following sho$ld be gi/en the highest p"io"ity befo"e pe"fo"ming physi%al e-amination to a patientQ a P"epa"ation of the "oom b P"epa"ation of the patient % P"epa"ation of the n$"se d P"epa"ation of en/i"onment .. It is a flip o/e" %a"d $s$ally 0ept in po"table file at n$"sing station a *$"sing %a"e plan b <edi%ine and t"eatment "e%o"d % :a"ded !P1 sheet .2 Bose has $nde"gone tho"a%entesis !he n$"se in %ha"ge is awa"e that the best position fo" Bose is: a Semi fowle"s b 'ow fowle"s % Side lying& $naffe%ted side d Side lying& affe%ted side .5 !he deg"ee of patients abdominal distension may be dete"mined by: a #$s%$ltation b Palpation % Inspe%tion d Pe"%$ssion .8 # male %lient is addi%ted with hall$%inogen Hhi%h physiologi% effe%t sho$ld the n$"se e-pe%tQ a @"adyp"ea b @"ady%a"dia % Const"i%ted p$pils d )ilated p$pils .9 !"istan a . yea" old boy has s$ffe"ed f"om f$ll thi%0ness b$"ns of the fa%e& %hest and ne%0 Hhat will be the p"io"ity n$"sing diagnosisQ a Ineffe%ti/e ai"way %lea"an%e "elated to edema b Impai"ed mobility "elated to pain % Impai"ed $"ina"y elimination "elated to fl$id loss d 1is0 fo" infe%tion "elated to epide"mal dis"$ption .9 In assessing a %lientKs in%ision 1 day afte" the s$"ge"y& *$"se @etty e-pe%t to see whi%h of the following as signs of a lo%al inflammato"y "esponseQ a D"eenish dis%ha"ge b @"own e-$dates at in%ision edges % Pallo" a"o$nd s$t$"es d 1edness and wa"mth 20 *$"se 1onald is awa"e that the amioti% fl$id in the thi"d t"imeste" weighs app"o-imately: a 2 0ilog"ams

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b 1 0ilog"ams % 100 g"ams d 1 2 0ilog"ams 21 #fte" deli/e"y of a baby gi"l *$"se Dina e-amines the $mbili%al %o"d and e-pe%ts to find a %o"d to: a !wo a"te"ies and two /eins b One a"te"y and one /ein % !wo a"te"ies and one /ein d One a"te"y and two /eins 22 <y"na a p"egnant %lient "epo"ts that he" last menst"$al %y%le is B$ly 11& he" e-pe%ted date of bi"th is a *o/embe" . b *o/embe" 11 % #p"il . d #p"il 19 2+ Hhi%h of the following is $#t a good so$"%e of i"onQ a @$tte" b Pe%hay % D"ains d @eef 2. <a$"een is admitted with a diagnosis of e%topi% p"egnan%y Hhi%h of the following wo$ld yo$ anti%ipateQ a *PO b @ed "est % Immediate s$"ge"y d ,nema 22 Dina a postpa"t$m %lient is diagnosed with endomet"itis Hhi%h position wo$ld yo$ e-pe%t to pla%e he" based on this diagnosisQ a S$pine b 'eft side lying % !"endelinb$"g d Semi=fowle"s 25 *$"se ?a(el 0nows that <y"na $nde"stands he" %ondition well when she "ema"0s that $"ina"y f"e6$en%y is %a$sed by: a P"ess$"e %a$sed by the as%ending $te"$s b Hate" inta0e of +' a day % ,ffe%t of %old weathe" d In%"ease inta0e of f"$its and /egetables 28 ?ow many ml of blood is loss d$"ing the fi"st 2. ho$"s post deli/e"y of <y"naQ a 100 b 200 % 200 d .00 29 Hhi%h of the following ho"mones stim$lates the se%"etion of mil0Q a P"ogeste"one b P"ola%tin % O-yto%in d ,st"ogen 29 *$"se Ca"la is awa"e that <ylaKs se%ond stage of labo" is beginning when the following assessment is noted: a @ay of wate" is b"o0en b Cont"a%tions a"e "eg$la" % Ce"/i- is %ompletely dilated d P"esen%e of bloody show 50 !he lea0ing fl$id is tested with nit"a(ine pape" *$"se :elly %onfi"ms that the %lientKs memb"ane ha/e "$pt$"es when the pape" t$"ns into a: a Pin0 b 7iolet % D"een d @l$e 51 #fte" amniotomy& the p"io"ity n$"sing a%tion is: a )o%$ment the %olo" and %onsisten%y of amnioti% fl$id b 'isten the fetal hea"t tone % Position the mothe" in he" left side d 'et the mothe" "est 52 Hhi%h is the most f"e6$ent "eason fo" postpa"t$m hemo""hageQ a Pe"ineal la%e"ations

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b F"e6$ent inte"nal e-amination OI,P % CS d Ute"ine atomy 5+ On 2nd postpa"t$m day& whi%h height wo$ld yo$ e-pe%t to find the f$nd$s in a woman who has had a %aesa"ian bi"thQ a 1 finge" abo/e $mbili%$s b 2 finge"s abo/e $mbili%$s % 2 finge"s below $mbili%$s d 1 finge" below $mbili%$s 5. Hhi%h of the following %"ite"ia allows *$"se :"is to pe"fo"m home deli/e"iesQ a *o"mal findings d$"ing assessment b P"e/io$s CS % )iabetes histo"y d ?ype"tensi/e histo"y 52 *$"se Ca"la is awa"e that one of the following /a%%ines is done by int"am$s%$la" OI<P inEe%tionQ a <easles b OP7 % @CD d !etan$s to-oid 55 #sin law is on whi%h legal basis: a 1# 9950 b 1# 2888 % 1I 9182 d 11 5510 58 *$"se Bohn is awa"e that the he"bal medi%ine app"op"iate fo" $"olithiasis is: a #0ap$l%o b Sambong % !saang g$bat d @ayabas 59 Comm$nityGP$bli% health bag is defined as: a #n essential and indispensable e6$ipment of the %omm$nity health n$"se d$"ing home /isit b It %ontains d"$gs and e6$ipment $sed by the %omm$nity health n$"se % Is a "e6$i"ement in the health %ente" and fo" home /isit d It is a tool $sed by the %omm$nity health n$"se in "ende"ing effe%ti/e p"o%ed$"es d$"ing home /isit 59 !!. p"o/ides how many pe"%entage of p"ote%tion against tetan$sQ a 80 b 90 % 90 d 99 80 !hi"d postpa"t$m /isit m$st be done by p$bli% health n$"se: a Hithin 2. ho$"s afte" deli/e"y b #fte" 2=. wee0s % Hithin 1 wee0 d #fte" 2 months 81 *$"se Candy is awa"e that the family planning method that may gi/e 99V p"ote%tion to anothe" p"egnan%y to women a Pills b !$bal ligation % 'a%tational #meno""hea method O'#<P d IU) 82 Hhi%h of the following is not a pa"t of I<CI %ase management p"o%ess a Co$nsel the mothe" b Identify the illness % #ssess the %hild d !"eat the %hild 8+ If a yo$ng %hild has pne$monia when sho$ld the mothe" b"ing him ba%0 fo" follow $pQ a #fte" 2 days b In the afte"noon % #fte" . days d #fte" 2 days 8. It is the %e"tifi%ation "e%ognition p"og"am that de/elop and p"omotes standa"d fo" health fa%ilities: a Fo"m$la b !$to0 gam$tan % Sent"ong p"og"am mo/ement

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d Sent"ong sigla mo/ement 82 @aby <a"ie was bo"n <ay 2+& 199. *$"se Bohn will e-pe%t finge" th$mb opposition on: a #p"il 1992 b Feb"$a"y 1992 % <a"%h 1992 d B$ne 1992 85 @aby 1eese is a 12 month old %hild *$"se Oli/e" wo$ld anti%ipate how many teethQ a 9 b 8 % 9 d 5 88 Hhi%h of the following is the p"ima"y antidote fo" !ylenol poisoningQ a *a"%an b )igo-in % #%etyl%ysteine d Fl$ma(enil 89 # male %hild has an intelligen%e 6$otient of app"o-imately .0 Hhi%h 0ind of en/i"onment and inte"dis%iplina"y p"og"am most li0ely to benefit this %hild wo$ld be best des%"ibed as: a ?abit t"aining b Shelte"ed wo"0shop % C$stodial d ,d$%ational 89 *$"se B$dy is awa"e that following %ondition wo$ld "efle%t p"esen%e of %ongenital D I anomalyQ a Co"d p"olapse b Polyhyd"amios % Pla%enta p"e/ia d Oligohyd"amios 90 *$"se Ch"istine p"o/ides health tea%hing fo" the pa"ents of a %hild diagnosed with %elia% disease *$"se Ch"istine tea%hes the pa"ents to in%l$de whi%h of the following food items in the %hildKs diet: a 1ye toast b Oatmeal % Hhite b"ead d 1i%e 91 *$"se 1andy is planning to administe" o"al medi%ation to a + yea" old %hild *$"se 1andy is awa"e that the best way to p"o%eed is by: a SHo$ld yo$ li0e to d"in0 yo$" medi%ineQT b SIf yo$ ta0e yo$" medi%ine now& IKll gi/e yo$ lollipopT % SSee the othe" boy too0 his medi%ineQ *ow itKs yo$" t$"n T d S?e"eKs yo$" medi%ine Ho$ld yo$ li0e a mango o" o"ange E$i%eQT 92 #t what age a %hild %an b"$sh he" teeth witho$t helpQ a 5 yea"s b 8 yea"s % 2 yea"s d 9 yea"s 9+ 1ibi/a"in O7i"a(oleP is p"es%"ibed fo" a female hospitali(ed %hild with 1S7 *$"se B$dy p"epa"e this medi%ation /ia whi%h "o$teQ a Int"a /eno$s b O"al % O-ygen tent d S$b%$taneo$s 9. !he p"esent %hai"man of the @oa"d of *$"sing in the Philippines is: a <a"ia Boanna Ce"/antes b Ca"men%ita #ba6$in % 'eono" 1ose"o d P"imiti/a Pa6$i% 92 !he obligation to maintain effi%ient ethi%al standa"ds in the p"a%ti%e of n$"sing belong to this body: a @O* b #*S#P % P*# d 1* 95 # male n$"se was fo$nd g$ilty of negligen%e ?is li%ense was "e/o0ed 1e=iss$an%e of "e/o0ed %e"tifi%ates is afte" how many yea"sQ a 1 yea" b 2 yea"s % + yea"s

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d . yea"s 98 Hhi%h of the following info"mation %annot be seen in the P1C identifi%ation %a"dQ a 1egist"ation )ate b 'i%ense *$mbe" % )ate of #ppli%ation d Signat$"e of P1C %hai"pe"son 99 @"eastfeeding is being enfo"%ed by mil0 %ode o": a ,O 21 b 1 # 8500 % 1 # 5800 d P ) 995 99 Self go/e"nan%e& ability to %hoose o" %a""y o$t de%ision witho$t $nd$e p"ess$"e o" %oe"%ion f"om anyone: a 7e"a%ity b #$tonomy % Fidelity d @enefi%en%e 90 # male patient %omplained be%a$se his s%hed$led s$"ge"y was %an%elled be%a$se of ea"th6$a0e !he hospital pe"sonnel may be e-%$sed be%a$se of: a Do/e"nan%e b 1espondent s$pe"io" % Fo"%e maEe$"e d 1es ipsa lo6$ito" 91 @eing on time& meeting deadlines and %ompleting all s%hed$led d$ties is what /i"t$eQ a Fidelity b #$tonomy % 7e"a%ity d Confidentiality 92 !his 6$ality is being demonst"ated by *$"se 1on who "aises the side "ails of a %onf$sed and diso"iented patientQ a 1esponsibility b 1eso$"%ef$lness % #$tonomy d P"$den%e 9+ Hhi%h of the following is fo"mal %ontin$ing ed$%ationQ a Confe"en%e b ,n"ollment in g"ad$ate s%hool % 1ef"eshe" %o$"se d Semina" 9. !he @S* %$""i%$l$m p"epa"es the g"ad$ates to be%omeQ a *$"se gene"alist b *$"se spe%ialist % P"ima"y health n$"se d Clini%al inst"$%to" 92 )isposal of medi%al "e%o"ds in go/e"nment hospitalGinstit$tions m$st be done in %lose %oo"dination with what agen%yQ a )epa"tment of ?ealth b 1e%o"ds <anagement #"%hi/es Offi%e % <et"o <anila )e/elopment #$tho"ity d @$"ea$ of Inte"nal 1e/en$e 95 *$"se Bolina m$st see to it that the w"itten %onsent of mentally ill patients m$st be ta0en f"om: a *$"se b P"iest % Family lawye" d Pa"entsGlegal g$a"dians 98 Hhen *$"se Cla"en%e "espe%ts the %lientKs self=dis%los$"e& this is a ga$ge fo" the n$"sesK a 1espe%tf$lness b 'oyalty % !"$stwo"thiness d P"ofessionalism 99 !he *$"se is awa"e that the following tas0s %an be safely delegated by the n$"se to a non=n$"se health wo"0e" e-%ept: a !a0ing /ital signs b Change I7 inf$sions % !"ansfe""ing the %lient f"om bed to %hai"

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d I""igation of *D! 99 )$"ing the e/ening "o$nd *$"se !ina saw <" !o"alba meditating and afte"wa"ds sta"ted singing p"aye"f$l hymns Hhat wo$ld be the best "esponse of *$"se !inaQ a Call the attention of the %lient and en%o$"age to sleep b 1epo"t the in%iden%e to head n$"se % 1espe%t the %lientKs a%tion d )o%$ment the sit$ation 100 In %a"ing fo" a dying %lient& yo$ sho$ld pe"fo"m whi%h of the following a%ti/ities a )o not "es$s%itate b #ssist %lient to pe"fo"m #)' % ,n%o$"age to e-e"%ise d #ssist %lient towa"ds a pea%ef$l death 101 !he *$"se is awa"e that the ability to ente" into the life of anothe" pe"son and pe"%ei/e his %$""ent feelings and thei" meaning is 0nown: a @elongingness b Den$ineness % ,mpathy d 1espe%t 102 !he te"mination phase of the *P1 is best des%"ibed one of the following: a 1e/iew p"og"ess of the"apy and attainment of goals b ,-plo"ing the %lientKs tho$ghts& feelings and %on%e"ns % Identifying and sol/ing patients p"oblem d ,stablishing "appo"t 10+ )$"ing the p"o%ess of %o%aine withd"awal& the physi%ian o"de"s whi%h of the following: a ?alope"idol O?aldolP b Imip"amine O!of"anilP % @en(t"opine OCogentinP d )ia(epam O7ali$mP 10. !he n$"se is awa"e that %o%aine is %lassified as: a ?all$%inogen b Psy%ho stim$lant % #n-iolyti% d *a"%oti% 102 In %omm$nity health n$"sing& it is the most impo"tant "is0 fa%to" in the de/elopment of mental illnessQ a Sepa"ation of pa"ents b Politi%al p"oblems % Po/e"ty d Se-$al ab$se 105 #ll of the following a"e %ha"a%te"isti%s of %"isis e-%ept a !he %lient may be%ome "esisti/e and a%ti/e in stopping the %"isis b It is self=limiting fo" .=5 wee0s % It is $ni6$e in e/e"y indi/id$al d It may also affe%t the family of the %lient 108 F"e$d states that tempe" tant"$ms is obse"/ed in whi%h of the following: a O"al b #nal % Phalli% d 'aten%y 109 !he n$"se is awa"e that ego de/elopment begins d$"ing: a !oddle" pe"iod b P"es%hool age % S%hool age d Infan%y 109 Sit$ation: # 19 yea" old n$"sing st$dent has lost +5 lbs fo" . wee0s ?e" pa"ents b"o$ght he" to the hospital fo" medi%al e/al$ation !he diagnosis was #*O1,;I# *,17OS# !he P"ima"y gain of a %lient with ano"e-ia ne"/osa is: a Height loss b Height gain % 1ed$%e an-iety d #tt"a%ti/e appea"an%e 110 !he n$"se is awa"e that the p"ima"y n$"sing diagnosis fo" the %lient is: a #lte"ed n$t"ition : less than body "e6$i"ement b #lte"ed n$t"ition : mo"e than body "e6$i"ement % Impai"ed tiss$e integ"ity

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d 1is0 fo" maln$t"ition 111 #fte" 1. days in the hospital& whi%h finding indi%ates that he" %ondition in imp"o/ingQ a She tells the n$"se that she had no idea that she is thin b She a""i/es ea"lie" than s%hed$led time of g"o$p the"apy % She tells the n$"se that she eat + times o" mo"e in a day d She gained . lbs in two wee0s 112 !he n$"se is awa"e that ata"a%ti%s o" psy%hi% ene"gi(e"s a"e also 0nown as: a #nti mani% b #nti dep"essants % #ntipsy%hoti%s d #nti an-iety 11+ :nown as mood ele/ato"s: a #nti dep"essants b #ntipsy%hoti%s % #nti mani% d #nti an-iety 11. !he p"io"ity of %a"e fo" a %lient with #l(heime"Ks disease is a ?elp %lient de/elop %oping me%hanism b ,n%o$"age to lea"n new hobbies and inte"est % P"o/ide him stim$lating en/i"onment d Simplify the en/i"onment to eliminate the need to ma0e %ho"es 112 #$tism is diagnosed at: a Infan%y b + yea"s old % 2 yea"s old d S%hool age 115 !he %ommon %ha"a%te"isti% of a$tism %hild is: a Imp$lsiti/ity b Self dest"$%ti/eness % ?ostility d Hithd"awal 118 !he n$"se is awa"e that the most %ommon indi%ation in $sing ,C! is: a S%hi(oph"enia b @ipola" % #no"e-ia *e"/osa d )ep"ession 119 # the"apy that fo%$ses on he"e and now p"in%iple to p"omote self=a%%eptan%eQ a Destalt the"apy b Cogniti/e the"apy % @eha/io" the"apy d Pe"sonality the"apy 119 # %lient has many i""ational tho$ghts !he goal of the"apy is to %hange he": a Pe"sonality b Comm$ni%ation % @eha/io" d Cognition 120 !he app"op"iate n$t"ition fo" @ipola" I diso"de"& in mani% phase is: a 'ow fat& low sodi$m b 'ow %alo"ie& high fat % Finge" foods& high in %alo"ie d Small f"e6$ent feedings 121 Hhi%h of the following a%ti/ity wo$ld be best fo" a dep"essed %lientQ a Chess b @as0etball % Swimming d Finge" painting 122 !he n$"se is awa"e that %lients with se/e"e dep"ession& possess whi%h defense me%hanism: a Int"oEe%tion b S$pp"ession % 1ep"ession d P"oEe%tion 12+ *$"se Bohn is awa"e that self m$tilation among @ipola" diso"de" patients is a means of: a O/e"%oming fea" of fail$"e b O/e"%oming feeling of inse%$"ity % 1elie/ing dep"ession

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d 1elie/ing an-iety 12. Hhi%h of the following may %a$se an in%"ease in the %ystitis symptomsQ a Hate" b O"ange E$i%e % Coffee d <ango E$i%e 122 In %a"ing fo" %lients with "enal %al%$li& whi%h is the p"io"ity n$"sing inte"/entionQ a 1e%o"d /ital signs b St"ain $"ine % 'imit fl$ids d #dministe" analgesi%s as p"es%"ibed 125 In patient with "enal fail$"e& the diet sho$ld be: a 'ow p"otein& low sodi$m& low potassi$m b 'ow p"otein& high potassi$m % ?igh %a"bohyd"ate& low p"otein d ?igh %al%i$m& high p"otein 128 Hhi%h of the following %annot be %o""e%ted by dialysisQ a ?ype"nat"emia b ?ype"0alemia % ,le/ated %"eatinine d )e%"eased hemoglobin 129 !ony with infe%tion is "e%ei/ing antibioti% the"apy 'ate" the %lient %omplaints of "inging in the ea"s !his ototo-i%ity is damage to: a .th C* b 9th C* % 8th C* d 9th C* 129 *$"se ,mma p"o/ides tea%hing to a patient with "e%$""ent $"ina"y t"a%t infe%tion in%l$des the following: a In%"ease inta0e of tea& %offee and %olas b 7oid e/e"y 5 ho$"s pe" day % 7oid immediately afte" inte"%o$"se d !a0e t$b bath e/e"yday 1+0 Hhi%h assessment finding indi%ates %i"%$lato"y %onst"i%tion in a male %lient with a newly applied long leg %astQ a @lan%hing o" %yanosis of legs b Complaints of p"ess$"e o" tightness % Inability to mo/e toes d *$mbness of toes 1+1 )$"ing a%$te go$t atta%0& the n$"se administe" whi%h of the following d"$g: a P"ednisone O)eltasoneP b Col%hi%ines % #spi"in d #llop$"inol OJylop"imP 1+2 Info"mation in the patients %ha"t is inadmissible in %o$"t as e/iden%e when: a !he %lient obEe%ts to its $se b ?andw"iting is not legible % It has too many $noffi%ial abb"e/iations d !he %lients pa"ents "ef$ses to $se it 1++ *$"se :a"en is "e/ising a %lient plan of %a"e )$"ing whi%h step of the n$"sing p"o%ess does s$%h "e/ision ta0e pla%eQ a Planning b Implementation % )iagnosing d ,/al$ation 1+. Hhen e-amining a %lient with abdominal pain& *$"se ?a(el sho$ld assess: a Symptomati% 6$ad"ant eithe" se%ond o" fi"st b !he symptomati% 6$ad"ant last % !he symptomati% 6$ad"ant fi"st d #ny 6$ad"ant 1+2 ?ow long will n$"se Bohn obtain an a%%$"ate "eading of tempe"at$"e /ia o"al "o$teQ a + min$tes b 1 min$te % 9 min$tes d 12 min$tes

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1+5 !he one filing the %"iminal %a"e against an a%%$sed pa"ty is said to be theQ a D$ilty b #%%$sed % Plaintiff d Hitness 1+8 # male %lient has a standing )*1 o"de" ?e then s$ddenly stopped b"eathing and yo$ a"e at his bedside Ao$ wo$ld: a Call the physi%ian b Stay with the %lient and do nothing % Call anothe" n$"se d Call the family 1+9 !he #*# "e%ogni(ed n$"sing info"mati%s he"alding its establishment as a new field in n$"sing d$"ing what yea"Q a 199. b 1992 % 2000 d 2001 1+9 Hhen is the fi"st %e"tifi%ation of n$"sing info"mati%s gi/enQ a 1990=199+ b 2001=2002 % 199.=1995 d 2002=2009 1.0 !he n$"se is assessing a female %lient with possible diagnosis of osteoa"th"itis !he most signifi%ant "is0 fa%to" fo" osteoa"th"itis is: a Obesity b 1a%e % Bob d #ge 1.1 # male %lient %omplains of /e"tigo *$"se @ea anti%ipates that the %lient may ha/e a p"oblem with whi%h po"tion of the ea"Q a !ympani% memb"anes b Inne" ea" % #$"i%le d ,-te"nal ea" 1.2 Hhen pe"fo"ming Hebe"Ks test& *$"se 1osean e-pe%ts that this %lient will hea" a On $naffe%ted side b 'onge" th"o$gh bone than ai" %ond$%tion % On affe%ted side by bone %ond$%tion d @y neithe" bone o" ai" %ond$%tion 1.+ !oy with a tentati/e diagnosis of myasthenia g"a/is is admitted fo" diagnosti% ma0e $p <yasthenia g"a/is %an %onfi"med by: a :e"nigKs sign b @"$d(ins0iKs sign % # positi/e sweat %hlo"ide test d # positi/e ed"ophoni$m O!ensilonP test 1.. # male %lient is hospitali(ed with D$illain=@a""e Synd"ome Hhi%h assessment finding is the most signifi%antQ a ,/en& $nlabo"ed "espi"ations b Soft& non distended abdomen % U"ine o$tp$t of 20 mlGh" d Ha"m s0in 1.2 Fo" a female %lient with s$spe%ted int"a%"anial p"ess$"e OICPP& a most app"op"iate "espi"ato"y goal is: a <aintain pa"tial p"ess$"e of a"te"ial o-ygen OPa O2P abo/e 90mm?g b P"omote elimination of %a"bon dio-ide % 'owe" the P? d P"e/ent "espi"ato"y al0alosis 1.5 Hhi%h n$"sing assessment wo$ld identify the ea"liest sign of ICPQ a Change in le/el of %ons%io$sness b !empe"at$"e of o/e" 10+RF % Hidening p$lse p"ess$"e d Une6$al p$pils 1.8 !he g"eatest dange" of an $n%o""e%ted at"ial fib"illation fo" a male patient will be whi%h of the following: a P$lmona"y embolism b Ca"dia% a""est

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% !h"omb$s fo"mation d <yo%a"dial infa"%tion 1.9 'inda& # +0 yea" old post hyste"e%tomy %lient has /isited the health %ente" She in6$i"ed abo$t @S, and as0ed the n$"se when @S, sho$ld be pe"fo"med Ao$ answe"ed that the @S, is best pe"fo"med: a 8 days afte" menst"$ation b #t the same day ea%h month % )$"ing menst"$ation d @efo"e menst"$ation 1.9 #n infant is o"de"ed to "e%i/e 200 ml of )2*SS fo" 2. ho$"s !he Int"a/eno$s d"ip is "$nning at 50 gttsGmin ?ow many d"ops pe" min$te sho$ld the flow "ate beQ a 50 gttsGmin b 21 gttsGmin % +0 gttsGmin d 12 gttsGmin 120 <" D$tie""e( is to "e%ei/e 1 lite" of )2'1 to "$n fo" 12 ho$"s !he d"op fa%to" of the I7 inf$sion set is 10 d"ops pe" min$te #pp"o-imately how many d"ops pe" min$tes sho$ld the I7 be "eg$latedQ a 1+=1. d"ops b 18=19 d"ops % 10=12 d"ops d 12=15 d"ops A$s-!r &! E

COMPRENSIVE EXAMINATION Part 2

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# .+=yea"=old #f"i%an #me"i%an male is admitted with si%0le %ell anemia !he n$"se plans to assess %i"%$lation in the lowe" e-t"emities e/e"y 2 ho$"s Hhi%h of the following o$t%ome %"ite"ia wo$ld the n$"se $seQ # @ody tempe"at$"e of 99RF o" less @ !oes mo/ed in a%ti/e "ange of motion C Sensation "epo"ted when soles of feet a"e to$%hed ) Capilla"y "efill of b + se%onds # +0=yea"=old male f"om ?aiti is b"o$ght to the eme"gen%y depa"tment in si%0le %ell %"isis Hhat is the best position fo" this %lientQ # Side=lying with 0nees fle-ed @ :nee=%hest C ?igh Fowle"Cs with 0nees fle-ed ) Semi=Fowle"Cs with legs e-tended on the bed # 22=yea"=old male is admitted in si%0le %ell %"isis Hhi%h of the following inte"/entions wo$ld be of highest p"io"ity fo" this %lientQ # !a0ing ho$"ly blood p"ess$"es with me%hani%al %$ff @ ,n%o$"aging fl$id inta0e of at least 200m' pe" ho$" C Position in high Fowle"Cs with 0nee gat%h "aised ) #dministe"ing !ylenol as o"de"ed Hhi%h of the following foods wo$ld the n$"se en%o$"age the %lient in si%0le %ell %"isis to eatQ # Pea%hes @ Cottage %heese C Popsi%le ) 'ima beans # newly admitted %lient has si%0le %ell %"isis !he n$"se is planning %a"e based on assessment of the %lient !he %lient is %omplaining of se/e"e pain in his feet and hands !he p$lse o-imet"y is 92 Hhi%h of the following inte"/entions wo$ld be implemented fi"stQ #ss$me that the"e a"e o"de"s fo" ea%h inte"/ention # #dE$st the "oom tempe"at$"e @ Di/e a bol$s of I7 fl$ids C Sta"t O2 ) #dministe" mepe"idine O)eme"olP 82mg I7 p$sh !he n$"se is inst"$%ting a %lient with i"on=defi%ien%y anemia Hhi%h of the following meal plans wo$ld the n$"se e-pe%t the %lient to sele%tQ # 1oast beef& gelatin salad& g"een beans& and pea%h pie @ Chi%0en salad sandwi%h& %oleslaw& F"en%h f"ies& i%e %"eam C ,gg salad on wheat b"ead& %a""ot sti%0s& lett$%e salad& "aisin pie ) Po"0 %hop& %"eamed potatoes& %o"n& and %o%on$t %a0e Clients with si%0le %ell anemia a"e ta$ght to a/oid a%ti/ities that %a$se hypo-ia and hypo-emia Hhi%h of the following a%ti/ities wo$ld the n$"se "e%ommendQ # # family /a%ation in the 1o%0y <o$ntains @ Chape"oning the lo%al boys %l$b on a snow=s0iing t"ip C !"a/eling by ai"plane fo" b$siness t"ips ) # b$s t"ip to the <$se$m of *at$"al ?isto"y !he n$"se is %ond$%ting an admission assessment of a %lient with /itamin @12 defi%ien%y Hhi%h of the following wo$ld the n$"se in%l$de in the physi%al assessmentQ # Palpate the spleen @ !a0e the blood p"ess$"e C ,-amine the feet fo" pete%hiae ) ,-amine the tong$e #n #f"i%an #me"i%an female %omes to the o$tpatient %lini% !he physi%ian s$spe%ts /itamin @12 defi%ien%y anemia @e%a$se Ea$ndi%e is often a %lini%al manifestation of this type of anemia& what body pa"t wo$ld be the best indi%ato"Q # ConE$n%ti/a of the eye @ Soles of the feet C 1oof of the mo$th ) Shins !he n$"se is %ond$%ting a physi%al assessment on a %lient with anemia Hhi%h of the following %lini%al manifestations wo$ld be most indi%ati/e of the anemiaQ # @P 1.5G99 @ 1espi"ations 29 shallow C Height gain of 10 po$nds in 5 months ) Pin0 %omple-ion !he n$"se is tea%hing the %lient with poly%ythemia /e"a abo$t p"e/ention of %ompli%ations of the disease Hhi%h of the following statements by the %lient indi%ates a need fo" f$"the" tea%hingQ # LI will d"in0 200m' of fl$id o" less ea%h day L

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@ LI will wea" s$ppo"t hose when I am $p L C LI will $se an ele%t"i% "a(o" fo" sha/ing L ) LI will eat foods low in i"on L # ++=yea"=old male is being e/al$ated fo" possible a%$te le$0emia Hhi%h of the following wo$ld the n$"se in6$i"e abo$t as a pa"t of the assessmentQ # !he %lient %olle%ts stamps as a hobby @ !he %lient "e%ently lost his Eob as a postal wo"0e" C !he %lient had "adiation fo" t"eatment of ?odg0inCs disease as a teenage" ) !he %lientCs b"othe" had le$0emia as a %hild #n #f"i%an #me"i%an %lient is admitted with a%$te le$0emia !he n$"se is assessing fo" signs and symptoms of bleeding Hhe"e is the best site fo" e-amining fo" the p"esen%e of pete%hiaeQ # !he abdomen @ !he tho"aC !he ea"lobes ) !he soles of the feet # %lient with a%$te le$0emia is admitted to the on%ology $nit Hhi%h of the following wo$ld be most impo"tant fo" the n$"se to in6$i"eQ # L?a/e yo$ noti%ed a %hange in sleeping habits "e%entlyQL @ L?a/e yo$ had a "espi"ato"y infe%tion in the last 5 monthsQL C L?a/e yo$ lost weight "e%entlyQL ) L?a/e yo$ noti%ed %hanges in yo$" ale"tnessQL Hhi%h of the following wo$ld be the p"io"ity n$"sing diagnosis fo" the ad$lt %lient with a%$te le$0emiaQ # O"al m$%o$s memb"ane& alte"ed "elated to %hemothe"apy @ 1is0 fo" inE$"y "elated to th"ombo%ytopenia C Fatig$e "elated to the disease p"o%ess ) Inte""$pted family p"o%esses "elated to life=th"eatening illness of a family membe" # 21=yea"=old male with ?odg0inCs lymphoma is a senio" at the lo%al $ni/e"sity ?e is engaged to be ma""ied and is to begin a new Eob $pon g"ad$ation Hhi%h of the following diagnoses wo$ld be a p"io"ity fo" this %lientQ # Se-$al dysf$n%tion "elated to "adiation the"apy @ #nti%ipato"y g"ie/ing "elated to te"minal illness C !iss$e integ"ity "elated to p"olonged bed "est ) Fatig$e "elated to %hemothe"apy # %lient has a$toimm$ne th"ombo%ytopeni% p$"p$"a !o dete"mine the %lientCs "esponse to t"eatment& the n$"se wo$ld monito": # Platelet %o$nt @ Hhite blood %ell %o$nt C Potassi$m le/els ) Pa"tial p"oth"ombin time OP!!P !he home health n$"se is /isiting a %lient with a$toimm$ne th"ombo%ytopeni% p$"p$"a O#!PP !he %lientCs platelet %o$nt %$""ently is 90& It will be most impo"tant to tea%h the %lient and family abo$t: # @leeding p"e%a$tions @ P"e/ention of falls C O-ygen the"apy ) Conse"/ation of ene"gy # %lient with a pit$ita"y t$mo" has had a t"ansphenoidal hyposphe%tomy Hhi%h of the following inte"/entions wo$ld be app"op"iate fo" this %lientQ # Pla%e the %lient in !"endelenb$"g position fo" post$"al d"ainage @ ,n%o$"age %o$ghing and deep b"eathing e/e"y 2 ho$"s C ,le/ate the head of the bed +0R ) ,n%o$"age the 7alsal/a mane$/e" fo" bowel mo/ements !he %lient with a histo"y of diabetes insipid$s is admitted with poly$"ia& polydipsia& and mental %onf$sion !he p"io"ity inte"/ention fo" this %lient is: # <eas$"e the $"ina"y o$tp$t @ Che%0 the /ital signs C ,n%o$"age in%"eased fl$id inta0e ) Heigh the %lient # %lient with hemophilia has a nosebleed Hhi%h n$"sing a%tion is most app"op"iate to %ont"ol the bleedingQ # Pla%e the %lient in a sitting position with the head hype"e-tended @ Pa%0 the na"es tightly with ga$(e to apply p"ess$"e to the so$"%e of bleeding C Pin%h the soft lowe" pa"t of the nose fo" a minim$m of 2 min$tes ) #pply i%e pa%0s to the fo"ehead and ba%0 of the ne%0 # %lient has had a $nilate"al ad"enale%tomy to "emo/e a t$mo" !o p"e/ent %ompli%ations& the most impo"tant meas$"ement in the immediate post=ope"ati/e pe"iod fo" the n$"se to ta0e is:

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# @lood p"ess$"e @ !empe"at$"e C O$tp$t ) Spe%ifi% g"a/ity # %lient with #ddisonCs disease has been admitted with a histo"y of na$sea and /omiting fo" the past + days !he %lient is "e%ei/ing I7 gl$%o%o"ti%oids OSol$=<ed"olP Hhi%h of the following inte"/entions wo$ld the n$"se implementQ # Dl$%omete" "eadings as o"de"ed @ Inta0eGo$tp$t meas$"ements C Sodi$m and potassi$m le/els monito"ed ) )aily weights # %lient had a total thy"oide%tomy yeste"day !he %lient is %omplaining of tingling a"o$nd the mo$th and in the finge"s and toes Hhat wo$ld the n$"sesC ne-t a%tion beQ # Obtain a %"ash %a"t @ Che%0 the %al%i$m le/el C #ssess the d"essing fo" d"ainage ) #ssess the blood p"ess$"e fo" hype"tension # +2=yea"=old mothe" of th"ee is b"o$ght to the %lini% ?e" p$lse is 22& the"e is a weight gain of +0 po$nds in . months& and the %lient is wea"ing two sweate"s !he %lient is diagnosed with hypothy"oidism Hhi%h of the following n$"sing diagnoses is of highest p"io"ityQ # Impai"ed physi%al mobility "elated to de%"eased end$"an%e @ ?ypothe"mia "Gt de%"eased metaboli% "ate C )ist$"bed tho$ght p"o%esses "Gt inte"stitial edema ) )e%"eased %a"dia% o$tp$t "Gt b"ady%a"dia !he %lient p"esents to the %lini% with a se"$m %holeste"ol of 282mgGd' and is pla%ed on "os$/astatin OC"esto"P Hhi%h inst"$%tion sho$ld be gi/en to the %lientQ # 1epo"t m$s%le wea0ness to the physi%ian @ #llow si- months fo" the d"$g to ta0e effe%t C !a0e the medi%ation with f"$it E$i%e ) #s0 the do%to" to pe"fo"m a %omplete blood %o$nt befo"e sta"ting the medi%ation !he %lient is admitted to the hospital with hype"tensi/e %"ises )ia(o-ide O?ype"statP is o"de"ed )$"ing administ"ation& the n$"se sho$ld: # Utili(e an inf$sion p$mp @ Che%0 the blood gl$%ose le/el C Pla%e the %lient in !"endelenb$"g position ) Co/e" the sol$tion with foil !he 5=month=old %lient with a /ent"al septal defe%t is "e%ei/ing )igitalis fo" "eg$lation of his hea"t "ate Hhi%h finding sho$ld be "epo"ted to the do%to"Q # @lood p"ess$"e of 125G90 @ @lood gl$%ose of 110mgGd' C ?ea"t "ate of 50bpm ) 1espi"ato"y "ate of +0 pe" min$te !he %lient admitted with angina is gi/en a p"es%"iption fo" nit"ogly%e"ine !he %lient sho$ld be inst"$%ted to: # 1eplenish his s$pply e/e"y + months @ !a0e one e/e"y 12 min$tes if pain o%%$"s C 'ea/e the medi%ation in the b"own bottle ) C"$sh the medi%ation and ta0e with wate" !he %lient is inst"$%ted "ega"ding foods that a"e low in fat and %holeste"ol Hhi%h diet sele%tion is lowest in sat$"ated fatsQ # <a%a"oni and %heese @ Sh"imp with "i%e C !$"0ey b"east ) Spaghetti !he %lient is admitted with left=sided %ongesti/e hea"t fail$"e In assessing the %lient fo" edema& the n$"se sho$ld %he%0 the: # Feet @ *e%0 C ?ands ) Sa%"$m !he n$"se is %he%0ing the %lientCs %ent"al /eno$s p"ess$"e !he n$"se sho$ld pla%e the (e"o of the manomete" at the: # Phlebostati% a-is @ P<I C ,"bCs point

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) !ail of Spen%e !he physi%ian o"de"s lisinop"il OJest"ilP and f$"osemide O'asi-P to be administe"ed %on%omitantly to the %lient with hype"tension !he n$"se sho$ld: # >$estion the o"de" @ #dministe" the medi%ations C #dministe" sepa"ately ) Conta%t the pha"ma%y !he best method of e/al$ating the amo$nt of pe"iphe"al edema is: # Heighing the %lient daily @ <eas$"ing the e-t"emity C <eas$"ing the inta0e and o$tp$t ) Che%0ing fo" pitting # %lient with /aginal %an%e" is being t"eated with a "adioa%ti/e /aginal implant !he %lientCs h$sband as0s the n$"se if he %an spend the night with his wife !he n$"se sho$ld e-plain that: # O/e"night stays by family membe"s is against hospital poli%y @ !he"e is no need fo" him to stay be%a$se staffing is ade6$ate C ?is wife will "est m$%h bette" 0nowing that he is at home ) 7isitation is limited to +0 min$tes when the implant is in pla%e !he n$"se is %a"ing fo" a %lient hospitali(ed with a fa%ial st"o0e Hhi%h diet sele%tion wo$ld be s$ited to the %lientQ # 1oast beef sandwi%h& potato %hips& pi%0le spea"& i%ed tea @ Split pea so$p& mashed potatoes& p$dding& mil0 C !omato so$p& %heese toast& Bello& %offee ) ?amb$"ge"& ba0ed beans& f"$it %$p& i%ed tea !he physi%ian has p"es%"ibed *o/alog ins$lin fo" a %lient with diabetes mellit$s Hhi%h statement indi%ates that the %lient 0nows when the pea0 a%tion of the ins$lin o%%$"sQ # LI will ma0e s$"e I eat b"ea0fast within 10 min$tes of ta0ing my ins$lin L @ LI will need to %a""y %andy o" some fo"m of s$ga" with me all the time L C LI will eat a sna%0 a"o$nd th"ee oC%lo%0 ea%h afte"noon L ) LI %an sa/e my desse"t f"om s$ppe" fo" a bedtime sna%0 L !he n$"se is tea%hing basi% infant %a"e to a g"o$p of fi"st=time pa"ents !he n$"se sho$ld e-plain that a sponge bath is "e%ommended fo" the fi"st 2 wee0s of life be%a$se: # *ew pa"ents need time to lea"n how to hold the baby @ !he $mbili%al %o"d needs time to sepa"ate C *ewbo"n s0in is easily t"a$mati(ed by washing ) !he %han%e of %hilling the baby o$tweighs the benefits of bathing # %lient with le$0emia is "e%ei/ing !"imet"e-ate #fte" "e/iewing the %lientCs %ha"t& the physi%ian o"de"s Hell%o/o"in Ole$%o/o"in %al%i$mP !he "ationale fo" administe"ing le$%o/o"in %al%i$m to a %lient "e%ei/ing !"imet"e-ate is to: # !"eat i"on=defi%ien%y anemia %a$sed by %hemothe"ape$ti% agents @ C"eate a syne"gisti% effe%t that sho"tens t"eatment time C In%"ease the n$mbe" of %i"%$lating ne$t"ophils ) 1e/e"se d"$g to-i%ity and p"e/ent tiss$e damage # .=month=old is b"o$ght to the well=baby %lini% fo" imm$ni(ation In addition to the )P! and polio /a%%ines& the baby sho$ld "e%ei/e: # ?ib tite" @ <$mps /a%%ine C ?epatitis @ /a%%ine ) <<1 !he physi%ian has p"es%"ibed *e-i$m Oesomep"a(oleP fo" a %lient with e"osi/e gast"itis !he n$"se sho$ld administe" the medi%ation: # +0 min$tes befo"e meals @ Hith ea%h meal C In a single dose at bedtime ) +0 min$tes afte" meals # %lient on the psy%hiat"i% $nit is in an $n%ont"olled "age and is th"eatening othe" %lients and staff Hhat is the most app"op"iate a%tion fo" the n$"se to ta0eQ # Call se%$"ity fo" assistan%e and p"epa"e to sedate the %lient @ !ell the %lient to %alm down and as0 him if he wo$ld li0e to play %a"ds C !ell the %lient that if he %ontin$es his beha/io" he will be p$nished ) 'ea/e the %lient alone $ntil he %alms down Hhen the n$"se %he%0s the f$nd$s of a %lient on the fi"st postpa"t$m day& she notes that the f$nd$s is fi"m& is at the le/el of the $mbili%$s& and is displa%ed to the "ight !he ne-t a%tion the n$"se sho$ld ta0e is to: # Che%0 the %lient fo" bladde" distention @ #ssess the blood p"ess$"e fo" hypotension

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C )ete"mine whethe" an o-yto%i% d"$g was gi/en ) Che%0 fo" the e-p$lsion of small %lots # %lient is admitted to the hospital with a tempe"at$"e of 99 9RF& %omplaints of blood=tinged hemoptysis& fatig$e& and night sweats !he %lientCs symptoms a"e %onsistent with a diagnosis of: # Pne$monia @ 1ea%tion to anti/i"al medi%ation C !$be"%$losis ) S$pe"infe%tion d$e to low C). %o$nt !he %lient is seen in the %lini% fo" t"eatment of mig"aine heada%hes !he d"$g Imit"e- Os$mat"iptan s$%%inateP is p"es%"ibed fo" the %lient Hhi%h of the following in the %lientCs histo"y sho$ld be "epo"ted to the do%to"Q # )iabetes @ P"in(metalCs angina C Can%e" ) Cl$ste" heada%hes !he %lient with s$spe%ted meningitis is admitted to the $nit !he do%to" is pe"fo"ming an assessment to dete"mine meningeal i""itation and spinal ne"/e "oot inflammation # positi/e :e"nigCs sign is %ha"ted if the n$"se notes: # Pain on fle-ion of the hip and 0nee @ *$%hal "igidity on fle-ion of the ne%0 C Pain when the head is t$"ned to the left side ) )i((iness when %hanging positions !he %lient with #l(heime"Cs disease is being assisted with a%ti/ities of daily li/ing when the n$"se notes that the %lient $ses he" toothb"$sh to b"$sh he" hai" !he n$"se is awa"e that the %lient is e-hibiting: # #gnosia @ #p"a-ia C #nomia ) #phasia !he %lient with dementia is e-pe"ien%ing %onf$sion late in the afte"noon and befo"e bedtime !he n$"se is awa"e that the %lient is e-pe"ien%ing what is 0nown as: # Ch"oni% fatig$e synd"ome @ *o"mal aging C S$ndowning ) )el$sions !he %lient with %onf$sion says to the n$"se& LI ha/enCt had anything to eat all day long Hhen a"e they going to b"ing b"ea0fastQL !he n$"se saw the %lient in the day "oom eating b"ea0fast with othe" %lients +0 min$tes befo"e this %on/e"sation Hhi%h "esponse wo$ld be best fo" the n$"se to ma0eQ # LAo$ 0now yo$ had b"ea0fast +0 min$tes ago L @ LI am so so""y that they didnCt get yo$ b"ea0fast ICll "epo"t it to the %ha"ge n$"se L C LICll get yo$ some E$i%e and toast Ho$ld yo$ li0e something elseQL ) LAo$ will ha/e to wait a whileW l$n%h will be he"e in a little while L !he do%to" has p"es%"ibed ,-elon O"i/astigmineP fo" the %lient with #l(heime"Cs disease Hhi%h side effe%t is most often asso%iated with this d"$gQ # U"ina"y in%ontinen%e @ ?eada%hes C Conf$sion ) *a$sea # %lient is admitted to the labo" and deli/e"y $nit in a%ti/e labo" )$"ing e-amination& the n$"se notes a pap$la" lesion on the pe"ine$m Hhi%h initial a%tion is most app"op"iateQ # )o%$ment the finding @ 1epo"t the finding to the do%to" C P"epa"e the %lient fo" a C=se%tion ) Contin$e p"ima"y %a"e as p"es%"ibed # %lient with a diagnosis of ?P7 is at "is0 fo" whi%h of the followingQ # ?odg0inCs lymphoma @ Ce"/i%al %an%e" C <$ltiple myeloma ) O/a"ian %an%e" )$"ing the initial inte"/iew& the %lient "epo"ts that she has a lesion on the pe"ine$m F$"the" in/estigation "e/eals a small bliste" on the /$l/a that is painf$l to to$%h !he n$"se is awa"e that the most li0ely so$"%e of the lesion is: # Syphilis @ ?e"pes C Dono""hea ) Condylomata

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# %lient /isiting a family planning %lini% is s$spe%ted of ha/ing an S!I !he best diagnosti% test fo" t"eponema pallid$m is: # 7ene"eal )isease 1esea"%h 'ab O7)1'P @ 1apid plasma "eagin O1P1P C Flo"es%ent t"eponemal antibody OF!#P ) !haye"=<a"tin %$lt$"e O!<CP # 12=yea"=old p"imig"a/ida is admitted with a tentati/e diagnosis of ?,''P synd"ome Hhi%h labo"ato"y finding is asso%iated with ?,''P synd"omeQ # ,le/ated blood gl$%ose @ ,le/ated platelet %o$nt C ,le/ated %"eatinine %lea"an%e ) ,le/ated hepati% en(ymes !he n$"se is assessing the deep tendon "efle-es of a %lient with p"ee%lampsia Hhi%h method is $sed to eli%it the bi%eps "efle-Q # !he n$"se pla%es he" th$mb on the m$s%le inset in the ante%$bital spa%e and taps the th$mb b"is0ly with the "efle- hamme" @ !he n$"se loosely s$spends the %lientCs a"m in an open hand while tapping the ba%0 of the %lientCs elbow C !he n$"se inst"$%ts the %lient to dangle he" legs as the n$"se st"i0es the a"ea below the patella with the bl$nt side of the "efle- hamme" ) !he n$"se inst"$%ts the %lient to pla%e he" a"ms loosely at he" side as the n$"se st"i0es the m$s%le inse"t E$st abo/e the w"ist # p"imig"a/ida with diabetes is admitted to the labo" and deli/e"y $nit at +. wee0s gestation Hhi%h do%to"Cs o"de" sho$ld the n$"se 6$estionQ # <agnesi$m s$lfate .gm O22VP I7 @ @"ethine 10m%g I7 C Stadol 1mg I7 p$sh e/e"y . ho$"s as needed p"n fo" pain ) #n%ef 2gm I7P@ e/e"y 5 ho$"s # diabeti% m$ltig"a/ida is s%hed$led fo" an amnio%entesis at +2 wee0s gestation to dete"mine the 'GS "atio and phosphatidyl gly%e"ol le/el !he 'GS "atio is 1:1 and the p"esen%e of phosphatidylgly%e"ol is noted !he n$"seCs assessment of this data is: # !he infant is at low "is0 fo" %ongenital anomalies @ !he infant is at high "is0 fo" int"a$te"ine g"owth "eta"dation C !he infant is at high "is0 fo" "espi"ato"y dist"ess synd"ome ) !he infant is at high "is0 fo" bi"th t"a$ma Hhi%h obse"/ation in the newbo"n of a diabeti% mothe" wo$ld "e6$i"e immediate n$"sing inte"/entionQ # C"ying @ Ha0ef$lness C Bitte"iness ) Aawning !he n$"se %a"ing fo" a %lient "e%ei/ing int"a/eno$s magnesi$m s$lfate m$st %losely obse"/e fo" side effe%ts asso%iated with d"$g the"apy #n e-pe%ted side effe%t of magnesi$m s$lfate is: # )e%"eased $"ina"y o$tp$t @ ?ype"somnolen%e C #bsen%e of 0nee Ee"0 "efle) )e%"eased "espi"ato"y "ate !he %lient has ele%ted to ha/e epid$"al anesthesia to "elie/e labo" pain If the %lient e-pe"ien%es hypotension& the n$"se wo$ld: # Pla%e he" in !"endelenb$"g position @ )e%"ease the "ate of I7 inf$sion C #dministe" o-ygen pe" nasal %ann$la ) In%"ease the "ate of the I7 inf$sion # %lient has %an%e" of the pan%"eas !he n$"se sho$ld be most %on%e"ned abo$t whi%h n$"sing diagnosisQ # #lte"ation in n$t"ition @ #lte"ation in bowel elimination C #lte"ation in s0in integ"ity ) Ineffe%ti/e indi/id$al %oping !he n$"se is %a"ing fo" a %lient with as%ites Hhi%h is the best method to $se fo" dete"mining ea"ly as%itesQ # Inspe%tion of the abdomen fo" enla"gement @ @iman$al palpation fo" hepatomegaly C )aily meas$"ement of abdominal gi"th ) #ssessment fo" a fl$id wa/e !he %lient a""i/es in the eme"gen%y depa"tment afte" a moto" /ehi%le a%%ident *$"sing assessment findings in%l$de @P 90G+.& p$lse "ate 120& and "espi"ations 20 Hhi%h is the %lientCs most app"op"iate p"io"ity n$"sing diagnosisQ

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# #lte"ation in %e"eb"al tiss$e pe"f$sion @ Fl$id /ol$me defi%it C Ineffe%ti/e ai"way %lea"an%e ) #lte"ation in senso"y pe"%eption !he home health n$"se is /isiting an 19=yea"=old with osteogenesis impe"fe%ta Hhi%h info"mation obtained on the /isit wo$ld %a$se the most %on%e"nQ !he %lient: # 'i0es to play football @ )"in0s se/e"al %a"bonated d"in0s pe" day C ?as two siste"s with si%0le %ell t"a%t ) Is ta0ing a%etaminophen to %ont"ol pain !he n$"se wo"0ing the o"gan t"ansplant $nit is %a"ing fo" a %lient with a white blood %ell %o$nt of )$"ing e/ening /isitation& a /isito" b"ings a bas0et of f"$it Hhat a%tion sho$ld the n$"se ta0eQ # #llow the %lient to 0eep the f"$it @ Pla%e the f"$it ne-t to the bed fo" easy a%%ess by the %lient C Offe" to wash the f"$it fo" the %lient ) !ell the family membe"s to ta0e the f"$it home !he n$"se is %a"ing fo" the %lient following a la"ynge%tomy when s$ddenly the %lient be%omes non"esponsi/e and pale& with a @P of 90G.0 systoli% !he initial n$"seCs a%tion sho$ld be to: # Pla%e the %lient in !"endelenb$"g position @ In%"ease the inf$sion of )e-t"ose in no"mal saline C #dministe" at"opine int"a/eno$sly ) <o/e the eme"gen%y %a"t to the bedside !he %lient admitted 2 days ea"lie" with a l$ng "ese%tion a%%identally p$lls o$t the %hest t$be Hhi%h a%tion by the n$"se indi%ates $nde"standing of the management of %hest t$besQ # O"de" a %hest -="ay @ 1einse"t the t$be C Co/e" the inse"tion site with a 7aseline ga$(e ) Call the do%to" # %lient being t"eated with sodi$m wa"fa"in has a P"otime of 120 se%onds Hhi%h inte"/ention wo$ld be most impo"tant to in%l$de in the n$"sing %a"e planQ # #ssess fo" signs of abno"mal bleeding @ #nti%ipate an in%"ease in the Co$madin dosage C Inst"$%t the %lient "ega"ding the d"$g the"apy ) In%"ease the f"e6$en%y of ne$"ologi%al assessments Hhi%h sele%tion wo$ld p"o/ide the most %al%i$m fo" the %lient who is . months p"egnantQ # # g"anola ba" @ # b"an m$ffin C # %$p of yog$"t ) # glass of f"$it E$i%e !he %lient with p"ee%lampsia is admitted to the $nit with an o"de" fo" magnesi$m s$lfate Hhi%h a%tion by the n$"se indi%ates $nde"standing of the possible side effe%ts of magnesi$m s$lfateQ # !he n$"se pla%es a sign o/e" the bed not to %he%0 blood p"ess$"e in the "ight a"m @ !he n$"se pla%es a padded tong$e blade at the bedside C !he n$"se inse"ts a Foley %athete" ) !he n$"se da"0ens the "oom # 5=yea"=old %lient is admitted to the $nit with a hemoglobin of 5gGd' !he physi%ian has w"itten an o"de" to t"ansf$se 2 $nits of whole blood Hhen dis%$ssing the t"eatment& the %hildCs mothe" tells the n$"se that she does not belie/e in ha/ing blood t"ansf$sions and that she will not allow he" %hild to ha/e the t"eatment Hhat n$"sing a%tion is most app"op"iateQ # #s0 the mothe" to lea/e while the blood t"ansf$sion is in p"og"ess @ ,n%o$"age the mothe" to "e%onside" C ,-plain the %onse6$en%es witho$t t"eatment ) *otify the physi%ian of the mothe"Cs "ef$sal # %lient is admitted to the $nit 2 ho$"s afte" an e-plosion %a$ses b$"ns to the fa%e !he n$"se wo$ld be most %on%e"ned with the %lient de/eloping whi%h of the followingQ # ?ypo/olemia @ 'a"yngeal edema C ?ype"nat"emia ) ?ype"0alemia !he n$"se is e/al$ating n$t"itional o$t%omes fo" an elde"ly %lient with b$limia Hhi%h data best indi%ates that the plan of %a"e is effe%ti/eQ # !he %lient sele%ts a balan%ed diet f"om the men$ @ !he %lientCs hemoglobin and hemato%"it imp"o/e C !he %lientCs tiss$e t$"go" imp"o/es ) !he %lient gains weight

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!he %lient is admitted following "epai" of a f"a%t$"ed tibia and %ast appli%ation Hhi%h n$"sing assessment sho$ld be "epo"ted to the do%to"Q # Pain beneath the %ast @ Ha"m toes C Pedal p$lses wea0 and "apid ) Pa"esthesia of the toes !he %lient is ha/ing an a"te"iog"am )$"ing the p"o%ed$"e& the %lient tells the n$"se& LICm feeing "eally hot L Hhi%h "esponse wo$ld be bestQ # LAo$ a"e ha/ing an alle"gi% "ea%tion I will get an o"de" fo" @enad"yl L @ L!hat feeling of wa"mth is no"mal when the dye is inEe%ted L C L!hat feeling of wa"mth indi%ates that the %lots in the %o"ona"y /essels a"e dissol/ing L ) LI will tell yo$" do%to" and let him e-plain to yo$ the "eason fo" the hot feeling that yo$ a"e e-pe"ien%ing L !he n$"se is obse"/ing se/e"al health%a"e wo"0e"s p"o/iding %a"e Hhi%h a%tion by the health%a"e wo"0e" indi%ates a need fo" f$"the" tea%hingQ # !he n$"sing assistant wea"s glo/es while gi/ing the %lient a bath @ !he n$"se wea"s goggles while d"awing blood f"om the %lient C !he do%to" washes his hands befo"e e-amining the %lient ) !he n$"se wea"s glo/es to ta0e the %lientCs /ital signs !he %lient is ha/ing ele%t"o%on/$lsi/e the"apy fo" t"eatment of se/e"e dep"ession Hhi%h of the following indi%ates that the %lientCs ,C! has been effe%ti/eQ # !he %lient loses %ons%io$sness @ !he %lient /omits C !he %lientCs ,CD indi%ates ta%hy%a"dia ) !he %lient has a g"and mal sei($"e !he 2=yea"=old is being tested fo" ente"obiasis Opinwo"msP !o %olle%t a spe%imen fo" assessment of pinwo"ms& the n$"se sho$ld tea%h the mothe" to: # ,-amine the pe"ianal a"ea with a flashlight 2 o" + ho$"s afte" the %hild is asleep @ S%"ape the s0in with a pie%e of %a"dboa"d and b"ing it to the %lini% C Obtain a stool spe%imen in the afte"noon ) @"ing a hai" sample to the %lini% fo" e/al$ation !he n$"se is tea%hing the mothe" "ega"ding t"eatment fo" ente"obiasis Hhi%h inst"$%tion sho$ld be gi/en "ega"ding the medi%ationQ # !"eatment is not "e%ommended fo" %hild"en less than 10 yea"s of age @ !he enti"e family sho$ld be t"eated C <edi%ation the"apy will %ontin$e fo" 1 yea" ) Int"a/eno$s antibioti% the"apy will be o"de"ed !he "egiste"ed n$"se is ma0ing assignments fo" the day Hhi%h %lient sho$ld be assigned to the p"egnant n$"seQ # !he %lient "e%ei/ing linea" a%%ele"ato" "adiation the"apy fo" l$ng %an%e" @ !he %lient with a "adi$m implant fo" %e"/i%al %an%e" C !he %lient who has E$st been administe"ed sol$ble b"a%hythe"apy fo" thy"oid %an%e" ) !he %lient who "et$"ned f"om pla%ement of i"idi$m seeds fo" p"ostate %an%e" !he n$"se is planning "oom assignments fo" the day Hhi%h %lient sho$ld be assigned to a p"i/ate "oom if only one is a/ailableQ # !he %lient with C$shingCs disease @ !he %lient with diabetes C !he %lient with a%"omegaly ) !he %lient with my-edema !he n$"se %a"ing fo" a %lient in the neonatal intensi/e %a"e $nit administe"s ad$lt=st"ength )igitalis to the +=po$nd infant #s a "es$lt of he" a%tions& the baby s$ffe"s pe"manent hea"t and b"ain damage !he n$"se %an be %ha"ged with: # *egligen%e @ !o"t C #ssa$lt ) <alp"a%ti%e Hhi%h assignment sho$ld not be pe"fo"med by the li%ensed p"a%ti%al n$"seQ # Inse"ting a Foley %athete" @ )is%ontin$ing a nasogast"i% t$be C Obtaining a sp$t$m spe%imen ) Sta"ting a blood t"ansf$sion !he %lient "et$"ns to the $nit f"om s$"ge"y with a blood p"ess$"e of 90G20& p$lse 1+2& and "espi"ations +0 Hhi%h a%tion by the n$"se sho$ld "e%ei/e p"io"ityQ # Contin$ing to monito" the /ital signs @ Conta%ting the physi%ian C #s0ing the %lient how he feels

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) #s0ing the 'P* to %ontin$e the post=op %a"e Hhi%h n$"se sho$ld be assigned to %a"e fo" the postpa"tal %lient with p"ee%lampsiaQ # !he 1* with 2 wee0s of e-pe"ien%e in postpa"t$m @ !he 1* with + yea"s of e-pe"ien%e in labo" and deli/e"y C !he 1* with 10 yea"s of e-pe"ien%e in s$"ge"y ) !he 1* with 1 yea" of e-pe"ien%e in the neonatal intensi/e %a"e $nit Hhi%h info"mation sho$ld be "epo"ted to the state @oa"d of *$"singQ # !he fa%ility fails to p"o/ide lite"at$"e in both Spanish and ,nglish @ !he na"%oti% %o$nt has been in%o""e%t on the $nit fo" the past + days C !he %lient fails to "e%ei/e an itemi(ed a%%o$nt of his bills and se"/i%es "e%ei/ed d$"ing his hospital stay ) !he n$"sing assistant assigned to the %lient with hepatitis fails to feed the %lient and gi/e the bath !he n$"se is s$spe%ted of %ha"ting medi%ation administ"ation that he did not gi/e #fte" tal0ing to the n$"se& the %ha"ge n$"se sho$ld: # Call the @oa"d of *$"sing @ File a fo"mal "ep"imand C !e"minate the n$"se ) Cha"ge the n$"se with a to"t !he home health n$"se is planning fo" the dayCs /isits Hhi%h %lient sho$ld be seen fi"stQ # !he 89=yea"=old who had a gast"e%tomy + wee0s ago and has a P,D t$be @ !he 2=month=old dis%ha"ged 1 wee0 ago with pne$monia who is being t"eated with amo-i%illin li6$id s$spension C !he 20=yea"=old with <1S# being t"eated with 7an%omy%in /ia a PICC line ) !he +0=yea"=old with an e-a%e"bation of m$ltiple s%le"osis being t"eated with %o"tisone /ia a %ent"ally pla%ed /eno$s %athete" !he eme"gen%y "oom is flooded with %lients inE$"ed in a to"nado Hhi%h %lients %an be assigned to sha"e a "oom in the eme"gen%y depa"tment d$"ing the disaste"Q # # s%hi(oph"eni% %lient ha/ing /is$al and a$dito"y hall$%inations and the %lient with $l%e"ati/e %olitis @ !he %lient who is 5 months p"egnant with abdominal pain and the %lient with fa%ial la%e"ations and a b"o0en a"m C # %hild whose p$pils a"e fi-ed and dilated and his pa"ents& and a %lient with a f"ontal head inE$"y ) !he %lient who a""i/es with a la"ge p$n%t$"e wo$nd to the abdomen and the %lient with %hest pain !he n$"se is %a"ing fo" a 5=yea"=old %lient admitted with a diagnosis of %onE$n%ti/itis @efo"e administe"ing eyed"ops& the n$"se sho$ld "e%ogni(e that it is essential to %onside" whi%h of the followingQ # !he eye sho$ld be %leansed with wa"m wate"& "emo/ing any e-$date& befo"e instilling the eyed"ops @ !he %hild sho$ld be allowed to instill his own eyed"ops C !he mothe" sho$ld be allowed to instill the eyed"ops ) If the eye is %lea" f"om any "edness o" edema& the eyed"ops sho$ld be held !he n$"se is dis%$ssing meal planning with the mothe" of a 2=yea"=old toddle" Hhi%h of the following statements& if made by the mothe"& wo$ld "e6$i"e a need fo" f$"the" inst"$%tionQ # LIt is o0ay to gi/e my %hild white g"ape E$i%e fo" b"ea0fast L @ L<y %hild %an ha/e a g"illed %heese sandwi%h fo" l$n%h L C LHe a"e going on a %amping t"ip this wee0end& and I ha/e bo$ght hot dogs to g"ill fo" his l$n%h L ) LFo" a sna%0& my %hild %an ha/e i%e %"eam L # 2=yea"=old toddle" is admitted to the hospital Hhi%h of the following n$"sing inte"/entions wo$ld yo$ e-pe%tQ # #s0 the pa"entGg$a"dian to lea/e the "oom when assessments a"e being pe"fo"med @ #s0 the pa"entGg$a"dian to ta0e the %hildCs fa/o"ite blan0et home be%a$se anything f"om the o$tside sho$ld not be b"o$ght into the hospital C #s0 the pa"entGg$a"dian to "oom=in with the %hild ) If the %hild is s%"eaming& tell him this is inapp"op"iate beha/io" Hhi%h inst"$%tion sho$ld be gi/en to the %lient who is fitted fo" a behind=the=ea" hea"ing aidQ # 1emo/e the mold and %lean e/e"y wee0 @ Sto"e the hea"ing aid in a wa"m pla%e C Clean the lint f"om the hea"ing aid with a toothpi%0 ) Change the batte"ies wee0ly # p"io"ity n$"sing diagnosis fo" a %hild being admitted f"om s$"ge"y following a tonsille%tomy is: # @ody image dist$"ban%e @ Impai"ed /e"bal %omm$ni%ation C 1is0 fo" aspi"ation ) Pain # %lient with ba%te"ial pne$monia is admitted to the pediat"i% $nit Hhat wo$ld the n$"se e-pe%t the admitting assessment to "e/ealQ # ?igh fe/e" @ *onp"od$%ti/e %o$gh C 1hinitis

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) 7omiting and dia""hea !he n$"se is %a"ing fo" a %lient admitted with epiglottis @e%a$se of the possibility of %omplete obst"$%tion of the ai"way& whi%h of the following sho$ld the n$"se ha/e a/ailableQ # Int"a/eno$s a%%ess s$pplies @ # t"a%heostomy set C Int"a/eno$s fl$id administ"ation p$mp ) S$pplemental o-ygen 99 # 22=yea"=old %lient with D"a/eCs disease is admitted to the $nit Hhat wo$ld the n$"se e-pe%t the admitting assessment to "e/ealQ # @"ady%a"dia @ )e%"eased appetite C ,-ophthalmos ) Height gain 99 !he n$"se is p"o/iding dieta"y inst"$%tions to the mothe" of an 9=yea"=old %hild diagnosed with %elia% disease Hhi%h of the following foods& if sele%ted by the mothe"& wo$ld indi%ate he" $nde"standing of the dieta"y inst"$%tionsQ # ?am sandwi%h on whole=wheat toast @ Spaghetti and meatballs C ?amb$"ge" with 0et%h$p ) Cheese omelet 100 !he n$"se is %a"ing fo" an 90=yea"=old with %h"oni% b"on%hitis Upon the mo"ning "o$nds& the n$"se finds an O2 sat of 85V Hhi%h of the following a%tions sho$ld the n$"se ta0e fi"stQ # *otify the physi%ian @ 1e%he%0 the O2 sat$"ation le/el in 12 min$tes C #pply o-ygen by mas0 ) #ssess the %hildCs p$lse 101 # g"a/ida III pa"a 0 is admitted to the labo" and deli/e"y $nit !he do%to" pe"fo"ms an amniotomy Hhi%h obse"/ation wo$ld the n$"se be e-pe%ted to ma0e afte" the amniotomyQ # Fetal hea"t tones 150bpm @ # mode"ate amo$nt of st"aw=%olo"ed fl$id C # small amo$nt of g"eenish fl$id ) # small segment of the $mbili%al %o"d 102 !he %lient is admitted to the $nit # /aginal e-am "e/eals that she is 2%m dilated Hhi%h of the following statements wo$ld the n$"se e-pe%t he" to ma0eQ # LHe ha/e a name pi%0ed o$t fo" the baby L @ LI need to p$sh when I ha/e a %ont"a%tion L C LI %anCt %on%ent"ate if anyone is to$%hing me L ) LHhen %an I get my epid$"alQL 10+ !he %lient is ha/ing fetal hea"t "ates of 90X110bpm d$"ing the %ont"a%tions !he fi"st a%tion the n$"se sho$ld ta0e is: # 1eposition the monito" @ !$"n the %lient to he" left side C #s0 the %lient to amb$late ) P"epa"e the %lient fo" deli/e"y 10. In e/al$ating the effe%ti/eness of I7 Pito%in fo" a %lient with se%onda"y dysto%ia& the n$"se sho$ld e-pe%t: # # painless deli/e"y @ Ce"/i%al effa%ement C Inf"e6$ent %ont"a%tions ) P"og"essi/e %e"/i%al dilation 102 # /aginal e-am "e/eals a footling b"ee%h p"esentation !he n$"se sho$ld ta0e whi%h of the following a%tions at this timeQ # #nti%ipate the need fo" a Caesa"ean se%tion @ #pply the fetal hea"t monito" C Pla%e the %lient in Den$ Pe%to"al position ) Pe"fo"m an $lt"aso$nd e-am 105 # /aginal e-am "e/eals that the %e"/i- is .%m dilated& with inta%t memb"anes and a fetal hea"t tone "ate of 150X180bpm !he n$"se de%ides to apply an e-te"nal fetal monito" !he "ationale fo" this implementation is: # !he %e"/i- is %losed @ !he memb"anes a"e still inta%t C !he fetal hea"t tones a"e within no"mal limits ) !he %ont"a%tions a"e intense eno$gh fo" inse"tion of an inte"nal monito" 108 !he following a"e all n$"sing diagnoses app"op"iate fo" a g"a/ida 1 pa"a 0 in labo" Hhi%h one wo$ld be most app"op"iate fo" the p"imag"a/ida as she %ompletes the ea"ly phase of labo"Q # Impai"ed gas e-%hange "elated to hype"/entilation @ #lte"ation in pla%ental pe"f$sion "elated to mate"nal position 98

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C Impai"ed physi%al mobility "elated to fetal=monito"ing e6$ipment ) Potential fl$id /ol$me defi%it "elated to de%"eased fl$id inta0e 109 #s the %lient "ea%hes 9%m dilation& the n$"se notes late de%ele"ations on the fetal monito" !he F?1 baseline is 152X182bpm with /a"iability of 0X2bpm Hhat is the most li0ely e-planation of this patte"nQ # !he baby is asleep @ !he $mbili%al %o"d is %omp"essed C !he"e is a /agal "esponse ) !he"e is $te"opla%ental ins$ffi%ien%y 109 !he n$"se notes /a"iable de%ele"ations on the fetal monito" st"ip !he most app"op"iate initial a%tion wo$ld be to: # *otify he" do%to" @ Sta"t an I7 C 1eposition the %lient ) 1eadE$st the monito" 110 Hhi%h of the following is a %ha"a%te"isti% of a "eass$"ing fetal hea"t "ate patte"nQ # # fetal hea"t "ate of 180X190bpm @ # baseline /a"iability of 22X+2bpm C Omino$s pe"iodi% %hanges ) #%%ele"ation of F?1 with fetal mo/ements 111 !he "ationale fo" inse"ting a F"en%h %athete" e/e"y ho$" fo" the %lient with epid$"al anesthesia is: # !he bladde" fills mo"e "apidly be%a$se of the medi%ation $sed fo" the epid$"al @ ?e" le/el of %ons%io$sness is s$%h that she is in a t"an%eli0e state C !he sensation of the bladde" filling is diminished o" lost ) She is emba""assed to as0 fo" the bedpan that f"e6$ently 112 # %lient in the family planning %lini% as0s the n$"se abo$t the most li0ely time fo" he" to %on%ei/e !he n$"se e-plains that %on%eption is most li0ely to o%%$" when: # ,st"ogen le/els a"e low @ '$teni(ing ho"mone is high C !he endomet"ial lining is thin ) !he p"ogeste"one le/el is low 11+ # %lient tells the n$"se that she plans to $se the "hythm method of bi"th %ont"ol !he n$"se is awa"e that the s$%%ess of the "hythm method depends on the: # #ge of the %lient @ F"e6$en%y of inte"%o$"se C 1eg$la"ity of the menses ) 1ange of the %lientCs tempe"at$"e 11. # %lient with diabetes as0s the n$"se fo" ad/i%e "ega"ding methods of bi"th %ont"ol Hhi%h method of bi"th %ont"ol is most s$itable fo" the %lient with diabetesQ # Int"a$te"ine de/i%e @ O"al %ont"a%epti/es C )iaph"agm ) Cont"a%epti/e sponge 112 !he do%to" s$spe%ts that the %lient has an e%topi% p"egnan%y Hhi%h symptom is %onsistent with a diagnosis of e%topi% p"egnan%yQ # Painless /aginal bleeding @ #bdominal %"amping C !h"obbing pain in the $ppe" 6$ad"ant ) S$dden& stabbing pain in the lowe" 6$ad"ant 115 !he n$"se is tea%hing a p"egnant %lient abo$t n$t"itional needs d$"ing p"egnan%y Hhi%h men$ sele%tion will best meet the n$t"itional needs of the p"egnant %lientQ # ?amb$"ge" pattie& g"een beans& F"en%h f"ies& and i%ed tea @ 1oast beef sandwi%h& potato %hips& ba0ed beans& and %ola C @a0ed %hi%0en& f"$it %$p& potato salad& %oleslaw& yog$"t& and i%ed tea ) Fish sandwi%h& gelatin with f"$it& and %offee 118 !he %lient with hype"emesis g"a/ida"$m is at "is0 fo" de/eloping: # 1espi"ato"y al0alosis witho$t dehyd"ation @ <etaboli% a%idosis with dehyd"ation C 1espi"ato"y a%idosis witho$t dehyd"ation ) <etaboli% al0alosis with dehyd"ation 119 # %lient tells the do%to" that she is abo$t 20 wee0s p"egnant !he most definiti/e sign of p"egnan%y is: # ,le/ated h$man %ho"ioni% gonadat"opin @ !he p"esen%e of fetal hea"t tones C Ute"ine enla"gement ) @"east enla"gement and tende"ness 119 !he n$"se is %a"ing fo" a neonate whose mothe" is diabeti% !he n$"se will e-pe%t the neonate to be:

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# ?ypogly%emi%& small fo" gestational age @ ?ype"gly%emi%& la"ge fo" gestational age C ?ypogly%emi%& la"ge fo" gestational age ) ?ype"gly%emi%& small fo" gestational age 120 Hhi%h of the following inst"$%tions sho$ld be in%l$ded in the n$"seCs tea%hing "ega"ding o"al %ont"a%epti/esQ # Height gain sho$ld be "epo"ted to the physi%ian @ #n alte"nate method of bi"th %ont"ol is needed when ta0ing antibioti%s C If the %lient misses one o" mo"e pills& two pills sho$ld be ta0en pe" day fo" 1 wee0 ) Changes in the menst"$al flow sho$ld be "epo"ted to the physi%ian 121 !he n$"se is dis%$ssing b"eastfeeding with a postpa"t$m %lient @"eastfeeding is %ont"aindi%ated in the postpa"t$m %lient with: # )iabetes @ Positi/e ?I7 C ?ype"tension ) !hy"oid disease 122 # %lient is admitted to the labo" and deli/e"y $nit %omplaining of /aginal bleeding with /e"y little dis%omfo"t !he n$"seCs fi"st a%tion sho$ld be to: # #ssess the fetal hea"t tones @ Che%0 fo" %e"/i%al dilation C Che%0 fo" fi"mness of the $te"$s ) Obtain a detailed histo"y 12+ # %lient telephones the eme"gen%y "oom stating that she thin0s that she is in labo" !he n$"se sho$ld tell the %lient that labo" has p"obably beg$n when: # ?e" %ont"a%tions a"e 2 min$tes apa"t @ She has ba%0 pain and a bloody dis%ha"ge C She e-pe"ien%es abdominal pain and f"e6$ent $"ination ) ?e" %ont"a%tions a"e 2 min$tes apa"t 12. !he n$"se is tea%hing a g"o$p of p"enatal %lients abo$t the effe%ts of %iga"ette smo0e on fetal de/elopment Hhi%h %ha"a%te"isti% is asso%iated with babies bo"n to mothe"s who smo0ed d$"ing p"egnan%yQ # 'ow bi"th weight @ 'a"ge fo" gestational age C P"ete"m bi"th& b$t app"op"iate si(e fo" gestation ) D"owth "eta"dation in weight and length 122 !he physi%ian has o"de"ed an inEe%tion of 1hoDam fo" the postpa"t$m %lient whose blood type is # negati/e b$t whose baby is O positi/e !o p"o/ide postpa"t$m p"ophyla-is& 1hoDam sho$ld be administe"ed: # Hithin 82 ho$"s of deli/e"y @ Hithin 1 wee0 of deli/e"y C Hithin 2 wee0s of deli/e"y ) Hithin 1 month of deli/e"y 125 #fte" the physi%ian pe"fo"ms an amniotomy& the n$"seCs fi"st a%tion sho$ld be to assess the: # )eg"ee of %e"/i%al dilation @ Fetal hea"t tones C ClientCs /ital signs ) ClientCs le/el of dis%omfo"t 128 # %lient is admitted to the labo" and deli/e"y $nit !he n$"se pe"fo"ms a /aginal e-am and dete"mines that the %lientCs %e"/i- is 2%m dilated with 82V effa%ement @ased on the n$"seCs assessment the %lient is in whi%h phase of labo"Q # #%ti/e @ 'atent C !"ansition ) ,a"ly 129 # newbo"n with na"%oti% abstinen%e synd"ome is admitted to the n$"se"y *$"sing %a"e of the newbo"n sho$ld in%l$de: # !ea%hing the mothe" to p"o/ide ta%tile stim$lation @ H"apping the newbo"n sn$gly in a blan0et C Pla%ing the newbo"n in the infant seat ) Initiating an ea"ly infant=stim$lation p"og"am 129 # %lient ele%ts to ha/e epid$"al anesthesia to "elie/e the dis%omfo"t of labo" Following the initiation of epid$"al anesthesia& the n$"se sho$ld gi/e p"io"ity to: # Che%0ing fo" %e"/i%al dilation @ Pla%ing the %lient in a s$pine position C Che%0ing the %lientCs blood p"ess$"e ) Obtaining a fetal hea"t "ate 1+0 !he n$"se is awa"e that the best way to p"e/ent post= ope"ati/e wo$nd infe%tion in the s$"gi%al %lient is to:

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# #dministe" a p"es%"ibed antibioti% @ Hash he" hands fo" 2 min$tes befo"e %a"e C Hea" a mas0 when p"o/iding %a"e ) #s0 the %lient to %o/e" he" mo$th when she %o$ghs 1+1 !he elde"ly %lient is admitted to the eme"gen%y "oom Hhi%h symptom is the %lient with a f"a%t$"ed hip most li0ely to e-hibitQ # Pain @ )isalignment C Cool e-t"emity ) #bsen%e of pedal p$lses 1+2 !he n$"se 0nows that a 50=yea"=old female %lientCs s$s%eptibility to osteopo"osis is most li0ely "elated to: # 'a%0 of e-e"%ise @ ?o"monal dist$"ban%es C 'a%0 of %al%i$m ) Deneti% p"edisposition 1++ # 2=yea"=old is admitted fo" "epai" of a f"a%t$"ed fem$" and is pla%ed in @"yantCs t"a%tion Hhi%h finding by the n$"se indi%ates that the t"a%tion is wo"0ing p"ope"lyQ # !he infant no longe" %omplains of pain @ !he b$tto%0s a"e 12R off the bed C !he legs a"e s$spended in the t"a%tion ) !he pins a"e se%$"ed within the p$lley 1+. # %lient with a f"a%t$"ed hip has been pla%ed in @$%0Cs t"a%tion Hhi%h statement is t"$e "ega"ding balan%ed s0eletal t"a%tionQ @alan%ed s0eletal t"a%tion: # Utili(es a Steinman pin @ 1e6$i"es that both legs be se%$"ed C Utili(es :i"s%hne" wi"es ) Is $sed p"ima"ily to heal the f"a%t$"ed hips 1+2 !he %lient is admitted fo" an open "ed$%tion inte"nal fi-ation of a f"a%t$"ed hip Immediately following s$"ge"y& the n$"se sho$ld gi/e p"io"ity to assessing the: # Se"$m %olle%tion O)a/olP d"ain @ ClientCs pain C *$t"itional stat$s ) Immobili(e" 1+5 Hhi%h statement made by the family membe" %a"ing fo" the %lient with a pe"%$taneo$s gast"ostomy t$be indi%ates $nde"standing of the n$"seCs tea%hingQ # LI m$st fl$sh the t$be with wate" afte" feedings and %lamp the t$be L @ LI m$st %he%0 pla%ement fo$" times pe" day L C LI will "epo"t to the do%to" any signs of indigestion L ) LIf my fathe" is $nable to swallow& I will dis%ontin$e the feeding and %all the %lini% L 1+8 !he n$"se is assessing the %lient with a total 0nee "epla%ement 2 ho$"s post=ope"ati/e Hhi%h info"mation "e6$i"es notifi%ation of the do%to"Q # @leeding on the d"essing is +%m in diamete" @ !he %lient has a tempe"at$"e of 5RF C !he %lientCs hemato%"it is 25V ) !he $"ina"y o$tp$t has been 50 d$"ing the last 2 ho$"s 1+9 !he n$"se is %a"ing fo" the %lient with a 2=yea"=old diagnosis of pl$mbism Hhi%h info"mation in the health histo"y is most li0ely "elated to the de/elopment of pl$mbismQ # !he %lient has t"a/eled o$t of the %o$nt"y in the last 5 months @ !he %lientCs pa"ents a"e s0illed stained=glass a"tists C !he %lient li/es in a ho$se b$ilt in 1 ) !he %lient has se/e"al b"othe"s and siste"s 1+9 # %lient with a total hip "epla%ement "e6$i"es spe%ial e6$ipment Hhi%h e6$ipment wo$ld assist the %lient with a total hip "epla%ement with a%ti/ities of daily li/ingQ # ?igh=seat %ommode @ 1e%line" C !,*S $nit ) #bd$%tion pillow 1.0 #n elde"ly %lient with an abdominal s$"ge"y is admitted to the $nit following s$"ge"y In anti%ipation of %ompli%ations of anesthesia and na"%oti% administ"ation& the n$"se sho$ld: # #dministe" o-ygen /ia nasal %ann$la @ ?a/e na"%an Onalo-aneP a/ailable C P"epa"e to administe" blood p"od$%ts ) P"epa"e to do %a"dio"es$s%itation 1.1 Hhi%h "oommate wo$ld be most s$itable fo" the 5=yea"=old male with a f"a%t$"ed fem$" in 1$ssellCs t"a%tionQ

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# 15=yea"=old female with s%oliosis @ 12=yea"=old male with a f"a%t$"ed fem$" C 10=yea"=old male with sa"%oma ) 5=yea"=old male with osteomylitis 1.2 # %lient with osteoa"th"itis has a p"es%"iption fo" Celeb"e- O%ele%o-ibP Hhi%h inst"$%tion sho$ld be in%l$ded in the dis%ha"ge tea%hingQ # !a0e the medi%ation with mil0 @ 1epo"t %hest pain C 1emain $p"ight afte" ta0ing fo" +0 min$tes ) #llow 5 wee0s fo" optimal effe%ts 1.+ # %lient with a f"a%t$"ed tibia has a plaste"=of=Pa"is %ast applied to immobili(e the f"a%t$"e Hhi%h a%tion by the n$"se indi%ates $nde"standing of a plaste"=of=Pa"is %astQ !he n$"se: # ?andles the %ast with the finge"tips @ Petals the %ast C )"ies the %ast with a hai" d"ye" ) #llows 2. ho$"s befo"e bea"ing weight 1.. !he teenage" with a fibe"glass %ast as0s the n$"se if it will be o0ay to allow his f"iends to a$tog"aph his %ast Hhi%h "esponse wo$ld be bestQ # LIt will be al"ight fo" yo$" f"iends to a$tog"aph the %ast L @ L@e%a$se the %ast is made of plaste"& a$tog"aphing %an wea0en the %ast L C LIf they donCt $se %hal0 to a$tog"aph& it is o0ay L ) L#$tog"aphing o" w"iting on the %ast in any fo"m will ha"m the %ast L 1.2 !he n$"se is assigned to %a"e fo" the %lient with a Steinmen pin )$"ing pin %a"e& she notes that the 'P* $ses ste"ile glo/es and >=tips to %lean the pin Hhi%h a%tion sho$ld the n$"se ta0e at this timeQ # #ssisting the 'P* with opening ste"ile pa%0ages and pe"o-ide @ !elling the 'P* that %lean glo/es a"e allowed C !elling the 'P* that the "egiste"ed n$"se sho$ld pe"fo"m pin %a"e ) #s0ing the 'P* to %lean the weights and p$lleys with pe"o-ide 1.5 # %hild with s%oliosis has a spi%a %ast applied Hhi%h a%tion spe%ifi% to the spi%a %ast sho$ld be ta0enQ # Che%0 the bowel so$nds @ #ssess the blood p"ess$"e C Offe" pain medi%ation ) Che%0 fo" swelling 1.8 !he %lient with a %e"/i%al f"a%t$"e is pla%ed in t"a%tion Hhi%h type of t"a%tion will be $tili(ed at the time of dis%ha"geQ # 1$ssellCs t"a%tion @ @$%0Cs t"a%tion C ?alo t"a%tion ) C"$t%hfield tong t"a%tion 1.9 # %lient with a total 0nee "epla%ement has a CP< O%ontin$o$s passi/e motion de/i%eP applied d$"ing the post=ope"ati/e pe"iod Hhi%h statement made by the n$"se indi%ates $nde"standing of the CP< ma%hineQ # LUse of the CP< will pe"mit the %lient to amb$late d$"ing the the"apy L @ L!he CP< ma%hine %ont"ols sho$ld be positioned distal to the site L C LIf the %lient %omplains of pain d$"ing the the"apy& I will t$"n off the ma%hine and %all the do%to" L ) LUse of the CP< ma%hine will alle/iate the need fo" physi%al the"apy afte" the %lient is dis%ha"ged L 1.9 # %lient with a f"a%t$"ed hip is being ta$ght %o""e%t $se of the wal0e" !he n$"se is awa"e that the %o""e%t $se of the wal0e" is a%hie/ed if the: # Palms "est lightly on the handles @ ,lbows a"e fle-ed 0R C Client wal0s to the f"ont of the wal0e" ) Client %a""ies the wal0e" 120 Hhen assessing a labo"ing %lient& the n$"se finds a p"olapsed %o"d !he n$"se sho$ld: # #ttempt to "epla%e the %o"d @ Pla%e the %lient on he" left side C ,le/ate the %lientCs hips ) Co/e" the %o"d with a d"y& ste"ile ga$(e 121 !he n$"se is %a"ing fo" a +0=yea"=old male admitted with a stab wo$nd Hhile in the eme"gen%y "oom& a %hest t$be is inse"ted Hhi%h of the following e-plains the p"ima"y "ationale fo" inse"tion of %hest t$besQ # !he t$be will allow fo" e6$ali(ation of the l$ng e-pansion @ Chest t$bes se"/e as a method of d"aining blood and se"o$s fl$id and assist in "einflating the l$ngs C Chest t$bes "elie/e pain asso%iated with a %ollapsed l$ng ) Chest t$bes assist with %a"dia% f$n%tion by stabili(ing l$ng e-pansion 122 # %lient who deli/e"ed this mo"ning tells the n$"se that she plans to b"eastfeed he" baby !he n$"se is awa"e that s$%%essf$l b"eastfeeding is most dependent on the: # <othe"Cs ed$%ational le/el

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@ InfantCs bi"th weight C Si(e of the mothe"Cs b"east ) <othe"Cs desi"e to b"eastfeed 12+ !he n$"se is monito"ing the p"og"ess of a %lient in labo" Hhi%h finding sho$ld be "epo"ted to the physi%ian immediatelyQ # !he p"esen%e of s%ant bloody dis%ha"ge @ F"e6$ent $"ination C !he p"esen%e of g"een=tinged amnioti% fl$id ) <ode"ate $te"ine %ont"a%tions 12. !he n$"se is meas$"ing the d$"ation of the %lientCs %ont"a%tions Hhi%h statement is t"$e "ega"ding the meas$"ement of the d$"ation of %ont"a%tionsQ # )$"ation is meas$"ed by timing f"om the beginning of one %ont"a%tion to the beginning of the ne-t %ont"a%tion @ )$"ation is meas$"ed by timing f"om the end of one %ont"a%tion to the beginning of the ne-t %ont"a%tion C )$"ation is meas$"ed by timing f"om the beginning of one %ont"a%tion to the end of the same %ont"a%tion ) )$"ation is meas$"ed by timing f"om the pea0 of one %ont"a%tion to the end of the same %ont"a%tion 122 !he physi%ian has o"de"ed an int"a/eno$s inf$sion of Pito%in fo" the ind$%tion of labo" Hhen %a"ing fo" the obstet"i% %lient "e%ei/ing int"a/eno$s Pito%in& the n$"se sho$ld monito" fo": # <ate"nal hypogly%emia @ Fetal b"ady%a"dia C <ate"nal hype""efle-ia ) Fetal mo/ement 125 # %lient with diabetes /isits the p"enatal %lini% at 29 wee0s gestation Hhi%h statement is t"$e "ega"ding ins$lin needs d$"ing p"egnan%yQ # Ins$lin "e6$i"ements mode"ate as the p"egnan%y p"og"esses @ # de%"eased need fo" ins$lin o%%$"s d$"ing the se%ond t"imeste" C ,le/ations in h$man %ho"ioni% gonadot"ophin de%"ease the need fo" ins$lin ) Fetal de/elopment depends on ade6$ate ins$lin "eg$lation 128 # %lient in the p"enatal %lini% is assessed to ha/e a blood p"ess$"e of 190G95 !he n$"se sho$ld gi/e p"io"ity to: # P"o/iding a %alm en/i"onment @ Obtaining a diet histo"y C #dministe"ing an analgesi% ) #ssessing fetal hea"t tones 129 # p"imig"a/ida& age .2& is 5 wee0s p"egnant @ased on the %lientCs age& he" infant is at "is0 fo": # )own synd"ome @ 1espi"ato"y dist"ess synd"ome C !$"ne"Cs synd"ome ) Pathologi%al Ea$ndi%e 129 # %lient with a missed abo"tion at 29 wee0s gestation is admitted to the hospital !he %lient will most li0ely be t"eated with: # <agnesi$m s$lfate @ Cal%i$m gl$%onate C )inop"ostone OP"ostin , P ) @"omo%"ystine OPa"delP 150 # %lient with p"ee%lampsia has been "e%ei/ing an inf$sion %ontaining magnesi$m s$lfate fo" a blood p"ess$"e that is 150G90W deep tendon "efle-es a"e 1 pl$s& and the $"ina"y o$tp$t fo" the past ho$" is 100m' !he n$"se sho$ld: # Contin$e the inf$sion of magnesi$m s$lfate while monito"ing the %lientCs blood p"ess$"e @ Stop the inf$sion of magnesi$m s$lfate and %onta%t the physi%ian C Slow the inf$sion "ate and t$"n the %lient on he" left side ) #dministe" %al%i$m gl$%onate I7 p$sh and %ontin$e to monito" the blood p"ess$"e 151 Hhi%h statement made by the n$"se des%"ibes the inhe"itan%e patte"n of a$tosomal "e%essi/e diso"de"sQ # #n affe%ted newbo"n has $naffe%ted pa"ents @ #n affe%ted newbo"n has one affe%ted pa"ent C #ffe%ted pa"ents ha/e a one in fo$" %han%e of passing on the defe%ti/e gene ) #ffe%ted pa"ents ha/e $naffe%ted %hild"en who a"e %a""ie"s 152 # p"egnant %lient& age +2& as0s the n$"se why he" do%to" has "e%ommended a se"$m alpha fetop"otein !he n$"se sho$ld e-plain that the do%to" has "e%ommended the test: # @e%a$se it is a state law @ !o dete%t %a"dio/as%$la" defe%ts C @e%a$se of he" age ) !o dete%t ne$"ologi%al defe%ts 15+ # %lient with hypothy"oidism as0s the n$"se if she will still need to ta0e thy"oid medi%ation d$"ing the p"egnan%y !he n$"seCs "esponse is based on the 0nowledge that:

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# !he"e is no need to ta0e thy"oid medi%ation be%a$se the fet$sCs thy"oid p"od$%es a thy"oid=stim$lating ho"mone @ 1eg$lation of thy"oid medi%ation is mo"e diffi%$lt be%a$se the thy"oid gland in%"eases in si(e d$"ing p"egnan%y C It is mo"e diffi%$lt to maintain thy"oid "eg$lation d$"ing p"egnan%y d$e to a slowing of metabolism ) Fetal g"owth is a""ested if thy"oid medi%ation is %ontin$ed d$"ing p"egnan%y 15. !he n$"se is "esponsible fo" pe"fo"ming a neonatal assessment on a f$ll=te"m infant #t 1 min$te& the n$"se %o$ld e-pe%t to find: # #n api%al p$lse of 100 @ #n absen%e of ton$s C Cyanosis of the feet and hands ) Ba$ndi%e of the s0in and s%le"a 152 # %lient with si%0le %ell anemia is admitted to the labo" and deli/e"y $nit d$"ing the fi"st phase of labo" !he n$"se sho$ld anti%ipate the %lientCs need fo": # S$pplemental o-ygen @ Fl$id "est"i%tion C @lood t"ansf$sion ) )eli/e"y by Caesa"ean se%tion 155 # %lient with diabetes has an o"de" fo" $lt"asonog"aphy P"epa"ation fo" an $lt"aso$nd in%l$des: # In%"easing fl$id inta0e @ 'imiting amb$lation C #dministe"ing an enema ) Hithholding food fo" 9 ho$"s 158 #n infant who weighs 9 po$nds at bi"th wo$ld be e-pe%ted to weigh how many po$nds at 1 yea"Q # 1. po$nds @ 15 po$nds C 19 po$nds ) 2. po$nds 159 # p"egnant %lient with a histo"y of al%ohol addi%tion is s%hed$led fo" a nonst"ess test !he nonst"ess test: # )ete"mines the l$ng mat$"ity of the fet$s @ <eas$"es the a%ti/ity of the fet$s C Shows the effe%t of %ont"a%tions on the fetal hea"t "ate ) <eas$"es the ne$"ologi%al well=being of the fet$s 159 # f$ll=te"m male has hypospadias Hhi%h statement des%"ibes hypospadiasQ # !he $"eth"al opening is absent @ !he $"eth"a opens on the do"sal side of the penis C !he penis is sho"te" than $s$al ) !he $"eth"a opens on the /ent"al side of the penis 180 # g"a/ida III pa"a II is admitted to the labo" $nit 7aginal e-am "e/eals that the %lientCs %e"/i- is 9%m dilated& with %omplete effa%ement !he p"io"ity n$"sing diagnosis at this time is: # #lte"ation in %oping "elated to pain @ Potential fo" inE$"y "elated to p"e%ipitate deli/e"y C #lte"ation in elimination "elated to anesthesia ) Potential fo" fl$id /ol$me defi%it "elated to *PO stat$s 181 !he %lient with /a"i%ella will most li0ely ha/e an o"de" fo" whi%h %atego"y of medi%ationQ # #ntibioti%s @ #ntipy"eti%s C #nti/i"als ) #nti%oag$lants 182 # %lient is admitted %omplaining of %hest pain Hhi%h of the following d"$g o"de"s sho$ld the n$"se 6$estionQ # *it"ogly%e"in @ #mpi%illin C P"op"anolol ) 7e"apamil 18+ Hhi%h of the following inst"$%tions sho$ld be in%l$ded in the tea%hing fo" the %lient with "he$matoid a"th"itisQ # #/oid e-e"%ise be%a$se it fatig$es the Eoints @ !a0e p"es%"ibed anti=inflammato"y medi%ations with meals C #lte"nate hot and %old pa%0s to affe%ted Eoints ) #/oid weight=bea"ing a%ti/ity 18. # %lient with a%$te pan%"eatitis is e-pe"ien%ing se/e"e abdominal pain Hhi%h of the following o"de"s sho$ld be 6$estioned by the n$"seQ # <epe"idine 100mg I< 6 . ho$"s P1* pain @ <ylanta +0 %%s 6 . ho$"s /ia *D

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C Cimetadine +00mg PO 6 i d ) <o"phine 9mg I< 6 . ho$"s P1* pain 182 !he %lient is admitted to the %hemi%al dependen%e $nit with an o"de" fo" %ontin$o$s obse"/ation !he n$"se is awa"e that the do%to" has o"de"ed %ontin$o$s obse"/ation be%a$se: # ?all$%inogeni% d"$gs %"eate both stim$lant and dep"essant effe%ts @ ?all$%inogeni% d"$gs ind$%e a state of alte"ed pe"%eption C ?all$%inogeni% d"$gs p"od$%e se/e"e "espi"ato"y dep"ession ) ?all$%inogeni% d"$gs ind$%e "apid physi%al dependen%e 185 # %lient with a histo"y of ab$sing ba"bit$"ates ab"$ptly stops ta0ing the medi%ation !he n$"se sho$ld gi/e p"io"ity to assessing the %lient fo": # )ep"ession and s$i%idal ideation @ !a%hy%a"dia and dia""hea C <$s%le %"amping and abdominal pain ) !a%hy%a"dia and e$pho"i% mood 188 )$"ing the assessment of a labo"ing %lient& the n$"se notes that the F?! a"e lo$dest in the $ppe"="ight 6$ad"ant !he infant is most li0ely in whi%h positionQ # 1ight b"ee%h p"esentation @ 1ight o%%ipital ante"io" p"esentation C 'eft sa%"al ante"io" p"esentation ) 'eft o%%ipital t"ans/e"se p"esentation 189 !he p"ima"y physiologi%al alte"ation in the de/elopment of asthma is: # @"on%hiola" inflammation and dyspnea @ ?ype"se%"etion of abno"mally /is%o$s m$%$s C Infe%tio$s p"o%esses %a$sing m$%osal edema ) Spasm of b"on%hiola" smooth m$s%le 189 # %lient with mania is $nable to finish he" dinne" !o help he" maintain s$ffi%ient no$"ishment& the n$"se sho$ld: # Se"/e high=%alo"ie foods she %an %a""y with he" @ ,n%o$"age he" appetite by sending o$t fo" he" fa/o"ite foods C Se"/e he" small& att"a%ti/ely a""anged po"tions ) #llow he" in the $nit 0it%hen fo" e-t"a food whene/e" she pleases 190 !o maintain @"yantCs t"a%tion& the n$"se m$st ma0e %e"tain that the %hildCs: # ?ips a"e "esting on the bed& with the legs s$spended at a "ight angle to the bed @ ?ips a"e slightly ele/ated abo/e the bed and the legs a"e s$spended at a "ight angle to the bed C ?ips a"e ele/ated abo/e the le/el of the body on a pillow and the legs a"e s$spended pa"allel to the bed ) ?ips and legs a"e flat on the bed& with the t"a%tion positioned at the foot of the bed 191 Hhi%h a%tion by the n$"se indi%ates $nde"standing of he"pes (oste"Q # !he n$"se %o/e"s the lesions with a ste"ile d"essing @ !he n$"se wea"s glo/es when p"o/iding %a"e C !he n$"se administe"s a p"es%"ibed antibioti% ) !he n$"se administe"s o-ygen 192 !he %lient has an o"de" fo" a t"o$gh to be d"awn on the %lient "e%ei/ing 7an%omy%in !he n$"se is awa"e that the n$"se sho$ld %onta%t the lab fo" them to %olle%t the blood: # 12 min$tes afte" the inf$sion @ +0 min$tes befo"e the inf$sion C 1 ho$" afte" the inf$sion ) 2 ho$"s afte" the inf$sion 19+ !he %lient $sing a diaph"agm sho$ld be inst"$%ted to: # 1ef"ain f"om 0eeping the diaph"agm in longe" than . ho$"s @ :eep the diaph"agm in a %ool lo%ation C ?a/e the diaph"agm "esi(ed if she gains 2 po$nds ) ?a/e the diaph"agm "esi(ed if she has any s$"ge"y 19. !he n$"se is p"o/iding postpa"t$m tea%hing fo" a mothe" planning to b"eastfeed he" infant Hhi%h of the %lientCs statements indi%ates the need fo" additional tea%hingQ # LICm wea"ing a s$ppo"t b"a L @ LICm e-p"essing mil0 f"om my b"east L C LICm d"in0ing fo$" glasses of fl$id d$"ing a 2.=ho$" pe"iod L ) LHhile ICm in the showe"& ICll allow the wate" to "$n o/e" my b"easts L 192 )amage to the 7II %"anial ne"/e "es$lts in: # Fa%ial pain @ #bsen%e of ability to smell C #bsen%e of eye mo/ement ) !innit$s 195 # %lient is "e%ei/ing Py"idi$m Ophena(opy"idine hyd"o%hlo"ideP fo" a $"ina"y t"a%t infe%tion !he %lient sho$ld be ta$ght that the medi%ation may:

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# Ca$se dia""hea @ Change the %olo" of he" $"ine C Ca$se mental %onf$sion ) Ca$se %hanges in taste 198 Hhi%h of the following tests sho$ld be pe"fo"med befo"e beginning a p"es%"iption of #%%$taneQ # Che%0 the %al%i$m le/el @ Pe"fo"m a p"egnan%y test C <onito" api%al p$lse ) Obtain a %"eatinine le/el 199 # %lient with #I)S is ta0ing Jo/i"a- Oa%y%lo/i"P Hhi%h n$"sing inte"/ention is most %"iti%al d$"ing the administ"ation of a%y%lo/i"Q # 'imit the %lientCs a%ti/ity @ ,n%o$"age a high=%a"bohyd"ate diet C Utili(e an in%enti/e spi"omete" to imp"o/e "espi"ato"y f$n%tion ) ,n%o$"age fl$ids 199 # %lient is admitted fo" an <1I !he n$"se sho$ld 6$estion the %lient "ega"ding: # P"egnan%y @ # titani$m hip "epla%ement C #lle"gies to antibioti%s ) Inability to mo/e his feet 190 !he n$"se is %a"ing fo" the %lient "e%ei/ing #mphote"i%in @ Hhi%h of the following indi%ates that the %lient has e-pe"ien%ed to-i%ity to this d"$gQ # Changes in /ision @ *a$sea C U"ina"y f"e6$en%y ) Changes in s0in %olo" 191 !he n$"se sho$ld /isit whi%h of the following %lients fi"stQ # !he %lient with diabetes with a blood gl$%ose of 92mgGd' @ !he %lient with hype"tension being maintained on 'isinop"il C !he %lient with %hest pain and a histo"y of angina ) !he %lient with 1ayna$dCs disease 192 # %lient with %ysti% fib"osis is ta0ing pan%"eati% en(ymes !he n$"se sho$ld administe" this medi%ation: # On%e pe" day in the mo"ning @ !h"ee times pe" day with meals C On%e pe" day at bedtime ) Fo$" times pe" day 19+ Cata"a%ts "es$lt in opa%ity of the %"ystalline lens Hhi%h of the following best e-plains the f$n%tions of the lensQ # !he lens %ont"ols stim$lation of the "etina @ !he lens o"%hest"ates eye mo/ement C !he lens fo%$ses light "ays on the "etina ) !he lens magnifies small obEe%ts 19. # %lient who has gla$%oma is to ha/e mioti% eyed"ops instilled in both eyes !he n$"se 0nows that the p$"pose of the medi%ation is to: # #nestheti(e the %o"nea @ )ilate the p$pils C Const"i%t the p$pils ) Pa"aly(e the m$s%les of a%%ommodation 192 # %lient with a se/e"e %o"neal $l%e" has an o"de" fo" Dentamy%in gtt 6 . ho$"s and *eomy%in 1 gtt 6 . ho$"s Hhi%h of the following s%hed$les sho$ld be $sed when administe"ing the d"opsQ # #llow 2 min$tes between the two medi%ations @ !he medi%ations may be $sed togethe" C !he medi%ations sho$ld be sepa"ated by a %y%loplegi% d"$g ) !he medi%ations sho$ld not be $sed in the same %lient 195 !he %lient with %olo" blindness will most li0ely ha/e p"oblems disting$ishing whi%h of the following %olo"sQ # O"ange @ 7iolet C 1ed ) Hhite 198 !he %lient with a pa%ema0e" sho$ld be ta$ght to: # 1epo"t an0le edema @ Che%0 his blood p"ess$"e daily C 1ef"ain f"om $sing a mi%"owa/e o/en ) <onito" his p$lse "ate

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199 !he %lient with en$"esis is being ta$ght "ega"ding bladde" "et"aining !he n$"se sho$ld ad/ise the %lient to "ef"ain f"om d"in0ing afte": # 1900 @ 1200 C 1000 ) 0800 199 Hhi%h of the following diet inst"$%tions sho$ld be gi/en to the %lient with "e%$""ing $"ina"y t"a%t infe%tionsQ # In%"ease inta0e of meats @ #/oid %it"$s f"$its C Pe"fo"m pe"i%a"e with hyd"ogen pe"o-ide ) )"in0 a glass of %"anbe""y E$i%e e/e"y day 200 !he physi%ian has p"es%"ibed *P? ins$lin fo" a %lient with diabetes mellit$s Hhi%h statement indi%ates that the %lient 0nows when the pea0 a%tion of the ins$lin o%%$"sQ # LI will ma0e s$"e I eat b"ea0fast within 2 ho$"s of ta0ing my ins$lin L @ LI will need to %a""y %andy o" some fo"m of s$ga" with me all the time L C LI will eat a sna%0 a"o$nd th"ee oC%lo%0 ea%h afte"noon L ) LI %an sa/e my desse"t f"om s$ppe" fo" a bedtime sna%0 L 201 # %lient with pne$ma%ystis %a"ini pne$monia is "e%ei/ing t"imet"e-ate !he "ationale fo" administe"ing le$%o/o"in %al%i$m to a %lient "e%ei/ing <ethot"e-ate is to: # !"eat anemia @ C"eate a syne"gisti% effe%t C In%"ease the n$mbe" of white blood %ells ) 1e/e"se d"$g to-i%ity 202 # %lient tells the n$"se that she is alle"gi% to eggs& dogs& "abbits& and %hi%0en feathe"s Hhi%h o"de" sho$ld the n$"se 6$estionQ # !@ s0in test @ 1$bella /a%%ine C ,'IS# test ) Chest -="ay 20+ !he physi%ian has p"es%"ibed "antidine OJanta%P fo" a %lient with e"osi/e gast"itis !he n$"se sho$ld administe" the medi%ation: # +0 min$tes befo"e meals @ Hith ea%h meal C In a single dose at bedtime ) 50 min$tes afte" meals 20. # tempo"a"y %olostomy is pe"fo"med on the %lient with %olon %an%e" !he n$"se is awa"e that the p"o-imal end of a do$ble ba""el %olostomy: # Is the opening on the %lientCs left side @ Is the opening on the distal end on the %lientCs left side C Is the opening on the %lientCs "ight side ) Is the opening on the distal "ight side 202 Hhile assessing the postpa"tal %lient& the n$"se notes that the f$nd$s is displa%ed to the "ight @ased on this finding& the n$"se sho$ld: # #s0 the %lient to /oid @ #ssess the blood p"ess$"e fo" hypotension C #dministe" o-yto%in ) Che%0 fo" /aginal bleeding 205 !he physi%ian has o"de"ed an <1I fo" a %lient with an o"thopedi% ailment #n <1I sho$ld not be done if the %lient has: # !he need fo" o-ygen the"apy @ # histo"y of %la$st"ophobia C # pe"manent pa%ema0e" ) Senso"y deafness 208 # 5=month=old %lient is pla%ed on st"i%t bed "est following a he"nia "epai" Hhi%h toy is best s$ited to the %lientQ # Colo"f$l %"ib mobile @ ?and=held ele%t"oni% games C Ca"s in a plasti% %ontaine" ) +0=pie%e Eigsaw p$((le 209 !he n$"se is p"epa"ing to dis%ha"ge a %lient with a long histo"y of polio !he n$"se sho$ld tell the %lient that: # !a0ing a hot bath will de%"ease stiffness and spasti%ity @ # s%hed$le of st"en$o$s e-e"%ise will imp"o/e m$s%le st"ength C 1est pe"iods sho$ld be s%hed$led th"o$gho$t the day

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) 7is$al dist$"ban%es %an be %o""e%ted with p"es%"iption glasses 209 # %lient on the postpa"t$m $nit has a p"o%toepisiotomy !he n$"se sho$ld anti%ipate administe"ing whi%h medi%ationQ # )$l%ola- s$pposito"y @ )o%$sate sodi$m OCola%eP C <ethye"gono/ine maleate O<ethe"gineP ) @"omo%"iptine s$lfate OPa"lodelP 210 # %lient with pan%"eati% %an%e" has an inf$sion of !P* O!otal Pa"ente"al *$t"itionP !he do%to" has o"de"ed fo" sliding=s%ale ins$lin !he most li0ely e-planation fo" this o"de" is: # !otal Pa"ente"al *$t"ition leads to negati/e nit"ogen balan%e and ele/ated gl$%ose le/els @ !otal Pa"ente"al *$t"ition %annot be managed with o"al hypogly%emi%s C !otal Pa"ente"al *$t"ition is a high=gl$%ose sol$tion that often ele/ates the blood gl$%ose le/els ) !otal Pa"ente"al *$t"ition leads to f$"the" pan%"eati% disease 211 #n adoles%ent p"imig"a/ida who is 10 wee0s p"egnant attends the antepa"tal %lini% fo" a fi"st %he%0=$p !o de/elop a tea%hing plan& the n$"se sho$ld initially assess: # !he %lientCs 0nowledge of the signs of p"ete"m labo" @ !he %lientCs feelings abo$t the p"egnan%y C Hhethe" the %lient was $sing a method of bi"th %ont"ol ) !he %lientCs tho$ght abo$t f$t$"e %hild"en 212 #n obstet"i% %lient is admitted with dehyd"ation Hhi%h I7 fl$id wo$ld be most app"op"iate fo" the %lientQ # .2 no"mal saline @ )e-t"ose 1V in wate" C 'a%tated 1inge"Cs ) )e-t"ose 2V in .2 no"mal saline 21+ !he physi%ian has o"de"ed a thy"oid s%an to %onfi"m the diagnosis @efo"e the p"o%ed$"e& the n$"se sho$ld: # #ssess the %lient fo" alle"gies @ @ol$s the %lient with I7 fl$id C !ell the %lient he will be asleep ) Inse"t a $"ina"y %athete" 21. !he physi%ian has o"de"ed an inEe%tion of 1hoDam fo" a %lient with blood type # negati/e !he n$"se $nde"stands that 1hoDam is gi/en to: # P"o/ide imm$nity against 1h isoen(ymes @ P"e/ent the fo"mation of 1h antibodies C ,liminate %i"%$lating 1h antibodies ) Con/e"t the 1h fa%to" f"om negati/e to positi/e 212 !he n$"se is %a"ing fo" a %lient admitted to the eme"gen%y "oom afte" a fall ;="ays "e/eal that the %lient has se/e"al f"a%t$"ed bones in the foot Hhi%h t"eatment sho$ld the n$"se anti%ipate fo" the f"a%t$"ed footQ # #ppli%ation of a sho"t in%l$si/e spi%a %ast @ Stabili(ation with a plaste"=of=Pa"is %ast C S$"ge"y with :i"s%hne" wi"e implantation ) # ga$(e d"essing only 215 # %lient with bladde" %an%e" is being t"eated with i"idi$m seed implants !he n$"seCs dis%ha"ge tea%hing sho$ld in%l$de telling the %lient to: # St"ain his $"ine @ In%"ease his fl$id inta0e C 1epo"t $"ina"y f"e6$en%y ) #/oid p"olonged sitting 218 Following a hea"t t"ansplant& a %lient is sta"ted on medi%ation to p"e/ent o"gan "eEe%tion Hhi%h %atego"y of medi%ation p"e/ents the fo"mation of antibodies against the new o"ganQ # #nti/i"als @ #ntibioti%s C Imm$nos$pp"essants ) #nalgesi%s 219 !he n$"se is p"epa"ing a %lient fo" %ata"a%t s$"ge"y !he n$"se is awa"e that the p"o%ed$"e will $se: # <yd"iati%s to fa%ilitate "emo/al @ <ioti% medi%ations s$%h as !imopti% C # lase" to smooth and "eshape the lens ) Sili%one oil inEe%tions into the eyeball 219 # %lient with #l(heime"Cs disease is awaiting pla%ement in a s0illed n$"sing fa%ility Hhi%h long=te"m plans wo$ld be most the"ape$ti% fo" the %lientQ # Pla%ing mi""o"s in se/e"al lo%ations in the home @ Pla%ing a pi%t$"e of he"self in he" bed"oom C Pla%ing simple signs to indi%ate the lo%ation of the bed"oom& bath"oom& and so on ) #lte"nating health%a"e wo"0e"s to p"e/ent bo"edom

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220 # %lient with an abdominal %hole%yste%tomy "et$"ns f"om s$"ge"y with a Ba%0son=P"att d"ain !he %hief p$"pose of the Ba%0son=P"att d"ain is to: # P"e/ent the need fo" d"essing %hanges @ 1ed$%e edema at the in%ision C P"o/ide fo" wo$nd d"ainage ) :eep the %ommon bile d$%t open 221 !he n$"se is pe"fo"ming an initial assessment of a newbo"n Ca$%asian male deli/e"ed at +2 wee0s gestation !he n$"se %an e-pe%t to find the p"esen%e of: # <ongolian spots @ S%"otal "$gae C ?ead lag ) 7e"ni- %aseosa 222 !he n$"se is %a"ing fo" a %lient admitted with m$ltiple t"a$ma F"a%t$"es in%l$de the pel/is& fem$"& and $lna Hhi%h finding sho$ld be "epo"ted to the physi%ian immediatelyQ # ?emat$"ia @ <$s%le spasms C )i((iness ) *a$sea 22+ # %lient is b"o$ght to the eme"gen%y "oom by the poli%e ?e is %ombati/e and yells& LI ha/e to get o$t of he"e !hey a"e t"ying to 0ill me L Hhi%h assessment is most li0ely %o""e%t in "elation to this statementQ # !he %lient is e-pe"ien%ing an a$dito"y hall$%ination @ !he %lient is ha/ing a del$sion of g"ande$" C !he %lient is e-pe"ien%ing pa"anoid del$sions ) !he %lient is into-i%ated 22. !he n$"se is p"epa"ing to s$%tion the %lient with a t"a%heotomy !he n$"se notes a p"e/io$sly $sed bottle of no"mal saline on the %lientCs bedside table !he"e is no label to indi%ate the date o" time of initial $se !he n$"se sho$ld: # 'ip the bottle and $se a pa%0 of ste"ile .-. fo" the d"essing @ Obtain a new bottle and label it with the date and time of fi"st $se C #s0 the wa"d se%"eta"y when the sol$tion was "e6$ested ) 'abel the e-isting bottle with the %$""ent date and time 222 #n infantCs #pga" s%o"e is 9 at 2 min$tes !he n$"se is awa"e that the most li0ely %a$se fo" the ded$%tion of one point is: # !he baby is %old @ !he baby is e-pe"ien%ing b"ady%a"dia C !he babyCs hands and feet a"e bl$e ) !he baby is letha"gi% 225 !he p"ima"y "eason fo" "apid %ontin$o$s "ewa"ming of the a"ea affe%ted by f"ostbite is to: # 'essen the amo$nt of %ell$la" damage @ P"e/ent the fo"mation of bliste"s C P"omote mo/ement ) P"e/ent pain and dis%omfo"t 228 # %lient "e%ently sta"ted on hemodialysis wants to 0now how the dialysis will ta0e the pla%e of his 0idneys !he n$"seCs "esponse is based on the 0nowledge that hemodialysis wo"0s by: # Passing wate" th"o$gh a dialy(ing memb"ane @ ,liminating plasma p"oteins f"om the blood C 'owe"ing the p? by "emo/ing non/olatile a%ids ) Filte"ing waste th"o$gh a dialy(ing memb"ane 229 )$"ing a home /isit& a %lient with #I)S tells the n$"se that he has been e-posed to measles Hhi%h a%tion by the n$"se is most app"op"iateQ # #dministe" an antibioti% @ Conta%t the physi%ian fo" an o"de" fo" imm$ne glob$lin C #dministe" an anti/i"al ) !ell the %lient that he sho$ld "emain in isolation fo" 2 wee0s 229 # %lient hospitali(ed with <1S# Omethi%illin="esistant staph a$"e$sP is pla%ed on %onta%t p"e%a$tions Hhi%h statement is t"$e "ega"ding p"e%a$tions fo" infe%tions sp"ead by %onta%tQ # !he %lient sho$ld be pla%ed in a "oom with negati/e p"ess$"e @ Infe%tion "e6$i"es %lose %onta%tW the"efo"e& the doo" may "emain open C !"ansmission is highly li0ely& so the %lient sho$ld wea" a mas0 at all times ) Infe%tion "e6$i"es s0in=to=s0in %onta%t and is p"e/ented by hand washing& glo/es& and a gown 2+0 # %lient who is admitted with an abo/e=the=0nee amp$tation tells the n$"se that his foot h$"ts and it%hes Hhi%h "esponse by the n$"se indi%ates $nde"standing of phantom limb painQ # L!he pain will go away in a few days L @ L!he pain is d$e to pe"iphe"al ne"/o$s system inte""$ptions I will get yo$ some pain medi%ation L C L!he pain is psy%hologi%al be%a$se yo$" foot is no longe" the"e L

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) L!he pain and it%hing a"e d$e to the infe%tion yo$ had befo"e the s$"ge"y L 2+1 # %lient with %an%e" of the pan%"eas has $nde"gone a Hhipple p"o%ed$"e !he n$"se is awa"e that d$"ing the Hhipple p"o%ed$"e& the do%to" will "emo/e the: # ?ead of the pan%"eas @ P"o-imal thi"d se%tion of the small intestines C Stoma%h and d$oden$m ) ,sophag$s and EeE$n$m 2+2 !he physi%ian has o"de"ed a minimal=ba%te"ia diet fo" a %lient with ne$t"openia !he %lient sho$ld be ta$ght to a/oid eating: # F"$its @ Salt C Peppe" ) :et%h$p 2++ # %lient is dis%ha"ged home with a p"es%"iption fo" Co$madin Osodi$m wa"fa"inP !he %lient sho$ld be inst"$%ted to: # ?a/e a P"otime done monthly @ ,at mo"e f"$its and /egetables C )"in0 mo"e li6$ids ) #/oid %"owds 2+. !he n$"se is assisting the physi%ian with "emo/al of a %ent"al /eno$s %athete" !o fa%ilitate "emo/al& the n$"se sho$ld inst"$%t the %lient to: # Pe"fo"m the 7alsal/a mane$/e" as the %athete" is ad/an%ed @ !$"n his head to the left side and hype"e-tend the ne%0 C !a0e slow& deep b"eaths as the %athete" is "emo/ed ) !$"n his head to the "ight while maintaining a sniffing position 2+2 # %lient has an o"de" fo" st"epto0inase @efo"e administe"ing the medi%ation& the n$"se sho$ld assess the %lient fo": # #lle"gies to pineapples and bananas @ # histo"y of st"epto%o%%al infe%tions C P"io" the"apy with phenytoin ) # histo"y of al%ohol ab$se 2+5 !he n$"se is p"o/iding dis%ha"ge tea%hing fo" the %lient with le$0emia !he %lient sho$ld be told to a/oid: # Using oil= o" %"eam=based soaps @ Flossing between the teeth C !he inta0e of salt ) Using an ele%t"i% "a(o" 2+8 !he n$"se is %hanging the ties of the %lient with a t"a%heotomy !he safest method of %hanging the t"a%heotomy ties is to: # #pply the new tie befo"e "emo/ing the old one @ ?a/e a helpe" p"esent C ?old the t"a%heotomy with the nondominant hand while "emo/ing the old tie ) #s0 the do%to" to s$t$"e the t"a%heostomy in pla%e 2+9 !he n$"se is monito"ing a %lient following a l$ng "ese%tion !he ho$"ly o$tp$t f"om the %hest t$be was +00m' !he n$"se sho$ld gi/e p"io"ity to: # !$"ning the %lient to the left side @ <il0ing the t$be to ens$"e paten%y C Slowing the int"a/eno$s inf$sion ) *otifying the physi%ian 2+9 !he infant is admitted to the $nit with tet"ology of falot !he n$"se wo$ld anti%ipate an o"de" fo" whi%h medi%ationQ # )igo-in @ ,pineph"ine C #minophyline ) #t"opine 2.0 !he n$"se is ed$%ating the ladyCs %l$b in self=b"east e-am !he n$"se is awa"e that most malignant b"east masses o%%$" in the !ail of Spen%e On the diag"am& pla%e an ; on the !ail of Spen%e

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2.1 !he toddle" is admitted with a %a"dia% anomaly !he n$"se is awa"e that the infant with a /ent"i%$la" septal defe%t will: # !i"e easily @ D"ow no"mally C *eed mo"e %alo"ies ) @e mo"e s$s%eptible to /i"al infe%tions 2.2 !he n$"se is monito"ing a %lient with a histo"y of stillbo"n infants !he n$"se is awa"e that a nonst"ess test %an be o"de"ed fo" this %lient to: # )ete"mine l$ng mat$"ity @ <eas$"e the fetal a%ti/ity C Show the effe%t of %ont"a%tions on fetal hea"t "ate ) <eas$"e the well=being of the fet$s 2.+ !he n$"se is e/al$ating the %lient who was admitted 9 ho$"s ago fo" ind$%tion of labo" !he following g"aph is noted on the monito" Hhi%h a%tion sho$ld be ta0en fi"st by the n$"seQ

# Inst"$%t the %lient to p$sh @ Pe"fo"m a /aginal e-am C !$"n off the Pito%in inf$sion ) Pla%e the %lient in a semi=Fowle"Cs position 2.. !he n$"se notes the following on the ,CD monito" !he n$"se wo$ld e/al$ate the %a"dia% a""hythmia as:

# #t"ial fl$tte" @ # sin$s "hythm C 7ent"i%$la" ta%hy%a"dia ) #t"ial fib"illation 2.2 # %lient with %lotting diso"de" has an o"de" to %ontin$e 'o/eno- Oeno-apa"inP inEe%tions afte" dis%ha"ge !he n$"se sho$ld tea%h the %lient that 'o/eno- inEe%tions sho$ld:

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# @e inEe%ted into the deltoid m$s%le @ @e inEe%ted into the abdomen C #spi"ate afte" the inEe%tion ) Clea" the ai" f"om the sy"inge befo"e inEe%tions 2.5 !he n$"se has a p"eop o"de" to administe" 7ali$m Odia(epamP 10mg and Phene"gan Op"ometha(ineP 22mg !he %o""e%t method of administe"ing these medi%ations is to: # #dministe" the medi%ations togethe" in one sy"inge @ #dministe" the medi%ation sepa"ately C #dministe" the 7ali$m& wait 2 min$tes& and then inEe%t the Phene"gan ) >$estion the o"de" be%a$se they %annot be gi/en at the same time 2.8 # %lient with f"e6$ent $"ina"y t"a%t infe%tions as0s the n$"se how she %an p"e/ent the "eo%%$""en%e !he n$"se sho$ld tea%h the %lient to: # )o$%he afte" inte"%o$"se @ 7oid e/e"y + ho$"s C Obtain a $"inalysis monthly ) Hipe f"om ba%0 to f"ont afte" /oiding 2.9 Hhi%h tas0 sho$ld be assigned to the n$"sing assistantQ # Pla%ing the %lient in se%l$sion @ ,mptying the Foley %athete" of the p"ee%lampti% %lient C Feeding the %lient with dementia ) #mb$lating the %lient with a f"a%t$"ed hip 2.9 !he %lient has "e%ently "et$"ned f"om ha/ing a thy"oide%tomy !he n$"se sho$ld 0eep whi%h of the following at the bedsideQ # # t"a%heotomy set @ # padded tong$e blade C #n endot"a%heal t$be ) #n ai"way 220 !he physi%ian has o"de"ed a histoplasmosis test fo" the elde"ly %lient !he n$"se is awa"e that histoplasmosis is t"ansmitted to h$mans by: # Cats @ )ogs C !$"tles ) @i"ds

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A$s-!rs a$% Rati#$a+!s ,#r C#6*r!/!$si8! E<a6i$ati#$ Part 2 1 #nswe" ) is %o""e%t It is impo"tant to assess the e-t"emities fo" blood /essel o%%l$sion in the %lient with si%0le %ell anemia be%a$se a %hange in %apilla"y "efill wo$ld indi%ate a %hange in %i"%$lation @ody tempe"at$"e& motion& and sensation wo$ld not gi/e info"mation "ega"ding pe"iphe"al %i"%$lationW the"efo"e& answe"s #& @& and C a"e in%o""e%t 2 #nswe" ) is %o""e%t Pla%ing the %lient in semi=Fowle"Ks position p"o/ides the best o-ygenation fo" this %lient Fle-ion of the hips and 0nees& whi%h in%l$des the 0nee=%hest position& impedes %i"%$lation and is not %o""e%t positioning fo" this %lient !he"efo"e& answe"s #& @& and C a"e in%o""e%t + #nswe" @ is %o""e%t It is impo"tant to 0eep the %lient in si%0le %ell %"isis hyd"ated to p"e/ent f$"the" si%0ling of the blood #nswe" # is in%o""e%t be%a$se a me%hani%al %$ff pla%es too m$%h p"ess$"e on the a"m #nswe" C is in%o""e%t be%a$se "aising the 0nee gat%h impedes %i"%$lation #nswe" ) is in%o""e%t be%a$se !ylenol is too mild an analgesi% fo" the %lient in %"isis . #nswe" C is %o""e%t ?yd"ation is impo"tant in the %lient with si%0le %ell disease to p"e/ent th"omb$s fo"mation Popsi%les& gelatin& E$i%e& and p$dding ha/e high fl$id %ontent !he foods in answe"s #& @& and ) do not aid in hyd"ation and a"e& the"efo"e& in%o""e%t 2 #nswe" C is %o""e%t !he most p"ominent %lini%al manifestation of si%0le %ell %"isis is pain ?owe/e"& the p$lse o-imet"y indi%ates that o-ygen le/els a"e lowW th$s& o-ygenation ta0es p"e%eden%e o/e" pain "elief #nswe" # is in%o""e%t be%a$se altho$gh a wa"m en/i"onment "ed$%es pain and minimi(es si%0ling& it wo$ld not be a p"io"ity #nswe" @ is in%o""e%t be%a$se altho$gh hyd"ation is impo"tant& it wo$ld not "e6$i"e a bol$s #nswe" ) is in%o""e%t be%a$se )eme"ol is a%idifying to the blood and in%"eases si%0ling 5 #nswe" C is %o""e%t ,gg yol0s& wheat b"ead& %a""ots& "aisins& and g"een& leafy /egetables a"e all high in i"on& whi%h is an impo"tant mine"al fo" this %lient 1oast beef& %abbage& and po"0 %hops a"e also high in i"on& b$t the side dishes a%%ompanying these %hoi%es a"e notW the"efo"e& answe"s #& @& and ) a"e in%o""e%t 8 #nswe" ) is %o""e%t !a0ing a t"ip to the m$se$m is the only answe" that does not pose a th"eat # family /a%ation in the 1o%0y <o$ntains at high altit$des& %old tempe"at$"es& and ai"plane t"a/el %an %a$se si%0ling episodes and sho$ld be a/oidedW the"efo"e& answe"s #& @& and C a"e in%o""e%t 9 #nswe" ) is %o""e%t !he tong$e is smooth and beefy "ed in the %lient with /itamin @12 defi%ien%y& so e-amining the tong$e sho$ld be in%l$ded in the physi%al assessment @leeding& splenomegaly& and blood p"ess$"e %hanges do not o%%$"& ma0ing answe"s #& @& and C in%o""e%t 9 #nswe" C is %o""e%t !he o"al m$%osa and ha"d palate O"oof of the mo$thP a"e the best indi%ato"s of Ea$ndi%e in da"0=s0inned pe"sons !he %onE$n%ti/a %an ha/e no"mal deposits of fat& whi%h gi/e a yellowish h$eW th$s& answe" # is in%o""e%t !he soles of the feet %an be yellow if they a"e %allo$sed& ma0ing answe" @ in%o""e%tW the shins wo$ld be an a"ea of da"0e" pigment& so answe" ) is in%o""e%t 10 #nswe" @ is %o""e%t Hhen the"e a"e fewe" "ed blood %ells& the"e is less hemoglobin and less o-ygen !he"efo"e& the %lient is often sho"t of b"eath& as indi%ated in answe" @ !he %lient with anemia is often pale in %olo"& has weight loss& and may be hypotensi/e #nswe"s #& C& and ) a"e within no"mal and& the"efo"e& a"e in%o""e%t 11 #nswe" # is %o""e%t !he %lient with poly%ythemia /e"a is at "is0 fo" th"omb$s fo"mation ?yd"ating the %lient with at least +' of fl$id pe" day is impo"tant in p"e/enting %lot fo"mation& so the statement to d"in0 less than 200m' is in%o""e%t #nswe"s @& C& and ) a"e in%o""e%t be%a$se they all %ont"ib$te to the p"e/ention of %ompli%ations S$ppo"t hose p"omotes /eno$s "et$"n& the ele%t"i% "a(o" p"e/ents bleeding d$e to inE$"y& and a diet low in i"on is essential to p"e/enting f$"the" "ed %ell fo"mation 12 #nswe" C is %o""e%t 1adiation t"eatment fo" othe" types of %an%e" %an "es$lt in le$0emia Some hobbies and o%%$pations in/ol/ing %hemi%als a"e lin0ed to le$0emia& b$t not the ones in these answe"sW the"efo"e& answe"s # and @ a"e in%o""e%t #nswe" ) is in%o""e%t be%a$se the in%iden%e of le$0emia is highe" in twins than in siblings 1+ #nswe" ) is %o""e%t Pete%hiae a"e not $s$ally /is$ali(ed on da"0 s0in !he soles of the feet and palms of the hand p"o/ide a lighte" s$"fa%e fo" assessing the %lient fo" peti%hiae #nswe"s #& @& and C a"e in%o""e%t be%a$se the s0in might be too da"0 to ma0e an assessment 1. #nswe" @ is %o""e%t !he %lient with le$0emia is at "is0 fo" infe%tion and has often had "e%$""ent "espi"ato"y infe%tions d$"ing the p"e/io$s 5 months Insomnolen%e& weight loss& and a de%"ease in ale"tness also o%%$" in le$0emia& b$t bleeding tenden%ies and infe%tions a"e the p"ima"y %lini%al manifestationsW the"efo"e& answe"s #& C& and ) a"e in%o""e%t 12 #nswe" @ is %o""e%t !he %lient with a%$te le$0emia has bleeding tenden%ies d$e to de%"eased platelet %o$nts& and any inE$"y wo$ld e-a%e"bate the p"oblem !he %lient wo$ld "e6$i"e %lose monito"ing fo" hemo""hage& whi%h is of highe" p"io"ity than the diagnoses in answe"s #& C& and )& whi%h a"e in%o""e%t 15 #nswe" # is %o""e%t 1adiation the"apy often %a$ses ste"ility in male %lients and wo$ld be of p"ima"y impo"tan%e to this %lient !he psy%hoso%ial needs of the %lient a"e impo"tant to add"ess in light of the age and life %hoi%es ?odg0inKs disease& howe/e"& has a good p"ognosis when diagnosed ea"ly #nswe"s @& C& and ) a"e in%o""e%t be%a$se they a"e of lesse" p"io"ity 18 #nswe" # is %o""e%t Clients with a$toimm$ne th"ombo%ytopeni% p$"p$"a O#!PP ha/e low platelet %o$nts& ma0ing answe" # the %o""e%t answe" Hhite %ell %o$nts& potassi$m le/els& and P!! a"e not affe%ted in #!PW th$s& answe"s @& C& and ) a"e in%o""e%t

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19 #nswe" # is %o""e%t !he no"mal platelet %o$nt is 120&000X.00&000 @leeding o%%$"s in %lients with low
platelets !he p"io"ity is to p"e/ent and minimi(e bleeding O-ygenation in answe" C is impo"tant& b$t platelets do not %a""y o-ygen #nswe"s @ and ) a"e of lesse" p"io"ity and a"e in%o""e%t in this instan%e 19 #nswe" C is %o""e%t ,le/ating the head of the bed +0R a/oids p"ess$"e on the sella t$"%i%a and alle/iates heada%hes #nswe"s #& @& and ) a"e in%o""e%t be%a$se !"endelenb$"g& 7alsal/a mane$/e"& and %o$ghing all in%"ease the int"a%"anial p"ess$"e 20 #nswe" @ is %o""e%t !he la"ge amo$nt of fl$id loss %an %a$se fl$id and ele%t"olyte imbalan%e that sho$ld be %o""e%ted !he loss of ele%t"olytes wo$ld be "efle%ted in the /ital signs <eas$"ing the $"ina"y o$tp$t is impo"tant& b$t the stem al"eady says that the %lient has poly$"ia& so answe" # is in%o""e%t ,n%o$"aging fl$id inta0e will not %o""e%t the p"oblem& ma0ing answe" C in%o""e%t #nswe" ) is in%o""e%t be%a$se weighing the %lient is not ne%essa"y at this time 21 #nswe" C is %o""e%t !he %lient sho$ld be positioned $p"ight and leaning fo"wa"d& to p"e/ent aspi"ation of blood #nswe"s #& @& and ) a"e in%o""e%t be%a$se di"e%t p"ess$"e to the nose stops the bleeding& and i%e pa%0s sho$ld be applied di"e%tly to the nose as well If a pa%0 is ne%essa"y& the na"es a"e loosely pa%0ed 22 #nswe" # is %o""e%t @lood p"ess$"e is the best indi%ato" of %a"dio/as%$la" %ollapse in the %lient who has had an ad"enal gland "emo/ed !he "emaining gland might ha/e been s$pp"essed d$e to the t$mo" a%ti/ity !empe"at$"e wo$ld be an indi%ato" of infe%tion& de%"eased o$tp$t wo$ld be a %lini%al manifestation b$t wo$ld ta0e longe" to o%%$" than blood p"ess$"e %hanges& and spe%ifi% g"a/ity %hanges o%%$" with othe" diso"de"sW the"efo"e& answe"s @& C& and ) a"e in%o""e%t 2+ #nswe" # is %o""e%t I7 gl$%o%o"ti%oids "aise the gl$%ose le/els and often "e6$i"e %o/e"age with ins$lin #nswe" @ is not ne%essa"y at this time& sodi$m and potassi$m le/els wo$ld be monito"ed when the %lient is "e%ei/ing mine"al %o"ti%oids& and daily weights is $nne%essa"yW the"efo"e& answe"s @& C& and ) a"e in%o""e%t 2. #nswe" @ is %o""e%t !he pa"athy"oid glands a"e "esponsible fo" %al%i$m p"od$%tion and %an be damaged d$"ing a thy"oide%tomy !he tingling is d$e to low %al%i$m le/els !he %"ash %a"t wo$ld be needed in "espi"ato"y dist"ess b$t wo$ld not be the ne-t a%tion to ta0eW th$s& answe" # is in%o""e%t ?ype"tension o%%$"s in thy"oid sto"m and the d"ainage wo$ld o%%$" in hemo""hage& so answe"s C and ) a"e in%o""e%t 22 #nswe" ) is %o""e%t !he de%"ease in p$lse %an affe%t the %a"dia% o$tp$t and lead to sho%0& whi%h wo$ld ta0e p"e%eden%e o/e" the othe" %hoi%esW the"efo"e& answe"s #& @& and C a"e in%o""e%t 25 #nswe" # is %o""e%t !he %lient ta0ing antilipidemi%s sho$ld be en%o$"aged to "epo"t m$s%le wea0ness be%a$se this is a sign of "habdomyositis !he medi%ation ta0es effe%t within 1 month of beginning the"apy& so answe" @ is in%o""e%t !he medi%ation sho$ld be ta0en with wate" be%a$se f"$it E$i%e& pa"ti%$la"ly g"apef"$it& %an de%"ease the effe%ti/eness& ma0ing answe" C in%o""e%t 'i/e" f$n%tion st$dies sho$ld be %he%0ed befo"e beginning the medi%ation& not afte" the fa%t& ma0ing answe" ) in%o""e%t 28 #nswe" @ is %o""e%t ?ype"stat is gi/en I7 p$sh fo" hype"tensi/e %"ises& b$t it often %a$ses hype"gly%emia !he gl$%ose le/el will d"op "apidly when stopped #nswe" # is in%o""e%t be%a$se the hype"stat is gi/en by I7 p$sh !he %lient sho$ld be pla%ed in do"sal "e%$mbent position& not a !"endelenb$"g position& as stated in answe" C #nswe" ) is in%o""e%t be%a$se the medi%ation does not ha/e to be %o/e"ed with foil 29 #nswe" C is %o""e%t # hea"t "ate of 50 in the baby sho$ld be "epo"ted immediately !he dose sho$ld be held if the hea"t "ate is below 100bpm !he blood gl$%ose& blood p"ess$"e& and "espi"ations a"e within no"mal limitsW th$s answe"s #& @& and ) a"e in%o""e%t 29 #nswe" C is %o""e%t *it"ogly%e"ine sho$ld be 0ept in a b"own bottle Oo" e/en a spe%ial ai"= and wate"=tight& solid o" plated sil/e" o" gold %ontaine"P be%a$se of its instability and tenden%y to be%ome less potent when e-posed to ai"& light& o" wate" !he s$pply sho$ld be "eplenished e/e"y 5 months& not + months& and one tablet sho$ld be ta0en e/e"y 2 min$tes $ntil pain s$bsides& so answe"s # and @ a"e in%o""e%t If the pain does not s$bside& the %lient sho$ld "epo"t to the eme"gen%y "oom !he medi%ation sho$ld be ta0en s$bling$ally and sho$ld not be %"$shed& as stated in answe" ) +0 #nswe" C is %o""e%t !$"0ey %ontains the least amo$nt of fats and %holeste"ol 'i/e"& eggs& beef& %"eam sa$%es& sh"imp& %heese& and %ho%olate sho$ld be a/oided by the %lientW th$s& answe"s #& @& and ) a"e in%o""e%t !he %lient sho$ld ba0e meat "athe" than f"ying to a/oid adding fat to the meat d$"ing %oo0ing +1 #nswe" @ is %o""e%t !he E$g$la" /eins in the ne%0 sho$ld be assessed fo" distension !he othe" pa"ts of the body will be edemato$s in "ight=sided %ongesti/e hea"t fail$"e& not left=sidedW th$s& answe"s #& C& and ) a"e in%o""e%t +2 #nswe" # is %o""e%t !he phlebostati% a-is is lo%ated at the fifth inte"%ostals spa%e mida-illa"y line and is the %o""e%t pla%ement of the manomete" !he P<I o" point of ma-imal imp$lse is lo%ated at the fifth inte"%ostals spa%e mid%la/i%$la" line& so answe" @ is in%o""e%t ,"bKs point is the point at whi%h yo$ %an hea" the /al/es %lose sim$ltaneo$sly& ma0ing answe" C in%o""e%t !he !ail of Spen%e Othe $ppe" o$te" 6$ad"antP is the a"ea whe"e most b"east %an%e"s a"e lo%ated and has nothing to do with pla%ement of a manomete"W th$s& answe" ) is in%o""e%t ++ #nswe" @ is %o""e%t Jest"il is an #C, inhibito" and is f"e6$ently gi/en with a di$"eti% s$%h as 'asi- fo" hype"tension #nswe"s #& C& and ) a"e in%o""e%t be%a$se the o"de" is a%%$"ate !he"e is no need to 6$estion the o"de"& administe" the medi%ation sepa"ately& o" %onta%t the pha"ma%y +. #nswe" @ is %o""e%t !he best indi%ato" of pe"iphe"al edema is meas$"ing the e-t"emity # pape" tape meas$"e sho$ld be $sed "athe" than one of plasti% o" %loth& and the a"ea sho$ld be ma"0ed with a pen& p"o/iding the most obEe%ti/e assessment #nswe" # is in%o""e%t be%a$se weighing the %lient will not indi%ate pe"iphe"al edema #nswe" C is in%o""e%t be%a$se %he%0ing the inta0e and o$tp$t will not indi%ate pe"iphe"al edema

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 21+

#nswe" ) is in%o""e%t be%a$se %he%0ing fo" pitting edema is less "eliable than meas$"ing with a pape" tape meas$"e +2 #nswe" ) is %o""e%t Clients with "adi$m implants sho$ld ha/e %lose %onta%t limited to +0 min$tes pe" /isit !he gene"al "$le is limiting time spent e-posed to "adi$m& p$tting distan%e between people and the "adi$m so$"%e& and $sing lead to shield against the "adi$m !ea%hing the family membe" these p"in%iples is e-t"emely impo"tant #nswe"s #& @& and C a"e not empatheti% and do not add"ess the 6$estionW the"efo"e& they a"e in%o""e%t +5 #nswe" @ is %o""e%t !he %lient with a fa%ial st"o0e will ha/e diffi%$lty swallowing and %hewing& and the foods in answe" @ p"o/ide the least amo$nt of %hewing !he foods in answe"s #& C& and ) wo$ld "e6$i"e mo"e %hewing and& th$s& a"e in%o""e%t +8 #nswe" # is %o""e%t *o/alog ins$lin onsets /e"y 6$i%0ly& so food sho$ld be a/ailable within 10X12 min$tes of ta0ing the ins$lin #nswe" @ does not add"ess a pa"ti%$la" type of ins$lin& so it is in%o""e%t *P? ins$lin pea0s in 9X12 ho$"s& so a sna%0 sho$ld be eaten at the e-pe%ted pea0 time It may not be + p m as stated in answe" C #nswe" ) is in%o""e%t be%a$se the"e is no need to sa/e the desse"t $ntil bedtime +9 #nswe" @ is %o""e%t !he $mbili%al %o"d needs time to d"y and fall off befo"e p$tting the infant in the t$b #ltho$gh answe"s #& C& and ) might be impo"tant& they a"e not the p"ima"y answe" to the 6$estion +9 #nswe" ) is %o""e%t 'e$%o/o"in is the antidote fo" <ethot"e-ate and !"imet"e-ate whi%h a"e foli% a%id antagonists 'e$%o/o"in is a foli% a%id de"i/ati/e #nswe"s #& @& and C a"e in%o""e%t be%a$se 'e$%o/o"in does not t"eat i"on defi%ien%y& in%"ease ne$t"ophils& o" ha/e a syne"gisti% effe%t .0 #nswe" # is %o""e%t !he ?emophil$s infl$en(a /a%%ine is gi/en at . months with the polio /a%%ine #nswe"s @& C& and ) a"e in%o""e%t be%a$se these /a%%ines a"e gi/en late" in life .1 #nswe" @ is %o""e%t P"oton p$mp inhibito"s s$%h as *e-i$m and P"otoni- sho$ld be ta0en with meals& fo" optimal effe%t ?istamine=blo%0ing agents s$%h as Janta% sho$ld be ta0en +0 min$tes befo"e meals& so answe" # is in%o""e%t !agamet %an be ta0en in a single dose at bedtime& ma0ing answe" C in%o""e%t #nswe" ) does not t"eat the p"oblem ade6$ately and& the"efo"e& is in%o""e%t .2 #nswe" # is %o""e%t If the %lient is a th"eat to the staff and to othe" %lients the n$"se sho$ld %all fo" help and p"epa"e to administe" a medi%ation s$%h as ?aldol to sedate him #nswe" @ is in%o""e%t be%a$se simply telling the %lient to %alm down will not wo"0 #nswe" C is in%o""e%t be%a$se telling the %lient that if he %ontin$es he will be p$nished is a th"eat and may f$"the" ange" him #nswe" ) is in%o""e%t be%a$se if the %lient is left alone he might ha"m himself .+ #nswe" # is %o""e%t If the f$nd$s of the %lient is displa%ed to the side& this might indi%ate a f$ll bladde" !he ne-t a%tion by the n$"se sho$ld be to %he%0 fo" bladde" distention and %athete"i(e& if ne%essa"y !he answe"s in @& C& and ) a"e a%tions that "elate to postpa"tal hemo""hage .. #nswe" C is %o""e%t # low=g"ade tempe"at$"e& blood=tinged sp$t$m& fatig$e& and night sweats a"e symptoms %onsistent with t$be"%$losis If the answe" in # had said pne$mo%ystis pne$monia& answe" # wo$ld ha/e been %onsistent with the symptoms gi/en in the stem& b$t E$st saying pne$monia isnKt spe%ifi% eno$gh to diagnose the p"oblem #nswe"s @ and ) a"e not di"e%tly "elated to the stem .2 #nswe" @ is %o""e%t If the %lient has a histo"y of P"in(metalKs angina& he sho$ld not be p"es%"ibed t"iptan p"epa"ations be%a$se they %a$se /aso%onst"i%tion and %o"ona"y spasms !he"e is no %ont"aindi%ation fo" ta0ing t"iptan d"$gs in %lients with diabetes& %an%e"& o" %l$ste" heada%hes ma0ing answe"s #& C& and ) in%o""e%t .5 #nswe" # is %o""e%t :e"nigKs sign is positi/e if pain o%%$"s on fle-ion of the hip and 0nee !he @"$d(ins0i "efle- is positi/e if pain o%%$"s on fle-ion of the head and ne%0 onto the %hest so answe" @ is in%o""e%t #nswe"s C and ) might be p"esent b$t a"e not "elated to :e"nigKs sign .8 #nswe" @ is %o""e%t #p"a-ia is the inability to $se obEe%ts app"op"iately #gnosia is loss of senso"y %omp"ehension& anomia is the inability to find wo"ds& and aphasia is the inability to spea0 o" $nde"stand so answe"s #& C& and ) a"e in%o""e%t .9 #nswe" C is %o""e%t In%"eased %onf$sion at night is 0nown as Ls$ndowningL synd"ome !his in%"eased %onf$sion o%%$"s when the s$n begins to set and %ontin$es d$"ing the night #nswe" # is in%o""e%t be%a$se fatig$e is not ne%essa"ily p"esent In%"eased %onf$sion at night is not pa"t of no"mal agingW the"efo"e& answe" @ is in%o""e%t # del$sion is a fi"m& fi-ed beliefW the"efo"e& answe" ) is in%o""e%t .9 #nswe" C is %o""e%t !he %lient who is %onf$sed might fo"get that he ate ea"lie" )onKt a"g$e with the %lient Simply get him something to eat that will satisfy him $ntil l$n%h #nswe"s # and ) a"e in%o""e%t be%a$se the n$"se is dismissing the %lient #nswe" @ is /alidating the del$sion 20 #nswe" ) is %o""e%t *a$sea and gast"ointestinal $pset a"e /e"y %ommon in %lients ta0ing a%etyl%holineste"ase inhibito"s s$%h as ,-elon Othe" side effe%ts in%l$de li/e" to-i%ity& di((iness& $nsteadiness& and %l$msiness !he %lient might al"eady be e-pe"ien%ing $"ina"y in%ontinen%e o" heada%hes& b$t they a"e not ne%essa"ily asso%iatedW and the %lient with #l(heime"Ks disease is al"eady %onf$sed !he"efo"e& answe"s #& @& and C a"e in%o""e%t 21 #nswe" @ is %o""e%t #ny lesion sho$ld be "epo"ted to the do%to" !his %an indi%ate a he"pes lesion Clients with open lesions "elated to he"pes a"e deli/e"ed by Cesa"ean se%tion be%a$se the"e is a possibility of t"ansmission of the infe%tion to the fet$s with di"e%t %onta%t to lesions It is not eno$gh to do%$ment the finding& so answe" # is in%o""e%t !he physi%ian m$st ma0e the de%ision to pe"fo"m a C=se%tion& ma0ing answe" C in%o""e%t It is not eno$gh to %ontin$e p"ima"y %a"e& so answe" ) is in%o""e%t 22 #nswe" @ is %o""e%t !he %lient with ?P7 is at highe" "is0 fo" %e"/i%al and /aginal %an%e" "elated to this S!I She is not at highe" "is0 fo" the othe" %an%e"s mentioned in answe"s #& C& and )& so those a"e in%o""e%t

COMPREHENSIVE NURSING REVIEW by R. C. REA

| 21.

2+ #nswe" @ is %o""e%t # lesion that is painf$l is most li0ely a he"peti% lesion # %han%"e lesion asso%iated with syphilis is not painf$l& so answe" # is in%o""e%t Condylomata lesions a"e painless wa"ts& so answe" ) is in%o""e%t In answe" C& gono""hea does not p"esent as a lesion& b$t is e-hibited by a yellow dis%ha"ge 2. #nswe" C is %o""e%t Flo"es%ent t"eponemal antibody OF!#P is the test fo" t"eponema pallid$m 7)1' and 1P1 a"e s%"eening tests done fo" syphilis& so answe"s # and @ a"e in%o""e%t !he !haye"=<a"tin %$lt$"e is done fo" gono""hea& so answe" ) is in%o""e%t 22 #nswe" ) is %o""e%t !he %"ite"ia fo" ?,''P is hemolysis& ele/ated li/e" en(ymes& and low platelet %o$nt In answe" #& an ele/ated blood gl$%ose le/el is not asso%iated with ?,''P Platelets a"e de%"eased& not ele/ated& in ?,''P synd"ome as stated in answe" @ !he %"eatinine le/els a"e ele/ated in "enal disease and a"e not asso%iated with ?,''P synd"ome so answe" C is in%o""e%t 25 #nswe" # is %o""e%t #nswe" @ eli%its the t"i%eps "efle-& so it is in%o""e%t #nswe" C eli%its the patella "efle-& ma0ing it in%o""e%t #nswe" ) eli%its the "adial ne"/e& so it is in%o""e%t 28 #nswe" @ is %o""e%t @"ethine is $sed %a$tio$sly be%a$se it "aises the blood gl$%ose le/els #nswe"s #& C& and ) a"e all medi%ations that a"e %ommonly $sed in the diabeti% %lient& so they a"e in%o""e%t 29 #nswe" C is %o""e%t Hhen the 'GS "atio "ea%hes 2:1& the l$ngs a"e %onside"ed to be mat$"e !he infant will most li0ely be small fo" gestational age and will not be at "is0 fo" bi"th t"a$ma& so answe" ) is in%o""e%t !he 'GS "atio does not indi%ate %ongenital anomalies& as stated in answe" #& and the infant is not at "is0 fo" int"a$te"ine g"owth "eta"dation& ma0ing answe" @ in%o""e%t 29 #nswe" C is %o""e%t Bitte"iness is a sign of sei($"e in the neonate C"ying& wa0ef$lness& and yawning a"e e-pe%ted in the newbo"n& so answe"s #& @& and ) a"e in%o""e%t 50 #nswe" @ is %o""e%t !he %lient is e-pe%ted to be%ome sleepy& ha/e hot flashes& and be letha"gi% # de%"easing $"ina"y o$tp$t& absen%e of the 0nee=Ee"0 "efle-& and de%"eased "espi"ations indi%ate to-i%ity& so answe"s #& C& and ) a"e in%o""e%t 51 #nswe" ) is %o""e%t If the %lient e-pe"ien%es hypotension afte" an inEe%tion of epid$"al anestheti%& the n$"se sho$ld t$"n he" to the left side& apply o-ygen by mas0& and speed the I7 inf$sion If the blood p"ess$"e does not "et$"n to no"mal& the physi%ian sho$ld be %onta%ted ,pineph"ine sho$ld be 0ept fo" eme"gen%y administ"ation #nswe" # is in%o""e%t be%a$se pla%ing the %lient in !"endelenb$"g position Ohead downP will allow the anesthesia to mo/e $p abo/e the "espi"ato"y %ente"& the"eby de%"easing the diaph"agmKs ability to mo/e $p and down and /entilate the %lient In answe" @& the I7 "ate sho$ld be in%"eased& not de%"eased In answe" C& the o-ygen sho$ld be applied by mas0& not %ann$la 52 #nswe" # is %o""e%t Can%e" of the pan%"eas f"e6$ently leads to se/e"e na$sea and /omiting and alte"ed n$t"ition !he othe" p"oblems a"e of lesse" %on%e"nW th$s& answe"s @& C& and ) a"e in%o""e%t 5+ #nswe" C is %o""e%t <eas$"ing with a pape" tape meas$"e and ma"0ing the a"ea that is meas$"ed is the most obEe%ti/e method of estimating as%ites Inspe%ting and %he%0ing fo" fl$id wa/es a"e mo"e s$bEe%ti/e& so answe"s # and @ a"e in%o""e%t Palpation of the li/e" will not tell the amo$nt of as%itesW th$s& answe" ) is in%o""e%t 5. #nswe" @ is %o""e%t !he /ital signs indi%ate hypo/olemi% sho%0 !hey do not indi%ate %e"eb"al tiss$e pe"f$sion& ai"way %lea"an%e& o" senso"y pe"%eption alte"ations& so answe"s #& C& and ) a"e in%o""e%t 52 #nswe" # is %o""e%t !he %lient with osteogenesis impe"fe%ta is at "is0 fo" pathologi%al f"a%t$"es and is li0ely to e-pe"ien%e these f"a%t$"es if he pa"ti%ipates in %onta%t spo"ts !he %lient might e-pe"ien%e symptoms of hypo-ia if he be%omes dehyd"ated o" deo-ygenatedW e-t"eme e-e"%ise& espe%ially in wa"m weathe"& %an e-a%e"bate the %ondition #nswe"s @& C& and ) a"e not fa%to"s fo" %on%e"n 55 #nswe" ) is %o""e%t !he %lient with ne$t"openia sho$ld not ha/e f"esh f"$it be%a$se it sho$ld be peeled andGo" %oo0ed befo"e eating ?e sho$ld also not eat foods g"own on o" in the g"o$nd o" eat f"om the salad ba" !he n$"se sho$ld "emo/e potted o" %$t flowe"s f"om the "oom as well #ny so$"%e of ba%te"ia sho$ld be eliminated& if possible #nswe"s #& @& and C will not help p"e/ent ba%te"ial in/asions 58 #nswe" @ is %o""e%t In %lients who ha/e not had s$"ge"y to the fa%e o" ne%0& the answe" wo$ld be answe" #W howe/e"& in this sit$ation& this %o$ld f$"the" inte"fe"e with the ai"way In%"easing the inf$sion and pla%ing the %lient in s$pine position wo$ld be bette" #nswe"s C is in%o""e%t be%a$se it is not ne%essa"y at this time and %o$ld %a$se hyponat"emia and f$"the" hypotension #nswe" ) is not ne%essa"y at this time 59 #nswe" C is %o""e%t If the %lient p$lls the %hest t$be o$t of the %hest& the n$"seKs fi"st a%tion sho$ld be to %o/e" the inse"tion site with an o%%l$si/e d"essing #fte"wa"d& the n$"se sho$ld %all the do%to"& who will o"de" a %hest -="ay and possibly "einse"t the t$be #nswe"s #& @& and ) a"e not the fi"st a%tion to be ta0en 59 #nswe" # is %o""e%t !he no"mal P"otime is 12X20 se%onds # P"otime of 120 se%onds indi%ates an e-t"emely p"olonged P"otime and %an "es$lt in a spontaneo$s bleeding episode #nswe"s @& C& and ) may be needed at a late" time b$t a"e not the most impo"tant a%tions to ta0e fi"st 80 #nswe" C is %o""e%t !he food with the most %al%i$m is the yog$"t #nswe"s #& @& and ) a"e good %hoi%es& b$t not as good as the yog$"t& whi%h has app"o-imately .00mg of %al%i$m 81 #nswe" C is %o""e%t !he %lient "e%ei/ing magnesi$m s$lfate sho$ld ha/e a Foley %athete" in pla%e& and ho$"ly inta0e and o$tp$t sho$ld be %he%0ed !he"e is no need to "ef"ain f"om %he%0ing the blood p"ess$"e in the "ight a"m # padded tong$e blade sho$ld be 0ept in the "oom at the bedside& E$st in %ase of a sei($"e& b$t this is not "elated to the magnesi$m s$lfate inf$sion )a"0ening the "oom is $nne%essa"y& so answe"s #& @& and ) a"e in%o""e%t 82 #nswe" ) is %o""e%t If the %lientKs mothe" "ef$ses the blood t"ansf$sion& the do%to" sho$ld be notified @e%a$se the %lient is a mino"& the %o$"t might o"de" t"eatment #nswe" # is in%o""e%t @e%a$se it is not the

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p"ima"y "esponsibility fo" the n$"se to en%o$"age the mothe" to %onsent o" e-plain the %onse6$en%es& so answe"s @ and C a"e in%o""e%t 8+ #nswe" @ is %o""e%t !he n$"se sho$ld be most %on%e"ned with la"yngeal edema be%a$se of the a"ea of b$"n !he ne-t p"io"ity sho$ld be answe" #& as well as hyponat"emia and hypo0alemia in C and )& b$t these answe"s a"e not of p"ima"y %on%e"n so a"e in%o""e%t 8. #nswe" ) is %o""e%t !he %lient with ano"e-ia shows the most imp"o/ement by weight gain Sele%ting a balan%ed diet does little good if the %lient will not eat& so answe" # is in%o""e%t !he hemato%"it might imp"o/e by se/e"al means& s$%h as blood t"ansf$sion& b$t that does not indi%ate imp"o/ement in the ano"e-i% %onditionW the"efo"e& answe" @ is in%o""e%t !he tiss$e t$"go" indi%ates fl$id stasis& not imp"o/ement of ano"e-ia& so answe" C is in%o""e%t 82 #nswe" ) is %o""e%t #t this time& pain beneath the %ast is no"mal !he %lientKs toes sho$ld be wa"m to the to$%h& and p$lses sho$ld be p"esent Pa"esthesia is not no"mal and might indi%ate %ompa"tment synd"ome !he"efo"e& #nswe"s #& @& and C a"e in%o""e%t 85 #nswe" @ is %o""e%t It is no"mal fo" the %lient to ha/e a wa"m sensation when dye is inEe%ted #nswe"s #& C& and ) indi%ate that the n$"se belie/es that the hot feeling is abno"mal& so they a"e in%o""e%t 88 #nswe" ) is %o""e%t It is not ne%essa"y to wea" glo/es to ta0e the /ital signs of the %lient If the %lient has a%ti/e infe%tion with methi%illin="esistant staphylo%o%%$s a$"e$s& glo/es sho$ld be wo"n !he health%a"e wo"0e"s in answe"s #& @& and C indi%ate 0nowledge of infe%tion %ont"ol by thei" a%tions 89 #nswe" ) is %o""e%t )$"ing ,C!& the %lient will ha/e a g"and mal sei(e !his indi%ates %ompletion of the ele%t"o%on/$lsi/e the"apy #nswe"s #& @& and C do not indi%ate that the ,C! has been effe%ti/e& so a"e in%o""e%t 89 #nswe" # is %o""e%t Infe%tion with pinwo"ms begins when the eggs a"e ingested o" inhaled !he eggs hat%h in the $ppe" intestine and mat$"e in 2X9 wee0s !he females then mate and mig"ate o$t the an$s& whe"e they lay $p to 18&000 eggs !his %a$ses intense it%hing !he mothe" sho$ld be told to $se a flashlight to e-amine the "e%tal a"ea abo$t 2X+ ho$"s afte" the %hild is asleep Pla%ing %lea" tape on a tong$e blade will allow the eggs to adhe"e to the tape !he spe%imen sho$ld then be b"o$ght in to be e/al$ated !he"e is no need to s%"ap the s0in& %olle%t a stool spe%imen& o" b"ing a sample of hai"& so answe"s @& C& and ) a"e in%o""e%t 90 #nswe" @ is %o""e%t ,"te"obiasis& o" pinwo"ms& is t"eated with 7e"mo- Omebenda(oleP o" #ntiminth Opy"antel pamoateP !he enti"e family sho$ld be t"eated to ens$"e that no eggs "emain @e%a$se a single t"eatment is $s$ally s$ffi%ient& the"e is $s$ally good %omplian%e !he family sho$ld then be tested again in 2 wee0s to ens$"e that no eggs "emain #nswe"s #& C& and ) a"e in%o""e%t statements 91 #nswe" # is %o""e%t !he p"egnant n$"se sho$ld not be assigned to any %lient with "adioa%ti/ity p"esent !he %lient "e%ei/ing linea" a%%ele"ato" the"apy t"a/els to the "adi$m depa"tment fo" the"apy !he "adiation stays in the depa"tment& so the %lient is not "adioa%ti/e !he %lients in answe"s @& C& and ) pose a "is0 to the p"egnant n$"se !hese %lients a"e "adioa%ti/e in /e"y small doses& espe%ially $pon "et$"ning f"om the p"o%ed$"es Fo" app"o-imately 82 ho$"s& the %lients sho$ld dispose of $"ine and fe%es in spe%ial %ontaine"s and $se plasti% spoons and fo"0s 92 #nswe" # is %o""e%t !he %lient with C$shingKs disease has ad"eno%o"ti%al hype"se%"etion !his in%"ease in the le/el of %o"tisone %a$ses the %lient to be imm$ne s$pp"essed In answe" @& the %lient with diabetes poses no "is0 to othe" %lients !he %lient in answe" C has an in%"ease in g"owth ho"mone and poses no "is0 to himself o" othe"s !he %lient in answe" ) has hype"thy"oidism o" my-edema and poses no "is0 to othe"s o" himself 9+ #nswe" ) is %o""e%t !he n$"se %o$ld be %ha"ged with malp"a%ti%e& whi%h is failing to pe"fo"m& o" pe"fo"ming an a%t that %a$ses ha"m to the %lient Di/ing the infant an o/e"dose falls into this %atego"y #nswe"s #& @& and C a"e in%o""e%t be%a$se they apply to othe" w"ongf$l a%ts *egligen%e is failing to pe"fo"m %a"e fo" the %lientW a to"t is a w"ongf$l a%t %ommitted on the %lient o" thei" belongingsW and assa$lt is a /iolent physi%al o" /e"bal atta%0 9. #nswe" ) is %o""e%t !he li%ensed p"a%ti%al n$"se sho$ld not be assigned to begin a blood t"ansf$sion !he li%ensed p"a%ti%al n$"se %an inse"t a Foley %athete"& dis%ontin$e a nasogast"i% t$be& and %olle%t sp$t$m spe%imenW the"efo"e& answe"s #& @& and C a"e in%o""e%t 92 #nswe" @ is %o""e%t !he /ital signs a"e abno"mal and sho$ld be "epo"ted immediately Contin$ing to monito" the /ital signs %an "es$lt in dete"io"ation of the %lientKs %ondition& ma0ing answe" # in%o""e%t #s0ing the %lient how he feels in answe" C will only p"o/ide s$bEe%ti/e data& and the n$"se in answe" ) is not the best n$"se to assign be%a$se this %lient is $nstable 95 #nswe" @ is %o""e%t !he n$"se with + yea"s of e-pe"ien%e in labo" and deli/e"y 0nows the most abo$t possible %ompli%ations in/ol/ing p"ee%lampsia !he n$"se in answe" # is a new n$"se to the $nit& and the n$"ses in answe"s C and ) ha/e no e-pe"ien%e with the postpa"t$m %lient 98 #nswe" @ is %o""e%t !he Boint Commission on #%%"editation of ?ospitals will p"obably be inte"ested in the p"oblems in answe"s # and C !he fail$"e of the n$"sing assistant to %a"e fo" the %lient with hepatitis might "es$lt in te"mination& b$t is not of inte"est to the Boint Commission 99 #nswe" @ is %o""e%t !he ne-t a%tion afte" dis%$ssing the p"oblem with the n$"se is to do%$ment the in%ident by filing a fo"mal "ep"imand If the beha/io" %ontin$es o" if ha"m has "es$lted to the %lient& the n$"se may be te"minated and "epo"ted to the @oa"d of *$"sing& b$t these a"e not the fi"st a%tions "e6$ested in the stem # to"t is a w"ongf$l a%t to the %lient o" his belongings and is not indi%ated in this instan%e !he"efo"e& #nswe"s #& C& and ) a"e in%o""e%t

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99 #nswe" ) is %o""e%t !he %lient at highest "is0 fo" %ompli%ations is the %lient with m$ltiple s%le"osis who is being t"eated with %o"tisone /ia the %ent"al line !he othe"s a"e mo"e stable <1S# is methi%illin="esistant staphylo%o%%$s a$"e$s 7an%omy%in is the d"$g of %hoi%e and is gi/en at s%hed$led times to maintain blood le/els of the d"$g !he %lients in answe"s #& @& and C a"e mo"e stable and %an be seen late" 90 #nswe" @ is %o""e%t !he p"egnant %lient and the %lient with a b"o0en a"m and fa%ial la%e"ations a"e the best %hoi%es fo" pla%ing in the same "oom !he %lients in answe"s #& C& and ) need to be pla%ed in sepa"ate "ooms d$e to the se"io$s nat$"es of thei" inE$"ies 91 #nswe" # is %o""e%t @efo"e instilling eyed"ops& the n$"se sho$ld %leanse the a"ea with wate" # 5=yea"=old %hild is not de/elopmentally "eady to instill his own eyed"ops& so answe" @ is in%o""e%t #ltho$gh the mothe" of the %hild %an instill the eyed"ops& the a"ea m$st be %leansed befo"e administ"ation& ma0ing answe" C in%o""e%t #ltho$gh the eye might appea" to be %lea"& the n$"se sho$ld instill the eyed"ops& as o"de"ed& so answe" ) is in%o""e%t 92 #nswe" C is %o""e%t 1emembe" the #@Cs Oai"way& b"eathing& %i"%$lationP when answe"ing this 6$estion #nswe" C is %o""e%t be%a$se a hotdog is the si(e and shape of the %hildKs t"a%hea and poses a "is0 of aspi"ation #nswe"s #& @& and C a"e in%o""e%t be%a$se white g"ape E$i%e& a g"illed %heese sandwi%h& and i%e %"eam do not pose a "is0 of aspi"ation fo" a %hild 9+ #nswe" C is %o""e%t !he n$"se sho$ld en%o$"age "ooming=in to p"omote pa"ent=%hild atta%hment It is o0ay fo" the pa"ents to be in the "oom fo" assessment of the %hild #llowing the %hild to ha/e items that a"e familia" to him is allowed and en%o$"agedW the"efo"e& answe"s # and @ a"e in%o""e%t #nswe" ) is not pa"t of the n$"seKs "esponsibilities 9. #nswe" @ is %o""e%t !he hea"ing aid sho$ld be sto"ed in a wa"m& d"y pla%e It sho$ld be %leaned daily b$t sho$ld not be moldy& so answe" # is in%o""e%t # toothpi%0 is inapp"op"iate to $se to %lean the aidW the toothpi%0 might b"ea0 off in the hea"ing aide& ma0ing answe" C in%o""e%t Changing the batte"ies wee0ly& as in answe" )& is not ne%essa"y 92 #nswe" C is %o""e%t #lways "emembe" yo$" #@Cs Oai"way& b"eathing& %i"%$lationP when sele%ting an answe" #ltho$gh answe"s @ and ) might be app"op"iate fo" this %hild& answe" C sho$ld ha/e the highest p"io"ity #nswe" # does not apply fo" a %hild who has $nde"gone a tonsille%tomy 95 #nswe" # is %o""e%t If the %hild has ba%te"ial pne$monia& a high fe/e" is $s$ally p"esent @a%te"ial pne$monia $s$ally p"esents with a p"od$%ti/e %o$gh& not a nonp"od$%ti/e %o$gh& ma0ing answe" @ in%o""e%t 1hinitis is often seen with /i"al pne$monia& and /omiting and dia""hea a"e $s$ally not seen with pne$monia& so answe"s C and ) a"e in%o""e%t 98 #nswe" @ is %o""e%t Fo" a %hild with epiglottis and the possibility of %omplete obst"$%tion of the ai"way& eme"gen%y t"a%heostomy e6$ipment sho$ld always be 0ept at the bedside Int"a/eno$s s$pplies& fl$id& and o-ygen will not t"eat an obst"$%tionW the"efo"e& answe"s #& C& and ) a"e in%o""e%t 99 #nswe" C is %o""e%t ,-ophthalmos Op"ot"$sion of eyeballsP often o%%$"s with hype"thy"oidism !he %lient with hype"thy"oidism will often e-hibit ta%hy%a"dia& in%"eased appetite& and weight lossW the"efo"e& answe"s #& @& and ) a"e in%o""e%t 99 #nswe" ) is %o""e%t !he %hild with %elia% disease sho$ld be on a gl$ten=f"ee diet #nswe"s #& @& and C all %ontain gl$ten& while answe" ) gi/es the only %hoi%e of foods that does not %ontain gl$ten 100 #nswe" C is %o""e%t 1emembe" the #@Cs Oai"way& b"eathing& %i"%$lationP when answe"ing this 6$estion @efo"e notifying the physi%ian o" assessing the p$lse& o-ygen sho$ld be applied to in%"ease the o-ygen sat$"ation& so answe"s # and ) a"e in%o""e%t !he no"mal o-ygen sat$"ation fo" a %hild is 92VX100V& ma0ing answe" @ in%o""e%t 101 #nswe" @ is %o""e%t #n amniotomy is an a"tifi%ial "$pt$"e of memb"anes and no"mal amnioti% fl$id is st"aw= %olo"ed and odo"less Fetal hea"t tones of 150 indi%ate ta%hy%a"dia& and g"eenish fl$id is indi%ati/e of me%oni$m& so answe"s # and C a"e in%o""e%t If the n$"se notes the $mbili%al %o"d& the %lient is e-pe"ien%ing a p"olapsed %o"d& so answe" ) is in%o""e%t and wo$ld need to be "epo"ted immediately 102 #nswe" ) is %o""e%t )ilation of 2%m ma"0s the end of the latent phase of labo" #nswe" # is a /ag$e answe"& answe" @ indi%ates the end of the fi"st stage of labo"& and answe" C indi%ates the t"ansition phase 10+ #nswe" @ is %o""e%t !he no"mal fetal hea"t "ate is 120X150bpmW 100X110bpm is b"ady%a"dia !he fi"st a%tion wo$ld be to t$"n the %lient to the left side and apply o-ygen #nswe" # is not indi%ated at this time #nswe" C is not the best a%tion fo" %lients e-pe"ien%ing b"ady%a"dia !he"e is no data to indi%ate the need to mo/e the %lient to the deli/e"y "oom at this time 10. #nswe" ) is %o""e%t !he e-pe%ted effe%t of Pito%in is %e"/i%al dilation Pito%in %a$ses mo"e intense %ont"a%tions& whi%h %an in%"ease the pain& ma0ing answe" # in%o""e%t Ce"/i%al effa%ement is %a$sed by p"ess$"e on the p"esenting pa"t& so answe" @ is in%o""e%t #nswe" C is opposite the a%tion of Pito%in 102 #nswe" @ is %o""e%t #pplying a fetal hea"t monito" is the %o""e%t a%tion at this time !he"e is no need to p"epa"e fo" a Caesa"ean se%tion o" to pla%e the %lient in Den$ Pe%to"al position O0nee=%hestP& so answe"s # and C a"e in%o""e%t #nswe" ) is in%o""e%t be%a$se the"e is no need fo" an $lt"aso$nd based on the finding 105 #nswe" @ is %o""e%t !he n$"se de%ides to apply an e-te"nal monito" be%a$se the memb"anes a"e inta%t #nswe"s #& C& and ) a"e in%o""e%t !he %e"/i- is dilated eno$gh to $se an inte"nal monito"& if ne%essa"y #n inte"nal monito" %an be applied if the %lient is at 0=station Cont"a%tion intensity has no bea"ing on the appli%ation of the fetal monito" 108 #nswe" ) is %o""e%t Clients admitted in labo" a"e told not to eat d$"ing labo"& to a/oid na$sea and /omiting I%e %hips may be allowed& b$t this amo$nt of fl$id might not be s$ffi%ient to p"e/ent fl$id /ol$me defi%it In

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answe" #& impai"ed gas e-%hange "elated to hype"/entilation wo$ld be indi%ated d$"ing the t"ansition phase #nswe"s @ and C a"e not %o""e%t in "elation to the stem 109 #nswe" ) is %o""e%t !his info"mation indi%ates a late de%ele"ation !his type of de%ele"ation is %a$sed by $te"opla%ental la%0 of o-ygen #nswe" # has no "elation to the "eadings& so itKs in%o""e%tW answe" @ "es$lts in a /a"iable de%ele"ationW and answe" C is indi%ati/e of an ea"ly de%ele"ation 109 #nswe" C is %o""e%t !he initial a%tion by the n$"se obse"/ing a late de%ele"ation sho$ld t$"n the %lient to the sideYp"efe"ably& the left side #dministe"ing o-ygen is also indi%ated #nswe" # might be ne%essa"y b$t not befo"e t$"ning the %lient to he" side #nswe" @ is not ne%essa"y at this time #nswe" ) is in%o""e%t be%a$se the"e is no data to indi%ate that the monito" has been applied in%o""e%tly 110 #nswe" ) is %o""e%t #%%ele"ations with mo/ement a"e no"mal #nswe"s #& @& and C indi%ate omino$s findings on the fetal hea"t monito" 111 #nswe" C is %o""e%t ,pid$"al anesthesia de%"eases the $"ge to /oid and sensation of a f$ll bladde" # f$ll bladde" will de%"ease the p"og"ession of labo" #nswe"s #& @& and ) a"e in%o""e%t fo" the stem 112 #nswe" @ is %o""e%t '$teni(ing ho"mone "eleased by the pit$ita"y is "esponsible fo" o/$lation #t abo$t day 1.& the %ontin$ed in%"ease in est"ogen stim$lates the "elease of l$teni(ing ho"mone f"om the ante"io" pit$ita"y !he '? s$"ge is "esponsible fo" o/$lation& o" the "elease of the dominant folli%le in p"epa"ation fo" %on%eption& whi%h o%%$"s within the ne-t 10X12 ho$"s afte" the '? le/els pea0 #nswe"s #& C& and ) a"e in%o""e%t be%a$se est"ogen le/els a"e high at the beginning of o/$lation& the endomet"ial lining is thi%0& not thin& and the p"ogeste"one le/els a"e high& not low 11+ #nswe" C is %o""e%t !he s$%%ess of the "hythm method of bi"th %ont"ol is dependent on the %lientKs menses being "eg$la" It is not dependent on the age of the %lient& f"e6$en%y of inte"%o$"se& o" "ange of the %lientKs tempe"at$"eW the"efo"e& answe"s #& @& and ) a"e in%o""e%t 11. #nswe" C is %o""e%t !he best method of bi"th %ont"ol fo" the %lient with diabetes is the diaph"agm # pe"manent int"a$te"ine de/i%e %an %a$se a %ontin$ing inflammato"y "esponse in diabeti%s that sho$ld be a/oided& o"al %ont"a%epti/es tend to ele/ate blood gl$%ose le/els& and %ont"a%epti/e sponges a"e not good at p"e/enting p"egnan%y !he"efo"e& answe"s #& @& and ) a"e in%o""e%t 112 #nswe" ) is %o""e%t !he signs of an e%topi% p"egnan%y a"e /ag$e $ntil the fallopian t$be "$pt$"es !he %lient will %omplain of s$dden& stabbing pain in the lowe" 6$ad"ant that "adiates down the leg o" $p into the %hest Painless /aginal bleeding is a sign of pla%enta p"e/ia& abdominal %"amping is a sign of labo"& and th"obbing pain in the $ppe" 6$ad"ant is not a sign of an e%topi% p"egnan%y& ma0ing answe"s #& @& and C in%o""e%t 115 #nswe" C is %o""e%t #ll of the %hoi%es a"e tasty& b$t the p"egnant %lient needs a diet that is balan%ed and has in%"eased amo$nts of %al%i$m #nswe" # is la%0ing in f"$its and mil0 #nswe" @ %ontains the potato %hips& whi%h %ontain a la"ge amo$nt of sodi$m #nswe" C %ontains meat& f"$it& potato salad& and yog$"t& whi%h has abo$t +50mg of %al%i$m #nswe" ) is not the best diet be%a$se it la%0s /egetables and mil0 p"od$%ts 118 #nswe" @ is %o""e%t !he %lient with hype"emesis has pe"sistent na$sea and /omiting Hith /omiting %omes dehyd"ation Hhen the %lient is dehyd"ated& she will ha/e metaboli% a%idosis #nswe"s # and C a"e in%o""e%t be%a$se they a"e "espi"ato"y dehyd"ation #nswe" ) is in%o""e%t be%a$se the %lient will not be in al0alosis with pe"sistent /omiting 119 #nswe" @ is %o""e%t !he most definiti/e diagnosis of p"egnan%y is the p"esen%e of fetal hea"t tones !he signs in answe"s #& C& and ) a"e s$bEe%ti/e and might be "elated to othe" medi%al %onditions #nswe"s # and C may be "elated to a hydatidifo"m mole& and answe" ) is often p"esent befo"e menses o" with the $se of o"al %ont"a%epti/es 119 #nswe" C is %o""e%t !he infant of a diabeti% mothe" is $s$ally la"ge fo" gestational age #fte" bi"th& gl$%ose le/els fall "apidly d$e to the absen%e of gl$%ose f"om the mothe" #nswe" # is in%o""e%t be%a$se the infant will not be small fo" gestational age #nswe" @ is in%o""e%t be%a$se the infant will not be hype"gly%emi% #nswe" ) is in%o""e%t be%a$se the infant will be la"ge& not small& and will be hypogly%emi%& not hype"gly%emi% 120 #nswe" @ is %o""e%t Hhen the %lient is ta0ing o"al %ont"a%epti/es and begins antibioti%s& anothe" method of bi"th %ont"ol sho$ld be $sed #ntibioti%s de%"ease the effe%ti/eness of o"al %ont"a%epti/es #pp"o-imately 2X10 po$nds of weight gain is not $n$s$al& so answe" # is in%o""e%t If the %lient misses a bi"th %ont"ol pill& she sho$ld be inst"$%ted to ta0e the pill as soon as she "emembe"s the pill #nswe" C is in%o""e%t If she misses two& she sho$ld ta0e twoW if she misses mo"e than two& she sho$ld ta0e the missed pills b$t $se anothe" method of bi"th %ont"ol fo" the "emainde" of the %y%le #nswe" ) is in%o""e%t be%a$se %hanges in menst"$al flow a"e e-pe%ted in %lients $sing o"al %ont"a%epti/es Often these %lients ha/e lighte" menses 121 #nswe" @ is %o""e%t Clients with ?I7 sho$ld not b"eastfeed be%a$se the infe%tion %an be t"ansmitted to the baby th"o$gh b"east mil0 !he %lients in answe"s #& C& and )Ythose with diabetes& hype"tension& and thy"oid diseaseY%an be allowed to b"eastfeed 122 #nswe" # is %o""e%t !he symptoms of painless /aginal bleeding a"e %onsistent with pla%enta p"e/ia #nswe"s @& C& and ) a"e in%o""e%t Ce"/i%al %he%0 fo" dilation is %ont"aindi%ated be%a$se this %an in%"ease the bleeding Che%0ing fo" fi"mness of the $te"$s %an be done& b$t the fi"st a%tion sho$ld be to %he%0 the fetal hea"t tones # detailed histo"y %an be done late" 12+ #nswe" ) is %o""e%t !he %lient sho$ld be ad/ised to %ome to the labo" and deli/e"y $nit when the %ont"a%tions a"e e/e"y 2 min$tes and %onsistent She sho$ld also be told to "epo"t to the hospital if she e-pe"ien%es "$pt$"e of memb"anes o" e-t"eme bleeding She sho$ld not wait $ntil the %ont"a%tions a"e e/e"y 2 min$tes o" $ntil she has bloody dis%ha"ge& so answe"s # and @ a"e in%o""e%t #nswe" C is a /ag$e answe" and %an be "elated to a $"ina"y t"a%t infe%tion

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12. #nswe" # is %o""e%t Infants of mothe"s who smo0e a"e often low in bi"th weight Infants who a"e la"ge fo" gestational age a"e asso%iated with diabeti% mothe"s& so answe" @ is in%o""e%t P"ete"m bi"ths a"e asso%iated with smo0ing& b$t not with app"op"iate si(e fo" gestation& ma0ing answe" C in%o""e%t D"owth "eta"dation is asso%iated with smo0ing& b$t this does not affe%t the infant lengthW the"efo"e& answe" ) is in%o""e%t 122 #nswe" # is %o""e%t !o p"o/ide p"ote%tion against antibody p"od$%tion& 1hoDam sho$ld be gi/en within 82 ho$"s !he answe"s in @& C& and ) a"e too late to p"o/ide antibody p"ote%tion 1hoDam %an also be gi/en d$"ing p"egnan%y 125 #nswe" @ is %o""e%t Hhen the memb"anes "$pt$"e& the"e is often a t"ansient d"op in the fetal hea"t tones !he hea"t tones sho$ld "et$"n to baseline 6$i%0ly #ny alte"ation in fetal hea"t tones& s$%h as b"ady%a"dia o" ta%hy%a"dia& sho$ld be "epo"ted #fte" the fetal hea"t tones a"e assessed& the n$"se sho$ld e/al$ate the %e"/i%al dilation& /ital signs& and le/el of dis%omfo"t& ma0ing answe"s #& C& and ) in%o""e%t 128 #nswe" # is %o""e%t !he a%ti/e phase of labo" o%%$"s when the %lient is dilated .X8%m !he latent o" ea"ly phase of labo" is f"om 1%m to +%m in dilation& so answe"s @ and ) a"e in%o""e%t !he t"ansition phase of labo" is 9X10%m in dilation& ma0ing answe" C in%o""e%t 129 #nswe" @ is %o""e%t !he infant of an addi%ted mothe" will $nde"go withd"awal Sn$gly w"apping the infant in a blan0et will help p"e/ent the m$s%le i""itability that these babies often e-pe"ien%e !ea%hing the mothe" to p"o/ide ta%tile stim$lation o" p"o/ide fo" ea"ly infant stim$lation a"e in%o""e%t be%a$se he is i""itable and needs 6$iet and little stim$lation at this time& so answe"s # and ) a"e in%o""e%t Pla%ing the infant in an infant seat in answe" C is in%o""e%t be%a$se this will also %a$se mo/ement that %an in%"ease m$s%le i""itability 129 #nswe" C is %o""e%t Following epid$"al anesthesia& the %lient sho$ld be %he%0ed fo" hypotension and signs of sho%0 e/e"y 2 min$tes fo" 12 min$tes !he %lient %an be %he%0ed fo" %e"/i%al dilation late" afte" she is stable !he %lient sho$ld not be positioned s$pine be%a$se the anesthesia %an mo/e abo/e the "espi"ato"y %ente" and the %lient %an stop b"eathing Fetal hea"t tones sho$ld be assessed afte" the blood p"ess$"e is %he%0ed !he"efo"e& answe"s #& @& and ) a"e in%o""e%t 1+0 #nswe" @ is %o""e%t !he best way to p"e/ent post=ope"ati/e wo$nd infe%tion is hand washing Use of p"es%"ibed antibioti%s will t"eat infe%tion& not p"e/ent infe%tions& ma0ing answe" # in%o""e%t Hea"ing a mas0 and as0ing the %lient to %o/e" he" mo$th a"e good p"a%ti%es b$t will not p"e/ent wo$nd infe%tionsW the"efo"e& answe"s C and ) a"e in%o""e%t 1+1 #nswe" @ is %o""e%t !he %lient with a hip f"a%t$"e will most li0ely ha/e disalignment #nswe"s #& C& and ) a"e in%o""e%t be%a$se all f"a%t$"es %a$se pain& and %oolness of the e-t"emities and absen%e of p$lses a"e indi%ati/e of %ompa"tment synd"ome o" pe"iphe"al /as%$la" disease 1+2 #nswe" @ is %o""e%t #fte" menopa$se& women la%0 ho"mones ne%essa"y to abso"b and $tili(e %al%i$m )oing weight=bea"ing e-e"%ises and ta0ing %al%i$m s$pplements %an help to p"e/ent osteopo"osis b$t a"e not %a$ses& so answe"s # and C a"e in%o""e%t @ody types that f"e6$ently e-pe"ien%e osteopo"osis a"e thin Ca$%asian females& b$t they a"e not most li0ely "elated to osteopo"osis& so answe" ) is in%o""e%t 1++ #nswe" @ is %o""e%t !he infantKs hips sho$ld be off the bed app"o-imately 12R in @"yantKs t"a%tion #nswe" # is in%o""e%t be%a$se this does not indi%ate that the t"a%tion is wo"0ing %o""e%tly& no" does C #nswe" ) is in%o""e%t be%a$se @"yantKs t"a%tion is a s0in t"a%tion& not a s0eletal t"a%tion 1+. #nswe" # is %o""e%t @alan%ed s0eletal t"a%tion $ses pins and s%"ews # Steinman pin goes th"o$gh la"ge bones and is $sed to stabili(e la"ge bones s$%h as the fem$" #nswe" @ is in%o""e%t be%a$se only the affe%ted leg is in t"a%tion :i"s%hne" wi"es a"e $sed to stabili(e small bones s$%h as finge"s and toes& as in answe" C #nswe" ) is in%o""e%t be%a$se this type of t"a%tion is not $sed fo" f"a%t$"ed hips 1+2 #nswe" # is %o""e%t @leeding is a %ommon %ompli%ation of o"thopedi% s$"ge"y !he blood=%olle%tion de/i%e sho$ld be %he%0ed f"e6$ently to ens$"e that the %lient is not hemo""haging !he %lientKs pain sho$ld be assessed& b$t this is not life=th"eatening Hhen the %lient is in less dange"& the n$t"itional stat$s sho$ld be assessed and an immobili(e" is not $sedW th$s& answe"s @& C& and ) a"e in%o""e%t 1+5 #nswe" # is %o""e%t !he %lientKs family membe" sho$ld be ta$ght to fl$sh the t$be afte" ea%h feeding and %lamp the t$be !he pla%ement sho$ld be %he%0ed befo"e feedings& and indigestion %an o%%$" with the P,D t$be& E$st as it %an o%%$" with any %lient& so answe"s @ and C a"e in%o""e%t <edi%ations %an be o"de"ed fo" indigestion& b$t it is not a "eason fo" ala"m # pe"%$taneo$s endos%opy gast"ostomy t$be is $sed fo" %lients who ha/e e-pe"ien%ed diffi%$lty swallowing !he t$be is inse"ted di"e%tly into the stoma%h and does not "e6$i"e swallowingW the"efo"e& answe" ) is in%o""e%t 1+8 #nswe" C is %o""e%t !he %lient with a total 0nee "epla%ement sho$ld be assessed fo" anemia # hemato%"it of 25V is e-t"emely low and might "e6$i"e a blood t"ansf$sion @leeding of 2%m on the d"essing is not e-t"eme Ci"%le and date and time the bleeding and monito" fo" %hanges in the %lientKs stat$s # low=g"ade tempe"at$"e is not $n$s$al afte" s$"ge"y ,ns$"e that the %lient is well hyd"ated& and "e%he%0 the tempe"at$"e in 1 ho$" If the tempe"at$"e is abo/e 101RF& "epo"t this finding to the do%to" !ylenol will p"obably be o"de"ed 7oiding afte" s$"ge"y is also not $n%ommon and no need fo" %on%e"nW the"efo"e answe"s #& @& and ) a"e in%o""e%t 1+9 #nswe" @ is %o""e%t Pl$mbism is lead poisoning One fa%to" asso%iated with the %ons$mption of lead is eating f"om potte"y made in Cent"al #me"i%a o" <e-i%o that is $nfi"ed !he %hild li/es in a ho$se b$ilt afte" 1985 Othis is when lead was ta0en o$t of paintP& and the pa"ents ma0e stained glass as a hobby Stained glass is p$t togethe" with lead& whi%h %an d"op on the wo"0 a"ea& whe"e the %hild %an %ons$me the lead beads #nswe" # is in%o""e%t be%a$se simply t"a/eling o$t of the %o$nt"y does not in%"ease the "is0 In answe" C& the ho$se was b$ilt afte" the lead was "emo/ed with the paint #nswe" ) is $n"elated to the stem

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1+9 #nswe" # is %o""e%t !he e6$ipment that %an help with a%ti/ities of daily li/ing is the high=seat %ommode !he hip sho$ld be 0ept highe" than the 0nee !he "e%line" is good be%a$se it p"e/ents 90R fle-ion b$t not daily a%ti/ities # !,*S O!"ans%$taneo$s ,le%t"i%al *e"/e Stim$lationP $nit helps with pain management and an abd$%tion pillow is $sed to p"e/ent add$%tion of the hip and possibly dislo%ation of the p"osthesisW the"efo"e& answe"s @& C& and ) a"e in%o""e%t 1.0 #nswe" @ is %o""e%t *a"%an is the antidote fo" na"%oti% o/e"dose If hypo-ia o%%$"s& the %lient sho$ld ha/e o-ygen administe"ed by mas0& not %ann$la !he"e is no data to s$ppo"t the administ"ation of blood p"od$%ts o" %a"dio"es$s%itation& so answe"s #& C& and ) a"e in%o""e%t 1.1 #nswe" @ is %o""e%t !he 5=yea"=old sho$ld ha/e a "oommate as %lose to the same age as possible& so the 12= yea"=old is the best mat%h !he 10=yea"=old with sa"%oma has %an%e" and will be t"eated with %hemothe"apy that ma0es him imm$ne s$pp"essed& the 5=yea"=old with osteomylitis is infe%ted& and the %lient in answe" # is too old and is femaleW the"efo"e& answe"s #& C& and ) a"e in%o""e%t 1.2 #nswe" @ is %o""e%t Co- II inhibito"s ha/e been asso%iated with hea"t atta%0s and st"o0es #ny %hanges in %a"dia% stat$s o" signs of a st"o0e sho$ld be "epo"ted immediately& along with any %hanges in bowel o" bladde" habits be%a$se bleeding has been lin0ed to $se of Co- II inhibito"s !he %lient does not ha/e to ta0e the medi%ation with mil0& "emain $p"ight& o" allow 5 wee0s fo" optimal effe%t& so answe"s #& C& and ) a"e in%o""e%t 1.+ #nswe" ) is %o""e%t # plaste"=of=Pa"is %ast ta0es 2. ho$"s to d"y& and the %lient sho$ld not bea" weight fo" 2. ho$"s !he %ast sho$ld be handled with the palms& not the finge"tips& so answe" # is in%o""e%t Petaling a %ast is %o/e"ing the end of the %ast with %ast batting o" a so%0& to p"e/ent s0in i""itation and fla0ing of the s0in $nde" the %ast& ma0ing answe" @ in%o""e%t !he %lient sho$ld be told not to d"y the %ast with a hai" d"ye" be%a$se this %a$ses hot spots and %o$ld b$"n the %lient !his also %a$ses $ne6$al d"yingW th$s& answe" C is in%o""e%t 1.. #nswe" # is %o""e%t !he"e is no "eason that the %lientKs f"iends sho$ld not be allowed to a$tog"aph the %astW it will not ha"m the %ast in any way& so answe"s @& C& and ) a"e in%o""e%t 1.2 #nswe" # is %o""e%t !he n$"se is pe"fo"ming the pin %a"e %o""e%tly when she $ses ste"ile glo/es and >=tips # li%ensed p"a%ti%al n$"se %an pe"fo"m pin %a"e& the"e is no need to %lean the weights& and the n$"se %an help with opening the pa%0ages b$t it isnKt "e6$i"edW the"efo"e& answe"s @& C& and ) a"e in%o""e%t 1.5 #nswe" # is %o""e%t # body %ast o" spi%a %ast e-tends f"om the $ppe" abdomen to the 0nees o" below @owel so$nds sho$ld be %he%0ed to ens$"e that the %lient is not e-pe"ien%ing a pa"alyti% ille$s Che%0ing the blood p"ess$"e is a t"eatment fo" any %lient& offe"ing pain medi%ation is not %alled fo"& and %he%0ing fo" swelling isnKt spe%ifi% to the stem& so answe"s @& C& and ) a"e in%o""e%t 1.8 #nswe" C is %o""e%t ?alo t"a%tion will be o"de"ed fo" the %lient with a %e"/i%al f"a%t$"e 1$ssellKs t"a%tion is $sed fo" bones of the lowe" e-t"emities& as is @$%0Ks t"a%tion C"$%hfield tongs a"e $sed while in the hospital and the %lient is immobileW the"efo"e& answe"s #& @& and ) a"e in%o""e%t 1.9 #nswe" @ is %o""e%t !he %ont"olle" fo" the %ontin$o$s passi/e=motion de/i%e sho$ld be pla%ed away f"om the %lient <any %lients %omplain of pain while ha/ing t"eatments with the CP<& so they might t$"n off the ma%hine !he CP< fle-es and e-tends the leg !he %lient is in the bed d$"ing CP< the"apy& so answe" # is in%o""e%t #nswe" C is in%o""e%t be%a$se %lients will e-pe"ien%e pain with the t"eatment Use of the CP< does not alle/iate the need fo" physi%al the"apy& as s$ggested in answe" ) 1.9 #nswe" # is %o""e%t !he %lientKs palms sho$ld "est lightly on the handles !he elbows sho$ld be fle-ed no mo"e than +0R b$t sho$ld not be e-tended #nswe" @ is in%o""e%t be%a$se 0R is not a "ela-ed angle fo" the elbows and will not fa%ilitate %o""e%t wal0e" $se !he %lient sho$ld wal0 to the middle of the wal0e"& not to the f"ont of the wal0e"& ma0ing answe" C in%o""e%t !he %lient sho$ld be ta$ght not to %a""y the wal0e" be%a$se this wo$ld not p"o/ide stabilityW th$s& answe" ) is in%o""e%t 120 #nswe" C is %o""e%t !he %lient with a p"olapsed %o"d sho$ld be t"eated by ele/ating the hips and %o/e"ing the %o"d with a moist& ste"ile saline ga$(e !he n$"se sho$ld $se he" finge"s to p$sh $p on the p"esenting pa"t $ntil a %esa"ean se%tion %an be pe"fo"med #nswe"s #& @& and ) a"e in%o""e%t !he n$"se sho$ld not attempt to "epla%e the %o"d& t$"n the %lient on the side& o" %o/e" with a d"y ga$(e 121 #nswe" @ is %o""e%t Chest t$bes wo"0 to "einflate the l$ng and d"ain se"o$s fl$id !he t$be does not e6$ali(e e-pansion of the l$ngs Pain is asso%iated with %ollapse of the l$ng& and inse"tion of %hest t$bes is painf$l& so answe"s # and C a"e in%o""e%t #nswe" ) is t"$e& b$t this is not the p"ima"y "ationale fo" pe"fo"ming %hest t$be inse"tion 122 #nswe" ) is %o""e%t S$%%ess with b"eastfeeding depends on many fa%to"s& b$t the most dependable "eason fo" s$%%ess is desi"e and willingness to %ontin$e the b"eastfeeding $ntil the infant and mothe" ha/e time to adapt !he ed$%ational le/el& the infantKs bi"th weight& and the si(e of the mothe"Ks b"east ha/e nothing to do with s$%%ess& so answe"s #& @& and C a"e in%o""e%t 12+ #nswe" C is %o""e%t D"een=tinged amnioti% fl$id is indi%ati/e of me%oni$m staining !his finding indi%ates fetal dist"ess !he p"esen%e of s%ant bloody dis%ha"ge is no"mal& as a"e f"e6$ent $"ination and mode"ate $te"ine %ont"a%tions& ma0ing answe"s #& @& and ) in%o""e%t 12. #nswe" C is %o""e%t )$"ation is meas$"ed f"om the beginning of one %ont"a%tion to the end of the same %ont"a%tion #nswe" # "efe"s to f"e6$en%y #nswe" @ is in%o""e%t be%a$se we do not meas$"e f"om the end of one %ont"a%tion to the beginning of the ne-t %ont"a%tion )$"ation is not meas$"ed f"om the pea0 of the %ont"a%tion to the end& as stated in )

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122 #nswe" @ is %o""e%t !he %lient "e%ei/ing Pito%in sho$ld be monito"ed fo" de%ele"ations !he"e is no asso%iation with Pito%in $se and hypogly%emia& mate"nal hype""efle-ia& o" fetal mo/ementW the"efo"e& answe"s #& C& and ) a"e in%o""e%t 125 #nswe" ) is %o""e%t Fetal de/elopment depends on ade6$ate n$t"ition and ins$lin "eg$lation Ins$lin needs in%"ease d$"ing the se%ond and thi"d t"imeste"s& ins$lin "e6$i"ements do not mode"ate as the p"egnan%y p"og"esses& and ele/ated h$man %ho"ioni% gonadot"ophin ele/ates ins$lin needs& not de%"eases themW the"efo"e& answe"s #& @& and C a"e in%o""e%t 128 #nswe" # is %o""e%t # %alm en/i"onment is needed to p"e/ent sei($"e a%ti/ity #ny stim$lation %an p"e%ipitate sei($"es Obtaining a diet histo"y sho$ld be done late"& and administe"ing an analgesi% is not indi%ated be%a$se the"e is no data in the stem to indi%ate pain !he"efo"e& answe"s @ and C a"e in%o""e%t #ssessing the fetal hea"t tones is impo"tant& b$t this is not the highest p"io"ity in this sit$ation as stated in answe" ) 129 #nswe" # is %o""e%t !he %lient who is age .2 is at "is0 fo" fetal anomalies s$%h as )own synd"ome and othe" %h"omosomal abe""ations #nswe"s @& C& and ) a"e in%o""e%t be%a$se the %lient is not at highe" "is0 fo" "espi"ato"y dist"ess synd"ome o" pathologi%al Ea$ndi%e& and !$"ne"Ks synd"ome is a geneti% diso"de" 129 #nswe" C is %o""e%t !he %lient with a missed abo"tion will ha/e ind$%tion of labo" P"ostin , is a fo"m of p"ostaglandin $sed to soften the %e"/i- <agnesi$m s$lfate is $sed fo" p"ete"m labo" and p"ee%lampsia& %al%i$m gl$%onate is the antidote fo" magnesi$m s$lfate& and Pa"del is a dopamine "e%epto" stim$lant $sed to t"eat Pa"0insonKs diseaseW the"efo"e& answe"s #& @& and ) a"e in%o""e%t Pa"del was $sed at one time to d"y b"east mil0 150 #nswe" # is %o""e%t !he %lientKs blood p"ess$"e and $"ina"y o$tp$t a"e within no"mal limits !he only alte"ation f"om no"mal is the de%"eased deep tendon "efle-es !he n$"se sho$ld %ontin$e to monito" the blood p"ess$"e and %he%0 the magnesi$m le/el !he the"ape$ti% le/el is . 9X9 5mgGd' #nswe"s @& C& and ) a"e in%o""e%t !he"e is no need to stop the inf$sion at this time o" slow the "ate Cal%i$m gl$%onate is the antidote fo" magnesi$m s$lfate& b$t the"e is no data to indi%ate to-i%ity 151 #nswe" C is %o""e%t #$tosomal "e%essi/e diso"de"s %an be passed f"om the pa"ents to the infant If both pa"ents pass the t"ait& the %hild will get two abno"mal genes and the disease "es$lts Pa"ents %an also pass the t"ait to the infant #nswe" # is in%o""e%t be%a$se& to ha/e an affe%ted newbo"n& the pa"ents m$st be %a""ie"s #nswe" @ is in%o""e%t be%a$se both pa"ents m$st be %a""ie"s #nswe" ) is in%o""e%t be%a$se the pa"ents might ha/e affe%ted %hild"en 152 #nswe" ) is %o""e%t #lpha fetop"otein is a s%"eening test done to dete%t ne$"al t$be defe%ts s$%h as spina bifida !he test is not mandato"y& as stated in answe" # It does not indi%ate %a"dio/as%$la" defe%ts& and the mothe"Ks age has no bea"ing on the need fo" the test& so answe"s @ and C a"e in%o""e%t 15+ #nswe" @ is %o""e%t )$"ing p"egnan%y& the thy"oid gland t"iples in si(e !his ma0es it mo"e diffi%$lt to "eg$late thy"oid medi%ation #nswe" # is in%o""e%t be%a$se the"e %o$ld be a need fo" thy"oid medi%ation d$"ing p"egnan%y #nswe" C is in%o""e%t be%a$se the thy"oid f$n%tion does not slow Fetal g"owth is not a""ested if thy"oid medi%ation is %ontin$ed& so answe" ) is in%o""e%t 15. #nswe" C is %o""e%t Cyanosis of the feet and hands is a%"o%yanosis !his is a no"mal finding 1 min$te afte" bi"th #n api%al p$lse sho$ld be 120X150& and the baby sho$ld ha/e m$s%le tone& ma0ing answe"s # and @ in%o""e%t Ba$ndi%e immediately afte" bi"th is pathologi%al Ea$ndi%e and is abno"mal& so answe" ) is in%o""e%t 152 #nswe" # is %o""e%t Clients with si%0le %ell %"ises a"e t"eated with heat& hyd"ation& o-ygen& and pain "elief Fl$ids a"e in%"eased& not de%"eased @lood t"ansf$sions a"e $s$ally not "e6$i"ed& and the %lient %an be deli/e"ed /aginallyW th$s& answe"s @& C& and ) a"e in%o""e%t 155 #nswe" # is %o""e%t @efo"e $lt"asonog"aphy& the %lient sho$ld be ta$ght to d"in0 plenty of fl$ids and not /oid !he %lient may amb$late& an enema is not needed& and the"e is no need to withhold food fo" 9 ho$"s !he"efo"e& answe"s @& C& and ) a"e in%o""e%t 158 #nswe" ) is %o""e%t @y 1 yea" of age& the infant is e-pe%ted to t"iple his bi"th weight #nswe"s #& @& and C a"e in%o""e%t be%a$se they a"e too low 159 #nswe" @ is %o""e%t # nonst"ess test is done to e/al$ate pe"iodi% mo/ement of the fet$s It is not done to e/al$ate l$ng mat$"ity as in answe" # #n o-yto%in %hallenge test shows the effe%t of %ont"a%tions on fetal hea"t "ate and a nonst"ess test does not meas$"e ne$"ologi%al well=being of the fet$s& so answe"s C and ) a"e in%o""e%t 159 #nswe" @ is %o""e%t ?ypospadia is a %ondition in whi%h the"e is an opening on the do"sal side of the penis #nswe" # is in%o""e%t be%a$se hypospadia does not %on%e"n the $"eth"al opening #nswe" C is in%o""e%t be%a$se the si(e of the penis is not affe%ted #nswe" ) is in%o""e%t be%a$se the opening is on the do"sal side& not the /ent"al side 180 #nswe" # is %o""e%t !"ansition is the time d$"ing labo" when the %lient loses %on%ent"ation d$e to intense %ont"a%tions Potential fo" inE$"y "elated to p"e%ipitate deli/e"y has nothing to do with the dilation of the %e"/i-& so answe" @ is in%o""e%t !he"e is no data to indi%ate that the %lient has had anesthesia o" fl$id /ol$me defi%it& ma0ing answe"s C and ) in%o""e%t 181 #nswe" C is %o""e%t 7a"i%ella is %hi%0en po- !his he"pes /i"$s is t"eated with anti/i"al medi%ations !he %lient is not t"eated with antibioti%s o" anti%oag$lants as stated in answe"s # and ) !he %lient might ha/e a fe/e" befo"e the "ash appea"s& b$t when the "ash appea"s& the tempe"at$"e is $s$ally gone& so answe" @ is in%o""e%t

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182 #nswe" @ is %o""e%t Clients with %hest pain %an be t"eated with nit"ogly%e"in& a beta blo%0e" s$%h as p"opanolol& o" 7a"apamil !he"e is no indi%ation fo" an antibioti% s$%h as #mpi%illin& so answe"s #& C& and ) a"e in%o""e%t 18+ #nswe" @ is %o""e%t #nti=inflammato"y d"$gs sho$ld be ta0en with meals to a/oid stoma%h $pset #nswe"s #& C& and ) a"e in%o""e%t Clients with "he$matoid a"th"itis sho$ld e-e"%ise& b$t not to the point of pain #lte"nating hot and %old is not ne%essa"y& espe%ially be%a$se wa"m& moist soa0s a"e mo"e $sef$l in de%"easing pain Height=bea"ing a%ti/ities s$%h as wal0ing a"e $sef$l b$t is not the best answe" fo" the stem 18. #nswe" ) is %o""e%t <o"phine is %ont"aindi%ated in %lients with gallbladde" disease and pan%"eatitis be%a$se mo"phine %a$ses spasms of the Sphente" of Oddi <epe"idine& <ylanta& and Cimetadine a"e o"de"ed fo" pan%"eatitis& ma0ing answe"s #& @& and C in%o""e%t 182 #nswe" @ is %o""e%t ?all$%inogeni% d"$gs %an %a$se hall$%inations Contin$o$s obse"/ation is o"de"ed to p"e/ent the %lient f"om ha"ming himself d$"ing withd"awal #nswe"s #& C& and ) a"e in%o""e%t be%a$se hall$%inogeni% d"$gs donKt %"eate both stim$lant and dep"essant effe%ts o" p"od$%e se/e"e "espi"ato"y dep"ession ?owe/e"& they do p"od$%e psy%hologi%al dependen%e "athe" than physi%al dependen%e 185 #nswe" @ is %o""e%t @a"bit$"ates %"eate a sedati/e effe%t Hhen the %lient stops ta0ing ba"bit$"ates& he will e-pe"ien%e ta%hy%a"dia& dia""hea& and ta%hpnea #nswe" # is in%o""e%t e/en tho$gh dep"ession and s$i%idal ideation go along with ba"bit$"ate $seW it is not the p"io"ity <$s%le %"amps and abdominal pain a"e /ag$e symptoms that %o$ld be asso%iated with othe" p"oblems !a%hy%a"dia is asso%iated with stopping ba"bit$"ates& b$t e$pho"ia is not 188 #nswe" # is %o""e%t If the fetal hea"t tones a"e hea"d in the "ight $ppe" abdomen& the infant is in a b"ee%h p"esentation If the infant is positioned in the "ight o%%ipital ante"io" p"esentation& the F?!s will be lo%ated in the "ight lowe" 6$ad"ant& so answe" @ is in%o""e%t If the fet$s is in the sa%"al position& the F?!s will be lo%ated in the %ente" of the abdomen& so answe" C is in%o""e%t If the F?!s a"e hea"d in the left lowe" abdomen& the infant is most li0ely in the left o%%ipital t"ans/e"se position& ma0ing answe" ) in%o""e%t 189 #nswe" ) is %o""e%t #sthma is the p"esen%e of b"on%hiola" spasms !his spasm %an be b"o$ght on by alle"gies o" an-iety #nswe" # is in%o""e%t be%a$se the p"ima"y physiologi%al alte"ation is not inflammation #nswe" @ is in%o""e%t be%a$se the"e is the p"od$%tion of abno"mally /is%o$s m$%$s& not a p"ima"y alte"ation #nswe" C is in%o""e%t be%a$se infe%tion is not p"ima"y to asthma 189 #nswe" # is %o""e%t !he %lient with mania is seldom sitting long eno$gh to eat and b$"ns many %alo"ies fo" ene"gy #nswe" @ is in%o""e%t be%a$se the %lient sho$ld be t"eated the same as othe" %lients Small meals a"e not a %o""e%t option fo" this %lient #llowing he" into the 0it%hen gi/es he" p"i/ileges that othe" %lients do not ha/e and sho$ld not be allowed& so answe" ) is in%o""e%t 190 #nswe" @ is %o""e%t @"yantKs t"a%tion is $sed fo" f"a%t$"ed fem$"s and dislo%ated hips !he hips sho$ld be ele/ated 12R off the bed #nswe" # is in%o""e%t be%a$se the hips sho$ld not be "esting on the bed #nswe" C is in%o""e%t be%a$se the hips sho$ld not be abo/e the le/el of the body #nswe" ) is in%o""e%t be%a$se the hips and legs sho$ld not be flat on the bed 191 #nswe" @ is %o""e%t ?e"pes (oste" is shingles Clients with shingles sho$ld be pla%ed in %onta%t p"e%a$tions Hea"ing glo/es d$"ing %a"e will p"e/ent t"ansmission of the /i"$s Co/e"ing the lesions with a ste"ile ga$(e is not ne%essa"y& antibioti%s a"e not p"es%"ibed fo" he"pes (oste"& and o-ygen is not ne%essa"y fo" shinglesW the"efo"e& answe"s #& C& and ) a"e in%o""e%t 192 #nswe" @ is %o""e%t # t"o$gh le/el sho$ld be d"awn +0 min$tes befo"e the thi"d o" fo$"th dose !he times in answe"s #& C& and ) a"e in%o""e%t times to d"aw blood le/els 19+ #nswe" @ is %o""e%t !he %lient $sing a diaph"agm sho$ld 0eep the diaph"agm in a %ool lo%ation #nswe"s #& C& and ) a"e in%o""e%t She sho$ld "ef"ain f"om lea/ing the diaph"agm in longe" than 9 ho$"s& not . ho$"s She sho$ld ha/e the diaph"agm "esi(ed when she gains o" loses 10 po$nds o" has abdominal s$"ge"y 19. #nswe" C is %o""e%t <othe"s who plan to b"eastfeed sho$ld d"in0 plenty of li6$ids& and fo$" glasses is not eno$gh in a 2.=ho$" pe"iod Hea"ing a s$ppo"t b"a is a good p"a%ti%e fo" the mothe" who is b"eastfeeding as well as the mothe" who plans to bottle=feed& so answe" # is in%o""e%t ,-p"essing mil0 f"om the b"east will stim$late mil0 p"od$%tion& ma0ing answe" @ in%o""e%t #llowing the wate" to "$n o/e" the b"east will also fa%ilitate Lletdown&L when the mil0 begins to be p"od$%edW th$s& answe" ) is in%o""e%t 192 #nswe" # is %o""e%t !he fa%ial ne"/e is %"anial ne"/e 7II If damage o%%$"s& the %lient will e-pe"ien%e fa%ial pain !he a$dito"y ne"/e is "esponsible fo" hea"ing loss and tinnit$s& eye mo/ement is %ont"olled by the !"o%hea" o" C I7& and the olfa%to"y ne"/e %ont"ols smellW the"efo"e& answe"s @& C& and ) a"e in%o""e%t 195 #nswe" @ is %o""e%t Clients ta0ing Py"idi$m sho$ld be ta$ght that the medi%ation will t$"n the $"ine o"ange o" "ed It is not asso%iated with dia""hea& mental %onf$sion& o" %hanges in tasteW the"efo"e& answe"s #& C& and ) a"e in%o""e%t Py"idi$m %an also %a$se a yellowish %olo" to s0in and s%le"a if ta0en in la"ge doses 198 #nswe" @ is %o""e%t #%%$tane is %ont"aindi%ated fo" $se by p"egnant %lients be%a$se it %a$ses te"atogeni% effe%ts Cal%i$m le/els& api%al p$lse& and %"eatinine le/els a"e not ne%essa"yW the"efo"e& answe"s #& C& and ) a"e in%o""e%t 199 #nswe" ) is %o""e%t Clients ta0ing #%y%lo/i" sho$ld be en%o$"aged to d"in0 plenty of fl$ids be%a$se "enal impai"ment %an o%%$" 'imiting a%ti/ity is not ne%essa"y& no" is eating a high=%a"bohyd"ate diet Use of an in%enti/e spi"omete" is not spe%ifi% to %lients ta0ing #%y%lo/i"W the"efo"e& answe"s #& @& and C a"e in%o""e%t 199 #nswe" # is %o""e%t Clients who a"e p"egnant sho$ld not ha/e an <1I be%a$se "adioa%ti/e isotopes a"e $sed ?owe/e"& %lients with a titani$m hip "epla%ement %an ha/e an <1I& so answe" @ is in%o""e%t *o

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antibioti%s a"e $sed with this test and the %lient sho$ld "emain still only when inst"$%ted& so answe"s C and ) a"e not spe%ifi% to this test 190 #nswe" ) is %o""e%t Clients ta0ing #mphote"i%in @ sho$ld be monito"ed fo" li/e"& "enal& and bone ma""ow f$n%tion be%a$se this d"$g is to-i% to the 0idneys and li/e"& and %a$ses bone ma""ow s$pp"ession Ba$ndi%e is a sign of li/e" to-i%ity and is not spe%ifi% to the $se of #mphote"i%in @ Changes in /ision a"e not "elated& and na$sea is a side effe%t& not a sign of to-i%ityW no" is $"ina"y f"e6$en%y !h$s& answe"s #& @& and C a"e in%o""e%t 191 #nswe" C is %o""e%t !he %lient with %hest pain sho$ld be seen fi"st be%a$se this %o$ld indi%ate a myo%a"dial infa"%tion !he %lient in answe" # has a blood gl$%ose within no"mal limits !he %lient in answe" @ is maintained on blood p"ess$"e medi%ation !he %lient in answe" ) is in no dist"ess 192 #nswe" @ is %o""e%t Pan%"eati% en(ymes sho$ld be gi/en with meals fo" optimal effe%ts !hese en(ymes assist the body in digesting needed n$t"ients #nswe"s #& C& and ) a"e in%o""e%t methods of administe"ing pan%"eati% en(ymes 19+ #nswe" C is %o""e%t !he lens allows light to pass th"o$gh the p$pil and fo%$s light on the "etina !he lens does not stim$late the "etina& assist with eye mo/ement& o" magnify small obEe%ts& so answe"s #& @& and ) a"e in%o""e%t 19. #nswe" C is %o""e%t <ioti% eyed"ops %onst"i%t the p$pil and allow a6$eo$s h$mo" to d"ain o$t of the Canal of S%hlemm !hey do not anestheti(e the %o"nea& dilate the p$pil& o" pa"aly(e the m$s%les of the eye& ma0ing answe"s #& @& and ) in%o""e%t 192 #nswe" # is %o""e%t Hhen $sing eyed"ops& allow 2 min$tes between the two medi%ationsW the"efo"e& answe" @ is in%o""e%t !hese medi%ations %an be $sed by the same %lient b$t it is not ne%essa"y to $se a %y%lopegi% with these medi%ations& ma0ing answe"s C and ) in%o""e%t 195 #nswe" @ is %o""e%t Clients with %olo" blindness will most li0ely ha/e p"oblems disting$ishing /iolets& bl$es& and g"een !he %olo"s in answe"s #& C& and ) a"e less %ommonly affe%ted 198 #nswe" ) is %o""e%t !he %lient with a pa%ema0e" sho$ld be ta$ght to %o$nt and "e%o"d his p$lse "ate #nswe"s #& @& and C a"e in%o""e%t #n0le edema is a sign of "ight=sided %ongesti/e hea"t fail$"e #ltho$gh this is not no"mal& it is often p"esent in %lients with hea"t disease If the edema is p"esent in the hands and fa%e& it sho$ld be "epo"ted Che%0ing the blood p"ess$"e daily is not ne%essa"y fo" these %lients !he %lient with a pa%ema0e" %an $se a mi%"owa/e o/en& b$t he sho$ld stand abo$t 2 feet f"om the o/en while it is ope"ating 199 #nswe" # is %o""e%t Clients who a"e being "et"ained fo" bladde" %ont"ol sho$ld be ta$ght to withhold fl$ids afte" abo$t 8 p m & o" 1 !he times in answe"s @& C& and ) a"e too ea"ly in the day 199 #nswe" ) is %o""e%t C"anbe""y E$i%e is mo"e al0aline and& when metaboli(ed by the body& is e-%"eted with a%idi% $"ine @a%te"ia does not g"ow f"eely in a%idi% $"ine In%"easing inta0e of meats is not asso%iated with $"ina"y t"a%t infe%tions& so answe" # is in%o""e%t !he %lient does not ha/e to a/oid %it"$s f"$its and pe"i%a"e sho$ld be done& b$t hyd"ogen pe"o-ide is d"ying& so answe"s @ and C a"e in%o""e%t 200 #nswe" C is %o""e%t *P? ins$lin pea0s in 9X12 ho$"s& so a sna%0 sho$ld be offe"ed at that time *P? ins$lin onsets in 90X120 min$tes& so answe" # is in%o""e%t #nswe" @ is $nt"$e be%a$se *P? ins$lin is time "eleased and does not $s$ally %a$se s$dden hypogly%emia #nswe" ) is in%o""e%t& b$t the %lient sho$ld eat a bedtime sna%0 201 #nswe" ) is %o""e%t <ethot"e-ate is a foli% a%id antagonist 'e$%o/o"in is the d"$g gi/en fo" to-i%ity to this d"$g It is not $sed to t"eat i"on=defi%ien%y anemia& %"eate a syne"gisti% effe%ts& o" in%"ease the n$mbe" of %i"%$lating ne$t"ophils !he"efo"e& answe"s #& @& and C a"e in%o""e%t 202 #nswe" @ is %o""e%t !he %lient who is alle"gi% to dogs& eggs& "abbits& and %hi%0en feathe"s is most li0ely alle"gi% to the "$bella /a%%ine !he %lient who is alle"gi% to neomy%in is also at "is0 !he"e is no dange" to the %lient if he has an o"de" fo" a !@ s0in test& ,'IS# test& o" %hest -="ayW th$s& answe"s #& C& and ) a"e in%o""e%t 20+ #nswe" @ is %o""e%t Janta% O"antidineP is a histamine blo%0e" that sho$ld be gi/en with meals fo" optimal effe%t& not befo"e meals ?owe/e"& !agamet O%imetidineP is a histamine blo%0e" that %an be gi/en in one dose at bedtime *eithe" of these d"$gs sho$ld be gi/en befo"e o" afte" meals& so answe"s # and ) a"e in%o""e%t 20. #nswe" C is %o""e%t !he p"o-imal end of the do$ble=ba""el %olostomy is the end towa"d the small intestines !his end is on the %lientKs "ight side !he distal end& as in answe"s #& @& and )& is on the %lientKs left side 202 #nswe" # is %o""e%t If the n$"se %he%0s the f$nd$s and finds it to be displa%ed to the "ight o" left& this is an indi%ation of a f$ll bladde" !his finding is not asso%iated with hypotension o" %lots& as stated in answe" @ O-yto-i% d"$gs OPito%inP a"e d"$gs $sed to %ont"a%t the $te"$s& so answe" C is in%o""e%t It has nothing to do with displa%ement of the $te"$s #nswe" ) is in%o""e%t be%a$se displa%ement is asso%iated with a f$ll bladde"& not /aginal bleeding 205 #nswe" C is %o""e%t Clients with an inte"nal defib"illato" o" a pa%ema0e" sho$ld not ha/e an <1I be%a$se it %an %a$se dys"hythmias in the %lient with a pa%ema0e" If the %lient has a need fo" o-ygen& is %la$st"ophobi%& o" is deaf& he %an ha/e an <1I& b$t p"o/isions s$%h as e-tension t$bes fo" the o-ygen& sedati/es& o" a signal system sho$ld be made to a%%ommodate these p"oblems !he"efo"e& answe"s #& @& and ) a"e in%o""e%t 208 #nswe" C is %o""e%t # 5=month=old is too old fo" the %olo"f$l mobile ?e is too yo$ng to play with the ele%t"oni% game o" the +0=pie%e Eigsaw p$((le !he best toy fo" this age is the %a"s in a plasti% %ontaine"& so answe"s #& @& and ) a"e in%o""e%t 209 #nswe" C is %o""e%t !he %lient with polio has m$s%le wea0ness Pe"iods of "est th"o$gho$t the day will %onse"/e the %lientKs ene"gy # hot bath %an %a$se b$"nsW howe/e"& a wa"m bath wo$ld be helpf$l& so answe" # is in%o""e%t St"en$o$s e-e"%ises a"e not ad/isable& ma0ing answe" @ in%o""e%t 7is$al dist$"ban%es a"e di"e%tly asso%iated with polio and %annot be %o""e%ted with glassesW the"efo"e& answe" ) is in%o""e%t

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209 #nswe" @ is %o""e%t !he %lient with a p"otoepisiotomy will need stool softene"s s$%h as do%$sate sodi$m S$pposito"ies a"e gi/en only with an o"de" f"om the do%to"& <ethe"gine is a d"$g $sed to %ont"a%t the $te"$s& and Pa"lodel is an anti=Pa"0insonian d"$gW the"efo"e& answe"s #& C& and ) a"e in%o""e%t 210 #nswe" C is %o""e%t !otal Pa"ente"al *$t"ition is a high=gl$%ose sol$tion !his the"apy often %a$ses the gl$%ose le/els to be ele/ated @e%a$se this is a %ommon %ompli%ation& ins$lin might be o"de"ed #nswe"s #& @& and ) a"e in%o""e%t !P* is $sed to t"eat negati/e nit"ogen balan%eW it will not lead to negati/e nit"ogen balan%e !otal Pa"ente"al *$t"ition %an be managed with o"al hypogly%emi% d"$gs& b$t it is diffi%$lt to do so !otal Pa"ente"al *$t"ition will not lead to f$"the" pan%"eati% disease 211 #nswe" @ is %o""e%t !he %lient who is 10 wee0s p"egnant sho$ld be assessed to dete"mine how she feels abo$t the p"egnan%y It is too ea"ly to dis%$ss p"ete"m labo"& too late to dis%$ss whethe" she was $sing a method of bi"th %ont"ol& and afte" the %lient deli/e"s& a dis%$ssion of f$t$"e %hild"en sho$ld be instit$ted !h$s& answe"s #& C& and ) a"e in%o""e%t 212 #nswe" # is %o""e%t !he best I7 fl$id fo" %o""e%tion of dehyd"ation is no"mal saline be%a$se it is most li0e no"mal se"$m )e-t"ose p$lls fl$id f"om the %ell& la%tated 1inge"Ks %ontains mo"e ele%t"olytes than the %lientKs se"$m& and de-t"ose with no"mal saline will also alte" the int"a%ell$la" fl$id !he"efo"e& answe"s @& C& and ) a"e in%o""e%t 21+ #nswe" # is %o""e%t # thy"oid s%an $ses a dye& so the %lient sho$ld be assessed fo" alle"gies to iodine !he %lient will not ha/e a bol$s of fl$id& will not be asleep& and will not ha/e a $"ina"y %athete" inse"ted& so answe"s @& C& and ) a"e in%o""e%t 21. #nswe" @ is %o""e%t 1hoDam is $sed to p"e/ent fo"mation of 1h antibodies It does not p"o/ide imm$nity to 1h isoen(ymes& eliminate %i"%$lating 1h antibodies& o" %on/e"t the 1h fa%to" f"om negati/e to positi/eW th$s& answe"s #& C& and ) a"e in%o""e%t 212 #nswe" @ is %o""e%t # %lient with a f"a%t$"ed foot often has a sho"t leg %ast applied to stabili(e the f"a%t$"e # spi%a %ast is $sed to stabili(e a f"a%t$"ed pel/is o" /e"teb"al f"a%t$"e :i"s%hne" wi"es a"e $sed to stabili(e small bones s$%h as toes and the %lient will most li0ely ha/e a %ast o" immobili(e"& so answe"s #& C& and ) a"e in%o""e%t 215 #nswe" # is %o""e%t I"idi$m seeds %an be e-pelled d$"ing $"ination& so the %lient sho$ld be ta$ght to st"ain his $"ine and "epo"t to the do%to" if any of the seeds a"e e-pelled In%"easing fl$ids& "epo"ting $"ina"y f"e6$en%y& and a/oiding p"olonged sitting a"e not ne%essa"yW the"efo"e& answe"s @& C& and ) a"e in%o""e%t 218 #nswe" C is %o""e%t Imm$nos$pp"essants a"e $sed to p"e/ent antibody fo"mation #nti/i"als& antibioti%s& and analgesi%s a"e not $sed to p"e/ent antibody p"od$%tion& so answe"s #& @& and ) a"e in%o""e%t 219 #nswe" # is %o""e%t @efo"e %ata"a%t "emo/al& the %lient will ha/e <yd"iati% d"ops instilled to dilate the p$pil !his will fa%ilitate "emo/al of the lens <ioti%s %onst"i%t the p$pil and a"e not $sed in %ata"a%t %lients # lase" is not $sed to smooth and "eshape the lensW the diseased lens is "emo/ed Sili%one oil is not inEe%ted in this %lientW th$s& answe"s @& C& and ) a"e in%o""e%t 219 #nswe" C is %o""e%t Pla%ing simple signs that indi%ate the lo%ation of "ooms whe"e the %lient sleeps& eats& and bathes will help the %lient be mo"e independent P"o/iding mi""o"s and pi%t$"es is not "e%ommended with the %lient who has #l(heime"Ks disease be%a$se mi""o"s and pi%t$"es tend to %a$se agitation& and alte"nating health%a"e wo"0e"s %onf$ses the %lientW the"efo"e& answe"s #& @& and ) a"e in%o""e%t 220 #nswe" C is %o""e%t # Ba%0son=P"att d"ain is a se"$m=%olle%tion de/i%e %ommonly $sed in abdominal s$"ge"y # Ba%0son=P"att d"ain will not p"e/ent the need fo" d"essing %hanges& "ed$%e edema of the in%ision& o" 0eep the %ommon bile d$%t open& so answe"s #& @& and ) a"e in%o""e%t # t=t$be is $sed to 0eep the %ommon bile d$%t open 221 #nswe" C is %o""e%t !he infant who is +2 wee0s gestation will not be able to %ont"ol his head& so head lag will be p"esent <ongolian spots a"e %ommon in #f"i%an #me"i%an infants& not Ca$%asian infantsW the %lient at +2 wee0s will ha/e s%"otal "$gae o" "edness b$t will not ha/e /e"ni- %aseosa& the %heesy appea"ing %o/e"ing fo$nd on most f$ll=te"m infants !he"efo"e& answe"s #& @& and ) a"e in%o""e%t 222 #nswe" # is %o""e%t ?emat$"ia in a %lient with a pel/i% f"a%t$"e %an indi%ate t"a$ma to the bladde" o" impending bleeding diso"de"s It is not $n$s$al fo" the %lient to %omplain of m$s%les spasms with m$ltiple f"a%t$"es& so answe" @ is in%o""e%t )i((iness %an be asso%iated with blood loss and is nonspe%ifi%& ma0ing answe" C in%o""e%t *a$sea& as stated in answe" )& is also %ommon in the %lient with m$ltiple t"a$mas 22+ #nswe" C is %o""e%t !he %lientKs statement L!hey a"e t"ying to 0ill meL indi%ates pa"anoid del$sions !he"e is no data to indi%ate that the %lient is hea"ing /oi%es o" is into-i%ated& so answe"s # and ) a"e in%o""e%t )el$sions of g"ande$" a"e fi-ed beliefs that the %lient is s$pe"io" o" pe"haps a famo$s pe"son& ma0ing answe" @ in%o""e%t 22. #nswe" @ is %o""e%t @e%a$se the n$"se is $nawa"e of when the bottle was opened o" whethe" the saline is ste"ile& it is safest to obtain a new bottle #nswe"s #& C& and ) a"e not safe p"a%ti%es 222 #nswe" C is %o""e%t Infants with an #pga" of 9 at 2 min$tes most li0ely ha/e a%"yo%yanosis& a no"mal physiologi% adaptation to bi"th It is not "elated to the infant being %old& e-pe"ien%ing b"ady%a"dia& o" being letha"gi%W th$s& answe"s #& @& and ) a"e in%o""e%t 225 #nswe" # is %o""e%t 1apid %ontin$o$s "ewa"ming of a f"ostbite p"ima"ily lessens %ell$la" damage It does not p"e/ent fo"mation of bliste"s It does p"omote mo/ement& b$t this is not the p"ima"y "eason fo" "apid "ewa"ming It might in%"ease pain fo" a sho"t pe"iod of time as the feeling %omes ba%0 into the e-t"emityW the"efo"e& answe"s @& C& and ) a"e in%o""e%t

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228 #nswe" ) is %o""e%t ?emodialysis wo"0s by $sing a dialy(ing memb"ane to filte" waste that has a%%$m$lated in the blood It does not pass wate" th"o$gh a dialy(ing memb"ane no" does it eliminate plasma p"oteins o" lowe" the p?& so answe"s #& @& and C a"e in%o""e%t 229 #nswe" @ is %o""e%t !he %lient who is imm$ne=s$pp"essed and is e-posed to measles sho$ld be t"eated with medi%ations to boost his imm$nity to the /i"$s #n antibioti% o" anti/i"al will not p"ote%t the %lient and it is too late to pla%e the %lient in isolation& so answe"s #& C& and ) a"e in%o""e%t 229 #nswe" ) is %o""e%t !he %lient with <1S# sho$ld be pla%ed in isolation Dlo/es& a gown& and a mas0 sho$ld be $sed when %a"ing fo" the %lient and hand washing is /e"y impo"tant !he doo" sho$ld "emain %losed& b$t a negati/e=p"ess$"e "oom is not ne%essa"y& so answe"s # and @ a"e in%o""e%t <1S# is sp"ead by %onta%t with blood o" body fl$id o" by to$%hing the s0in of the %lient It is %$lt$"ed f"om the nasal passages of the %lient& so the %lient sho$ld be inst"$%ted to %o/e" his nose and mo$th when he snee(es o" %o$ghs It is not ne%essa"y fo" the %lient to wea" the mas0 at all timesW the n$"se sho$ld wea" the mas0& so answe" C is in%o""e%t 2+0 #nswe" @ is %o""e%t Pain "elated to phantom limb synd"ome is d$e to pe"iphe"al ne"/o$s system inte""$ption #nswe" # is in%o""e%t be%a$se phantom limb pain %an last se/e"al months o" indefinitely #nswe" C is in%o""e%t be%a$se it is not psy%hologi%al It is also not d$e to infe%tions& as stated in answe" ) 2+1 #nswe" # is %o""e%t )$"ing a Hhipple p"o%ed$"e the head of the pan%"eas& whi%h is a pa"t of the stoma%h& the EeE$n$m& and a po"tion of the stoma%h a"e "emo/ed and "eanastomosed #nswe" @ is in%o""e%t be%a$se the p"o-imal thi"d of the small intestine is not "emo/ed !he enti"e stoma%h is not "emo/ed& as in answe" C& and in answe" )& the esophag$s is not "emo/ed 2+2 #nswe" C is %o""e%t Peppe" is not p"o%essed and %ontains ba%te"ia #nswe"s #& @& and ) a"e in%o""e%t be%a$se f"$its sho$ld be %oo0ed o" washed and peeled& and salt and 0et%h$p a"e allowed 2++ #nswe" # is %o""e%t Co$madin is an anti%oag$lant One of the tests fo" bleeding time is a P"otime !his test sho$ld be done monthly ,ating mo"e f"$its and /egetables is not ne%essa"y& and da"0=g"een /egetables %ontain /itamin :& whi%h in%"eases %lotting& so answe" @ is in%o""e%t )"in0ing mo"e li6$ids and a/oiding %"owds is not ne%essa"y& so answe"s C and ) a"e in%o""e%t 2+. #nswe" # is %o""e%t !he %lient who is ha/ing a %ent"al /eno$s %athete" "emo/ed sho$ld be told to hold his b"eath and bea" down !his p"e/ents ai" f"om ente"ing the line #nswe"s @& C& and ) will not fa%ilitate "emo/al 2+2 #nswe" @ is %o""e%t Clients with a histo"y of st"epto%o%%al infe%tions %o$ld ha/e antibodies that "ende" the st"epto0inase ineffe%ti/e !he"e is no "eason to assess the %lient fo" alle"gies to pineapples o" bananas& the"e is no %o""elation to the $se of phenytoin and st"epto0inase& and a histo"y of al%ohol ab$se is also not a fa%to" in the o"de" fo" st"epto0inaseW the"efo"e& answe"s #& C& and ) a"e in%o""e%t 2+5 #nswe" @ is %o""e%t !he %lient who is imm$ne=s$pp"essed and has bone ma""ow s$pp"ession sho$ld be ta$ght not to floss his teeth be%a$se platelets a"e de%"eased Using oils and %"eam=based soaps is allowed& as is eating salt and $sing an ele%t"i% "a(o"W the"efo"e& answe"s #& C& and ) a"e in%o""e%t 2+8 #nswe" # is %o""e%t !he best method and safest way to %hange the ties of a t"a%heotomy is to apply the new ones befo"e "emo/ing the old ones ?a/ing a helpe" is good& b$t the helpe" might not p"e/ent the %lient f"om %o$ghing o$t the t"a%heotomy #nswe" C is not the best way to p"e/ent the %lient f"om %o$ghing o$t the t"a%heotomy #s0ing the do%to" to s$t$"e the t"a%heotomy in pla%e is not app"op"iate 2+9 #nswe" ) is %o""e%t !he o$tp$t of +00m' is indi%ati/e of hemo""hage and sho$ld be "epo"ted immediately #nswe" # does nothing to help the %lient <il0ing the t$be is done only with an o"de" and will not help in this sit$ation& and slowing the int"a/eno$s inf$sion is not %o""e%tW th$s& answe"s @ and C a"e in%o""e%t 2+9 #nswe" # is %o""e%t !he infant with tet"ology of falot has fi/e hea"t defe%ts ?e will be t"eated with digo-in to slow and st"engthen the hea"t ,pineph"ine& aminophyline& and at"opine will speed the hea"t "ate and a"e not $sed in this %lientW the"efo"e& answe"s @& C& and ) a"e in%o""e%t 2.0 !he %o""e%t answe" is ma"0ed by an ; in the diag"am !he !ail of Spen%e is lo%ated in the $ppe" o$te" 6$ad"ant of the b"east 2.1 #nswe" # is %o""e%t !he toddle" with a /ent"i%$la" septal defe%t will ti"e easily ?e will not g"ow no"mally b$t will not need mo"e %alo"ies ?e will be s$s%eptible to ba%te"ial infe%tion& b$t he will be no mo"e s$s%eptible to /i"al infe%tions than othe" %hild"en !he"efo"e& answe"s @& C& and ) a"e in%o""e%t 2.2 #nswe" @ is %o""e%t # nonst"ess test dete"mines pe"iodi% mo/ement of the fet$s It does not dete"mine l$ng mat$"ity& show %ont"a%tions& o" meas$"e ne$"ologi%al well=being& ma0ing answe"s #& C& and ) in%o""e%t 2.+ #nswe" C is %o""e%t !he monito" indi%ates /a"iable de%ele"ations %a$sed by %o"d %omp"ession If Pito%in is inf$sing& the n$"se sho$ld t$"n off the Pito%in Inst"$%ting the %lient to p$sh is in%o""e%t be%a$se p$shing %o$ld in%"ease the de%ele"ations and be%a$se the %lient is 9%m dilated& ma0ing answe" # in%o""e%t Pe"fo"ming a /aginal e-am sho$ld be done afte" t$"ning off the Pito%in& and pla%ing the %lient in a semi=Fowle"Ks position is not app"op"iate fo" this sit$ationW the"efo"e& answe"s @ and ) a"e in%o""e%t 2.. #nswe" C is %o""e%t !he g&