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Philippine NLE Board Exam: Psychiatric Nursing Question & Answer w/ rationale

PS!"#A$%#! N&%S#N'
1. Mental health is defined as:
A. The ability to distinguish what is real from what is not.
B. A state of well-being where a person can realize his own abilities can cope with normal stresses of
life and work productiely.
!. "s the promotion of mental health# preention of mental disorders# nursing care of patients during
illness and rehabilitation
$. Absence of mental illness
Answer: %B& A state of well-being where a person can realize his own abilities can cope with normal
stresses of life and work productiely.
Mental health is a state of emotional and psychosocial well being. A mentally healthy indiidual is
self aware and self directie# has the ability to sole problems# can cope with crisis without assistance
beyond the support of family and friends fulfill the capacity to loe and work and sets goals and
realistic limits. A. This describes the ego function reality testing. !. This is the definition of Mental
'ealth and (sychiatric )ursing. $. Mental health is not *ust the absence of mental illness.
+. ,hich of the following describes the role of a technician-
A. Administers medications to a schizophrenic patient.
B. The nurse feeds and bathes a catatonic client
!. !oordinates dierse aspects of care rendered to the patient
$. $isseminates information about alcohol and its effects.
Answer: %A& Administers medications to a schizophrenic patient.
Administration of medications and treatments# assessment# documentation are the actiities of the
nurse as a technician. B. Actiities as a parent surrogate. !. .efers to the ward manager role. $. .ole
as a teacher.
/. 0iza says# 12ie me 13 minutes to recall the name of our college professor who failed many
students in our anatomy class.4 5he is operating on her:
A. 5ubconscious
B. !onscious
!. 6nconscious
$. 7go
Answer: %A& 5ubconscious
5ubconscious refers to the materials that are partly remembered partly forgotten but these can be
recalled spontaneously and oluntarily. B. This functions when one is awake. 8ne is aware of his
thoughts# feelings actions and what is going on in the enironment. !. The largest potion of the mind
that contains the memories of one9s past particularly the unpleasant. "t is difficult to recall the
unconscious content. $. The conscious self that deals and tests reality.
:. The superego is that part of the psyche that:
A. 6ses defensie function for protection.
B. "s impulsie and without morals.
!. $etermines the circumstances before making decisions.
$. The censoring portion of the mind.
Answer: %$& The censoring portion of the mind.
The critical censoring portion of one9s personality; the conscience. A. This refers to the ego function
that protects itself from anything that threatens it.. B. The "d is composed of the untamed# primitie
dries and impulses. !. This refers to the ego that acts as the moderator of the struggle between the id
and the superego.
<. (rimary leel of preention is e=emplified by:
A. 'elping the client resume self care.
B. 7nsuring the safety of a suicidal client in the institution.
!. Teaching the client stress management techni>ues
$. !ase finding and sureillance in the community
Answer: %!& Teaching the client stress management techni>ues
(rimary leel of preention refers to the promotion of mental health and preention of mental illness.
This can be achieed by rendering health teachings such as modifying ones responses to stress. A.
This is tertiary leel of preention that deals with rehabilitation. B and $. 5econdary leel of
preention which inoles reduction of actual illness through early detection and treatment of illness.
?. 5ituation: "n a home isit done by the nurse# she suspects that the wife and her child are ictims of
abuse.
,hich of the following is the most appropriate for the nurse to ask-
A. 1Are you being threatened or hurt by your partner-
B. 1Are you frightened of you partner4
!. 1"s something bothering you-4
$. 1,hat happens when you and your partner argue-4
Answer: %A& 1Are you being threatened or hurt by your partner-
The nurse alidates her obseration by asking simple# direct >uestion. This also shows empathy. B# !#
and $ are indirect >uestions which may not lead to the discussion of abuse.
@. The wife admits that she is a ictim of abuse and opens up about her persistent distaste for se=.
This se=ual disorder is:
A. 5e=ual desire disorder
B. 5e=ual arousal $isorder
!. 8rgasm $isorder
$. 5e=ual (ain $isorder
Answer: %A& 5e=ual desire disorder
'as little or no se=ual desire or has distaste for se=. B. Aailure to maintain the physiologic
re>uirements for se=ual intercourse. !. (ersistent and recurrent inability to achiee an orgasm. $.
Also called dyspareunia. "ndiiduals with this disorder suffer genital pain before# during and after
se=ual intercourse.
B. ,hat would be the best approach for a wife who is still liing with her abusie husband-
A. 1'ere9s the number of a crisis center that you can call for help .4
B. 1"ts best to leae your husband.4
!. 1$id you discuss this with your family-4
$. 1 ,hy do you allow yourself to be treated this way4
Answer: %A& 1'ere9s the number of a crisis center that you can call for help .4
(rotection is a priority concern in abuse. 'elp the ictim to deelop a plan to ensure safety. B. $o not
gie adice to leae the abuser. Making decisions for the ictim further erodes her esteem. 'oweer
discuss options aailable. !. The ictim tends to isolate from friends and family. $. This is
*udgmental. Aoid in anyway implying that she is at fault.
C. ,hich comment about a / year old child if made by the parent may indicate child abuse-
A. 18nce my child is toilet trained# " can still e=pect her to hae someD
B. 1,hen " tell my child to do something once# " don9t e=pect to hae to tellD
!. 1My child is e=pected to try to do things such as# dress and feed.4
$. 1My / year old loes to say )8.4
Answer: %B& 1,hen " tell my child to do something once# " don9t e=pect to hae to tellD
Abusie parents tend to hae unrealistic e=pectations on the child. A#B and ! are realistic
e=pectations on a / year old.
13. The primary nursing interention for a ictim of child abuse is:
A. Assess the scope of the problem
B. Analyze the family dynamics
!. 7nsure the safety of the ictim
$. Teach the ictim coping skills
Answer: %!& 7nsure the safety of the ictim
The priority consideration is the safety of the ictim. Attend to the physical in*uries to ensure the
physiologic safety and integrity of the child. .eporting suspected case of abuse may deter recurrence
of abuse. A#B and $ may be addressed later.
11. 5ituation: A /3 year old male employee fre>uently complains of low back pain that leads to
fre>uent absences from work. !onsultation and tests reeal negatie results.
The client has which somatoform disorder-
A. 5omatization $isorder
B. 'ypochondriaisis
!. !onersion $isorder
$. 5omatoform (ain $isorder
Answer: %$& 5omatoform (ain $isorder
This is characterized by seere and prolonged pain that causes significant distress. A. This is a
chronic syndrome of somatic symptoms that cannot be e=plained medically and is associated with
psychosocial distress. B. This is an unrealistic preoccupation with a fear of haing a serious illness.
!. !haracterized by alteration or loss in sensory or motor function resulting from a psychological
conflict.
1+. Areud e=plains an=iety as:
A. 5tries to gratify the needs for satisfaction and security
B. !onflict between id and superego
!. A hypothalamic-pituitary-adrenal reaction to stress
$. A conditioned response to stressors
Answer: %B& !onflict between id and superego
Areud e=plains an=iety as due to opposing action dries between the id and the superego. A. 5ullian
identified + types of needs# satisfaction and security. Aailure to gratify these needs may result in
an=iety. !. Biomedical perspectie of an=iety. $. 7=planation of an=iety using the behaioral model.
1/. The following are appropriate nursing diagnosis for the client 7E!7(T:
A. "neffectie indiidual coping
B. Alteration in comfort# pain
!. Altered role performance
$. "mpaired social interaction
Answer: %$& "mpaired social interaction
The client may not hae difficulty in social e=change. The cues do not support this diagnosis. A. The
client maladaptiely uses body symptoms to manage an=iety. B. The client will hae discomfort due
to pain. !. The client may fail to meet enironmental e=pectations due to pain.
1:. The following statements describe somatoform disorders:
A. (hysical symptoms are e=plained by organic causes
B. "t is a oluntary e=pression of psychological conflicts
!. 7=pression of conflicts through bodily symptoms
$. Management entails a specific medical treatment
Answer: %!& 7=pression of conflicts through bodily symptoms
Bodily symptoms are used to handle conflicts. A. Manifestations do not hae an organic basis. B.
This occurs unconsciously. $. Medical treatment is not used because the disorder does not hae a
structural or organic basis.
1<. ,hat would be the best response to the client9s repeated complaints of pain:
A. 1" know the feeling is real tests reealed negatie results.4
B. . 1" think you9re e=aggerating things a little bit.4
!. 1Try to forget this feeling and hae actiities to take it off your mind4
$. 15o tell me more about the pain4
Answer: %A& 1" know the feeling is real tests reealed negatie results.4
5hows empathy and offers information. B. This is a demeaning statement. !. This belittles the client9s
feelings. $. 2iing undue attention to the physical symptom reinforces the complaint.
1?. 5ituation: A nurse may encounter children with mental disorders. 'er knowledge of these arious
disorders is ital.
,hen planning school interentions for a child with a diagnosis of attention deficit hyperactiity
disorder# a guide to remember is to:
A. proide as much structure as possible for the child
B. ignore the child9s oeractiity.
!. encourage the child to engage in any play actiity to dissipate energy
$. remoe the child from the classroom when disruptie behaior occurs
Answer: %A& proide as much structure as possible for the child
$ecrease stimuli for behaior control thru an enironment that is free of distractions# a calm non F
confrontational approach and setting limit to time allotted for actiities. B. The child will not benefit
from a lenient approach. !. $issipate energy through safe actiities. $. This indicates that the
classroom enironment lacks structure.
1@. The child with conduct disorder will likely demonstrate:
A. 7asy distractibility to e=ternal stimuli.
B. .itualistic behaiors
!. (reference for inanimate ob*ects.
$. 5erious iolations of age related norms.
Answer: %$& 5erious iolations of age related norms.
This is a disruptie disorder among children characterized by more serious iolations of social
standards such as aggression# andalism# stealing# lying and truancy. A. This is characteristic of
attention deficit disorder. B and !. These are noted among children with autistic disorder.
1B. .italin is the drug of choice for chidren with A$'$. The side effects of the following may be
noted:
A. increased attention span and concentration
B. increase in appetite
!. sleepiness and lethargy
$. bradycardia and diarrhea
Answer: %A& increased attention span and concentration
The medication has a parado=ic effect that decrease hyperactiity and impulsiity among children
with A$'$. B# !# $. 5ide effects of .italin include anore=ia# insomnia# diarrhea and irritability.
1C. 5chool phobia is usually treated by:
A. .eturning the child to the school immediately with family support.
B. !almly e=plaining why attendance in school is necessary
!. Allowing the child to enter the school before the other children
$. Allowing the parent to accompany the child in the classroom
Answer: %A& .eturning the child to the school immediately with family support.
7=posure to the feared situation can help in oercoming an=iety. A. This will not help in relieing the
an=iety due separation from a significant other. !. and !. An=iety in school phobia is not due to being
in school but due to separation from parentsGcaregiers so these interentions are not applicable. $.
This will not help the child oercome the fear
+3. A 13 year old child has ery limited ocabulary and interaction skills. 5he has an ".H. of :<. 5he
is diagnosed to hae Mental retardation of this classification:
A. (rofound
B. Mild
!. Moderate
$. 5eere
Answer: %!& Moderate
The child with moderate mental retardation has an ".H. of /<-<3 (rofound Mental retardation has an
".H. of below +3; Mild mental retardation <3-@3 and 5eere mental retardation has an ".H. of +3-/<.
+1. The nurse teaches the parents of a mentally retarded child regarding her care. The following
guidelines may be taught e=cept:
A. oerprotection of the child
B. patience# routine and repetition
!. assisting the parents set realistic goals
$. giing reasonable compliments
Answer: %A& oerprotection of the child
The child with mental retardation should not be oerprotected but need protection from in*ury and the
teasing of other children. B#!# and $ !hildren with mental retardation hae learning difficulty. They
should be taught with patience and repetition# start from simple to comple=# use isuals and
compliment them for motiation. .ealistic e=pectations should be set and optimize their capability.
++. The parents e=press apprehensions on their ability to care for their maladaptie child. The nurse
identifies what nursing diagnosis:
A. hopelessness
B. altered parenting role
!. altered family process
$. ineffectie coping
Answer: %B& altered parenting role
Altered parenting role refers to the inability to create an enironment that promotes optimum growth
and deelopment of the child. This is reflected in the parent9s inability to care for the child. A. This
refers to lack of choices or inability to mobilize one9s resources. !. .efers to change in family
relationship and function. $. "neffectie coping is the inability to form alid appraisal of the stressor
or inability to use aailable resources
+/. A < year old boy is diagnosed to hae autistic disorder.
,hich of the following manifestations may be noted in a client with autistic disorder-
A. argumentatieness# disobedience# angry outburst
B. intolerance to change# disturbed relatedness# stereotypes
!. distractibility# impulsieness and oeractiity
$. aggression# truancy# stealing# lying
Answer: %B& intolerance to change# disturbed relatedness# stereotypes
These are manifestations of autistic disorder. A. These manifestations are noted in 8ppositional
$efiant $isorder# a disruptie disorder among children. !. These are manifestations of Attention
$eficit $isorder $. These are the manifestations of !onduct $isorder
+:. The therapeutic approach in the care of an autistic child include the following 7E!7(T:
A. 7ngage in diersionary actiities when acting -out
B. (roide an atmosphere of acceptance
!. (roide safety measures
$. .earrange the enironment to actiate the child
Answer: %$& .earrange the enironment to actiate the child
The child with autistic disorder does not want change. Maintaining a consistent enironment is
therapeutic. A. Angry outburst can be rechannelled through safe actiities. B. Acceptance enhances a
trusting relationship. !. 7nsure safety from self-destructie behaiors like head banging and hair
pulling.
+<. According to (iaget a < year old is in what stage of deelopment:
A. 5ensory motor stage
B. !oncrete operations
!. (re-operational
$. Aormal operation
Answer: %!& (re-operational
(re-operational stage %+-@ years& is the stage when the use of language# the use of symbols and the
concept of time occur. A. 5ensory-motor stage %3-+ years& is the stage when the child uses the senses
in learning about the self and the enironment through e=ploration. B. !oncrete operations %@-1+
years& when inductie reasoning deelops. $. Aormal operations %+ till adulthood& is when abstract
thinking and deductie reasoning deelop.
+?. 5ituation : The nurse assigned in the deto=ification unit attends to arious patients with
substance-related disorders.
A :< years old male reealed that he e=perienced a marked increase in his intake of alcohol to
achiee the desired effect This indicates:
A. withdrawal
B. tolerance
!. into=ication
$. psychological dependence
Answer: %B& tolerance
tolerance refers to the increase in the amount of the substance to achiee the same effects. A.
,ithdrawal refers to the physical signs and symptoms that occur when the addictie substance is
reduced or withheld. B. "nto=ication refers to the behaioral changes that occur upon recent ingestion
of a substance. $. (sychological dependence refers to the intake of the substance to preent the onset
of withdrawal symptoms.
+@. The client admitted for alcohol deto=ification deelops increased tremors# irritability#
hypertension and feer. The nurse should be alert for impending:
A. delirium tremens
B. Iorsakoff9s syndrome
!. esophageal arices
$. ,ernicke9s syndrome
Answer: %A& delirium tremens
$elirium Tremens is the most e=treme central nerous system irritability due to withdrawal from
alcohol B. This refers to an amnestic syndrome associated with chronic alcoholism due to a
deficiency in Jit. B !. This is a complication of lier cirrhosis which may be secondary to alcoholism
. $. This is a complication of alcoholism characterized by irregularities of eye moements and lack of
coordination.
+B. The care for the client places priority to which of the following:
A. Monitoring his ital signs eery hour
B. (roiding a >uiet# dim room
!. 7ncouraging ade>uate fluids and nutritious foods
$. Administering 0ibrium as ordered
Answer: %A& Monitoring his ital signs eery hour
(ulse and blood pressure are usually eleated during withdrawal# 7leation may indicate impending
delirium tremens B. !lient needs >uiet# well lighted# consistent and secure enironment. 7=cessie
stimulation can aggraate an=iety and cause illusions and hallucinations. !. Ade>uate nutrition with
sulpplement of Jit. B should be ensured. $. 5edaties are used to reliee an=iety.
+C. Another client is brought to the emergency room by friends who state that he took something an
hour ago. 'e is actiely hallucinating# agitated# with irritated nasal septum.
A. 'eroin
B. cocaine
!. 05$
$. mari*uana
Answer: %B& cocaine
The manifestations indicate into=ication with cocaine# a !)5 stimulant. A. "nto=ication with heroine
is manifested by euphoria then impairment in *udgment# attention and the presence of papillary
constriction. !. "nto=ication with hallucinogen like 05$ is manifested by grandiosity# hallucinations#
synesthesia and increase in ital signs $. "nto=ication with Mari*uana# a cannabinoid is manifested by
sensation of slowed time# con*unctial redness# social withdrawal# impaired *udgment and
hallucinations.
/3. A client is admitted with needle tracts on his arm# stuporous and with pin point pupil will likely be
managed with:
A. )altre=one %.eia&
B. )arcan %)alo=one&
!. $isulfiram %Antabuse&
$. Methadone %$olophine&
Answer: %B& )arcan %)alo=one&
)arcan is a narcotic antagonist used to manage the !)5 depression due to oerdose with heroin. A.
This is an opiate receptor blocker used to reliee the craing for heroine !. $isulfiram is used as a
deterrent in the use of alcohol. $. Methadone is used as a substitute in the withdrawal from heroine
/1. 5ituation: An old woman was brought for ealuation due to the hospital for ealuation due to
increasing forgetfulness and limitations in daily function.
The daughter reealed that the client used her toothbrush to comb her hair. 5he is manifesting:
A. apra=ia
B. aphasia
!. agnosia
$. amnesia
Answer: %!& agnosia
This is the inability to recognize ob*ects. A. Apra=ia is the inability to e=ecute motor actiities despite
intact comprehension. B. Aphasia is the loss of ability to use or understand words. $. Amnesia is loss
of memory.
/+. 5he tearfully tells the nurse 1" can9t take it when she accuses me of stealing her things.4 ,hich
response by the nurse will be most therapeutic-
A. 4$on9t take it personally. Kour mother does not mean it.4
B. 1'ae you tried discussing this with your mother-4
!. 1This must be difficult for you and your mother.4
$. 1)e=t time ask your mother where her things were last seen.4
Answer: %!& 1This must be difficult for you and your mother.4
This reflecting the feeling of the daughter that shows empathy. A and $. 2iing adise does not
encourage erbalization. B. This response does not encourage erbalization of feelings.
//. The primary nursing interention in working with a client with moderate stage dementia is
ensuring that the client:
A. receies ade>uate nutrition and hydration
B. will reminisce to decrease isolation
!. remains in a safe and secure enironment
$. independently performs self care
Answer: %!& remains in a safe and secure enironment
5afety is a priority consideration as the client9s cognitie ability deteriorates.. A is appropriate
interentions because the client9s cognitie impairment can affect the client9s ability to attend to his
nutritional needs# but it is not the priority B. (atient is allowed to reminisce but it is not the priority.
$. The client in the moderate stage of Alzheimer9s disease will hae difficulty in performing
actiities independently
/:. 5he says to the nurse who offers her breakfast# 18h no# " will wait for my husband. ,e will eat
together4 The therapeutic response by the nurse is:
A. 1Kour husband is dead. 0et me sere you your breakfast.4
B. 1"9e told you seeral times that he is dead. "t9s time to eat.4
!. 1Kou9re going to hae to wait a long time.4
$. 1,hat made you say that your husband is alie-
Answer: %A& 1Kour husband is dead. 0et me sere you your breakfast.4
The client should be reoriented to reality and be focused on the here and now.. B. This is not a helpful
approach because of the short term memory of the client. !. This indicates a pompous response. $.
The cognitie limitation of the client makes the client incapable of giing e=planation.
/<. $ementia unlike delirium is characterized by:
A. slurred speech
B. insidious onset
!. clouding of consciousness
$. sensory perceptual change
Answer: %B& insidious onset
$ementia has a gradual onset and progressie deterioration. "t causes pronounced memory and
cognitie disturbances. A#! and $ are all characteristics of delirium.
/?. 5ituation: A 1@ year old gymnast is admitted to the hospital due to weight loss and dehydration
secondary to staration.
,hich of the following nursing diagnoses will be gien priority for the client-
A. altered self-image
B. fluid olume deficit
!. altered nutrition less than body re>uirements
$. altered family process
Answer: %B& fluid olume deficit
Aluid olume deficit is the priority oer altered nutrition %A& since the situation indicates that the
client is dehydrated. A and $ are psychosocial needs of a client with anore=ia nerosa but they are
not the priority.
/@. ,hat is the best interention to teach the client when she feels the need to stare-
A. Allow her to stare to reliee her an=iety
B. $o a short term e=ercise until the urge passes
!. Approach the nurse and talk out her feelings
$. !all her mother on the phone and tell her how she feels
Answer: %!& Approach the nurse and talk out her feelings
The client with anore=ia nerosa uses staration as a way of managing an=iety. Talking out feelings
with the nurse is an adaptie coping. A. 5taration should not be encouraged. (hysical safety is a
priority. ,ithout ade>uate nutrition# a life threatening situation e=ists. B. The client with anore=ia
nerosa is preoccupied with losing weight due to disturbed body image. 0imits should be set on
attempts to lose more weight. $. The client may hae a domineering mother which causes the client
to feel ambialent. The client will not discuss her feelings with her mother.
/B. The client with anore=ia nerosa is improing if:
A. 5he eats meals in the dining room.
B. ,eight gain
!. 5he attends ward actiities.
$. 5he has a more realistic self concept.
Answer: %B& ,eight gain
,eight gain is the best indication of the client9s improement. The goal is for the client to gain 1-+
pounds per week. %A&The client may purge after eating. %!& Attending an actiity does not indicate
improement in nutritional state. %$& Body image is a factor in anore=ia nerosa but it is not an
indicator for improement.
/C. The characteristic manifestation that will differentiate bulimia nerosa from anore=ia nerosa is
that bulimic indiiduals
A. hae episodic binge eating and purging
B. hae repeated attempts to stabilize their weight
!. hae peculiar food handling patterns
$. hae threatened self-esteem
Answer: %A& hae episodic binge eating and purging
Bulimia is characterized by binge eating which is characterized by taking in a large amount of food
oer a short period of time. B and ! are characteristics of a client with anore=ia nerosa $. 0ow
esteem is noted in both eating disorders
:3. A nursing diagnosis for bulimia nerosa is powerlessness related to feeling not in control of eating
habits. The goal for this problem is:
A. (atient will learn problem soling skills
B. (atient will hae decreased symptoms of an=iety.
!. (atient will perform self care actiities daily.
$. (atient will erbalize how to set limits on others.
Answer: %A& (atient will learn problem soling skills
if the client learns problem soling skills she will gain a sense of control oer her life. %B& An=iety is
caused by powerlessness. %!& (erforming self care actiities will not decrease ones powerlessness %$&
5etting limits to control imposed by others is a necessary skill but problem soling skill is the
priority.
:1. "n the management of bulimic patients# the following nursing interentions will promote a
therapeutic relationship 7E!7(T:
A. 7stablish an atmosphere of trust
B. $iscuss their eating behaior.
!. 'elp patients identify feelings associated with binge-purge behaior
$. Teach patient about bulimia nerosa
Answer: %B& $iscuss their eating behaior.
The client is often ashamed of her eating behaior. $iscussion should focus on feelings. A#! and $
promote a therapeutic relationship
:+. 5ituation: A /< year old male has intense fear of riding an eleator. 'e claims 1 As if " will die
inside.4 This has affected his studies
The client is suffering from:
A. agoraphobia
B. social phobia
!. !laustrophobia
$. =enophobia
Answer: %!& !laustrophobia
!laustrophobia is fear of closed space. A. Agoraphobia is fear of open space or being a situation
where escape is difficult. B. 5ocial phobia is fear of performing in the presence of others in a way
that will be humiliating or embarrassing. $. Eenophobia is fear of strangers.
:/. "nitial interention for the client should be to:
A. 7ncourage to erbalize his fears as much as he wants.
B. Assist him to find meaning to his feelings in relation to his past.
!. 7stablish trust through a consistent approach.
$. Accept her fears without criticizing.
Answer: %$& Accept her fears without criticizing.
The client cannot control her fears although the client knows its silly and can *oke about it. A. Allow
e=pression of the client9s fears but he should focus on other productie actiities as well. B and !.
These are not the initial interentions.
::. The nurse deelops a countertransference reaction. This is eidenced by:
A. .eealing personal information to the client
B. Aocusing on the feelings of the client.
!. !onfronting the client about discrepancies in erbal or non-erbal behaior
$. The client feels angry towards the nurse who resembles his mother.
Answer: %A& .eealing personal information to the client
A. !ountertransference is an emotional reaction of the nurse on the client based on her unconscious
needs and conflicts. B and !. These are therapeutic approaches. $. This is transference reaction
where a client has an emotional reaction towards the nurse based on her past.
:<. ,hich is the desired outcome in conducting desensitization:
A. The client erbalize his fears about the situation
B. The client will oluntarily attend group therapy in the social hall.
!. The client will socialize with others willingly
$. The client will be able to oercome his disabling fear.
Answer: %$& The client will be able to oercome his disabling fear.
The client will oercome his disabling fear by gradual e=posure to the feared ob*ect. A#B and ! are
not the desired outcome of desensitization.
:?. ,hich of the following should be included in the health teachings among clients receiing
Jalium:
A. Aoid taking !)5 depressant like alcohol.
B. There are no restrictions in actiities.
!. 0imit fluid intake.
$. Any beerage like coffee may be taken
Answer: %A& Aoid taking !)5 depressant like alcohol.
Jalium is a !)5 depressant. Taking it with other !)5 depressants like alcohol; potentiates its effect.
B. The client should be taught to aoid actiities that re>uire alertness. !. Jalium causes dry mouth
so the client must increase her fluid intake. $. 5timulants must not be taken by the client because it
can decrease the effect of Jalium.
:@. 5ituation: A +3 year old college student is admitted to the medical ward because of sudden onset
of paralysis of both legs. 7=tensie e=amination reealed no physical basis for the complaint.
The nurse plans interention based on which correct statement about conersion disorder-
A. The symptoms are conscious effort to control an=iety
B. The client will e=perience high leel of an=iety in response to the paralysis.
!. The conersion symptom has symbolic meaning to the client
$. A confrontational approach will be beneficial for the client.
Answer: %!& The conersion symptom has symbolic meaning to the client
the client uses body symptoms to reliee an=iety. A. The condition occurs unconsciously. B. The
client is not distressed by the lost or altered body function. $. The client should not be confronted by
the underlying cause of his condition because this can aggraate the client9s an=iety.
:B. )ina reeals that the boyfriend has been pressuring her to engage in premarital se=. The most
therapeutic response by the nurse is:
A. 1" can refer you to a spiritual counselor if you like.4
B. 1Kou shouldn9t allow anyone to pressure you into se=.4
!. 1"t sounds like this problem is related to your paralysis.4
$. 1'ow do you feel about being pressured into se= by your boyfriend-4
Answer: %$& 1'ow do you feel about being pressured into se= by your boyfriend-4
Aocusing on e=pression of feelings is therapeutic. The central force of the client9s condition is
an=iety. A. This is not therapeutic because the nurse passes the responsibility to the counselor. B.
2iing adice is not therapeutic. !. This is not therapeutic because it confronts the underlying cause.
:C. Malingering is different from somatoform disorder because the former:
A. 'as eidence of an organic basis.
B. "t is a deliberate effort to handle upsetting eents
!. 2ratification from the enironment are obtained.
$. 5tress is e=pressed through physical symptoms.
Answer: %B& "t is a deliberate effort to handle upsetting eents
Malingering is a conscious simulation of an illness while somatoform disorder occurs unconscious.
A. Both disorders do not hae an organic or structural basis. !. Both hae primary gains. $. This is a
characteristic of somatoform disorder.
<3. 6nlike psychophysiologic disorder 0inda may be best managed with:
A. medical regimen
B. milieu therapy
!. stress management techni>ues
$. psychotherapy
Answer: %!& stress management techni>ues
5tree management techni>ues is the best management of somatoform disorder because the disorder is
related to stress and it does not hae a medical basis. A. This disorder is not supported by organic
pathology so no medical regimen is re>uired. B and $. Milieu therapy and psychotherapy may be
used a therapeutic modalities but these are not the best.
<1. ,hich is the best indicator of success in the long term management of the client-
A. 'is symptoms are replaced by indifference to his feelings
B. 'e participates in diersionary actiities.
!. 'e learns to erbalize his feelings and concerns
$. 'e states that his behaior is irrational.
Answer: %!& 'e learns to erbalize his feelings and concerns
!. The client is encouraged to talk about his feelings and concerns instead of using body symptoms to
manage his stressors. A. The client is encouraged to acknowledge feelings rather than being
indifferent to her feelings. B. (articipation in actiities dierts the client9s attention away from his
bodily concerns but this is not the best indicator of success. $. 'elp the client recognize that his
physical symptoms occur because of or are e=acerbated by specific stressor# not as irrational.
<+. 5ituation: A young woman is brought to the emergency room appearing depressed. The nurse
learned that her child died a year ago due to an accident.
The initial nursing diagnosis is dysfunctional grieing. The statement of the woman that supports this
diagnosis is:
A. 1" feel enious of mothers who hae toddlers4
B. 1" haen9t been able to open the door and go into my baby9s room 1
!. 1" watch other toddlers and think about their play actiities and " cry.4
$. 1" often find myself thinking of how " could hae preented the death.
Answer: %B& 1" haen9t been able to open the door and go into my baby9s room 1
This indicates denial. This defense is adaptie as an initial reaction to loss but an e=tended#
unsuccessful use of denial is dysfunctional. A. This indicates acknowledgement of the loss.
7=pressing feelings openly is acceptable. !. This indicates the stage of depression in the grieing
process. $. .emembering both positie and negatie aspects of the deceased loe one signals
successful mourning.
</. The client said 1" can9t een take care of my baby. "9m good for nothing.4 ,hich is the
appropriate nursing diagnosis-
A. "neffectie indiidual coping related to loss.
B. "mpaired erbal communication related to inade>uate social skills.
!. 0ow esteem related to failure in role performance
$. "mpaired social interaction related to repressed anger.
Answer: %!& 0ow esteem related to failure in role performance
This indicates the client9s negatie self ealuation. A sense of worthlessness may accompany
depression. A#B and $ are not releant. The cues do not indicate inability to use coping resources#
decreased ability to transmitGprocess symbols# nor insufficient >uality of social e=change
<:. The following medications will likely be prescribed for the client 7E!7(T:
A. (rozac
B. Tofranil
!. (arnate
$. Lypre=a
Answer: %$& Lypre=a
This is an antipsychotic. A. This is a 55." antidepressant. B. This antidepressant belongs to the
Tricyclic group. !. This is a MA8" antidepressant.
<<. ,hich is the highest priority in the post 7!T care-
A. 8bsere for confusion
B. Monitor respiratory status
!. .eorient to time# place and person
$. $ocument the client9s response to the treatment
Answer: %B& Monitor respiratory status
A side effect of 7!T which is life threatening is respiratory arrest. A and !. !onfusion and
disorientation are side effects of 7!T but these are not the highest priority.
<?. 5ituation: A +@ year old writer is admitted for the second time accompanied by his wife. 'e is
demanding# arrogant talked fast and hyperactie.
"nitially the nurse should plan this for a manic client:
A. set realistic limits to the client9s behaior
B. repeat erbal instructions as often as needed
!. allow the client to get out feelings to reliee tension
$. assign a staff to be with the client at all times to help maintain control
Answer: %A& set realistic limits to the client9s behaior
The manic client is hyperactie and may engage in in*urious actiities. A >uiet enironment and
consistent and firm limits should be set to ensure safety. B. !lear# concise directions are gien
because of the distractibility of the client but this is not the priority. !. The manic client tend to
e=ternalize hostile feelings# howeer only non-destructie methods of e=pression should be allowed
$. )urses set limit as needed. Assigning a staff to be with the client at all times is not realistic.
<@. An actiity appropriate for the client is:
A. table tennis
B. painting
!. chess
$. cleaning
Answer: %$& cleaning
The client9s e=cess energy can be rechanelled through physical actiities that are not competitie like
cleaning. This is also a way to dissipate tension. A. Tennis is a competitie actiity which can
stimulate the client.
<B. The client is arrogant and manipulatie. "n ensuring a therapeutic milieu# the nurse does one of
the following:
A. Agree on a consistent approach among the staff assigned to the client.
B. 5uggest that the client take a leading role in the social actiities
!. (roide the client with e=tra time for one on one sessions
$. Allow the client to negotiate the plan of care
Answer: %A& Agree on a consistent approach among the staff assigned to the client.
A consistent firm approach is appropriate. This is a therapeutic way of to handle attempts of
e=ploiting the weakness in others or create conflicts among the staff. Bargaining should not be
allowed. B. This is not therapeutic because the client tends to control and dominate others. !. 0imits
are set for interaction time. $. Allowing the client to negotiate may reinforce manipulatie behaior.
<C. The nurse e=emplifies awareness of the rights of a client whose anger is escalating by:
A. Taking a directie role in erbalizing feelings
B. 6sing an authoritarian# confrontational approach
!. (utting the client in a seclusion room
$. Applying mechanical restraints
Answer: %A& Taking a directie role in erbalizing feelings
The client has the right to be free from unnecessary restraints. Jerbalization of feelings or 1talking
down4 in a non-threatening enironment is helpful to reliee the client9s anger. B. This is a
threatening approach. ! and $. 5eclusion and application restraints are done only when less
restrictie measures hae failed to contain the client9s anger.
?3. A client on 0ithium has diarrhea and omiting. ,hat should the nurse do first:
A. .ecognize this as a drug interaction
B. 2ie the client !ogentin
!. .eassure the client that these are common side effects of lithium therapy
$. 'old the ne=t dose and obtain an order for a stat serum lithium leel
Answer: %$& 'old the ne=t dose and obtain an order for a stat serum lithium leel
$iarrhea and omiting are manifestations of 0ithium to=icity. The ne=t dose of lithium should be
withheld and test is done to alidate the obseration. A. The manifestations are not due to drug
interaction. B. !ogentin is used to manage the e=tra pyramidal symptom side effects of
antipsychotics. !. The common side effects of 0ithium are fine hand tremors# nausea# polyuria and
polydipsia.
?1. 5ituation: A widow age +B# whose husband died one year ago due to A"$5# has *ust been told that
she has A"$5.
(amela says to the nurse# 1,hy me- 'ow could 2od do this to me-4 This reaction is one of:
A. $epression
B. $enial
!. anger
$. bargaining
Answer: %!& anger
Anger is e=perienced as reality sets in. This may either be directed to 2od# the deceased or displaced
on others. A. $epression is a painful stage where the indiidual mourns for what was lost. B. $enial
is the first stage of the grieing process eidenced by the statement 1)o# it can9t be true.4 The
indiidual does not acknowledge that the loss has occurred to protect self from the psychological pain
of the loss. $. "n bargaining the indiidual holds out hope for additional alternaties to forestall the
loss# eidenced by the statement 1"f onlyM4
?+. The nurse9s therapeutic response is:
A. 1" will refer you to a clergy who can help you understand what is happening to you.4
B. 1 "t isn9t fair that an innocent like you will suffer from A"$5.4
!. 1That is a negatie attitude.4
$. 4"t must really be frustrating for you. 'ow can " best help you-4
Answer: %$& 4"t must really be frustrating for you. 'ow can " best help you-4
This response reflects the pain due to loss. A helping relationship can be forged by showing empathy
and concern. A. This is not therapeutic since it passes the buck or responsibility to the clergy. B. This
response is not therapeutic because it gies the client the impression that she is right which preents
the client from reconsidering her thoughts. !. This statement passes *udgment on the client.
?/. 8ne morning the nurse sees the client in a depressed mood. The nurse asks her 1,hat are you
thinking about-4 This communication techni>ue is:
A. focusing
B. alidating
!. reflecting
$. giing broad opening
Answer: %$& giing broad opening
Broad opening techni>ue allows the client to take the initiatie in introducing the topic. A#B and !
are all therapeutic techni>ues but these are not e=emplified by the nurse9s statement.
?:. The client says to the nurse 4 (ray for me4 and entrusts her wedding ring to the nurse. The nurse
knows that this may signal which of the following:
A. an=iety
B. suicidal ideation
!. Ma*or depression
$. 'opelessness
Answer: %B& suicidal ideation
The client9s statement is a erbal cue of suicidal ideation not an=iety. ,hile suicide is common
among clients with ma*or depression# this occurs when their depression starts to lift. 'opelessness
indicates no alternaties aailable and may lead to suicide# the statement and non erbal cue of the
client indicate suicide.
?<. ,hich of the following interentions should be prioritized in the care of the suicidal client-
A. .emoe all potentially harmful items from the client9s room.
B. Allow the client to e=press feelings of hopelessness.
!. )ote the client9s capabilities to increase self esteem.
$. 5et a 1no suicide4 contract with the client.
Answer: %A& .emoe all potentially harmful items from the client9s room.
Accessibility of the means of suicide increases the lethality. Allowing patient to e=press feelings and
setting a no suicide contract are interentions for suicidal client but blocking the means of suicide is
priority. "ncreasing self esteem is an interention for depressed clients bur not specifically for suicide.
??. 5ituation: A 1: year old male was admitted to a medical ward due to bronchial asthma after
learning that his mother was leaing soon for 6.I. to work as nurse.
The client has which of the following deelopmental focus:
A. 7stablishing relationship with the opposite se= and career planning.
B. (arental and societal responsibilities.
!. 7stablishing ones sense of competence in school.
$. $eeloping initial commitments and collaboration in work
Answer: %A& 7stablishing relationship with the opposite se= and career planning.
The client belongs to the adolescent stage. The adolescent establishes his sense of identity by making
decisions regarding familial# occupational and social roles. The adolescent emancipates himself from
the family and decides what career to pursue# what set of friends to hae and what alue system to
uphold. B. This refers to the middle adulthood stage concerned with transmitting his alues to the
ne=t generation to ensure his immortality through the perpetuation of his culture. !. This reflects
school age which is concerned with the pursuit of knowledge and skills to deal with the enironment
both in the present and in the future. $. The stage of young adulthood is concerned with deelopment
of intimate relationship with the opposite se=# establishment of a safe and congenial family
enironment and building of one9s lifework.
?@. The personality type of .yan is:
A. conforming
B. dependent
!. perfectionist
$. masochistic
Answer: %B& dependent
A client with dependent personality is predisposed to deelop asthma. A. The conforming non-
assertie client is predisposed to deelop hypertension because of the tendency to repress rage. !.
The perfectionist and compulsie tend to deelop migraine. $. The masochistic# self sacrificing type
are prone to deelop rheumatoid arthritis.
?B. The nurse ensures a therapeutic enironment for the client. ,hich of the following best describes
a therapeutic milieu-
A. A therapy that rewards adaptie behaior
B. A cognitie approach to change behaior
!. A liing# learning or working enironment.
$. A permissie and congenial enironment
Answer: %!& A liing# learning or working enironment.
A therapeutic milieu refers to a broad conceptual approach in which all aspects of the enironment
are channeled to proide a therapeutic enironment for the client. The si= enironmental elements
include structure# safety# norms# limit setting# balance and unit modification. A. Behaioral approach
in psychiatric care is based on the premise that behaior can be learned or unlearned through the use
of reward and punishment. B. !ognitie approach to change behaior is done by correcting distorted
perceptions and irrational beliefs to correct maladaptie behaiors. $. This is not congruent with
therapeutic milieu.
?C. "ncluded as priority of care for the client will be:
A. 7ncourage erbalization of concerns instead of demonstrating them through the body
B. $iert attention to ward actiities
!. (lace in semi-fowlers position and render 8+ inhalation as ordered
$. 'elp her recognize that her physical condition has an emotional component
Answer: %!& (lace in semi-fowlers position and render 8+ inhalation as ordered
5ince psychopysiologic disorder has organic basis# priority interention is directed towards disease-
specific management. Aailure to address the medical condition of the client may be a life threat. A and
B. The client has physical symptom that is adersely affected by psychological factors. Jerbalization
of feelings in a non threatening enironment and inolement in rela=ing actiities are adaptie way
of dealing with stressors. 'oweer# these are not the priority. $. 'elping the client connect the
physical symptoms with the emotional problems can be done when the client is ready.
@3. The client is concerned about his coming discharge# manifested by being unusually sad. ,hich is
the most therapeutic approach by the nurse-
A. 1Kou are much better than when you were admitted so there9s no reason to worry.4
B. 1,hat would you like to do now that you9re about to go home-4
!. 1Kou seem to hae concerns about going home.4
$. 1Aren9t you glad that you9re going home soon-4
Answer: %!& 1Kou seem to hae concerns about going home.4
. This statement reflects how the client feels. 5howing empathy can encourage the client to talk which
is important as an alternatie more adaptie way of coping with stressors.. A. 2iing false
reassurance is not therapeutic. B. ,hile this techni>ue e=plores plans after discharge# it does not
focus on e=pression of feelings. $. This close ended >uestion does not encourage erbalization of
feelings.
@1. 5ituation: The nurse may encounter clients with concerns on se=uality.
The most basic factor in the interention with clients in the area of se=uality is:
A. Inowledge about se=uality.
B. 7=perience in dealing with clients with se=ual problems
!. !omfort with one9s se=uality
$. Ability to communicate effectiely
Answer: %!& !omfort with one9s se=uality
The nurse must be accepting# empathetic and non-*udgmental to patients who disclose concerns
regarding se=uality. This can happen only when the nurse has reconciled and accepted her feelings
and beliefs related to se=uality. A#B and $ are important considerations but these are not the priority.
@+. ,hich of the following statements is true for gender identity disorder-
A. "t is the se=ual pleasure deried from inanimate ob*ects.
B. "t is the pleasure deried from being humiliated and made to suffer
!. "t is the pleasure of shocking the ictim with e=posure of the genitalia
$. "t is the desire to lie or inole in reactions of the opposite se=
Answer: %$& "t is the desire to lie or inole in reactions of the opposite se=
2ender identity disorder is a strong and persistent desire to be the other se=. A. This is fetishism. B.
This refers to masochism. !. This describes e=hibitionism.
@/. The se=ual response cycle in which the se=ual interest continues to build:
A. 5e=ual $esire
B. 5e=ual arousal
!. 8rgasm
$. .esolution
Answer: %B& 5e=ual arousal
5e=ual arousal or e=citement refers to attaining and maintaining the physiologic re>uirements for
se=ual intercourse. A. 5e=ual $esire refers to the ability# interest or willingness for se=ual
stimulation. !. 8rgasm refers to the peak of the se=ual response where the female has aginal
contractions for the female and e*aculatory contractions for the male. $. .esolution is the final phase
of the se=ual response in which the organs and the body systems gradually return to the unaroused
state.
@:. The inability to maintain the physiologic re>uirements in se=ual intercourse is:
A. 5e=ual $esire $isorder
B. 5e=ual Arousal $isorder
!. 8rgasm $isorder
$. 5e=ual (ain disorder
Answer: %B& 5e=ual Arousal $isorder
This describes se=ual arousal disorder. A. 5e=ual $esire $isorder refers to the persistent and
recurrent lack of desire or willingness for se=ual intercourse. !. 8rgasm $isorder is the inability to
complete the se=ual response cycle because of the inability to achiee an orgasm. $. 5e=ual (ain
$isorder is characterized by genital pain before# during or after se=ual intercourse.
@<. The nurse asks a client to roll up his sleees so she can take his blood pressure. The client replies
1"f you want " can go naked for you.4 The most therapeutic response by the nurse is:
A. 1Kou9re attractie but "9m not interested.4
B. 1Kou wouldn9t be the first that " will see naked.4
!. 1" will report you to the guard if you don9t control yourself.4
$. 1" only need access to your arm. (utting up your sleee is fine.4
Answer: %$& 1" only need access to your arm. (utting up your sleee is fine.4
The nurse needs to deal with the client with se=ually connotatie behaior in a casual# matter of fact
way. A and B. These responses are not therapeutic because they are challenging and re*ecting. !.
Threatening the client is not therapeutic.
@?. 5ituation: Inowledge and skills in the care of iolent clients is ital in the psychiatric unit. A
nurse obseres that a client with a potential for iolence is agitated# pacing up and down the hallway
and making aggressie remarks.
,hich of the following statements is most appropriate to make to this patient-
A. ,hat is causing you to become agitated-
B. Kou need to stop that behaior now.
!. Kou will need to be restrained if you do not change your behaior.
$. Kou will need to be placed in seclusion.
Answer: %A& ,hat is causing you to become agitated-
"n a non-iolent aggressie behaior# help the client identify the stressor or the true ob*ect of hostility.
This helps reeal unresoled issues so that they may be confronted. B. (acing is a tension relieing
measure for an agitated client. !. This is a threatening statement that can heighten the client9s tension.
$. 5eclusion is used when less restrictie measures hae failed.
@@. The nurse closely obseres the client who has been displaying aggressie behaior. The nurse
obseres that the client9s anger is escalating. ,hich approach is least helpful for the client at this
time-
A. Acknowledge the client9s behaior
B. Maintain a safe distance from the client
!. Assist the client to an area that is >uiet
$. "nitiate confinement measures
Answer: %$& "nitiate confinement measures
The proper procedure for dealing with harmful behaior is to first try to calm patient erbally. . ,hen
erbal and psychopharmacologic interentions are not ade>uate to handle the aggressieness#
seclusion or restraints may be applicable. A# B and ! are appropriate approaches during the escalation
phase of aggression.
@B. The charge nurse of a psychiatric unit is planning the client assignment for the day. The most
appropriate staff to be assigned to a client with a potential for iolence is which of the following:
A. A timid nurse
B. A mature e=perienced nurse
!. an ine=perienced nurse
$. a soft spoken nurse
Answer: %B& A mature e=perienced nurse
The unstable# aggressie client should be assigned to the most e=perienced nurse. A# ! and $. A shy#
ine=perienced# soft spoken nurse may feel intimidated by the angry patient.
@C. The nurse e=emplifies awareness of the rights of a client whose anger is escalating by:
A. Taking a directie role in erbalizing feelings
B. 6sing an authoritarian# confrontational approach
!. (utting the client in a seclusion room
$. Applying mechanical restraints
Answer: %A& Taking a directie role in erbalizing feelings
Taking a directie role in the client9s erbalization of feelings can deescalate the client9s anger. B. A
confrontational approach can be threatening and adds to the client9s tension. ! and $. 6se of
restraints and isolation may be re>uired if less restrictie interentions are unsuccessful.
B3. The client *umps up and throws a chair out of the window. 'e was restrained after his behaior
can no longer be controlled by the staff. ,hich of these documentations indicates the safeguarding of
the patient9s rights-
A. There was a doctor9s order for restraintsGseclusion
B. The patient9s rights were e=plained to him.
!. The staff obsered confidentiality
$. The staff carried out less restrictie measures but were unsuccessful.
Answer: %$& The staff carried out less restrictie measures but were unsuccessful.
This documentation indicates that the client has been placed on restraints after the least restrictie
measures failed in containing the client9s iolent behaior.
B1. 5ituation: !lients with personality disorders hae difficulties in their social and occupational
functions.
!lients with personality disorder will most likely:
A. recoer with therapeutic interention
B. respond to antian=iety medication
!. manifest enduring patterns of infle=ible behaiors
$. 5eek treatment willingly from some personally distressing symptoms
Answer: %!& manifest enduring patterns of infle=ible behaiors
(ersonality disorders are characterized by infle=ible traits and characteristics that are lifelong. A and
$. This disorder is manifested by life-long patterns of behaior. The client with this disorder will not
likely present himself for treatment unless something has gone wrong in his life so he may not
recoer from therapeutic interention. B. Medications are generally not recommended for personality
disorders.
B+. A client tends to be insensitie to others# engages in abusie behaiors and does not hae a sense
of remorse. ,hich personality disorder is he likely to hae-
A. )arcissistic
B. (aranoid
!. 'istrionic
$. Antisocial
Answer: %$& Antisocial
These are the characteristics of an indiidual with antisocial personality. A. )arcissistic personality
disorder is characterized by grandiosity and a need for constant admiration from others. B.
"ndiiduals with paranoid personality demonstrate a pattern of distrust and suspiciousness and
interprets others moties as threatening. !. "ndiiduals with histrionic hae e=cessie emotionality#
and attention-seeking behaiors.
B/. The client *oins a support group and fre>uently preaches against abuse# is demonstrating the use
of:
A. denial
B. reaction formation
!. rationalization
$. pro*ection
Answer: %B& reaction formation
.eaction formation is the adoption of behaior or feelings that are e=actly opposite of one9s true
emotions. A. $enial is refusal to accept a painful reality. !. .ationalization is attempting to *ustify
one9s behaior by presenting reasons that sounds logical. $. (ro*ection is attributing of one9s
behaiors and feelings to another person.
B:. A teenage girl is diagnosed to hae borderline personality disorder. ,hich manifestations support
the diagnosis-
A. 0ack of self esteem# strong dependency needs and impulsie behaior
B. social withdrawal# inade>uacy# sensitiity to re*ection and criticism
!. 5uspicious# hyperigilance and coldness
$. (reoccupation with perfectionism# orderliness and need for control
Answer: %A& 0ack of self esteem# strong dependency needs and impulsie behaior
These are the characteristics of client with borderline personality. B. This describes the aoidant
personality. !. These are the characteristics of a client with paranoid personality $. This describes the
obsessie compulsie personality
B<. The plan of care for clients with borderline personality should include:
A. 0imit setting and fle=ibility in schedule
B. 2iing medications to preent acting out
!. .estricting her from other clients
$. 7nsuring she adheres to certain restrictions
Answer: %$& 7nsuring she adheres to certain restrictions
The client is manipulatie. The client must be informed about the policies# e=pectations# rules and
regulation upon admission. A. 0imits should be firmly and consistently implemented. Ale=ibility and
bargaining are not therapeutic in dealing with a manipulatie client. B. There is no specific
medication prescribed for this condition. !. This is not part of the care plan. "nteraction with other
clients are allowed but the client should be obsered and gien limits in her attempt to manipulate
and dominate others.
B?. 5ituation: A :+ year old male client# is admitted in the ward because of bizarre behaiors. 'e is
gien a diagnosis of schizophrenia paranoid type.
The client should hae achieed the deelopmental task of:
A. Trust s. mistrust
B. "ndustry s. inferiority
!. 2eneratiity s. stagnation
$. 7go integrity s. despair
Answer: %$& 7go integrity s. despair
The client belongs to the middle adulthood stage %/3 to ?< yrs.& The deelopmental task generatiity
is characterized by concern and care for others. "t is a productie and creatie stage. %A& "nfancy stage
%3 F 1B mos.& is concerned with gratification of oral needs %B& 5chool Age child %? F 1+ yrs.& is
characterized by ac>uisition of school competencies and social skills %!& 0ate adulthood % ?3 and
aboe& !oncerned with reflection on the past and his contributions to others and face the future.
B@. !lients who are suspicious primarily use pro*ection for which purpose:
A. deny reality
B. to deal with feelings and thoughts that are not acceptable
!. to show resentment towards others
$. manipulate others
Answer: %B& to deal with feelings and thoughts that are not acceptable
(ro*ection is a defense mechanism where one attributes ones feelings and inade>uacies to others to
reduce an=iety. A. This is not true in all instances of pro*ection ! and $. This focuses on the self
rather than others
BB. The client says 1 the )B" is out to get me.4 The nurse9s best response is:
A. 1The )B" is not out to catch you.4
B. 1" don9t beliee that.4
!. 1" don9t know anything about that. Kou are afraid of being harmed.4
$. 1 ,hat made you think of that.4
Answer: %!& 1" don9t know anything about that. Kou are afraid of being harmed.4
This presents reality and acknowledges the clients feeling A and B. are not therapeutic responses
because these disagree with the client9s false belief and makes the client feel challenged $.
unnecessary e=ploration of the false
BC. The client on 'aldol has pill rolling tremors and muscle rigidity. 'e is likely manifesting:
A. tardie dyskinesia
B. (seudoparkinsonism
!. akinesia
$. dystonia
Answer: %B& (seudoparkinsonism
(seudoparkinsonism is a side effect of antipsychotic drugs characterized by mask-like facies# pill
rolling tremors# muscle rigidity A. Tardie dyskinesia is manifested by lip smacking# wormlike
moement of the tongue !. Akinesia is characterized by feeling of weakness and muscle fatigue $.
$ystonia is manifested by torticollis and rolling back of the eyes
C3. The client is ery hostile toward one of the staff for no apparent reason. The client is manifesting:
A. 5plitting
B. Transference
!. !ountertransference
$. .esistance
Answer: %B& Transference
Transference is a positie or negatie feeling associated with a significant person in the client9s past
that are unconsciously assigned to another A. 5plitting is a defense mechanism commonly seen in a
client with personality disorder in which the world is perceied as all good or all bad !.
!ounterttransference is a phenomenon where the nurse shifts feelings assigned to someone in her past
to the patient $. .esistance is the client9s refusal to submit himself to the care of the nurse
C1. 5ituation: An 1B year old female was se=ually attacked while on her way home from work. 5he is
brought to the hospital by her mother.
.ape is an e=ample of which type of crisis:
A. 5ituational
B. Adentitious
!. $eelopmental
$. "nternal
Answer: %B& Adentitious
Adentitious crisis is a crisis inoling a traumatic eent. "t is not part of eeryday life. A. 5ituational
crisis is from an e=ternal source that upset ones psychological e>uilibrium ! and $. Are the same.
They are transitional or deelopmental periods in life
C+. $uring the initial care of rape ictims the following are to be considered 7E!7(T:
A. Assure priacy.
B. Touch the client to show acceptance and empathy
!. Accompany the client in the e=amination room.
$. Maintain a non-*udgmental approach.
Answer: %B& Touch the client to show acceptance and empathy
The client finds touch intrusie and therefore should be aoided. A. (riacy is one of the rights of a
ictim of rape. !.The client is an=ious. Accompanying the client in a >uiet room ensures safety and
offers emotional support. $. 2uilt feeling is common among rape ictims. They should not be
blamed.
C/. The nurse acts as a patient adocate when she does one of the following:
A. 5he encourages the client to e=press her feeling regarding her e=perience.
B. 5he assesses the client for in*uries.
!. 5he postpones the physical assessment until the client is calm
$. 7=plains to the client that her reactions are normal
Answer: %!& 5he postpones the physical assessment until the client is calm
The nurse acts as a patient adocate as she protects the client from psychological harm A. The nurse
acts a a counselor B. The nurse acts as a technician $. This e=emplifies the role of a teacher
C:. !risis interention carried out to the client has this primary goal:
A. Assist the client to e=press her feelings
B. 'elp her identify her resources
!. 5upport her adaptie coping skills
$. 'elp her return to her pre-rape leel of function
Answer: %$& 'elp her return to her pre-rape leel of function
The goal of crisis interention to help the client return to her leel of function prior to the crisis. A#B
and ! are interentions or strategies to attain the goal
C<. Aie months after the incident the client complains of difficulty to concentrate# poor appetite#
inability to sleep and guilt. 5he is likely suffering from:
A. Ad*ustment disorder
B. 5omatoform $isorder
!. 2eneralized An=iety $isorder
$. (ost traumatic disorder
Answer: %$& (ost traumatic disorder
(ost traumatic stress disorder is characterized by flashback# irritability# difficulty falling asleep and
concentrating following an e=tremely traumatic eent. This lasts for more that one month A.
Ad*ustment disorder is the maladaptie reaction to stressful eents characterized by an=iety#
depression and work or social impairments. This occurs within / months after the eent B.
5omatoform disorders are an=iety related disorders characterized by presence of physical symptoms
without demonstrable organic basis !. 2eneralized an=iety disorder is characterized by chronic#
e=cessie an=iety for at least ? months
C?. 5ituation: A +C year old client newly diagnosed with breast cancer is pacing# with rapid speech
headache and inability to focus with what the doctor was saying.
The nurse assesses the leel of an=iety as:
A. Mild
B. Moderate
!. 5eere
$. (anic
Answer: %!& 5eere
The client9s manifestations indicate seere an=iety. A Mild an=iety is manifested by slight muscle
tension# slight fidgeting# alertness# ability to concentrate and capable of problem soling. B. Moderate
muscle tension# increased ital signs# periodic slow pacing# increased rate of speech and difficulty in
concentrating are noted in moderate an=iety. $. (anic leel of an=iety is characterized
immobilization# incoherence# feeling of being oerwhelmed and disorganization
C@. An=iety is caused by:
A. an ob*ectie threat
B. a sub*ectiely perceied threat
!. hostility turned to the self
$. masked depression
Answer: %B& a sub*ectiely perceied threat
An=iety is caused by a sub*ectiely perceied threat A. Aear is caused by an ob*ectie threat !. A
depressed client internalizes hostility $. Mania is due to masked depression
CB. "t would be most helpful for the nurse to deal with a client with seere an=iety by:
A. 2ie specific instructions using speak in concise statements.
B. Ask the client to identify the cause of her an=iety.
!. 7=plain i
detail the plan of care deeloped
$. 6rge the client to focus on what the nurse is saying
Answer: %A& 2ie specific instructions using speak in concise statements.
The client has narrowed perceptual field. 0engthy e=planations cannot be followed by the client. B.
The client will not be able to identify the cause of an=iety ! and $. The client has difficulty
concentrating and will not be able to focus.
CC. ,hich of the following medications will likely be ordered for the client-4
A. (rozac
B. Jalium
!. .isperdal
$. 0ithium
Answer: %B& Jalium
Antian=iety A. Antidepressant !. Antipsychotic $. Antimanic
133. ,hich of the following is included in the health teachings among clients receiing Jalium-:
A. Aoid foods rich in tyramine.
B. Take the medication after meals.
!. "t is safe to stop it anytime after long term use.
$. $ouble up the dose if the client forgets her medication.
Answer: %B& Take the medication after meals.
Antian=iety medications cause 2.". upset so it should be taken after meals. A. This is specific for
antidepressant MA8". Taking tyramine rich food can cause hypertensie crisis. !. Jalium causes
dependency. "n which case# the medication should be gradually withdrawn to preent the occurrence
of conulsion. $ The dose of Jalium should not be doubled if the preious dose was not taken. "t can
intensify the !)5 depressant effects.
Philippine NLE Board Exam: !ommunity "ealth Nursing Question & Answer w/ rationale
!8MM6)"TK '7A0T' )6.5")2
1. ,hich is the primary goal of community health nursing-
A. To support and supplement the efforts of the medical profession in the promotion of health and
preention of illness
B. To enhance the capacity of indiiduals# families and communities to cope with their health needs
!. To increase the productiity of the people by proiding them with serices that will increase their
leel of health
$. To contribute to national deelopment through promotion of family welfare# focusing particularly
on mothers and children.
Answer: %B& To enhance the capacity of indiiduals# families and communities to cope with their
health needs
To contribute to national deelopment through promotion of family welfare# focusing particularly on
mothers and children.
+. !') is a community-based practice. ,hich best e=plains this statement-
A. The serice is proided in the natural enironment of people.
B. The nurse has to conduct community diagnosis to determine nursing needs and problems.
!. The serices are based on the aailable resources within the community.
$. (riority setting is based on the magnitude of the health problems identified.
Answer: %B& The nurse has to conduct community diagnosis to determine nursing needs and
problems.
!ommunity-based practice means proiding care to people in their own natural enironments: the
home# school and workplace# for e=ample.
/. (opulation-focused nursing practice re>uires which of the following processes-
A. !ommunity organizing
B. )ursing process
!. !ommunity diagnosis
$. 7pidemiologic process
Answer: %!& !ommunity diagnosis
(opulation-focused nursing care means proiding care based on the greater need of the ma*ority of
the population. The greater need is identified through community diagnosis.
:. ..A. 13<: is also known as the 8ccupational 'ealth Act. Aside from number of employees# what
other factor must be considered in determining the occupational health priileges to which the
workers will be entitled-
A. Type of occupation: agricultural# commercial# industrial
B. 0ocation of the workplace in relation to health facilities
!. !lassification of the business enterprise based on net profit
$. 5e= and age composition of employees
Answer: %B& 0ocation of the workplace in relation to health facilities
Based on ..A. 13<:# an occupational nurse must be employed when there are /3 to 133 employees
and the workplace is more than 1 km. away from the nearest health center.
<. A business firm must employ an occupational health nurse when it has at least how many
employees-
A. +1
B. 131
!. +31
$. /31
Answer: %B& 131
Again# this is based on ..A. 13<:.
?. ,hen the occupational health nurse employs ergonomic principles# she is performing which of her
roles-
A. 'ealth care proider
B. 'ealth educator
!. 'ealth care coordinator
$. 7nironmental manager
Answer: %$& 7nironmental manager
7rgonomics is improing efficiency of workers by improing the worker9s enironment through
appropriately designed furniture# for e=ample.
@. A garment factory does not hae an occupational nurse. ,ho shall proide the occupational health
needs of the factory workers-
A. 8ccupational health nurse at the (roincial 'ealth 8ffice
B. (hysician employed by the factory
!. (ublic health nurse of the .'6 of their municipality
$. .ural sanitary inspector of the .'6 of their municipality
Answer: %!& (ublic health nurse of the .'6 of their municipality
Kou9re rightN This >uestion is based on ..A.13<:.
B. 1(ublic health serices are gien free of charge.4 "s this statement true or false-
A. The statement is true; it is the responsibility of goernment to proide basic serices.
B. The statement is false; people pay indirectly for public health serices.
!. The statement may be true or false# depending on the specific serice re>uired.
$. The statement may be true or false# depending on policies of the goernment concerned.
Answer: %B& The statement is false; people pay indirectly for public health serices.
!ommunity health serices# including public health serices# are pre-paid serices# though ta=ation#
for e=ample.
C. According to !.7.,inslow# which of the following is the goal of (ublic 'ealth-
A. Aor people to attain their birthrights of health and longeity
B. Aor promotion of health and preention of disease
!. Aor people to hae access to basic health serices
$. Aor people to be organized in their health efforts
Answer: %A& Aor people to attain their birthrights of health and longeity
According to ,inslow# all public health efforts are for people to realize their birthrights of health and
longeity.
13. ,e say that a Ailipino has attained longeity when he is able to reach the aerage lifespan of
Ailipinos. ,hat other statistic may be used to determine attainment of longeity-
A. Age-specific mortality rate
B. (roportionate mortality rate
!. 5waroop9s inde=
$. !ase fatality rate
Answer: %!& 5waroop9s inde=
5waroop9s inde= is the percentage of the deaths aged <3 years or older. "ts inerse represents the
percentage of untimely deaths %those who died younger than <3 years&.
11. ,hich of the following is the most prominent feature of public health nursing-
A. "t inoles proiding home care to sick people who are not confined in the hospital.
B. 5erices are proided free of charge to people within the catchment area.
!. The public health nurse functions as part of a team proiding a public health nursing serices.
$. (ublic health nursing focuses on preentie# not curatie# serices.
Answer: %$& (ublic health nursing focuses on preentie# not curatie# serices.
The catchment area in (') consists of a residential community# many of whom are well indiiduals
who hae greater need for preentie rather than curatie serices.
1+. According to Margaret 5hetland# the philosophy of public health nursing is based on which of the
following-
A. 'ealth and longeity as birthrights
B. The mandate of the state to protect the birthrights of its citizens
!. (ublic health nursing as a specialized field of nursing
$. The worth and dignity of man
Answer: %$& The worth and dignity of man
This is a direct >uote from $r. Margaret 5hetland9s statements on (ublic 'ealth )ursing.
1/. ,hich of the following is the mission of the $epartment of 'ealth-
A. 'ealth for all Ailipinos
B. 7nsure the accessibility and >uality of health care
!. "mproe the general health status of the population
$. 'ealth in the hands of the Ailipino people by the year +3+3
Answer: %B& 7nsure the accessibility and >uality of health care
%none&
1:. .egion "J 'ospital is classified as what leel of facility-
A. (rimary
B. 5econdary
!. "ntermediate
$. Tertiary
Answer: %$& Tertiary
.egional hospitals are tertiary facilities because they sere as training hospitals for the region.
1<. ,hich is true of primary facilities-
A. They are usually goernment-run.
B. Their serices are proided on an out-patient basis.
!. They are training facilities for health professionals.
$. A community hospital is an e=ample of this leel of health facilities.
Answer: %B& Their serices are proided on an out-patient basis.
(rimary facilities goernment and non-goernment facilities that proide basic out-patient serices.
1?. ,hich is an e=ample of the school nurse9s health care proider functions-
A. .e>uesting for B!2 from the .'6 for school entrant immunization
B. !onducting random classroom inspection during a measles epidemic
!. Taking remedial action on an accident hazard in the school playground
$. 8bsering places in the school where pupils spend their free time
Answer: %B& !onducting random classroom inspection during a measles epidemic
.andom classroom inspection is assessment of pupilsGstudents and teachers for signs of a health
problem prealent in the community.
1@. ,hen the nurse determines whether resources were ma=imized in implementing 0igtas Tigdas#
she is ealuating
A. 7ffectieness
B. 7fficiency
!. Ade>uacy
$. Appropriateness
Answer: %B& 7fficiency
7fficiency is determining whether the goals were attained at the least possible cost.
1B. Kou are a new B.5.). graduate. Kou want to become a (ublic 'ealth )urse. ,here will you
apply-
A. $epartment of 'ealth
B. (roincial 'ealth 8ffice
!. .egional 'ealth 8ffice
$. .ural 'ealth 6nit
Answer: %$& .ural 'ealth 6nit
..A. @1?3 deoled basic health serices to local goernment units %0269s &. The public health nurse
is an employee of the 026.
1C. ..A. @1?3 mandates deolution of basic serices from the national goernment to local
goernment units. ,hich of the following is the ma*or goal of deolution-
A. To strengthen local goernment units
B. To allow greater autonomy to local goernment units
!. To empower the people and promote their self-reliance
$. To make basic serices more accessible to the people
Answer: %!& To empower the people and promote their self-reliance
(eople empowerment is the basic motiation behind deolution of basic serices to 0269s.
+3. ,ho is the !hairman of the Municipal 'ealth Board-
A. Mayor
B. Municipal 'ealth 8fficer
!. (ublic 'ealth )urse
$. Any >ualified physician
Answer: %A& Mayor
The local e=ecutie seres as the chairman of the Municipal 'ealth Board.
+1. ,hich leel of health facility is the usual point of entry of a client into the health care deliery
system-
A. (rimary
B. 5econdary
!. "ntermediate
$. Tertiary
Answer: %A& (rimary
The entry of a person into the health care deliery system is usually through a consultation in out-
patient serices.
++. The public health nurse is the superisor of rural health midwies. ,hich of the following is a
superisory function of the public health nurse-
A. .eferring cases or patients to the midwife
B. (roiding technical guidance to the midwife
!. (roiding nursing care to cases referred by the midwife
$. Aormulating and implementing training programs for midwies
Answer: %B& (roiding technical guidance to the midwife
The nurse proides technical guidance to the midwife in the care of clients# particularly in the
implementation of management guidelines# as in "ntegrated Management of !hildhood "llness.
+/. 8ne of the participants in a hilot training class asked you to whom she should refer a patient in
labor who deelops a complication. Kou will answer# to the
A. (ublic 'ealth )urse
B. .ural 'ealth Midwife
!. Municipal 'ealth 8fficer
$. Any of these health professionals
Answer: %!& Municipal 'ealth 8fficer
A public health nurse and rural health midwife can proide care during normal childbirth. A physician
should attend to a woman with a complication during labor.
+:. Kou are the public health nurse in a municipality with a total population of about +3#333. There
are / rural health midwies among the .'6 personnel. 'ow many more midwife items will the .'6
need-
A. 1
B. +
!. /
$. The .'6 does not need any more midwife item.
Answer: %A& 1
7ach rural health midwife is gien a population assignment of about <#333.
+<. "f the .'6 needs additional midwife items# you will submit the re>uest for additional midwife
items for approal to the
A. .ural 'ealth 6nit
B. $istrict 'ealth 8ffice
!. (roincial 'ealth 8ffice
$. Municipal 'ealth Board
Answer: %$& Municipal 'ealth Board
As mandated by ..A. @1?3# basic health serices hae been deoled from the national goernment
to local goernment units.
+?. As an epidemiologist# the nurse is responsible for reporting cases of notifiable diseases. ,hat law
mandates reporting of cases of notifiable diseases-
A. Act /<@/
B. ..A. /@</
!. ..A. 13<:
$. ..A. 13B+
Answer: %A& Act /<@/
Act /<@/# the 0aw on .eporting of !ommunicable $iseases# enacted in 1C+C# mandated the reporting
of diseases listed in the law to the nearest health station.
+@. According to Areeman and 'einrich# community health nursing is a deelopmental serice.
,hich of the following best illustrates this statement-
A. The community health nurse continuously deelops himself personally and professionally.
B. 'ealth education and community organizing are necessary in proiding community health
serices.
!. !ommunity health nursing is intended primarily for health promotion and preention and
treatment of disease.
$. The goal of community health nursing is to proide nursing serices to people in their own places
of residence.
Answer: %B& 'ealth education and community organizing are necessary in proiding community
health serices.
The community health nurse deelops the health capability of people through health education and
community organizing actiities.
+B. ,hich disease was declared through (residential (roclamation )o. : as a target for eradication in
the (hilippines-
A. (oliomyelitis
B. Measles
!. .abies
$. )eonatal tetanus
Answer: %B& Measles
(residential (roclamation )o. : is on the 0igtas Tigdas (rogram.
+C. The public health nurse is responsible for presenting the municipal health statistics using graphs
and tables. To compare the fre>uency of the leading causes of mortality in the municipality# which
graph will you prepare-
A. 0ine
B. Bar
!. (ie
$. 5catter diagram
Answer: %B& Bar
A bar graph is used to present comparison of alues# a line graph for trends oer time or age# a pie
graph for population composition or distribution# and a scatter diagram for correlation of two
ariables.
/3. ,hich step in community organizing inoles training of potential leaders in the community-
A. "ntegration
B. !ommunity organization
!. !ommunity study
$. !ore group formation
Answer: %$& !ore group formation
"n core group formation# the nurse is able to transfer the technology of community organizing to the
potential or informal community leaders through a training program.
/1. "n which step are plans formulated for soling community problems-
A. Mobilization
B. !ommunity organization
!. Aollow-upGe=tension
$. !ore group formation
Answer: %B& !ommunity organization
!ommunity organization is the step when community assemblies take place. $uring the community
assembly# the people may opt to formalize the community organization and make plans for
community action to resole a community health problem.
/+. The public health nurse takes an actie role in community participation. ,hat is the primary goal
of community organizing-
A. To educate the people regarding community health problems
B. To mobilize the people to resole community health problems
!. To ma=imize the community9s resources in dealing with health problems
$. To ma=imize the community9s resources in dealing with health problems
Answer: %$& To ma=imize the community9s resources in dealing with health problems
!ommunity organizing is a deelopmental serice# with the goal of deeloping the people9s self-
reliance in dealing with community health problems. A# B and ! are ob*ecties of contributory
ob*ecties to this goal.
//. An indicator of success in community organizing is when people are able to
A. (articipate in community actiities for the solution of a community problem
B. "mplement actiities for the solution of the community problem
!. (lan actiities for the solution of the community problem
$. "dentify the health problem as a common concern
Answer: %A& (articipate in community actiities for the solution of a community problem
(articipation in community actiities in resoling a community problem may be in any of the
processes mentioned in the other choices.
/:. Tertiary preention is needed in which stage of the natural history of disease-
A. (re-pathogenesis
B. (athogenesis
!. (rodromal
$. Terminal
Answer: %$& Terminal
Tertiary preention inoles rehabilitation# preention of permanent disability and disability
limitation appropriate for conalescents# the disabled# complicated cases and the terminally ill %those
in the terminal stage of a disease&
/<. "solation of a child with measles belongs to what leel of preention-
A. (rimary
B. 5econdary
!. "ntermediate
$. Tertiary
Answer: %A& (rimary
The purpose of isolating a client with a communicable disease is to protect those who are not sick
%specific disease preention&.
/?. 8n the other hand# 8peration Timbang is OOOOO preention.
A. (rimary
B. 5econdary
!. "ntermediate
$. Tertiary
Answer: %B& 5econdary
8peration Timbang is done to identify members of the susceptible population who are malnourished.
"ts purpose is early diagnosis and# subse>uently# prompt treatment.
/@. ,hich type of family-nurse contact will proide you with the best opportunity to obsere family
dynamics-
A. !linic consultation
B. 2roup conference
!. 'ome isit
$. ,ritten communication
Answer: %!& 'ome isit
$ynamics of family relationships can best be obsered in the family9s natural enironment# which is
the home.
/B. The typology of family nursing problems is used in the statement of nursing diagnosis in the care
of families. The youngest child of the de los .eyes family has been diagnosed as mentally retarded.
This is classified as a
A. 'ealth threat
B. 'ealth deficit
!. Aoreseeable crisis
$. 5tress point
Answer: %B& 'ealth deficit
Aailure of a family member to deelop according to what is e=pected# as in mental retardation# is a
health deficit.
/C. The de los .eyes couple hae a ?-year old child entering school for the first time. The de los
.eyes family has a
A. 'ealth threat
B. 'ealth deficit
!. Aoreseeable crisis
$. 5tress point
Answer: %!& Aoreseeable crisis
7ntry of the ?-year old into school is an anticipated period of unusual demand on the family.
:3. ,hich of the following is an adantage of a home isit-
A. "t allows the nurse to proide nursing care to a greater number of people.
B. "t proides an opportunity to do first hand appraisal of the home situation.
!. "t allows sharing of e=periences among people with similar health problems.
$. "t deelops the family9s initiatie in proiding for health needs of its members.
Answer: %B& "t proides an opportunity to do first hand appraisal of the home situation.
!hoice A is not correct since a home isit re>uires that the nurse spend so much time with the family.
!hoice ! is an adantage of a group conference# while choice $ is true of a clinic consultation.
:1. ,hich is !8)T.A.K to the principles in planning a home isit-
A. A home isit should hae a purpose or ob*ectie.
B. The plan should reole around family health needs.
!. A home isit should be conducted in the manner prescribed by the .'6.
$. (lanning of continuing care should inole a responsible family member.
Answer: %!& A home isit should be conducted in the manner prescribed by the .'6.
The home isit plan should be fle=ible and practical# depending on factors# such as the family9s needs
and the resources aailable to the nurse and the family.
:+. The (') bag is an important tool in proiding nursing care during a home isit. The most
important principle of bag techni>ue states that it
A. 5hould sae time and effort.
B. 5hould minimize if not totally preent the spread of infection.
!. 5hould not oershadow concern for the patient and his family.
$. May be done in a ariety of ways depending on the home situation# etc.
Answer: %B& 5hould minimize if not totally preent the spread of infection.
Bag techni>ue is performed before and after handling a client in the home to preent transmission of
infection to and from the client.
:/. To maintain the cleanliness of the bag and its contents# which of the following must the nurse do-
A. ,ash hisGher hands before and after proiding nursing care to the family members.
B. "n the care of family members# as much as possible# use only articles taken from the bag.
!. (ut on an apron to protect her uniform and fold it with the right side out before putting it back into
the bag.
$. At the end of the isit# fold the lining on which the bag was placed# ensuring that the contaminated
side is on the outside.
Answer: %A& ,ash hisGher hands before and after proiding nursing care to the family members.
!hoice B goes against the idea of utilizing the family9s resources# which is encouraged in !').
!hoices ! and $ goes against the principle of asepsis of confining the contaminated surface of
ob*ects.
::. The public health nurse conducts a study on the factors contributing to the high mortality rate due
to heart disease in the municipality where she works. ,hich branch of epidemiology does the nurse
practice in this situation-
A. $escriptie
B. Analytical
!. Therapeutic
$. 7aluation
Answer: %B& Analytical
Analytical epidemiology is the study of factors or determinants affecting the patterns of occurrence
and distribution of disease in a community.
:<. ,hich of the following is a function of epidemiology-
A. "dentifying the disease condition based on manifestations presented by a client
B. $etermining factors that contributed to the occurrence of pneumonia in a / year old
!. $etermining the efficacy of the antibiotic used in the treatment of the / year old client with
pneumonia
$. 7aluating the effectieness of the implementation of the "ntegrated Management of !hildhood
"llness
Answer: %$& 7aluating the effectieness of the implementation of the "ntegrated Management of
!hildhood "llness
7pidemiology is used in the assessment of a community or ealuation of interentions in community
health practice.
:?. ,hich of the following is an epidemiologic function of the nurse during an epidemic-
A. !onducting assessment of suspected cases to detect the communicable disease
B. Monitoring the condition of the cases affected by the communicable disease
!. (articipating in the inestigation to determine the source of the epidemic
$. Teaching the community on preentie measures against the disease
Answer: %!& (articipating in the inestigation to determine the source of the epidemic
7pidemiology is the study of patterns of occurrence and distribution of disease in the community# as
well as the factors that affect disease patterns. The purpose of an epidemiologic inestigation is to
identify the source of an epidemic# i.e.# what brought about the epidemic.
:@. The primary purpose of conducting an epidemiologic inestigation is to
A. $elineate the etiology of the epidemic
B. 7ncourage cooperation and support of the community
!. "dentify groups who are at risk of contracting the disease
$. "dentify geographical location of cases of the disease in the community
Answer: %A& $elineate the etiology of the epidemic
$elineating the etiology of an epidemic is identifying its source.
:B. ,hich is a characteristic of person-to-person propagated epidemics-
A. There are more cases of the disease than e=pected.
B. The disease must necessarily be transmitted through a ector.
!. The spread of the disease can be attributed to a common ehicle.
$. There is a gradual build up of cases before the epidemic becomes easily noticeable.
Answer: %$& There is a gradual build up of cases before the epidemic becomes easily noticeable.
A gradual or insidious onset of the epidemic is usually obserable in person-to-person propagated
epidemics.
:C. "n the inestigation of an epidemic# you compare the present fre>uency of the disease with the
usual fre>uency at this time of the year in this community. This is done during which stage of the
inestigation-
A. 7stablishing the epidemic
B. Testing the hypothesis
!. Aormulation of the hypothesis
$. Appraisal of facts
Answer: %A& 7stablishing the epidemic
7stablishing the epidemic is determining whether there is an epidemic or not. This is done by
comparing the present number of cases with the usual number of cases of the disease at the same time
of the year# as well as establishing the relatedness of the cases of the disease.
<3. The number of cases of $engue feer usually increases towards the end of the rainy season. This
pattern of occurrence of $engue feer is best described as
A. 7pidemic occurrence
B. !yclical ariation
!. 5poradic occurrence
$. 5ecular ariation
Answer: %B& !yclical ariation
A cyclical ariation is a periodic fluctuation in the number of cases of a disease in the community.
<1. "n the year 1CB3# the ,orld 'ealth 8rganization declared the (hilippines# together with some
other countries in the ,estern (acific .egion# 1free4 of which disease-
A. (neumonic plague
B. (oliomyelitis
!. 5mall po=
$. Anthra=
Answer: %!& 5mall po=
The last documented case of 5mall po= was in 1C@@ at 5omalia.
<+. "n the census of the (hilippines in 1CC<# there were about /<#+CC#333 males and about /:#C?B#333
females. ,hat is the se= ratio-
A. CC.3?:133
B. 133.C::133
!. <3.+/P
$. :C.@?P
Answer: %B& 133.C::133
5e= ratio is the number of males for eery 133 females in the population.
</. (rimary health care is a total approach to community deelopment. ,hich of the following is an
indicator of success in the use of the primary health care approach-
A. 'ealth serices are proided free of charge to indiiduals and families.
B. 0ocal officials are empowered as the ma*or decision makers in matters of health.
!. 'ealth workers are able to proide care based on identified health needs of the people.
$. 'ealth programs are sustained according to the leel of deelopment of the community.
Answer: %$& 'ealth programs are sustained according to the leel of deelopment of the community.
(rimary health care is essential health care that can be sustained in all stages of deelopment of the
community.
<:. 5putum e=amination is the ma*or screening tool for pulmonary tuberculosis. !lients would
sometimes get false negatie results in this e=am. This means that the test is not perfect in terms of
which characteristic of a diagnostic e=amination-
A. 7ffectieness
B. 7fficacy
!. 5pecificity
$. 5ensitiity
Answer: %$& 5ensitiity
5ensitiity is the capacity of a diagnostic e=amination to detect cases of the disease. "f a test is 133P
sensitie# all the cases tested will hae a positie result# i.e.# there will be no false negatie results.
<<. 6se of appropriate technology re>uires knowledge of indigenous technology. ,hich medicinal
herb is gien for feer# headache and cough-
A. 5ambong
B. Tsaang gubat
!. Akapulko
$. 0agundi
Answer: %$& 0agundi
5ambong is used as a diuretic. Tsaang gubat is used to reliee diarrhea. Akapulko is used for its
antifungal property.
<?. ,hat law created the (hilippine "nstitute of Traditional and Alternatie 'ealth !are-
A. ..A. B:+/
B. ..A. :B+/
!. ..A. +:B/
$. ..A. /:B+
Answer: %A& ..A. B:+/
%none&
<@. "n traditional !hinese medicine# the yielding# negatie and feminine force is termed
A. Kin
B. Kang
!. Hi
$. !hai
Answer: %A& Kin
Kang is the male dominating# positie and masculine force.
<B. ,hat is the legal basis for (rimary 'ealth !are approach in the (hilippines-
A. Alma Ata $eclaration on ('!
B. 0etter of "nstruction )o. C:C
!. (residential $ecree )o. 1:@
$. (residential $ecree CC?
Answer: %B& 0etter of "nstruction )o. C:C
0etter of "nstruction C:C was issued by then (resident Aerdinand Marcos# directing the formerly
called Ministry of 'ealth# now the $epartment of 'ealth# to utilize (rimary 'ealth !are approach in
planning and implementing health programs.
<C. ,hich of the following demonstrates intersectoral linkages-
A. Two-way referral system
B. Team approach
!. 7ndorsement done by a midwife to another midwife
$. !ooperation between the (') and public school teacher
Answer: %$& !ooperation between the (') and public school teacher
"ntersectoral linkages refer to working relationships between the health sector and other sectors
inoled in community deelopment.
?3. The municipality assigned to you has a population of about +3#333. 7stimate the number of 1-:
year old children who will be gien .etinol capsule +33#333 ".6. eery ? months.
A. 1#<33
B. 1#B33
!. +#333
$. +#/33
Answer: %$& +#/33
Based on the (hilippine population composition# to estimate the number of 1-: year old children#
multiply total population by 11.<P.
?1. 7stimate the number of pregnant women who will be gien tetanus to=oid during an
immunization outreach actiity in a barangay with a population of about 1#<33.
A. +?<
B. /33
!. /@<
$. :33
Answer: %A& +?<
To estimate the number of pregnant women# multiply the total population by /.<P.
?+. To describe the se= composition of the population# which demographic tool may be used-
A. 5e= ratio
B. 5e= proportion
!. (opulation pyramid
$. Any of these may be used.
Answer: %$& Any of these may be used.
5e= ratio and se= proportion are used to determine the se= composition of a population. A population
pyramid is used to present the composition of a population by age and se=.
?/. ,hich of the following is a natality rate-
A. !rude birth rate
B. )eonatal mortality rate
!. "nfant mortality rate
$. 2eneral fertility rate
Answer: %A& !rude birth rate
)atality means birth. A natality rate is a birth rate.
?:. Kou are computing the crude death rate of your municipality# with a total population of about
1B#333# for last year. There were C: deaths. Among those who died# +3 died because of diseases of
the heart and /+ were aged <3 years or older. ,hat is the crude death rate-
A. :.+G1#333
B. <.+G1#333
!. ?./G1#333
$. @./G1#333
Answer: %B& <.+G1#333
To compute crude death rate diide total number of deaths %C:& by total population %1B#333& and
multiply by 1#333.
?<. Inowing that malnutrition is a fre>uent community health problem# you decided to conduct
nutritional assessment. ,hat population is particularly susceptible to protein energy malnutrition
%(7M&-
A. (regnant women and the elderly
B. 6nder-< year old children
!. 1-: year old children
$. 5chool age children
Answer: %!& 1-: year old children
(reschoolers are the most susceptible to (7M because they hae generally been weaned. Also# this is
the population who# unable to feed themseles# are often the ictims of poor intrafamilial food
distribution.
??. ,hich statistic can gie the most accurate reflection of the health status of a community-
A. 1-: year old age-specific mortality rate
B. "nfant mortality rate
!. 5waroop9s inde=
$. !rude death rate
Answer: %!& 5waroop9s inde=
5waroop9s inde= is the proportion of deaths aged <3 years and aboe. The higher the 5waroop9s inde=
of a population# the greater the proportion of the deaths who were able to reach the age of at least <3
years# i.e.# more people grew old before they died.
?@. "n the past year# Barangay A had an aerage population of 1?<<. :? babies were born in that year#
+ of whom died less than : weeks after they were born. There were : recorded stillbirths. ,hat is the
neonatal mortality rate-
A. +@.BG1#333
B. :/.<G1#333
!. B?.CG1#333
$. 1/3.:G1#333
Answer: %B& :/.<G1#333
To compute for neonatal mortality rate# diide the number of babies who died before reaching the age
of +B days by the total number of lie births# then multiply by 1#333.
?B. ,hich statistic best reflects the nutritional status of a population-
A. 1-: year old age-specific mortality rate
B. (roportionate mortality rate
!. "nfant mortality rate
$. 5waroop9s inde=
Answer: %A& 1-: year old age-specific mortality rate
5ince preschoolers are the most susceptible to the effects of malnutrition# a population with poor
nutritional status will most likely hae a high 1-: year old age-specific mortality rate# also known as
child mortality rate.
?C. ,hat numerator is used in computing general fertility rate-
A. 7stimated midyear population
B. )umber of registered lie births
!. )umber of pregnancies in the year
$. )umber of females of reproductie age
Answer: %B& )umber of registered lie births
To compute for general or total fertility rate# diide the number of registered lie births by the
number of females of reproductie age %1<-:< years&# then multiply by 1#333.
@3. Kou will gather data for nutritional assessment of a purok. Kou will gather information only from
families with members who belong to the target population for (7M. ,hat method of data gathering
is best for this purpose-
A. !ensus
B. 5urey
!. .ecord reiew
$. .eiew of ciil registry
Answer: %B& 5urey
A surey# also called sample surey# is data gathering about a sample of the population.
@1. "n the conduct of a census# the method of population assignment based on the actual physical
location of the people is termed
A. $e *ure
B. $e locus
!. $e facto
$. $e noo
Answer: %!& $e facto
The other method of population assignment# de *ure# is based on the usual place of residence of the
people.
@+. The Aield 'ealth 5erices and "nformation 5ystem %A'5"5& is the recording and reporting system
in public health care in the (hilippines. The Monthly Aield 'ealth 5erice Actiity .eport is a form
used in which of the components of the A'5"5-
A. Tally report
B. 8utput report
!. TargetGclient list
$. "ndiidual health record
Answer: %A& Tally report
A tally report is prepared monthly or >uarterly by the .'6 personnel and transmitted to the
(roincial 'ealth 8ffice.
@/. To monitor clients registered in long-term regimens# such as the Multi-$rug Therapy# which
component will be most useful-
A. Tally report
B. 8utput report
!. TargetGclient list
$. "ndiidual health record
Answer: %!& TargetGclient list
The M$T !lient 0ist is a record of clients enrolled in M$T and other releant data# such as dates
when clients collected their monthly supply of drugs.
@:. !iil registries are important sources of data. ,hich law re>uires registration of births within /3
days from the occurrence of the birth-
A. (.$. ?<1
B. Act /<@/
!. ..A. /@</
$. ..A. //@<
Answer: %A& (.$. ?<1
(.$. ?<1 amended ..A. /@</# re>uiring the registry of births within /3 days from their occurrence.
@<. ,hich of the following professionals can sign the birth certificate-
A. (ublic health nurse
B. .ural health midwife
!. Municipal health officer
$. Any of these health professionals
Answer: %$& Any of these health professionals
$. ..A. /@</ states that any birth attendant may sign the certificate of lie birth.
@?. ,hich criterion in priority setting of health problems is used only in community health care-
A. Modifiability of the problem
B. )ature of the problem presented
!. Magnitude of the health problem
$. (reentie potential of the health problem
Answer: %!& Magnitude of the health problem
Magnitude of the problem refers to the percentage of the population affected by a health problem.
The other choices are criteria considered in both family and community health care.
@@. The 5entrong 5igla Moement has been launched to improe health serice deliery. ,hich of
the following isGare true of this moement-
A. This is a pro*ect spearheaded by local goernment units.
B. "t is a basis for increasing funding from local goernment units.
!. "t encourages health centers to focus on disease preention and control.
$. "ts main strategy is certification of health centers able to comply with standards.
Answer: %$& "ts main strategy is certification of health centers able to comply with standards.
5entrong 5igla Moement is a *oint pro*ect of the $8' and local goernment units. "ts main strategy
is certification of health centers that are able to comply with standards set by the $8'.
@B. ,hich of the following women should be considered as special targets for family planning-
A. Those who hae two children or more
B. Those with medical conditions such as anemia
!. Those younger than +3 years and older than /< years
$. Those who *ust had a deliery within the past 1< months
Answer: %$& Those who *ust had a deliery within the past 1< months
The ideal birth spacing is at least two years. 1< months plus C months of pregnancy Q + years.
@C. Areedom of choice is one of the policies of the Aamily (lanning (rogram of the (hilippines.
,hich of the following illustrates this principle-
A. "nformation dissemination about the need for family planning
B. 5upport of research and deelopment in family planning methods
!. Ade>uate information for couples regarding the different methods
$. 7ncouragement of couples to take family planning as a *oint responsibility
Answer: %!& Ade>uate information for couples regarding the different methods
To enable the couple to choose freely among different methods of family planning# they must be
gien full information regarding the different methods that are aailable to them# considering the
aailability of >uality serices that can support their choice.
B3. A woman# ? months pregnant# came to the center for consultation. ,hich of the following
substances is contraindicated-
A. Tetanus to=oid
B. .etinol +33#333 "6
!. Aerrous sulfate +33 mg
$. (otassium iodate +33 mg. capsule
Answer: %B& .etinol +33#333 "6
.etinol +33#333 "6 is a form of megadose Jitamin A. This may hae a teratogenic effect.
B1. $uring prenatal consultation# a client asked you if she can hae her deliery at home. After
history taking and physical e=amination# you adised her against a home deliery. ,hich of the
following findings dis>ualifies her for a home deliery-
A. 'er 8B score is 2<(/.
B. 5he has some palmar pallor.
!. 'er blood pressure is 1/3GB3.
$. 'er baby is in cephalic presentation.
Answer: %A& 'er 8B score is 2<(/.
8nly women with less than < pregnancies are >ualified for a home deliery. "t is also adisable for a
primigraida to hae deliery at a childbirth facility.
B+. "nade>uate intake by the pregnant woman of which itamin may cause neural tube defects-
A. )iacin
B. .iboflain
!. Aolic acid
$. Thiamine
Answer: %!& Aolic acid
"t is estimated that the incidence of neural tube defects can be reduced drastically if pregnant women
hae an ade>uate intake of folic acid.
B/. Kou are in a client9s home to attend to a deliery. ,hich of the following will you do first-
A. 5et up the sterile area.
B. (ut on a clean gown or apron.
!. !leanse the client9s ula with soap and water.
$. )ote the interal# duration and intensity of labor contractions.
Answer: %$& )ote the interal# duration and intensity of labor contractions.
Assessment of the woman should be done first to determine whether she is haing true labor and# if
so# what stage of labor she is in.
B:. "n preparing a primigraida for breastfeeding# which of the following will you do-
A. Tell her that lactation begins within a day after deliery.
B. Teach her nipple stretching e=ercises if her nipples are eerted.
!. "nstruct her to wash her nipples before and after each breastfeeding.
$. 7=plain to her that putting the baby to breast will lessen blood loss after deliery.
Answer: %$& 7=plain to her that putting the baby to breast will lessen blood loss after deliery.
5uckling of the nipple stimulates the release of o=ytocin by the posterior pituitary gland# which
causes uterine contraction. 0actation begins 1 to / days after deliery. )ipple stretching e=ercises are
done when the nipples are flat or inerted. Are>uent washing dries up the nipples# making them prone
to the formation of fissures.
B<. A primigraida is instructed to offer her breast to the baby for the first time within /3 minutes
after deliery. ,hat is the purpose of offering the breast this early-
A. To initiate the occurrence of milk letdown
B. To stimulate milk production by the mammary acini
!. To make sure that the baby is able to get the colostrum
$. To allow the woman to practice breastfeeding in the presence of the health worker
Answer: %B& To stimulate milk production by the mammary acini
5uckling of the nipple stimulates prolactin refle= %the release of prolactin by the anterior pituitary
gland&# which initiates lactation.
B?. "n a mothers9 class# you discuss proper breastfeeding techni>ue. ,hich is of these is a sign that
the baby has 1latched on4 to the breast properly-
A. The baby takes shallow# rapid sucks.
B. The mother does not feel nipple pain.
!. The baby9s mouth is only partly open.
$. 8nly the mother9s nipple is inside the baby9s mouth.
Answer: %B& The mother does not feel nipple pain.
,hen the baby has properly latched on to the breast# he takes deep# slow sucks; his mouth is wide
open; and much of the areola is inside his mouth. And# you9re rightN The mother does not feel nipple
pain.
B@. Kou e=plain to a breastfeeding mother that breast milk is sufficient for all of the baby9s nutrient
needs only up to OOOO.
A. / months
B. ? months
!. 1 year
$. + years
Answer: %B& ? months
After ? months# the baby9s nutrient needs# especially the baby9s iron re>uirement# can no longer be
proided by mother9s milk alone.
BB. ,hat is gien to a woman within a month after the deliery of a baby-
A. Malunggay capsule
B. Aerrous sulfate 133 mg. 8$
!. .etinol +33#333 ".6.# 1 capsule
$. (otassium iodate +33 mg# 1 capsule
Answer: %!& .etinol +33#333 ".6.# 1 capsule
A capsule of .etinol +33#333 "6 is gien within 1 month after deliery. (otassium iodate is gien
during pregnancy; malunggay capsule is not routinely administered after deliery; and ferrous sulfate
is taken for two months after deliery.
BC. ,hich biological used in 7=panded (rogram on "mmunization %7("& is stored in the freezer-
A. $(T
B. Tetanus to=oid
!. Measles accine
$. 'epatitis B accine
Answer: %!& Measles accine
Among the biologicals used in the 7=panded (rogram on "mmunization# measles accine and 8(J
are highly sensitie to heat# re>uiring storage in the freezer.
C3. 6nused B!2 should be discarded how many hours after reconstitution-
A. +
B. :
!. ?
$. At the end of the day
Answer: %B& :
,hile the unused portion of other biologicals in 7(" may be gien until the end of the day# only B!2
is discarded : hours after reconstitution. This is why B!2 immunization is scheduled only in the
morning.
C1. "n immunizing school entrants with B!2# you are not obliged to secure parental consent. This is
because of which legal document-
A. (.$. CC?
B. ..A. @B:?
!. (residential (roclamation )o. ?
$. (residential (roclamation )o. :?
Answer: %A& (.$. CC?
(residential $ecree CC?# enacted in 1C@?# made immunization in the 7(" compulsory for children
under B years of age. 'epatitis B accination was made compulsory for the same age group by ..A.
@B:?.
C+. ,hich immunization produces a permanent scar-
A. $(T
B. B!2
!. Measles accination
$. 'epatitis B accination
Answer: %B& B!2
B!2 causes the formation of a superficial abscess# which begins + weeks after immunization. The
abscess heals without treatment# with the formation of a permanent scar.
C/. A :-week old baby was brought to the health center for his first immunization. ,hich can be
gien to him-
A. $(T1
B. 8(J1
!. "nfant B!2
$. 'epatitis B accine 1
Answer: %!& "nfant B!2
"nfant B!2 may be gien at birth. All the other immunizations mentioned can be gien at ? weeks of
age.
C:. Kou will not gie $(T + if the mother says that the infant had
A. 5eizures a day after $(T 1.
B. Aeer for / days after $(T 1.
!. Abscess formation after $(T 1.
$. 0ocal tenderness for / days after $(T 1.
Answer: %A& 5eizures a day after $(T 1.
5eizures within / days after administration of $(T is an indication of hypersensitiity to pertussis
accine# a component of $(T. This is considered a specific contraindication to subse>uent doses of
$(T.
C<. A +-month old infant was brought to the health center for immunization. $uring assessment# the
infant9s temperature registered at /B.1R!. ,hich is the best course of action that you will take-
A. 2o on with the infant9s immunizations.
B. 2ie (aracetamol and wait for his feer to subside.
!. .efer the infant to the physician for further assessment.
$. Adise the infant9s mother to bring him back for immunization when he is well.
Answer: %A& 2o on with the infant9s immunizations.
"n the 7("# feer up to /B.<R! is not a contraindication to immunization. Mild acute respiratory tract
infection# simple diarrhea and malnutrition are not contraindications either.
C?. A pregnant woman had *ust receied her :th dose of tetanus to=oid. 5ubse>uently# her baby will
hae protection against tetanus for how long-
A. 1 year
B. / years
!. 13 years
$. 0ifetime
Answer: %A& 1 year
The baby will hae passie natural immunity by placental transfer of antibodies. The mother will
hae actie artificial immunity lasting for about 13 years. < doses will gie the mother lifetime
protection.
C@. A :-month old infant was brought to the health center because of cough. 'er respiratory rate is
:+Gminute. 6sing the "ntegrated Management of !hild "llness %"M!"& guidelines of assessment# her
breathing is considered
A. Aast
B. 5low
!. )ormal
$. "nsignificant
Answer: %!& )ormal
"n "M!"# a respiratory rate of <3Gminute or more is fast breathing for an infant aged + to 1+ months.
CB. ,hich of the following signs will indicate that a young child is suffering from seere pneumonia-
A. $yspnea
B. ,heezing
!. Aast breathing
$. !hest indrawing
Answer: %$& !hest indrawing
"n "M!"# chest indrawing is used as the positie sign of dyspnea# indicating seere pneumonia.
CC. 6sing "M!" guidelines# you classify a child as haing seere pneumonia. ,hat is the best
management for the child-
A. (rescribe an antibiotic.
B. .efer him urgently to the hospital.
!. "nstruct the mother to increase fluid intake.
$. "nstruct the mother to continue breastfeeding.
Answer: %B& .efer him urgently to the hospital.
5eere pneumonia re>uires urgent referral to a hospital. Answers A# ! and $ are done for a client
classified as haing pneumonia.
133. A <-month old infant was brought by his mother to the health center because of diarrhea
occurring : to < times a day. 'is skin goes back slowly after a skin pinch and his eyes are sunken.
6sing the "M!" guidelines# you will classify this infant in which category-
A. )o signs of dehydration
B. 5ome dehydration
!. 5eere dehydration
$. The data is insufficient.
Answer: %B& 5ome dehydration
6sing the assessment guidelines of "M!"# a child %+ months to < years old& with diarrhea is classified
as haing 58M7 $7'K$.AT"8) if he shows + or more of the following signs: restless or irritable#
sunken eyes# the skin goes back slow after a skin pinch.
131. Based on assessment# you classified a /-month old infant with the chief complaint of diarrhea in
the category of 58M7 $7'K$.AT"8). Based on "M!" management guidelines# which of the
following will you do-
A. Bring the infant to the nearest facility where "J fluids can be gien.
B. 5uperise the mother in giing +33 to :33 ml. of 8resol in : hours.
!. 2ie the infant9s mother instructions on home management.
$. Ieep the infant in your health center for close obseration.
Answer: %B& 5uperise the mother in giing +33 to :33 ml. of 8resol in : hours.
"n the "M!" management guidelines# 58M7 $7'K$.AT"8) is treated with the administration of
8resol within a period of : hours. The amount of 8resol is best computed on the basis of the child9s
weight %@< mlGkg body weight&. "f the weight is unknown# the amount of 8resol is based on the
child9s age.
13+. A mother is using 8resol in the management of diarrhea of her /-year old child. 5he asked you
what to do if her child omits. Kou will tell her to
A. Bring the child to the nearest hospital for further assessment.
B. Bring the child to the health center for intraenous fluid therapy.
!. Bring the child to the health center for assessment by the physician.
$. 0et the child rest for 13 minutes then continue giing 8resol more slowly.
Answer: %$& 0et the child rest for 13 minutes then continue giing 8resol more slowly.
"f the child omits persistently# that is# he omits eerything that he takes in# he has to be referred
urgently to a hospital. 8therwise# omiting is managed by letting the child rest for 13 minutes and
then continuing with 8resol administration. Teach the mother to gie 8resol more slowly.
13/. A 1 S year old child was classified as haing /rd degree protein energy malnutrition#
kwashiorkor. ,hich of the following signs will be most apparent in this child-
A. Joracious appetite
B. ,asting
!. Apathy
$. 7dema
Answer: %$& 7dema
7dema# a ma*or sign of kwashiorkor# is caused by decreased colloidal osmotic pressure of the blood
brought about by hypoalbuminemia. $ecreased blood albumin leel is due a protein-deficient diet.
13:. Assessment of a +-year old child reealed 1baggy pants4. 6sing the "M!" guidelines# how will
you manage this child-
A. .efer the child urgently to a hospital for confinement.
B. !oordinate with the social worker to enroll the child in a feeding program.
!. Make a teaching plan for the mother# focusing on menu planning for her child.
$. Assess and treat the child for health problems like infections and intestinal parasitism.
Answer: %A& .efer the child urgently to a hospital for confinement.
1Baggy pants4 is a sign of seere marasmus. The best management is urgent referral to a hospital.
13<. $uring the physical e=amination of a young child# what is the earliest sign of =erophthalmia that
you may obsere-
A. Ieratomalacia
B. !orneal opacity
!. )ight blindness
$. !on*unctial =erosis
Answer: %$& !on*unctial =erosis
The earliest sign of Jitamin A deficiency %=erophthalmia& is night blindness. 'oweer# this is a
functional change# which is not obserable during physical e=amination.The earliest isible lesion is
con*unctial =erosis or dullness of the con*unctia due to inade>uate tear production.
13?. To preent =erophthalmia# young children are gien .etinol capsule eery ? months. ,hat is the
dose gien to preschoolers-
A. 13#333 "6
B. +3#333 "6
!. 133#333 "6
$. +33#333 "6
Answer: %$& +33#333 "6
(reschoolers are gien .etinol +33#333 "6 eery ? months. 133#333 "6 is gien once to infants aged
? to 1+ months. The dose for pregnant women is 13#333 "6.
13@. The ma*or sign of iron deficiency anemia is pallor. ,hat part is best e=amined for pallor-
A. (alms
B. )ailbeds
!. Around the lips
$. 0ower con*unctial sac
Answer: %A& (alms
The anatomic characteristics of the palms allow a reliable and conenient basis for e=amination for
pallor.
13B. Aood fortification is one of the strategies to preent micronutrient deficiency conditions. ..A.
BC@? mandates fortification of certain food items. ,hich of the following is among these food items-
A. 5ugar
B. Bread
!. Margarine
$. Ailled milk
Answer: %A& 5ugar
..A. BC@? mandates fortification of rice# wheat flour# sugar and cooking oil with Jitamin A# iron
andGor iodine.
13C. ,hat is the best course of action when there is a measles epidemic in a nearby municipality-
A. 2ie measles accine to babies aged ? to B months.
B. 2ie babies aged ? to 11 months one dose of 133#333 ".6. of .etinol
!. "nstruct mothers to keep their babies at home to preent disease transmission.
$. "nstruct mothers to feed their babies ade>uately to enhance their babies9 resistance.
Answer: %A& 2ie measles accine to babies aged ? to B months.
8rdinarily# measles accine is gien at C months of age. $uring an impending epidemic# howeer#
one dose may be gien to babies aged ? to B months. The mother is instructed that the baby needs
another dose when the baby is C months old.
113. A mother brought her daughter# : years old# to the .'6 because of cough and colds. Aollowing
the "M!" assessment guide# which of the following is a danger sign that indicates the need for urgent
referral to a hospital-
A. "nability to drink
B. 'igh grade feer
!. 5igns of seere dehydration
$. !ough for more than /3 days
Answer: %A& "nability to drink
A sick child aged + months to < years must be referred urgently to a hospital if heGshe has one or
more of the following signs: not able to feed or drink# omits eerything# conulsions# abnormally
sleepy or difficult to awaken.
111. Management of a child with measles includes the administration of which of the following-
A. 2entian iolet on mouth lesions
B. Antibiotics to preent pneumonia
!. Tetracycline eye ointment for corneal opacity
$. .etinol capsule regardless of when the last dose was gien
Answer: %$& .etinol capsule regardless of when the last dose was gien
An infant ? to 1+ months classified as a case of measles is gien .etinol 133#333 "6; a child is gien
+33#333 "6 regardless of when the last dose was gien.
11+. A mother brought her 13 month old infant for consultation because of feer# which started : days
prior to consultation. To determine malaria risk# what will you do-
A. $o a tourni>uet test.
B. Ask where the family resides.
!. 2et a specimen for blood smear.
$. Ask if the feer is present eeryday.
Answer: %B& Ask where the family resides.
Because malaria is endemic# the first >uestion to determine malaria risk is where the client9s family
resides. "f the area of residence is not a known endemic area# ask if the child had traeled within the
past ? months# where heGshe was brought and whether heGshe stayed oernight in that area.
11/. The following are strategies implemented by the $epartment of 'ealth to preent mos>uito-
borne diseases. ,hich of these is most effectie in the control of $engue feer-
A. 5tream seeding with lara-eating fish
B. $estroying breeding places of mos>uitoes
!. !hemoprophyla=is of non-immune persons going to endemic areas
$. Teaching people in endemic areas to use chemically treated mos>uito nets
Answer: %B& $estroying breeding places of mos>uitoes
Aedes aegypti# the ector of $engue feer# breeds in stagnant# clear water. "ts feeding time is usually
during the daytime. "t has a cyclical pattern of occurrence# unlike malaria which is endemic in certain
parts of the country.
11:. 5econdary preention for malaria includes
A. (lanting of neem or eucalyptus trees
B. .esidual spraying of insecticides at night
!. $etermining whether a place is endemic or not
$. 2rowing lara-eating fish in mos>uito breeding places
Answer: %!& $etermining whether a place is endemic or not
This is diagnostic and therefore secondary leel preention. The other choices are for primary
preention.
11<. 5cotch tape swab is done to check for which intestinal parasite-
A. Ascaris
B. (inworm
!. 'ookworm
$. 5chistosoma
Answer: %B& (inworm
(inworm oa are deposited around the anal orifice.
11?. ,hich of the following signs indicates the need for sputum e=amination for AAB-
A. 'ematemesis
B. Aeer for 1 week
!. !ough for / weeks
$. !hest pain for 1 week
Answer: %!& !ough for / weeks
A client is considered a (TB suspect when he has cough for + weeks or more# plus one or more of the
following signs: feer for 1 month or more; chest pain lasting for + weeks or more not attributed to
other conditions; progressie# une=plained weight loss; night sweats; and hemoptysis.
11@. ,hich clients are considered targets for $8T5 !ategory "-
A. 5putum negatie caitary cases
B. !lients returning after a default
!. .elapses and failures of preious (TB treatment regimens
$. !lients diagnosed for the first time through a positie sputum e=am
Answer: %$& !lients diagnosed for the first time through a positie sputum e=am
!ategory " is for new clients diagnosed by sputum e=amination and clients diagnosed to hae a
serious form of e=trapulmonary tuberculosis# such as TB osteomyelitis.
11B. To improe compliance to treatment# what innoation is being implemented in $8T5-
A. 'aing the health worker follow up the client at home
B. 'aing the health worker or a responsible family member monitor drug intake
!. 'aing the patient come to the health center eery month to get his medications
$. 'aing a target list to check on whether the patient has collected his monthly supply of drugs
Answer: %B& 'aing the health worker or a responsible family member monitor drug intake
$irectly 8bsered Treatment 5hort !ourse is so-called because a treatment partner# preferably a
health worker accessible to the client# monitors the client9s compliance to the treatment.
11C. $iagnosis of leprosy is highly dependent on recognition of symptoms. ,hich of the following is
an early sign of leprosy-
A. Macular lesions
B. "nability to close eyelids
!. Thickened painful neres
$. 5inking of the nosebridge
Answer: %!& Thickened painful neres
The lesion of leprosy is not macular. "t is characterized by a change in skin color %either reddish or
whitish& and loss of sensation# sweating and hair growth oer the lesion. "nability to close the eyelids
%lagophthalmos& and sinking of the nosebridge are late symptoms.
1+3. ,hich of the following clients should be classified as a case of multibacillary leprosy-
A. / skin lesions# negatie slit skin smear
B. / skin lesions# positie slit skin smear
!. < skin lesions# negatie slit skin smear
$. < skin lesions# positie slit skin smear
Answer: %$& < skin lesions# positie slit skin smear
A multibacillary leprosy case is one who has a positie slit skin smear and at least < skin lesions.
1+1. "n the (hilippines# which condition is the most fre>uent cause of death associated with
schistosomiasis-
A. 0ier cancer
B. 0ier cirrhosis
!. Bladder cancer
$. "ntestinal perforation
Answer: %B& 0ier cirrhosis
The etiologic agent of schistosomiasis in the (hilippines is 5chistosoma *aponicum# which affects the
small intestine and the lier. 0ier damage is a conse>uence of fibrotic reactions to schistosoma eggs
in the lier.
1++. ,hat is the most effectie way of controlling schistosomiasis in an endemic area-
A. 6se of molluscicides
B. Building of foot bridges
!. (roper use of sanitary toilets
$. 6se of protectie footwear# such as rubber boots
Answer: %!& (roper use of sanitary toilets
The oa of the parasite get out of the human body together with feces. !utting the cycle at this stage
is the most effectie way of preenting the spread of the disease to susceptible hosts.
1+/. ,hen residents obtain water from an artesian well in the neighborhood# the leel of this
approed type of water facility is
A. "
B. ""
!. """
$. "J
Answer: %B& ""
A communal faucet or water standpost is classified as 0eel "".
1+:. Aor preention of hepatitis A# you decided to conduct health education actiities. ,hich of the
following is "..707JA)T-
A. 6se of sterile syringes and needles
B. 5afe food preparation and food handling by endors
!. (roper disposal of human e=creta and personal hygiene
$. "mmediate reporting of water pipe leaks and illegal water connections
Answer: %A& 6se of sterile syringes and needles
'epatitis A is transmitted through the fecal oral route. 'epatitis B is transmitted through infected
body secretions like blood and semen.
1+?. ,hich biological used in 7=panded (rogram on "mmunization %7("& should )8T be stored in
the freezer-
A. $(T
B. 8ral polio accine
!. Measles accine
$. MM.
Answer: %A& $(T
$(T is sensitie to freezing. The appropriate storage temperature of $(T is + to BR ! only. 8(J and
measles accine are highly sensitie to heat and re>uire freezing. MM. is not an immunization in the
7=panded (rogram on "mmunization.
1+@. Kou will conduct outreach immunization in a barangay with a population of about 1<33.
7stimate the number of infants in the barangay.
A. :<
B. <3
!. <<
$. ?3
Answer: %A& :<
To estimate the number of infants# multiply total population by /P.
1+B. "n "ntegrated Management of !hildhood "llness# seere conditions generally re>uire urgent
referral to a hospital. ,hich of the following seere conditions $875 )8T always re>uire urgent
referral to a hospital-
A. Mastoiditis
B. 5eere dehydration
!. 5eere pneumonia
$. 5eere febrile disease
Answer: %B& 5eere dehydration
The order of priority in the management of seere dehydration is as follows: intraenous fluid
therapy# referral to a facility where "J fluids can be initiated within /3 minutes# 8resolGnasogastric
tube# 8resolGorem. ,hen the foregoing measures are not possible or effectie# tehn urgent referral to
the hospital is done.
1+C. A client was diagnosed as haing $engue feer. Kou will say that there is slow capillary refill
when the color of the nailbed that you pressed does not return within how many seconds-
A. /
B. <
!. B
$. 13
Answer: %A& /
Ade>uate blood supply to the area allows the return of the color of the nailbed within / seconds.
1/3. A /-year old child was brought by his mother to the health center because of feer of :-day
duration. The child had a positie tourni>uet test result. "n the absence of other signs# which is the
most appropriate measure that the (') may carry out to preent $engue shock syndrome-
A. "nsert an )2T and gie fluids per )2T.
B. "nstruct the mother to gie the child 8resol.
!. 5tart the patient on intraenous fluids 5TAT.
$. .efer the client to the physician for appropriate management.
Answer: %B& "nstruct the mother to gie the child 8resol.
5ince the child does not manifest any other danger sign# maintenance of fluid balance and
replacement of fluid loss may be done by giing the client 8resol.
1/1. The pathognomonic sign of measles is Ioplik9s spot. Kou may see Ioplik9s spot by inspecting
the OOOOO.
A. )asal mucosa
B. Buccal mucosa
!. 5kin on the abdomen
$. 5kin on the antecubital surface
Answer: %B& Buccal mucosa
Ioplik9s spot may be seen on the mucosa of the mouth or the throat.
1/+. Among the following diseases# which is airborne-
A. Jiral con*unctiitis
B. Acute poliomyelitis
!. $iphtheria
$. Measles
Answer: %$& Measles
Jiral con*unctiitis is transmitted by direct or indirect contact with discharges from infected eyes.
Acute poliomyelitis is spread through the fecal-oral route and contact with throat secretions# whereas
diphtheria is through direct and indirect contact with respiratory secretions.
1//. Among children aged + months to / years# the most prealent form of meningitis is caused by
which microorganism-
A. 'emophilus influenzae
B. Morbilliirus
!. 5teptococcus pneumoniae
$. )eisseria meningitidis
Answer: %A& 'emophilus influenzae
'emophilus meningitis is unusual oer the age of < years. "n deeloping countries# the peak
incidence is in children less than ? months of age. Morbilliirus is the etiology of measles.
5treptococcus pneumoniae and )eisseria meningitidis may cause meningitis# but age distribution is
not specific in young children.
1/:. 'uman beings are the ma*or reseroir of malaria. ,hich of the following strategies in malaria
control is based on this fact-
A. 5tream seeding
B. 5tream clearing
!. $estruction of breeding places
$. Looprophyla=is
Answer: %$& Looprophyla=is
Looprophyla=is is done by putting animals like cattle or dogs close to windows or doorways *ust
before nightfall. The Anopheles mos>uito takes his blood meal from the animal and goes back to its
breeding place# thereby preenting infection of humans.
1/<. The use of lariorous fish in malaria control is the basis for which strategy of malaria control-
A. 5tream seeding
B. 5tream clearing
!. $estruction of breeding places
$. Looprophyla=is
Answer: %A& 5tream seeding
5tream seeding is done by putting tilapia fry in streams or other bodies of water identified as breeding
places of the Anopheles mos>uito
1/?. Mos>uito-borne diseases are preented mostly with the use of mos>uito control measures.
,hich of the following is )8T appropriate for malaria control-
A. 6se of chemically treated mos>uito nets
B. 5eeding of breeding places with lara-eating fish
!. $estruction of breeding places of the mos>uito ector
$. 6se of mos>uito-repelling soaps# such as those with basil or citronella
Answer: %!& $estruction of breeding places of the mos>uito ector
Anopheles mos>uitoes breed in slow-moing# clear water# such as mountain streams.
1/@. A :-year old client was brought to the health center with the chief complaint of seere diarrhea
and the passage of 1rice water4 stools. The client is most probably suffering from which condition-
A. 2iardiasis
B. !holera
!. Amebiasis
$. $ysentery
Answer: %B& !holera
(assage of profuse watery stools is the ma*or symptom of cholera. Both amebic and bacillary
dysentery are characterized by the presence of blood andGor mucus in the stools. 2iardiasis is
characterized by fat malabsorption and# therefore# steatorrhea.
1/B. "n the (hilippines# which specie of schistosoma is endemic in certain regions-
A. 5. mansoni
B. 5. *aponicum
!. 5. malayensis
$. 5. haematobium
Answer: %B& 5. *aponicum
5. mansoni is found mostly in Africa and 5outh America; 5. haematobium in Africa and the Middle
7ast; and 5. malayensis only in peninsular Malaysia.
1/C. A /+-year old client came for consultation at the health center with the chief complaint of feer
for a week. Accompanying symptoms were muscle pains and body malaise. A week after the start of
feer# the client noted yellowish discoloration of his sclera. 'istory showed that he waded in flood
waters about + weeks before the onset of symptoms. Based on his history# which disease condition
will you suspect-
A. 'epatitis A
B. 'epatitis B
!. Tetanus
$. 0eptospirosis
Answer: %$& 0eptospirosis
0eptospirosis is transmitted through contact with the skin or mucous membrane with water or moist
soil contaminated with urine of infected animals# like rats.
1:3. M,55 proides water to Manila and other cities in Metro Manila. This is an e=ample of which
leel of water facility-
A. "
B. ""
!. """
$. "J
Answer: %!& """
,aterworks systems# such as M,55# are classified as leel """.
1:1. Kou are the (') in the city health center. A client underwent screening for A"$5 using 70"5A.
'is result was positie. ,hat is the best course of action that you may take-
A. 2et a thorough history of the client# focusing on the practice of high risk behaiors.
B. Ask the client to be accompanied by a significant person before reealing the result.
!. .efer the client to the physician since he is the best person to reeal the result to the client.
$. .efer the client for a supplementary test# such as ,estern blot# since the 70"5A result may be
false.
Answer: %$& .efer the client for a supplementary test# such as ,estern blot# since the 70"5A result
may be false.
A client haing a reactie 70"5A result must undergo a more specific test# such as ,estern blot. A
negatie supplementary test result means that the 70"5A result was false and that# most probably# the
client is not infected.
1:+. ,hich is the B75T control measure for A"$5-
A. Being faithful to a single se=ual partner
B. 6sing a condom during each se=ual contact
!. Aoiding se=ual contact with commercial se= workers
$. Making sure that one9s se=ual partner does not hae signs of A"$5
Answer: %A& Being faithful to a single se=ual partner
5e=ual fidelity rules out the possibility of getting the disease by se=ual contact with another infected
person. Transmission occurs mostly through se=ual intercourse and e=posure to blood or tissues.
1:/. The most fre>uent causes of death among clients with A"$5 are opportunistic diseases. ,hich
of the following opportunistic infections is characterized by tonsillopharyngitis-
A. .espiratory candidiasis
B. "nfectious mononucleosis
!. !ytomegaloirus disease
$. (neumocystis carinii pneumonia
Answer: %B& "nfectious mononucleosis
!ytomegaloirus disease is an acute iral disease characterized by feer# sore throat and
lymphadenopathy.
1::. To determine possible sources of se=ually transmitted infections# which is the B75T method that
may be undertaken by the public health nurse-
A. !ontact tracing
B. !ommunity surey
!. Mass screening tests
$. "nteriew of suspects
Answer: %A& !ontact tracing
!ontact tracing is the most practical and reliable method of finding possible sources of person-to-
person transmitted infections# such as se=ually transmitted diseases.
1:<. Antiretroiral agents# such as ALT# are used in the management of A"$5. ,hich of the
following is )8T an action e=pected of these drugs.
A. They prolong the life of the client with A"$5.
B. They reduce the risk of opportunistic infections
!. They shorten the period of communicability of the disease.
$. They are able to bring about a cure of the disease condition.
Answer: %$& They are able to bring about a cure of the disease condition.
There is no known treatment for A"$5. Antiretroiral agents reduce the risk of opportunistic
infections and prolong life# but does not cure the underlying immunodeficiency.
1:?. A barangay had an outbreak of 2erman measles. To preent congenital rubella# what is the
B75T adice that you can gie to women in the first trimester of pregnancy in the barangay-
A. Adice them on the signs of 2erman measles.
B. Aoid crowded places# such as markets and moiehouses.
!. !onsult at the health center where rubella accine may be gien.
$. !onsult a physician who may gie them rubella immunoglobulin.
Answer: %$& !onsult a physician who may gie them rubella immunoglobulin.
.ubella accine is made up of attenuated 2erman measles iruses. This is contraindicated in
pregnancy. "mmune globulin# a specific prophylactic against 2erman measles# may be gien to
pregnant women.
1:@. Kou were inited to be the resource person in a training class for food handlers. ,hich of the
following would you emphasize regarding preention of staphylococcal food poisoning-
A. All cooking and eating utensils must be thoroughly washed.
B. Aood must be cooked properly to destroy staphylococcal microorganisms.
!. Aood handlers and food serers must hae a negatie stool e=amination result.
$. (roper handwashing during food preparation is the best way of preenting the condition.
Answer: %$& (roper handwashing during food preparation is the best way of preenting the condition.
5ymptoms of this food poisoning are due to staphylococcal enteroto=in# not the microorganisms
themseles. !ontamination is by food handling by persons with staphylococcal skin or eye infections.
1:B. "n a mothers9 class# you discussed childhood diseases such as chicken po=. ,hich of the
following statements about chicken po= is correct-
A. The older one gets# the more susceptible he becomes to the complications of chicken po=.
B. A single attack of chicken po= will preent future episodes# including conditions such as shingles.
!. To preent an outbreak in the community# >uarantine may be imposed by health authorities.
$. !hicken po= accine is best gien when there is an impending outbreak in the community.
Answer: %A& The older one gets# the more susceptible he becomes to the complications of chicken
po=.
!hicken po= is usually more seere in adults than in children. !omplications# such as pneumonia# are
higher in incidence in adults.
1:C. !omplications to infectious parotitis %mumps& may be serious in which type of clients-
A. (regnant women
B. 7lderly clients
!. Koung adult males
$. Koung infants
Answer: %!& Koung adult males
7pididymitis and orchitis are possible complications of mumps. "n post-adolescent males# bilateral
inflammation of the testes and epididymis may cause sterility.
Philippine NLE Board Exam: Leadership Nursing Question & Answer w/ rationale
LEA(E%S"#P) *ANA'E*EN$) B#+E$"#!S AN( %ESEA%!"
1. Ms. !astro is newly-promoted to a patient care manager position. 5he updates her knowledge on
the theories in management and leadership in order to become effectie in her new role. 5he learns
that some managers hae low concern for serices and high concern for staff. ,hich style of
management refers to this-
A. 8rganization Man
B. "mpoerished Management
!. !ountry !lub Management
$. Team Management
Answer: %!& !ountry !lub Management
!ountry club management style puts concern for the staff as number one priority at the e=pense of the
deliery of serices. 'eGshe runs the department *ust like a country club where eery one is happy
including the manager.
+. 'er former manager demonstrated passion for sering her staff rather than being sered. 5he takes
time to listen# prefers to be a teacher first before being a leader# which is characteristic of
A. Transformational leader
B. Transactional leader
!. 5erant leader
$. !harismatic leader
Answer: %!& 5erant leader
5erant leaders are open-minded# listen deeply# try to fully understand others and not being
*udgmental
/. 8n the other hand# Ms. !astro notices that the !hief )urse 7=ecutie has charismatic leadership
style. ,hich of the following behaiors best describes this style-
A. (ossesses inspirational >uality that makes followers gets attracted of him and regards him with
reerence
B. Acts as he does because he e=pects that his behaior will yield positie results
!. 6ses isioning as the core of his leadership
$. Matches his leadership style to the situation at hand.
Answer: %A& (ossesses inspirational >uality that makes followers gets attracted of him and regards
him with reerence
!harismatic leaders make the followers feel at ease in their presence. They feel that they are in good
hands wheneer the leader is around.
:. ,hich of the following conclusions of Ms. !astro about leadership characteristics is T.67-
A. There is a high correlation between the communication skills of a leader and the ability to get the
*ob done.
B. A manager is effectie when he has the ability to plan well.
!. Assessment of personal traits is a reliable tool for predicting a manager9s potential.
$. There is good eidence that certain personal >ualities faor success in managerial role.
Answer: %!& Assessment of personal traits is a reliable tool for predicting a manager9s potential.
"t is not conclusie that certain >ualities of a person would make him become a good manager. "t can
only predict a manager9s potential of becoming a good one.
<. 5he reads about (ath 2oal theory. ,hich of the following behaiors is manifested by the leader
who uses this theory-
A. .ecognizes staff for going beyond e=pectations by giing them citations
B. !hallenges the staff to take indiidual accountability for their own practice
!. Admonishes staff for being laggards.
$. .eminds staff about the sanctions for non performance.
Answer: %A& .ecognizes staff for going beyond e=pectations by giing them citations
(ath 2oal theory according to 'ouse and associates rewards good performance so that others would
do the same
?. 8ne leadership theory states that 1leaders are born and not made#4 which refers to which of the
following theories-
A. Trait
B. !harismatic
!. 2reat Man
$. 5ituational
Answer: %!& 2reat Man
0eaders become leaders because of their birth right. This is also called 2enetic theory or the
Aristotelian theory
@. 5he came across a theory which states that the leadership style is effectie dependent on the
situation. ,hich of the following styles best fits a situation when the followers are self-directed#
e=perts and arematured indiiduals-
A. $emocratic
B. Authoritarian
!. 0aissez faire
$. Bureaucratic
Answer: %!& 0aissez faire
0aissez faire leadership is preferred when the followers know what to do and are e=perts in the field.
This leadership style is relationship-oriented rather than task-centered.
B. 5he surfs the internet for more information about leadership styles. 5he reads about shared
leadership as a practice in some magnet hospitals. ,hich of the following describes this style of
leadership-
A. 0eadership behaior is generally determined by the relationship between the leader9s personality
and the specific situation
B. 0eaders beliee that people are basically good and need not be closely controlled
!. 0eaders rely heaily on isioning and inspire members to achiee results
$. 0eadership is shared at the point of care.
Answer: %$& 0eadership is shared at the point of care.
5hared goernance allows the staff nurses to hae the authority# responsibility and accountability for
their own practice.
C. Ms. !astro learns that some leaders are transactional leaders. ,hich of the following does )8T
characterize a transactional leader-
A. Aocuses on management tasks
B. "s a caretaker
!. 6ses trade-offs to meet goals
$. "nspires others with ision
Answer: %$& "nspires others with ision
"nspires others with a ision is characteristic of a transformational leader. 'e is focused more on the
day-to-day operations of the departmentGunit.
13. 5he finds out that some managers hae beneolent-authoritatie style of management. ,hich of
the following behaiors will she e=hibit most likely-
A. 'ae condescending trust and confidence in their subordinates
B. 2ies economic or ego awards
!. !ommunicates downward to the staff
$. Allows decision making among subordinates
Answer: %A& 'ae condescending trust and confidence in their subordinates
Beneolent-authoritatie managers pretentiously show their trust and confidence to their followers
11. 'arry is a 6nit Manager " the Medical 6nit. 'e is not satisfied with the way things are going in
his unit. (atient satisfaction rate is ?3P for two consecutie months and staff morale is at its lowest.
'e decides to plan and initiate changes that will push for a turnaround in the condition of the unit.
,hich of the following actions is a priority for 'arry-
A. !all for a staff meeting and take this up in the agenda.
B. 5eek help from her manager.
!. $eelop a strategic action on how to deal with these concerns.
$. "gnore the issues since these will be resoled naturally.
Answer: %A& !all for a staff meeting and take this up in the agenda.
This will allow for the participation of eery staff in the unit. "f they contribute to the solutions of the
problem# they will own the solutions; hence the chance for compliance would be greater.
1+. 5he knows that there are e=ternal forces that influence changes in his unit. ,hich of the following
is )8T an e=ternal force-
A. Memo from the !78 to cut down on electrical consumption
B. $emands of the labor sector to increase wages
!. 0ow morale of staff in her unit
$. 7=acting regulatory and accreditation standards
Answer: %!& 0ow morale of staff in her unit
0ow morale of staff is an internal factor that affects only the unit. All the rest of the options emanate
from the top e=ecutie or from outside the institution.
1/. After discussing the possible effects of the low patient satisfaction rate# the staff started to list
down possible strategies to sole the problems head-on. 5hould they decide to ote on the best
change strategy# which of the following strategies is referred to this-
A. !ollaboration
B. Ma*ority rule
!. $ominance
$. !ompromise
Answer: %B& Ma*ority rule
Ma*ority rule inoles diiding the house and the highest ote wins.1G+ T 1 is a ma*ority.
1:. 8ne staff suggests that they reiew the pattern of nursing care that they are using# which is
described as a
A. *ob description
B. system used to delier care
!. manual of procedure
$. rules to be followed
Answer: %B& system used to delier care
A system used to delier care. "n the @39s it was termed as methods of patient assignment; in the early
B39s it was called modalities of patient care then patterns of nursing care in the C39s until recently
authors called it nursing care systems.
1<. ,hich of the following is T.67 about functional nursing-
A. !oncentrates on tasks and actiities
B. 7mphasizes use of group collaboration
!. 8ne-to-one nurse-patient ratio
$. (roides continuous# coordinated and comprehensie nursing serices
Answer: %A& !oncentrates on tasks and actiities
Aunctional nursing is focused on tasks and actiities and not on the holistic care of the patients
1?. Aunctional nursing has some adantages# which one is an 7E!7(T"8)-
A. (sychological and sociological needs are emphasized.
B. 2reat control of work actiities.
!. Most economical way of deliering nursing serices.
$. ,orkers feel secure in dependent role
Answer: %A& (sychological and sociological needs are emphasized.
,hen the functional method is used# the psychological and sociological needs of the patients are
neglected; the patients are regarded as Utasks to be done U
1@. 'e raised the issue on giing priority to patient needs. ,hich of the following offers the best way
for setting priority-
A. Assessing nursing needs and problems
B. 2iing instructions on how nursing care needs are to be met
!. !ontrolling and ealuating the deliery of nursing care
$. Assigning safe nurse: patient ratio
Answer: %A& Assessing nursing needs and problems
This option follows the framework of the nursing process at the same time applies the management
process of planning# organizing# directing and controlling
1B. ,hich of the following is the best guarantee that the patient9s priority needs are met-
A. !hecking with the relatie of the patient
B. (reparing a nursing care plan in collaboration with the patient
!. !onsulting with the physician
$. !oordinating with other members of the team
Answer: %B& (reparing a nursing care plan in collaboration with the patient
The best source of information about the priority needs of the patient is the patient himself. 'ence
using a nursing care plan based on his e=pressed priority needs would ensure meeting his needs
effectiely.
1C. ,hen 'arry uses team nursing as a care deliery system# he and his team need to assess the
priority of care for a group of patients# which of the following should be a priority-
A. 7ach patient as listed on the worksheet
B. (atients who needs least care
!. Medications and treatments re>uired for all patients
$. (atients who need the most care
Answer: %$& (atients who need the most care
"n setting priorities for a group of patients# those who need the most care should be number-one
priority to ensure that their critical needs are met ade>uately. The needs of other patients who need
less care ca be attended to later or een delegated to assistie personnel according to rules on
delegation.
+3. 5he is hopeful that her unit will make a big turnaround in the succeeding months. ,hich of the
following actions of 'arry demonstrates that he has reached the third stage of change-
A. ,onders why things are not what it used to be
B. Ainds solutions to the problems
!. "ntegrate the solutions to his day-to-day actiities
$. 5elects the best change strategy
Answer: %!& "ntegrate the solutions to his day-to-day actiities
"ntegrate the solutions to his day-to-day actiities is a e=pected to happen during the third stage of
change when the change agent incorporate the selected solutions to his system and begins to create a
change.
+1. Vulius is a newly-appointed nurse manager of The 2ood 5hepherd Medical !enter# a tertiary
hospital located within the heart of the metropolis. 'e thinks of scheduling planning workshop with
his staff in order to ensure an effectie and efficient management of the department. 5hould he decide
to conduct a strategic planning workshop# which of the following is )8T a characteristic of this
actiity-
A. 0ong-term goal-setting
B. 7=tends to /-< years in the future
!. Aocuses on routine tasks
$. $etermines directions of the organization
Answer: %!& Aocuses on routine tasks
5trategic planning inoles options A# B and $ e=cept ! which is attributed to operational planning
++. ,hich of the following statements refer to the ision of the hospital-
A. The 2ood 5hepherd Medical !enter is a trendsetter in tertiary health care in the (hilippines in the
ne=t fie years
B. The officers and staff of The 2ood 5hepherd Medical !enter beliee in the uni>ue nature of the
human person
!. All the nurses shall undergo continuing competency training program.
$. The 2ood 5hepherd Medical !enter aims to proide a patient-centered care in a total healing
enironment.
Answer: %A& The 2ood 5hepherd Medical !enter is a trendsetter in tertiary health care in the
(hilippines in the ne=t fie years
A ision refers to what the institution wants to become within a particular period of time.
+/. The statement# 1The 2ood 5hepherd Medical !enter aims to proide patient-centered care in a
total healing enironment4 refers to which of the following-
A. Jision
B. 2oal
!. (hilosophy
$. Mission
Answer: %B& 2oal
B
+:. Vulius plans to reisit the organizational chart of the department. 'e plans to create a new position
of a (atient 7ducator who has a coordinating relationship with the head nurse in the unit. ,hich of
the following will likely depict this organizational relationship-
A. Bo=
B. 5olid line
!. Broken line
$. $otted line
Answer: %!& Broken line
This is a staff relationship hence it is depicted by a broken line in the organizational structure
+<. 'e likewise stresses the need for all the employees to follow orders and instructions from him and
not from anyone else. ,hich of the following principles does he refer to-
A. 5calar chain
B. $iscipline
!. 6nity of command
$. 8rder
Answer: %!& 6nity of command
The principle of unity of command means that employees should receie orders coming from only
one manager and not from two managers. This aerts the possibility of sowing confusion among the
members of the organization
+?. Vulius orients his staff on the patterns of reporting relationship throughout the organization.
,hich of the following principles refer to this-
A. 5pan of control
B. 'ierarchy
!. 7sprit d9 corps
$. 6nity of direction
Answer: %B& 'ierarchy
'ierarchy refers to the pattern of reporting or the formal line of authority in an organizational
structure.
+@. 'e emphasizes to the team that they need to put their efforts together towards the attainment of
the goals of the program. ,hich of the following principles refers to this-
A. 5pan of control
B. 6nity of direction
!. 6nity of command
$. !ommand responsibility
Answer: %B& 6nity of direction
6nity of direction means haing one goal or one ob*ectie for the team to pursue; hence all members
of the organization should put their efforts together towards the attainment of their common goal or
ob*ectie.
+B. Vulius stresses the importance of promoting Uesprit d corps9 among the members of the unit.
,hich of the following remarks of the staff indicates that they understand what he pointed out-
A. 10et9s work together in harmony; we need to be supportie of one another4
B. 1"n order that we achiee the same results; we must all follow the directies of Vulius and not from
other managers.4
!. 1,e will ensure that all the resources we need are aailable when needed.4
$. 1,e need to put our efforts together in order to raise the bar of e=cellence in the care we proide
to all our patients.4
Answer: %A& 10et9s work together in harmony; we need to be supportie of one another4
The principle of Uesprit d9 corps9 refers to promoting harmony in the workplace# which is essential in
maintaining a climate conducie to work.
+C. 'e discusses the goal of the department. ,hich of the following statements is a goal-
A. "ncrease the patient satisfaction rate
B. 7liminate the incidence of delayed administration of medications
!. 7stablish rapport with patients.
$. .educe response time to two minutes.
Answer: %A& "ncrease the patient satisfaction rate
2oal is a desired result towards which efforts are directed. 8ptions AB# ! and $ are all ob*ecties
which are aimed at specific end.
/3. 'e wants to influence the customary way of thinking and behaing that is shared by the members
of the department. ,hich of the following terms refer to this-
A. 8rganizational chart
B. !ultural network
!. 8rganizational structure
$. 8rganizational culture
Answer: %$& 8rganizational culture
An organizational culture refers to the way the members of the organization think together and do
things around them together. "t9s their way of life in that organization
/1. 'e asserts the importance of promoting a positie organizational culture in their unit. ,hich of
the following behaiors indicate that this is attained by the group-
A. (roactie and caring with one another
B. !ompetitie and perfectionist
!. (owerful and oppositional
$. 8bedient and uncomplaining
Answer: %A& (roactie and caring with one another
(ositie culture is based on humanism and affiliatie norms
/+. 5tephanie is a new 5taff 7ducator of a priate tertiary hospital. 5he conducts orientation among
new staff nurses in her department. Voseph# one of the new staff nurses# wants to understand the
channel of communication# span of control and lines of communication. ,hich of the following will
proide this information-
A. 8rganizational structure
B. (olicy
!. Vob description
$. Manual of procedures
Answer: %A& 8rganizational structure
8rganizational structure proides information on the channel of authority# i.e.# who reports to whom
and with what authority; the number of people who directly reports to the arious leels of hierarchy
and the lines of communication whether line or staff.
//. 5tephanie is often seen interacting with the medical intern during coffee breaks and after duty
hours. ,hat type of organizational structure is this-
A. Aormal
B. "nformal
!. 5taff
$. 0ine
Answer: %B& "nformal
This is usually not published and oftentimes concealed.
/:. 5he takes pride in saying that the hospital has a decentralized structure. ,hich of the following is
)8T compatible with this type of model-
A. Alat organization
B. (articipatory approach
!. 5hared goernance
$. Tall organization
Answer: %$& Tall organization
Tall organizations are highly centralized organizations where decision making is centered on one
authority leel.
/<. !entralized organizations hae some adantages. ,hich of the following statements are T.67-
1. 'ighly cost-effectie
+. Makes management easier
/. .eflects the interest of the worker
:. Allows >uick decisions or actions.
A. 1 W +
B. + W :
!. +# /W :
$. 1# +# W :
Answer: %A& 1 W +
!entralized organizations are needs only a few managers hence they are less e=pensie and easier to
manage
/?. 5tephanie delegates effectiely if she has authority to act# which is B75T defined as:
A. haing responsibility to direct others
B. being accountable to the organization
!. haing legitimate right to act
$. telling others what to do
Answer: %!& haing legitimate right to act
Authority is a legitimate or official right to gie command. This is an officially sanctioned
responsibility
/@. .egardless of the size of a work group# enough staff must be aailable at all times to accomplish
certain purposes. ,hich of these purposes in )8T included-
A. Meet the needs of patients
B. (roide a pair of hands to other units as needed
!. !oer all time periods ade>uately.
$. Allow for growth and deelopment of nursing staff.
Answer: %B& (roide a pair of hands to other units as needed
(roiding a pair of hands for other units is not a purpose in doing an effectie staffing process. This is
a function of a staffing coordinator at a centralized model.
/B. ,hich of the following guidelines should be least considered in formulating ob*ecties for
nursing care-
A. ,ritten nursing care plan
B. 'olistic approach
!. (rescribed standards
$. 5taff preferences
Answer: %$& 5taff preferences
5taff preferences should be the least priority in formulating ob*ecties of nursing care. "ndiidual
preferences should be subordinate to the interest of the patients.
:1. 5tephanie considers shifting to transformational leadership. ,hich of the following statements
best describes this type of leadership-
A. 6ses isioning as the essence of leadership.
B. 5eres the followers rather than being sered.
!. Maintains full trust and confidence in the subordinates
$. (ossesses innate charisma that makes others feel good in his presence.
Answer: %A& 6ses isioning as the essence of leadership.
Transformational leadership relies heaily on isioning as the core of leadership.
:+. As a manager# she focuses her energy on both the >uality of serices rendered to the patients as
well as the welfare of the staff of her unit. ,hich of the following management styles does she
adopt-
A. !ountry club management
B. 8rganization man management
!. Team management
$. Authority-obedience management
Answer: %!& Team management
Team management has a high concern for serices and high concern for staff.
:/. Iatherine is a young 6nit Manager of the (ediatric ,ard. Most of her staff nurses are senior to
her# ery articulate# confident and sometimes aggressie. Iatherine feels uncomfortable belieing
that she is the scapegoat of eerything that goes wrong in her department. ,hich of the following is
the best action that she must take-
A. "dentify the source of the conflict and understand the points of friction
B. $isregard what she feels and continue to work independently
!. 5eek help from the $irector of )ursing
$. Huit her *ob and look for another employment.
Answer: %A& "dentify the source of the conflict and understand the points of friction
This inoles a problem soling approach# which addresses the root cause of the problem.
::. As a young manager# she knows that conflict occurs in any organization. ,hich of the following
statements regarding conflict is )8T true-
A. !an be destructie if the leel is too high
B. "s not beneficial; hence it should be preented at all times
!. May result in poor performance
$. May create leaders
Answer: %B& "s not beneficial; hence it should be preented at all times
!onflicts are beneficial because it surfaces out issues in the open and can be soled right away.
0ikewise# members of the team become more conscientious with their work when they are aware that
other members of the team are watching them.
:<. Iatherine tells one of the staff# 1" don9t hae time to discuss the matter with you now. 5ee me in
my office later4 when the latter asks if they can talk about an issue. ,hich of the following conflict
resolution strategies did she use-
A. 5moothing
B. !ompromise
!. Aoidance
$. .estriction
Answer: %!& Aoidance
This strategy shuns discussing the issue head-on and prefers to postpone it to a later time. "n effect
the problem remains unsoled and both parties are in a lose-lose situation.
:?. Iathleen knows that one of her staff is e=periencing burnout. ,hich of the following is the best
thing for her to do-
A. Adise her staff to go on acation.
B. "gnore her obserations; it will be resoled een without interention
!. .emind her to show loyalty to the institution.
$. 0et the staff entilate her feelings and ask how she can be of help.
Answer: %$& 0et the staff entilate her feelings and ask how she can be of help.
.eaching out and helping the staff is the most effectie strategy in dealing with burn out. Inowing
that someone is ready to help makes the staff feel important; hence her self-worth is enhanced.
:@. 5he knows that performance appraisal consists of all the following actiities 7E!7(T:
A. 5etting specific standards and actiities for indiidual performance.
B. 6sing agency standards as a guide.
!. $etermine areas of strength and weaknesses
$. Aocusing actiity on the correction of identified behaior.
Answer: %$& Aocusing actiity on the correction of identified behaior.
(erformance appraisal deal with both positie and negatie performance; is not meant to be a fault-
finding actiity
:B. ,hich of the following statements is )8T true about performance appraisal-
A. "nforming the staff about the specific impressions of their work help improe their performance.
B. A erbal appraisal is an acceptable substitute for a written report
!. (atients are the best source of information regarding personnel appraisal.
$. The outcome of performance appraisal rests primarily with the staff.
Answer: %!& (atients are the best source of information regarding personnel appraisal.
The patient can be a source of information about the performance of the staff but it is neer the best
source. $irectly obsering the staff is the best source of information for personnel appraisal.
:C. There are times when Iatherine ealuates her staff as she makes her daily rounds. ,hich of the
following is )8T a benefit of conducting an informal appraisal-
A. The staff member is obsered in natural setting.
B. "ncidental confrontation and collaboration is allowed.
!. The ealuation is focused on ob*ectie data systematically.
$. The ealuation may proide alid information for compilation of a formal report.
Answer: %!& The ealuation is focused on ob*ectie data systematically.
!ollecting ob*ectie data systematically can not be achieed in an informal appraisal. "t is focused on
what actually happens in the natural work setting.
<3. 5he conducts a ?-month performance reiew session with a staff member. ,hich of the following
actions is appropriate-
A. 5he asks another nurse to attest the session as a witness.
B. 5he informs the staff that she may ask another nurse to read the appraisal before the session is
oer.
!. 5he tells the staff that the session is manager-centered.
$. The session is priate between the two members.
Answer: %$& The session is priate between the two members.
The session is priate between the manager and the staff and remains to be so when the two parties
do not diulge the information to others.
<1. Ale=andra is tasked to organize the new wing of the hospital. 5he was gien the authority to do as
she deems fit. <1. 5he is aware that the director of nursing has substantial trust and confidence in her
capabilities# communicates through downward and upward channels and usually uses the ideas and
opinions of her staff. ,hich of the following is her style of management-
A. Beneolent Fauthoritatie
B. !onsultatie
!. 7=ploitie-authoritatie
$. (articipatie
Answer: %B& !onsultatie
A consultatie manager is almost like a participatie manager. The participatie manager has
complete trust and confidence in the subordinate# always uses the opinions and ideas of subordinates
and communicates in all directions.
<+. 5he decides to illustrate the organizational structure. ,hich of the following elements is )8T
included-
A. 0eel of authority
B. 0ines of communication
!. 5pan of control
$. 6nity of direction
Answer: %$& 6nity of direction
6nity of direction is a management principle# not an element of an organizational structure.
</. 5he plans of assigning competent people to fill the roles designed in the hierarchy. ,hich process
refers to this-
A. 5taffing
B. 5cheduling
!. .ecruitment
$. "nduction
Answer: %A& 5taffing
5taffing is a management function inoling putting the best people to accomplish tasks and
actiities to attain the goals of the organization.
<:. 5he checks the documentary re>uirements for the applicants for staff nurse position. ,hich one is
)8T necessary-
A. !ertificate of preious employment
B. .ecord of related learning e=perience %.07&
!. Membership to accredited professional organization
$. (rofessional identification card
Answer: %B& .ecord of related learning e=perience %.07&
.ecord of .07 is not re>uired for employment purposes but it is re>uired for the nurse9s licensure
e=amination.
<<. ,hich phase of the employment process includes getting on the payroll and completing
documentary re>uirements-
A. 8rientation
B. "nduction
!. 5election
$. .ecruitment
Answer: %B& "nduction
This step in the recruitment process gies time for the staff to submit all the documentary
re>uirements for employment.
<?. 5he tries to design an organizational structure that allows communication to flow in all directions
and inole workers in decision making. ,hich form of organizational structure is this-
A. !entralized
B. $ecentralized
!. Matri=
$. "nformal
Answer: %B& $ecentralized
$ecentralized structures allow the staff to make decisions on matters pertaining to their practice and
communicate in downward# upward# lateral and diagonal flow.
<@. "n a horizontal chart# the lowest leel worker is located at the
A. 0eftmost bo=
B. Middle
!. .ightmost bo=
$. Bottom
Answer: %!& .ightmost bo=
The leftmost bo= is occupied by the highest authority while the lowest leel worker occupies the
rightmost bo=.
<B. 5he decides to hae a decentralized staffing system. ,hich of the following is an adantage of
this system of staffing-
A. greater control of actiities
B. !onseres time
!. !ompatible with computerization
$. (romotes better interpersonal relationship
Answer: %$& (romotes better interpersonal relationship
$ecentralized structures allow the staff to sole decisions by themseles# inole them in decision
making; hence they are always gien opportunities to interact with one another.
<C. Aubrey thinks about primary nursing as a system to delier care. ,hich of the following actiities
is )8T done by a primary nurse-
A. !ollaborates with the physician
B. (roides care to a group of patients together with a group of nurses
!. (roides care for <-? patients during their hospital stay.
$. (erforms comprehensie initial assessment
Answer: %B& (roides care to a group of patients together with a group of nurses
This function is done in team nursing where the nurse is a member of a team that proides care for a
group of patients.
?3. ,hich pattern of nursing care inoles the care gien by a group of paraprofessional workers led
by a professional nurse who take care of patients with the same disease conditions and are located
geographically near each other-
A. !ase method
B. Modular nursing
!. )ursing case management
$. Team nursing
Answer: %B& Modular nursing
Modular nursing is a ariant of team nursing. The difference lies in the fact that the members in
modular nursing are paraprofessional workers.
?1. 5t. .aphael Medical !enter *ust opened its new (erformance "mproement $epartment. Ms.
Jalencia is appointed as the Huality !ontrol 8fficer. 5he commits herself to her new role and plans
her strategies to realize the goals and ob*ecties of the department. ,hich of the following is a
primary task that they should perform to hae an effectie control system-
A. Make an interpretation about strengths and weaknesses
B. "dentify the alues of the department
!. "dentify structure# process# outcome standards W criteria
$. Measure actual performances
Answer: %B& "dentify the alues of the department
"dentify the alues of the department will set the guiding principles within which the department will
operate its actiities
?+. Ms. Jalencia deelops the standards to be followed. Among the following standards# which is
considered as a structure standard-
A. The patients erbalized satisfaction of the nursing care receied
B. .otation of duty will be done eery four weeks for all patient care personnel.
!. All patients shall hae their weights taken recorded
$. (atients shall answer the ealuation form before discharge
Answer: %B& .otation of duty will be done eery four weeks for all patient care personnel.
5tructure standards include management system# facilities# e>uipment# materials needed to delier
care to patients. .otation of duty is a management system.
?/. ,hen she presents the nursing procedures to be followed# she refers to what type of standards-
A. (rocess
B. 8utcome
!. 5tructure
$. !riteria
Answer: %A& (rocess
(rocess standards include care plans# nursing procedure to be done to address the needs of the
patients.
?:. The following are basic steps in the controlling process of the department. ,hich of the following
is )8T included-
A. Measure actual performance
B. 5et nursing standards and criteria
!. !ompare results of performance to standards and ob*ecties
$. "dentify possible courses of action
Answer: %$& "dentify possible courses of action
This is a step in a >uality control process and not a basic step in the control process.
?<. ,hich of the following statements refers to criteria-
A. Agreed on leel of nursing care
B. !haracteristics used to measure the leel of nursing care
!. 5tep-by-step guidelines
$. 5tatement which guide the group in decision making and problem soling
Answer: %B& !haracteristics used to measure the leel of nursing care
!riteria are specific characteristics used to measure the standard of care.
??. 5he wants to ensure that eery task is carried out as planned. ,hich of the following tasks is
)8T included in the controlling process-
A. "nstructing the members of the standards committee to prepare policies
B. .eiewing the e=isting policies of the hospital
!. 7aluating the credentials of all nursing staff
$. !hecking if actiities conform to schedule
Answer: %A& "nstructing the members of the standards committee to prepare policies
"nstructing the members inoles a directing function.
?@. Ms. Jalencia prepares the process standards. ,hich of the following is )8T a process standard-
A. "nitial assessment shall be done to all patients within twenty four hours upon admission.
B. "nformed consent shall be secured prior to any inasie procedure
!. (atients9 reports C<P satisfaction rate prior to discharge from the hospital.
$. (atient education about their illness and treatment shall be proided for all patients and their
families.
Answer: %!& (atients9 reports C<P satisfaction rate prior to discharge from the hospital.
This refers to an outcome standard# which is a result of the care that is rendered to the patient.
?B. ,hich of the following is eidence that the controlling process is effectie-
A. The things that were planned are done
B. (hysicians do not complain.
!. 7mployees are contended
$. There is an increase in customer satisfaction rate.
Answer: %A& The things that were planned are done
!ontrolling is defined as seeing to it that what is planned is done.
?C. Ms. Jalencia is responsible to the number of personnel reporting to her. This principle refers to:
A. 5pan of control
B. 6nity of command
!. !arrot and stick principle
$. 7sprit d9 corps
Answer: %A& 5pan of control
5pan of control refers to the number of workers who report directly to a manager.
@3. 5he notes that there is an increasing unrest of the staff due to fatigue brought about by shortage of
staff. ,hich action is a priority-
A. 7aluate the oerall result of the unrest
B. "nitiate a group interaction
!. $eelop a plan and implement it
$. "dentify e=ternal and internal forces.
Answer: %B& "nitiate a group interaction
"nitiate a group interaction will be an opportunity to discuss the problem in the open.
@1. Iein is a member of the )ursing .esearch !ouncil of the hospital. 'is first assignment is to
determine the leel of patient satisfaction on the care they receied from the hospital. 'e plans to
include all adult patients admitted from April to May# with aerage length of stay of /-: days# first
admission# and with no complications. ,hich of the following is an e=traneous ariable of the study-
A. $ate of admission
B. 0ength of stay
!. Age of patients
$. Absence of complications
Answer: %!& Age of patients
An e=traneous ariable is not the primary concern of the researcher but has an effect on the results of
the study. Adult patients may be young# middle or late adult.
@+. 'e thinks of an appropriate theoretical framework. ,hose theory addresses the four modes of
adaptation-
A. Martha .ogers
B. 5r. !allista .oy
!. Alorence )ightingale
$. Vean ,atson
Answer: %B& 5r. !allista .oy
5r. !allista .oy deeloped the Adaptation Model which inoles the physiologic mode# self-concept
mode# role function mode and dependence mode
@/. 'e opts to use a self-report method. ,hich of the following is )8T T.67 about this method-
A. Most direct means of gathering information
B. Jersatile in terms of content coerage
!. Most accurate and alid method of data gathering
$. Kields information that would be difficult to gather by another method
Answer: %!& Most accurate and alid method of data gathering
The most serious disadantage of this method is accuracy and alidity of information gathered
@:. ,hich of the following articles would Iein least consider for his reiew of literature-
A. 15tory-Telling and An=iety .eduction Among (ediatric (atients4
B. 1Turnaround Time in 7mergency .ooms4
!. 18utcome 5tandards in Tertiary 'ealth !are "nstitutions4
$. 17nironmental Manipulation and !lient 8utcomes4
Answer: %B& 1Turnaround Time in 7mergency .ooms4
The article is for pediatric patients and may not be releant for adult patients.
@<. ,hich of the following ariables will he likely 7E!06$7 in his study-
A. !ompetence of nurses
B. !aring attitude of nurses
!. 5alary of nurses
$. .esponsieness of staff
Answer: %!& 5alary of nurses
5alary of staff nurses is not an indicator of patient satisfaction# hence need not be included as a
ariable in the study.
@?. 'e plans to use a 0ikert 5cale to determine
A. degree of agreement and disagreement
B. compliance to e=pected standards
!. leel of satisfaction
$. degree of acceptance
Answer: %A& degree of agreement and disagreement
0ikert scale is a <-point summated scale used to determine the degree of agreement or disagreement
of the respondents to a statement in a study.
@@. 'e checks if his instruments meet the criteria for ealuation. ,hich of the following criteria
refers to the consistency or the ability to yield the same response upon its repeated administration-
A. Jalidity
B. .eliability
!. 5ensitiity
$. 8b*ectiity
Answer: %B& .eliability
.eliability is repeatability of the instrument; it can elicit the same responses een with aried
administration of the instrument
@B. ,hich criteria refer to the ability of the instrument to detect fine differences among the sub*ects
being studied-
A. 5ensitiity
B. .eliability
!. Jalidity
$. 8b*ectiity
Answer: %A& 5ensitiity
5ensitiity is an attribute of the instrument that allow the respondents to distinguish differences of the
options where to choose from
@C. ,hich of the following terms refer to the degree to which an instrument measures what it is
supposed to be measure-
A. Jalidity
B. .eliability
!. Meaningfulness
$. 5ensitiity
Answer: %A& Jalidity
Jalidity is ensuring that the instrument contains appropriate >uestions about the research topic
B3. 'e plans for his sampling method. ,hich sampling method gies e>ual chance to all units in the
population to get picked-
A. .andom
B. Accidental
!. Huota
$. Vudgment
Answer: %A& .andom
.andom sampling gies e>ual chance for all the elements in the population to be picked as part of the
sample.
B1. .aphael is interested to learn more about transcultural nursing because he is assigned at the
family suites where most patients come from different cultures and countries. ,hich of the following
designs is appropriate for this study-
A. 2rounded theory
B. 7thnography
!. !ase study
$. (henomenology
Answer: %B& 7thnography
7thnography is focused on patterns of behaior of selected people within a culture
B+. The nursing theorist who deeloped transcultural nursing theory is
A. $orothea 8rem
B. Madeleine 0eininger
!. Betty )ewman
$. 5r. !allista .oy
Answer: %B& Madeleine 0eininger
Madeleine 0eininger deeloped the theory on transcultural theory based on her obserations on the
behaior of selected people within a culture
B/. ,hich of the following statements best describes a phenomenological study-
A. "noles the description and interpretation of cultural behaior
B. Aocuses on the meaning of e=periences as those who e=perience it
!. "noles an in-depth study of an indiidual or group
$. "noles collecting and analyzing data that aims to deelop theories grounded in real-world
obserations
Answer: %B& Aocuses on the meaning of e=periences as those who e=perience it
(henomenological study inoles understanding the meaning of e=periences as those who
e=perienced the phenomenon.
B:. 'e systematically plans his sampling plan. 5hould he decides to include whoeer patients are
admitted during the study he uses what sampling method-
A. Vudgment
B. Accidental
!. .andom
$. Huota
Answer: %B& Accidental
Accidental sampling is a non-probability sampling method which includes those who are at the site
during data collection.
B<. 'e finally decides to use *udgment sampling. ,hich of the following actions of .aphael is
correct-
A. (lans to include whoeer is there during his study.
B. $etermines the different nationality of patients fre>uently admitted and decides to get
representations samples from each.
!. Assigns numbers for each of the patients# place these in a fishbowl and draw 13 from it.
$. $ecides to get +3 samples from the admitted patients
Answer: %B& $etermines the different nationality of patients fre>uently admitted and decides to get
representations samples from each.
Vudgment sampling inoles including samples according to the knowledge of the inestigator about
the participants in the study.
B?. 'e knows that certain patients who are in a specialized research setting tend to respond
psychologically to the conditions of the study. This is referred to as
A. Bias
B. 'awthorne effect
!. 'alo effect
$. 'orns effect
Answer: %B& 'awthorne effect
'awthorne effect is based on the study of 7lton Mayo and company about the effect of an
interention done to improe the working conditions of the workers on their productiity. "t resulted
to an increased productiity but not due to the interention but due to the psychological effects of
being obsered. They performed differently because they were under obseration.
B@. ,hich of the following items refer to the sense of closure that .aphael e=periences when data
collection ceases to yield any new information-
A. 5aturation
B. (recision
!. 0imitation
$. .eleance
Answer: %A& 5aturation
5aturation is achieed when the inestigator can not e=tract new responses from the informants# but
instead# gets the same responses repeatedly.
BB. "n >ualitatie research the actual analysis of data begins with:
A. search for themes
B. alidation of thematic analysis
!. weae the thematic strands together
$. >uasi statistics
Answer: %A& search for themes
The inestigator starts data analysis by looking for themes from the erbatim responses of the
informants.
BC. .aphael is also interested to know the coping abilities of patients who are newly diagnosed to
hae terminal cancer. ,hich of the following types of research is appropriate-
A. (henomenological
B. 7thnographic
!. 2rounded Theory
$. !ase 5tudy
Answer: %!& 2rounded Theory
2rounded theory inductiely deelops a theory based on the obsered processes inoling selected
people
C3. ,hich of the following titles of the study is appropriate for this study-
A. 0ied 7=periences of Terminally-"ll !ancer (atients
B. !oping 5kills of Terminally-"ll !ancer (atients in a 5elected 'ospital
!. Two !ase 5tudies of Terminally-"ll (atients in Manila
$. Beliefs W (ractices of (atients with Terminal !ancer
Answer: %B& !oping 5kills of Terminally-"ll !ancer (atients in a 5elected 'ospital
The title has a specific phenomenon# sample and research locale.
C1. Ms. Montana plans to conduct a research on the use of a new method of pain assessment scale.
,hich of the following is the second step in the conceptualizing phase of the research process-
A. Aormulating the research hypothesis
B. .eiew related literature
!. Aormulating and delimiting the research problem
$. $esign the theoretical and conceptual framework
Answer: %B& .eiew related literature
After formulating and delimiting the research problem# the researcher conducts a reiew of related
literature to determine the e=tent of what has been done on the study by preious researchers.
C+. ,hich of the following codes of research ethics re>uires informed consent in all cases goerning
human sub*ects-
A. 'elsinki $eclaration
B. )uremberg !ode
!. Belmont .eport
$. "!) !ode of 7thics
Answer: %A& 'elsinki $eclaration
'elsinki $eclaration is the first international attempt to set up ethical standards in research inoling
human research sub*ects.
C/. ,hich of the following ethical principles was )8T articulated in the Belmont .eport-
A. Beneficence
B. .espect for human dignity
!. Vustice
$. )on-maleficence
Answer: %$& )on-maleficence
)on-maleficence is not articulated in the Belmont .eport. "t only includes beneficence# respect for
human dignity and *ustice.
/C. ,hich one of the following criteria should be considered as a top priority in nursing care-
A. Aoidance of destructie changes
B. (reseration of life
!. Assurance of safety
$. (reseration of integrity
Answer: %B& (reseration of life
The preseration of life at all cost is a primary responsibility of the nurse. This is embodied in the
!ode of 7thics for registered nurses % B8) .esolution ++3 s. +33:&.
:3. ,hich of the following procedures ensures that the inestigator has fully described to prospectie
sub*ects the nature of the study and the sub*ectXs rights-
A. $ebriefing
B. Aull disclosure
!. "nformed consent
$. !oer data collection
Answer: %B& Aull disclosure
Aull disclosure is giing the sub*ects of the research information that they desere to know prior to
the conduct of the study.
C:. After the reiew session has been completed# Iaren and the staff signed the document. ,hich of
the following is the purpose of this-
A. Agree about the content of the ealuation.
B. 5ignify disagreement of the content of the ealuation.
!. $ocument that Iaren and the staff reiewed the ealuation.
$. 5ere as basis for future ealuation.
Answer: %!& $ocument that Iaren and the staff reiewed the ealuation.
5igning the document is done to sere as a proof that performance reiew was conducted during that
date and time.
C<. A nurse who would like to practice nursing in the (hilippines can obtain a license to practice by:
A. (aying the professional ta= after taking the board e=ams
B. (assing the board e=ams and taking the oath of professionals
!. (aying the e=amination fee before taking the board e=ams
$. 6ndergoing the interiew conducted by the Board of )ursing and taking the board e=ams
Answer: %B& (assing the board e=ams and taking the oath of professionals
Aor a nurse to obtain a license to practice nursing in the (hilippines# sGhe must pass the board
e=aminations and then take the oath of professionals before the Board of )ursing.
C?. .eciprocity of license to practice re>uires that the country of origin of the interested foreign nurse
complies with the following conditions:
A. The country of origin has similar preparation for a nurse and has laws allowing Ailipino nurses to
practice in their country.
B. The (hilippines is recognized by the country of origin as one that has high >uality of nursing
education
!. The country of origin re>uires Ailipinos to take their own board e=amination
$. The country of origin e=empts Ailipinos from passing their licensure e=amination
Answer: %A& The country of origin has similar preparation for a nurse and has laws allowing Ailipino
nurses to practice in their country.
According to the (hilippine )urses Act of +33+# foreign nurses wanting to practice in the (hilippines
must show proof that hisGher country of origin meets the two essential conditions: a& the re>uirements
for registration between the two countries are substantially the same; and b& the country of origin of
the foreign nurse has laws allowing the Ailipino nurse to practice in hisGher country *ust like its own
citizens.
C@. )urses practicing the profession in the (hilippines and are employed in goernment hospitals are
re>uired to pay ta=es such as:
A. Both income ta= and professional ta=
B. "ncome ta= only since they are e=empt from paying professional ta=
!. (rofessional ta= which is paid by all nurses employed in both goernment and priate hospitals
$. "ncome ta= which paid eery March 1< and professional ta= which is paid eery Vanuary /1.
Answer: %B& "ncome ta= only since they are e=empt from paying professional ta=
According to the Magna !arta for (ublic 'ealth ,orkers# goernment nurses are e=empted from
paying professional ta=. 'ence# as an employee in the goernment# sGhe will pay only the income ta=.
CB. According to .A C1@/ (hilippine )ursing Act of +33+# a graduate nurse who wants to take must
licensure e=amination must comply with the following >ualifications:
A. At least +1 years old# graduate of B5) from a recognized school# and of good moral character
B. At least 1B years old# graduate of B5) from a recognized school and of good moral character
!. At least 1B years old# proided that when sGhe passes the board e=ams# sGhe must be at least +1
years old; B5) graduate of a recognized school# and of good moral character
$. Ailipino citizen or a citizen of a country where we hae reciprocity; graduate of B5) from a
recognized school and of good moral character
Answer: %$& Ailipino citizen or a citizen of a country where we hae reciprocity; graduate of B5)
from a recognized school and of good moral character
.A C1@/ section 1/ states that the >ualifications to take the board e=ams are: Ailipino citizen or
citizen of a country where the (hilippines has reciprocity; of good moral character and graduate of
B5) from a recognized school of nursing. There is no e=plicit proision about the age re>uirement in
.A C1@/ unlike in .A@1?: %old law&.
CC. ,hich of the following is T.67 about membership to the (hilippine )urses Association %()A&-
A. Membership to ()A is mandatory and is stipulated in the (hilippine )ursing Act of +33+
B. Membership to ()A is compulsory for newly registered nurses wanting to enter the practice of
nursing in the country
!. Membership to ()A is oluntary and is encouraged by the (.! !ode of 7thics for )urses
$. Membership to ()A is re>uired by goernment hospitals prior to employment
Answer: %!& Membership to ()A is oluntary and is encouraged by the (.! !ode of 7thics for
)urses
Membership to any organization# including the ()A# is only oluntary and this right to *oin any
organization is guaranteed in the 1CB@ constitution of the (hilippines. 'oweer# the (.! !ode of
7thics states that one of the ethical obligations of the professional nurse towards the profession is to
be an actie member of the accredited professional organization.
133. ,hen the license of the nurse is reoked# it means that the nurse:
A. "s no longer allowed to practice the profession for the rest of her life
B. ,ill neer hae herGhis license re-issued since it has been reoked
!. May apply for re-issuance of hisGher license based on certain conditions stipulated in .A C1@/
$. ,ill remain unable to practice professional nursing
Answer: %!& May apply for re-issuance of hisGher license based on certain conditions stipulated in .A
C1@/
.A C1@/ sec. +: states that for e>uity and *ustice# a reoked license maybe re-issued proided that the
following conditions are met: a& the cause for reocation of license has already been corrected or
remoed; and# b& at least four years has elapsed since the license has been reoked.
131. According to the current nursing law# the minimum educational >ualification for a faculty
member of a college of nursing is:
A. 8nly a Master of Arts in )ursing is acceptable
B. Masters degree in )ursing or in the related fields
!. At least a doctorate in nursing
$. At least 1B units in the Master of Arts in )ursing (rogram
Answer: %B& Masters degree in )ursing or in the related fields
According to .A C1@/ sec. +@# the educational >ualification of a faculty member teaching in a
college of nursing must be masters degree which maybe in nursing or related fields like education#
allied health professions# psychology.
13+. The educational >ualification of a nurse to become a superisor in a hospital is:
A. B5) with at least C units of post graduate studies in nursing administration
B. Master of Arts in )ursing ma*or in administration
!. At least + years e=perience as a headnurse
$. At least 1B units of post graduate studies in nursing administration
Answer: %A& B5) with at least C units of post graduate studies in nursing administration
According to .A C1@/ sec. +C# the educational >ualification to be a superisor in a hospital is at least
C units of postgraduate studies in nursing administration. A masters degree in nursing is re>uired for
the chief nurse of a secondary or tertiary hospital.
13/. The Board of )ursing has >uasi-*udicial power. An e=ample of this power is:
A. The Board can issue rules and regulations that will goern the practice of nursing
B. The Board can inestigate iolations of the nursing law and code of ethics
!. The Board can isit a school applying for a permit in collaboration with !'7$
$. The Board prepares the board e=aminations
Answer: %B& The Board can inestigate iolations of the nursing law and code of ethics
Huasi-*udicial power means that the Board of )ursing has the authority to inestigate iolations of
the nursing law and can issue summons# subpoena or subpoena duces tecum as needed.
13:. ,hen a nurse causes an in*ury to the patient and the in*ury caused becomes the proof of the
negligent act# the presence of the in*ury is said to e=emplify the principle of:
A. Aorce ma*eure
B. .espondeat superior
!. .es ipsa lo>uitur
$. 'oldoer doctrine
Answer: %!& .es ipsa lo>uitur
.es ipsa lo>uitur literally means the thing speaks for itself. This means in operational terms that the
in*ury caused is the proof that there was a negligent act.
13<. 7nsuring that there is an informed consent on the part of the patient before a surgery is done#
illustrates the bioethical principle of:
A. Beneficence
B. Autonomy
!. Truth tellingGeracity
$. )on-maleficence
Answer: %B& Autonomy
"nformed consent means that the patient fully understands what will be the surgery to be done# the
risks inoled and the alternatie solutions so that when sGhe gie consent it is done with full
knowledge and is gien freely. The action of allowing the patient to decide whether a surgery is to be
done or not e=emplifies the bioethical principle of autonomy.
13?. ,hen a nurse is proiding care to herGhis patient# sGhe must remember that she is duty bound not
to do doing any action that will cause the patient harm. This is the meaning of the bioethical
principle:
A. )on-maleficence
B. Beneficence
!. Vustice
$. 5olidarity
Answer: %A& )on-maleficence
)on-maleficence means do not cause harm or do any action that will cause any harm to the
patientGclient. To do good is referred as beneficence.
13@. ,hen the patient is asked to testify in court# sGhe must abide by the ethical principle of:
A. (riileged communication
B. "nformed consent
!. 5olidarity
$. Autonomy
Answer: %A& (riileged communication
All confidential information that comes to the knowledge of the nurse in the care of herGhis patients is
considered priileged communications. 'ence# sGhe is not allowed to *ust reeal the confidential
information arbitrarily. 5Ghe may only be allowed to break the seal of secrecy in certain conditions.
8ne such condition is when the court orders the nurse to testify in a criminal or medico-legal case.
13B. ,hen the doctor orders 1do not resuscitate4# this means that
A. The nurse need not gie due care to the patient since sGhe is terminally ill
B. The patient need not be gien food and water after all sGhe is dying
!. The nurses and the attending physician should not do any heroic or e=traordinary measures for the
patient
$. The patient need not be gien ordinary care so that herGhis dying process is hastened
Answer: %!& The nurses and the attending physician should not do any heroic or e=traordinary
measures for the patient
$o not resuscitate4 is a medical order which is written on the chart after the doctor has consulted the
family and this means that the members of the health team are not re>uired to gie e=traordinary
measures but cannot withhold the basic needs like food# water# and air. "t also means that the nurse is
still duty bound to gie the basic nursing care to the terminally ill patient and ensure that the spiritual
needs of the patient is taken cared of.
13C. ,hich of the following statements is T.67 of abortion in the (hilippines-
A. "nduced abortion is allowed in cases of rape and incest
B. "nduced abortion is both a criminal act and an unethical act for the nurse
!. Abortion maybe considered acceptable if the mother is unprepared for the pregnancy
$. A nurse who performs induced abortion will hae no legal accountability if the mother re>uested
that the abortion done on her.
Answer: %B& "nduced abortion is both a criminal act and an unethical act for the nurse
"nduced abortion is considered a criminal act which is punishable by imprisonment which maybe up
to a ma=imum of 1+ years if the nurse gets paid for it. Also# the (.! !ode of 7thics states that the
nurse must respect life and must not do any action that will destroy life. Abortion is an act that
destroys life albeit at the beginning of life.
113. ,hich of the following is )8T true about a hypothesis- 'ypothesis is:
A. testable
B. proen
!. stated in a form that it can be accepted or re*ected
$. states a relationship between ariables
Answer: %B& proen
'ypothesis is not proen; it is either accepted or re*ected. 'ypothesis is testable and is defined as a
statement that predicts the relationship between ariables
111. ,hich of the following measures will best preent manipulation of ulnerable groups-
A. 5ecure informed consent
B. (ayment of stipends for sub*ects
!. (rotect priacy of patient
$. 7nsure confidentiality of data
Answer: %A& 5ecure informed consent
5ecuring informed consent will free the researcher from being accused of manipulating the sub*ects
because by so doing heGshe gies ample opportunity for the sub*ects to weigh the
adantagesGdisadantages of being included in the study prior to giing his consent. This is done
without any element of force# coercion# threat or een inducement.
11+. ,hich of the following procedures ensures that Ms. Montana has fully described to prospectie
sub*ects the nature of the study and the sub*ect9s rights-
A. $ebriefing
B. Aull disclosure
!. "nformed consent
$. !oert data collection
Answer: %B& Aull disclosure
Aull disclosure is giing the sub*ects of the research information that they desere to know prior to
the conduct of the study
11/. This techni>ue refers to the use of multiple referents to draw conclusions about what constitutes
the truth
A. Triangulation
B. 7=periment
!. Meta-analysis
$. $elphi techni>ue
Answer: %A& Triangulation
Triangulation makes use of different sources of information such as triangulation in design#
researcher and instrument.
11:. The statement# 1)inety percent %C3P& of the respondents are female staff nurses alidates
preious research findings %5antos# +331; .eyes# +33<& that the nursing profession is largely a female
dominated profession is an e=ample of
A. implication
B. interpretation
!. analysis
$. conclusion
Answer: %B& interpretation
"nterpretation includes the inferences of the researcher about the findings of the study.
11<. The study is said to be completed when Ms. Montana achieed which of the following
actiities-
A. (ublished the results in a nursing *ournal.
B. (resented the study in a research forum.
!. The results of the study is used by the nurses in the hospital
$. 5ubmitted the research report to the !78.
Answer: %!& The results of the study is used by the nurses in the hospital
The last step in the research process is the utilization of the research findings.
11?. 5ituation : 5tephanie is a nurse researcher of the (atient !are 5erices $iision. 5he plans to
conduct a literature search for her study.
,hich of the following is the first step in selecting appropriate materials for her reiew-
A. Track down most of the releant resources
B. !opy releant materials
!. 8rganize materials according to function
$. 5ynthesize literature gathered.
Answer: %A& Track down most of the releant resources
The first step in the reiew of related literature is to track down releant sources before copying
these. The last step is to synthesize the literature gathered.
11@. 5he knows that the most important categories of information in literature reiew is the:
A. research findings
B. theoretical framework
!. methodology
$. opinions
Answer: %A& research findings
The research findings is the most important category of information that the researcher should copy
because this will gie her aluable information as to what has been discoered in past studies about
the same topic.
11B. 5he also considers accessing electronic data bases for her literature reiew. ,hich of the
following is the most useful electronic database for nurses-
A. !")A'0
B. M7$0")7
!. 'ealth5TA.
$. 7MBA57
Answer: %A& !")A'0
This refers to !umulatie "nde= to )ursing and Allied 'ealth 0iterature which is a rich source for
literature reiew for nurses. The rest of the sites are for medicine# pharmacy and other health-related
sites.
11C. ,hile reiewing *ournal articles# 5tephanie got interested in reading the brief summary of the
article placed at the beginning of the *ournal report. ,hich of the following refers to this-
A. "ntroduction
B. (reface
!. Abstract
$. Background
Answer: %!& Abstract
Abstract contains concise description of the background of the study# research >uestions# research
ob*ecties# methods# findings# implications to nursing practice as well as keywords used in the study.
1+3. 5he notes down ideas that were deried from the description of an inestigation written by the
person who conducted it. ,hich type of reference source refers to this-
A. Aootnote
B. Bibliography
!. (rimary source
$. 7ndnotes
Answer: %!& (rimary source
. This refers to a primary source which is a direct account of the inestigation done by the
inestigator. "n contrast to this is a secondary source# which is written by someone other than the
original researcher.
1+1. 5he came across a study which is referred to as meta-analysis. ,hich of the following
statements best defines this type of study-
A. Treats the findings from one study as a single piece of data
B. Aindings from multiple studies are combined to yield a data set which is analyzed as indiidual
data
!. .epresents an application of statistical procedures to findings from each report
$. Techni>ue for >uantitatiely combining and thus integrating the results of multiple studies on a
gien topic.
Answer: %$& Techni>ue for >uantitatiely combining and thus integrating the results of multiple
studies on a gien topic.
Though all the options are correct# the best definition is option $ because it combines >uantitatiely
the results and at the same time it integrates the results of the different studies as one finding.
1++. This kind of research gathers data in detail about a indiidual or groups and presented in
narratie form# which is
A. !ase study
B. 'istorical
!. Analytical
$. 7=perimental
Answer: %A& !ase study
!ase study focuses on in-depth inestigations of single entity or small number of entities. "t attempts
to analyze and understand issues of importance to history# deelopment or circumstances of the
person or entity under study.
1+/. 5tephanie is finished with the steps in the conceptual phase when she has conducted the 0A5T
step# which is
A. formulating and delimiting the problem.
B. reiew of related literature
!. deelop a theoretical framework
$. formulate a hypothesis
Answer: %$& formulate a hypothesis
The last step in the conceptualizing phase of the research process is formulating a hypothesis. The
rest are the first three steps in this phase.
1+:. 5he states the hypothesis of the study. ,hich of the following is a null hypothesis-
A. "nfants who are breastfed hae the same weight as those who are bottle fed.
B. Bottle-fed infants hae lower weight than breast-fed infants
!. !uddled infants sleep longer than those who are left by themseles to sleep.
$. !hildren of absentee parents are more prone to e=perience depression than those who lie with
both parents.
Answer: %A& "nfants who are breastfed hae the same weight as those who are bottle fed.
)ull hypothesis predicts that there is no change# no difference or no relationship between the
ariables in the study
1+<. 5he notes that the dependent ariable in the hypothesis 1$uration of sleep of cuddled infants is
longer than those infants who are not cuddled by mothers4 is
A. !uddled infants
B. $uration of sleep
!. "nfants
$. Absence of cuddling
Answer: %B& $uration of sleep
$uration of sleep is the Ueffect9 %dependent ariable& of cuddling Ucause9 %independent ariable&.
1+?. 5ituation: Aretha is a nurse researcher in a tertiary hospital. 5he is tasked to conduct a research
on the effects of structured discharge plan for post-open heart surgery patients.
5he states the significance of the research problem. ,hich of the following statements is the M85T
significant for this study-
A. "mproement in patient care
B. $eelopment of a theoretical basis for nursing
!. "ncrease the accountability of nurses.
$. "mproes the image of nursing
Answer: %A& "mproement in patient care
The ultimate goal of conducting research is to improe patient care which is achieed by enhancing
the practice of nurses when they utilize research results in their practice.
1+@. .egardless of the significance of the study# the feasibility of the study needs to be considered.
,hich of the following is considered a priority-
A. Aailability of research sub*ects
B. Budgetary allocation
!. Time frame
$. 7=perience of the researcher
Answer: %A& Aailability of research sub*ects
Aailability is the most important criteria to be considered by the researcher in determining whether
the study is feasible or not. )o matter how significant the study may be if there are no aailable
sub*ectsGrespondents# the study can not push through.
1+B. Aretha knows that a good research problem e=hibits the following characteristics; which one is
)8T included-
A. !learly identified the ariablesGphenomenon under consideration.
B. 5pecifies the population being studied.
!. "mplies the feasibility of empirical testing
$. "ndicates the hypothesis to be tested.
Answer: %$& "ndicates the hypothesis to be tested.
)ot all studies re>uire a hypothesis such as >ualitatie studies# which does not deal with ariables but
with phenomenon or concepts.
1+C. 5he states the purposes of the study. ,hich of the following describe the purpose of a study-
1. 7stablishes the general direction of a study
+. !aptures the essence of the study
/. Aormally articulates the goals of the study
:. 5ometimes worded as an intent
A. 1# +# /
B. +# /# :
!. 1# /# :
$. 1# +# /# :
Answer: %$& 1# +# /# :
The purposes of a research study coers all the options indicated.
1/3. 5he opts to use interiews in data collection. "n addition to alidity# what is the other M85T
serious weakness of this method-
A. Accuracy
B. 5ensitiity
!. 8b*ectiity
$. .eliability
Answer: %A& Accuracy
Accuracy and alidity are the most serious weaknesses of the self-report data. This is due to the fact
that the respondents sometimes do not want to tell the truth for fear of being re*ected or in order to
please the interiewer.
1/1. 5he plans to sub*ect her instrument to pretesting. ,hich of the following is )8T achieed in
doing pretesting-
A. $etermines how much time it takes to administer the instrument package
B. "dentify parts that are difficult to read or understand
!. $etermine the budgetary allocation for the study
$. $etermine if the measures yield data with sufficient ariability
Answer: %!& $etermine the budgetary allocation for the study
$etermining budgetary allocation for the study is not a purpose of doing a pretesting of the
instruments. This is done at an earlier stage of the design and planning phase.
1/+. 5he tests the instrument whether it looks as though it is measuring appropriate constructs. ,hich
of the following refers to this-
A. Aace alidity
B. !ontent alidity
!. !onstruct Jalidity
$. !riterion-related alidity
Answer: %A& Aace alidity
Aace alidity measures whether the instrument appears to be measuring the appropriate construct. "t is
the easiest type of alidity testing.
1//. ,hich of the following >uestions would determine the construct alidity of the instrument-
A. 1,hat is this instrument really measuring-4
B. 1'ow representatie are the >uestions on this test of the unierse of >uestions on this topic-4
!. 1$oes the >uestion asked looks as though it is measuring the appropriate construct-4
$. 1$oes the instrument correlate highly with an e=ternal criterion-
Answer: %A& 1,hat is this instrument really measuring-4
!onstruct alidity aims to alidate what the instrument is really measuring. The more abstract the
concept# the more difficult to measure the construct.
1/:. ,hich of the following e=perimental research designs would be appropriate for this study if she
wants to find out a cause and effect relationship between the structured discharge plan and
compliance to home care regimen among the sub*ects-
A. True e=periment
B. Huasi e=periment
!. (ost-test only design
$. 5olomon four-group
Answer: %!& (ost-test only design
(ost- Test only design is appropriate because it is impossible to measure the compliance to home care
regimen ariable prior to the discharge of the patient from the hospital.
1/<. 8ne hypothesis that she formulated is 1!ompliance to home care regimen is greater among
patients who receied the structured discharge plan than those who receied erbal discharge
instructions.9 ,hich is the independent ariable in this study-
A. 5tructured discharge plan
B. !ompliance to home care regimen
!. (ost-open heart surgery patients
$. 2reater compliance
Answer: %A& 5tructured discharge plan
5tructured discharge plan is the interention or the Ucause9 in the study that results to an Ueffect9#
which is compliance to home care regimen or the dependent ariable.
1/?. 5ituation : Alyssa plans to conduct a study about nursing practice in the country. 5he decides to
refresh her knowledge about the different types of research in order to choose the most appropriate
design for her study.
5he came across sureys# like the 5ocial ,eather 5tation and (ulse Asia 5urey. ,hich of the
following is the purpose of this kind of research-
A. 8btains information regarding the prealence# distribution and interrelationships of ariables
within a population at a particular time
B. 2et an accurate and complete data about a phenomenon.
!. $eelop a tool for data gathering.
$. Aormulate a framework for the study
Answer: %A& 8btains information regarding the prealence# distribution and interrelationships of
ariables within a population at a particular time
5ureys are done to gather information on people9s actions# knowledge# intentions# opinions and
attitudes.
1/@. 5he will likely use self-report method. ,hich of the following self-report methods is the most
respected method used in sureys-
A. (ersonal interiews
B. Huestionnaires
!. Telephone interiews
$. .ating 5cale
Answer: %A& (ersonal interiews
(ersonal interiews is the best method of collecting surey data because the >uality of information
they yield is higher than other methods and because relatiely few people refuse to be interiewed in
person.
1/B. Alyssa reads about e=ploratory research. ,hich of the following is the purpose of doing this
type of research-
A. "nductiely deelops a theory based on obserations about processes inoling selected people
B. Makes new knowledge useful and practical.
!. "dentifies the ariables in the study
$. Ainds out the cause and effect relationship between ariables
Answer: %!& "dentifies the ariables in the study
7=ploratory research is the first leel of inestigation and it deals with identifying the ariables in the
study.
1/C. 5he reiews >ualitatie design of research. ,hich of the following is true about ethnographic
study-
A. $eelops theories that increase the knowledge about a certain phenomenon.
B. Aocuses on the meanings of life e=periences of people
!. $eals with patterns and e=periences of a defined cultural group in a holistic fashion
$. "n-depth inestigation of a single entity
Answer: %!& $eals with patterns and e=periences of a defined cultural group in a holistic fashion
7thnographic research deals with the cultural patterns and beliefs of certain culture groups.
1:3. 5he knows that the purpose of doing ethnographic study is to:
A. 6nderstand the worldiew of a cultural group
B. 5tudy the life e=periences of people
!. $etermine the relationship between ariables
$. "nestigate intensiely a single entity
Answer: %A& 6nderstand the worldiew of a cultural group
The aim of ethnographers is to learn from the members of a cultural group by understanding their
way of life as they perceie and lie it.
1:1. Alyssa wants to learn more about e=perimental design. ,hich is the purpose of this research-
A. Test the cause and effect relationship among the ariable under a controlled situation
B. "dentify the ariables in the study
!. (redicts the future based on current interention
$. $escribe the characteristics# opinions# attitudes or behaiors of certain population about a current
issue or eent
Answer: %A& Test the cause and effect relationship among the ariable under a controlled situation
7=perimental research is a 0eel """ inestigation which determines the cause and effect relationship
between ariables.
1:+. 5he knows that there are three elements of e=perimental research. ,hich is )8T included-
A. Manipulation
B. .andomization
!. !ontrol
$. Trial
Answer: %$& Trial
Trial is not an element of e=perimental research. Manipulation of ariables# randomization and
control are the three elements of this type of research
1:/. Alyssa knows that there are times when only manipulation of study ariables is possible and the
elements of control or randomization are not attendant. ,hich type of research is referred to this-
A. Aield study
B. Huasi-e=periment
!. 5olomon-Aour group design
$. (ost-test only design
Answer: %B& Huasi-e=periment
Huasi-e=periment is done when randomization and control of the ariables are not possible.
1::. 8ne of the related studies that she reads is a phenomenological research. ,hich of the following
>uestions is answered by this type of >ualitatie research-
A. 4 ,hat is the way of life of this cultural group-4
B. 1,hat is the effect of the interention to the dependent ariable-4
!. 1,hat the essence of the phenomenon is as e=perienced by these people-4
$. 1,hat is the core category that is central in e=plaining what is going on in that social scene-4
Answer: %!& 1,hat the essence of the phenomenon is as e=perienced by these people-4
(henomenological research deals with the meaning of e=periences as those who e=perienced the
phenomenon understand it.
1:<. 8ther studies are categorized according to the time frame. ,hich of the following refers to a
study of ariables in the present which is linked to a ariable that occurred in the past-
A. (rospectie design
B. .etrospectie design
!. !ross sectional study
$. 0ongitudinal study
Answer: %B& .etrospectie design
.etrospectie studies are done in order to establish a correlation between present ariables and the
antecedent factors that hae caused it.
1:?. 5ituation : 'arry a new research staff of the .esearch and $eelopment $epartment of a tertiary
hospital is tasked to conduct a research study about the increased incidence of nosocomial infection
in the hospital.
,hich of the following ethical issues should he consider in the conduct of his study-
1. !onfidentiality of information gien to him by the sub*ects
+. 5elf-determination which includes the right to withdraw from the study group
/. (riacy or the right not to be e=posed publicly
:. Aull disclosure about the study to be conducted
A. 1# +# /
B. 1# /# :
!. +# /# :
$. 1# +# /# :
Answer: %$& 1# +# /# :
This includes all the options as these are the four basic rights of sub*ects for research.
1:@. ,hich of the following is the best tool for data gathering-
A. "nteriew schedule
B. Huestionnaire
!. 6se of laboratory data.
$. 8bseration
Answer: %!& 6se of laboratory data.
"ncidence of nosocomial infection is best collected through the use of biophysiologic measures#
particularly in itro measurements# hence laboratory data is essential.
1:B. $uring data collection# 'arry encounters a patient who refuses to talk to him. ,hich of the
following is a limitation of the study-
A. (atient9s refusal to fully diulge information.
B. (atients with history of feer and cough
!. (atients admitted or who seeks consultation at the 7. and doctors offices
$. !ontacts of patients with history of feer and cough
Answer: %A& (atient9s refusal to fully diulge information.
(atient9s refusal to diulge information is a limitation because it is beyond the control of 'arry.
1:C. ,hat type of research is appropriate for this study-
A. $escriptie- correlational
B. 7=periment
!. Huasi-e=periment
$. 'istorical
Answer: %A& $escriptie- correlational
$escriptie- correlational study is the most appropriate for this study because it studies the ariables
that could be the antecedents of the increased incidence of nosocomial infection.
1<3. "n the statement# 1Are>uent hand washing of health workers decreases the incidence of
nosocomial infections among post-surgery patients4# the dependent ariable is
A. incidence of nosocomial infections
B. decreases
!. fre>uent hand washing
$. post-surgery patients
Answer: %A& incidence of nosocomial infections
The dependent ariable is the incidence of nosocomial infection# which is the outcome or effect of the
independent ariable# fre>uent hand washing.
1<1. 'arry knows that he has to protect the rights of human research sub*ects. ,hich of the following
actions of 'arry ensures anonymity-
A. Ieep the identities of the sub*ect secret
B. 8btain informed consent
!. (roide e>ual treatment to all the sub*ects of the study.
$. .elease findings only to the participants of the study
Answer: %A& Ieep the identities of the sub*ect secret
Ieeping the identities of the research sub*ect secret will ensure anonymity because this will hinder
proiding link between the information gien to whoeer is its source.
1<+. 'e is oriented to the use of electronic databases for nursing research. ,hich of the following
will she likely access-
A. M7$0")7
B. )ational "nstitute of )ursing .esearch
!. American Vournal of )ursing
$. "nternational !ouncil of )urses
Answer: %B& )ational "nstitute of )ursing .esearch
)ational "nstitute for )ursing .esearch is a useful source of information for nursing research. The
rest of the options may be helpful but )"). is the most useful site for nurses.
1</. 'e deelops methods for data gathering. ,hich of the following criteria of a good instrument
refers to the ability of the instrument to yield the same results upon its repeated administration-
A. Jalidity
B. 5pecificity
!. 5ensitiity
$. .eliability
Answer: %$& .eliability
.eliability is consistency of the research instrument. "t refers to the repeatability of the instrument in
e=tracting the same responses upon its repeated administration.
1<:. 'arry is aware of the importance of controlling threats to internal alidity for e=perimental
research# which include the following e=amples 7E!7(T:
A. 'istory
B. Maturation
!. Attrition
$. $esign
Answer: %$& $esign
$esign is not a threat to internal alidity of the instrument *ust like the other options.
1<<. 'is colleague asks about the e=ternal alidity of the research findings. ,hich of the responses of
'arry is appropriate- The research findings can be
A. generalized to other settings or samples
B. shown to result only from the effect of the independent ariable
!. reflected as results of e=traneous ariables
$. free of selection biases
Answer: %A& generalized to other settings or samples
7=ternal alidity refers to the generalizability of research findings to other settings or samples. This is
an issue of importance to eidence-based nursing practice.
Philippine NLE Board Exam: *edical Surgical Nursing Question & Answer w/ rationale
*E(#!AL S&%'#!AL N&%S#N'
1. Aollowing surgery# Mario complains of mild incisional pain while performing deep- breathing and
coughing e=ercises. The nurse9s best response would be:
A. 1(ain will become less each day.4
B. 1This is a normal reaction after surgery.4
!. 1,ith a pillow# apply pressure against the incision.4
$. 1" will gie you the pain medication the physician ordered.4
Answer: %!& 1,ith a pillow# apply pressure against the incision.4
Applying pressure against the incision with a pillow will help lessen the intra-abdominal pressure
created by coughing which causes tension on the incision that leads to pain.
+. The nurse needs to carefully assess the complaint of pain of the elderly because older people
A. are e=pected to e=perience chronic pain
B. hae a decreased pain threshold
!. e=perience reduced sensory perception
$. hae altered mental function
Answer: %!& e=perience reduced sensory perception
$egeneratie changes occur in the elderly. The response to pain in the elderly maybe lessened
because of reduced acuity of touch# alterations in neural pathways and diminished processing of
sensory data.
/. Mary receied Atropine58: as a pre-medication /3 minutes ago and is now complaining of dry
mouth and her (. is higher# than before the medication was administered. The nurse9s best
A. The patient is haing an allergic reaction to the drug.
B. The patient needs a higher dose of this drug
!. This is normal side-effect of At58:
$. The patient is an=ious about upcoming surgery
Answer: %!& This is normal side-effect of At58:
Atropine sulfate is a agolytic drug that decreases oropharyngeal secretions and increases the heart
rate.
:. Ana9s postoperatie ital signs are a blood pressure of B3G<3 mm 'g# a pulse of 1:3# and
respirations of /+. 5uspecting shock# which of the following orders would the nurse >uestion-
A. (ut the client in modified TrendelenbergXs position.
B. Administer o=ygen at 133P.
!. Monitor urine output eery hour.
$. Administer $emerol <3mg "M >:h
Answer: %$& Administer $emerol <3mg "M >:h
Administering $emerol# which is a narcotic analgesic# can depress respiratory and cardiac function
and thus not gien to a patient in shock. ,hat is needed is promotion for ade>uate o=ygenation and
perfusion. All the other interentions can be e=pected to be done by the nurse.
<. Mr. (ablo# diagnosed with Bladder !ancer# is scheduled for a cystectomy with the creation of an
ileal conduit in the morning. 'e is wringing his hands and pacing the floor when the nurse enters his
room. ,hat is the best approach-
A. D2ood eening# Mr. (ablo. ,asnXt it a pleasant day# today-D
B. DMr# (ablo# you must be so worried# "Xll leae you alone with your thoughts.
!. 1Mr. (ablo# youXll wear out the hospital floors and yourself at this rate.D
$. DMr. (ablo# you appear an=ious to me. 'ow are you feeling about tomorrowXs surgery-D
Answer: %$& DMr. (ablo# you appear an=ious to me. 'ow are you feeling about tomorrowXs surgery-D
The client is showing signs of an=iety reaction to a stressful eent. .ecognizing the client9s an=iety
coneys acceptance of his behaior and will allow for erbalization of feelings and concerns.
?. After surgery# 2ina returns from the (ost-anesthesia !are 6nit %.ecoery .oom& with a
nasogastric tube in place following a gall bladder surgery. 5he continues to complain of nausea.
,hich action would the nurse take-
A. !all the physician immediately.
B. Administer the prescribed antiemetic.
!. !heck the patency of the nasogastric tube for any obstruction.
$. !hange the patient9s position.
Answer: %!& !heck the patency of the nasogastric tube for any obstruction.
)ausea is one of the common complaints of a patient after receiing general anesthesia. But this
complaint could be aggraated by gastric distention especially in a patient who has undergone
abdominal surgery. "nsertion of the )2T helps reliee the problem. !hecking on the patency of the
)2T for any obstruction will help the nurse determine the cause of the problem and institute the
necessary interention.
@. Mr. (erez is in continuous pain from cancer that has metastasized to the bone. (ain medication
proides little relief and he refuses to moe. The nurse should plan to:
A. .eassure him that the nurses will not hurt him
B. 0et him perform his own actiities of daily liing
!. 'andle him gently when assisting with re>uired care
$. !omplete A.M. care >uickly as possible when necessary
Answer: %!& 'andle him gently when assisting with re>uired care
(atients with cancer and bone metastasis e=perience seere pain especially when moing. Bone
tumors weaken the bone to appoint at which normal actiities and een position changes can lead to
fracture. $uring nursing care# the patient needs to be supported and handled gently.
B. A client returns from the recoery room at CAM alert and oriented# with an "J infusing. 'is pulse
is B+# blood pressure is 1+3GB3# respirations are +3# and all are within normal range. At 13 am and at
11 am# his ital signs are stable. At noon# howeer# his pulse rate is C:# blood pressure is 11?G@:# and
respirations are +:. ,hat nursing action is most appropriate-
A. )otify his physician.
B. Take his ital signs again in 1< minutes.
!. Take his ital signs again in an hour.
$. (lace the patient in shock position.
Answer: %B& Take his ital signs again in 1< minutes.
Monitoring the client9s ital signs following surgery gies the nurse a sound information about the
client9s condition. !omplications can occur during this period as a result of the surgery or the
anesthesia or both. Ieeping close track of changes in the J5 and alidating them will help the nurse
initiate interentions to preent complications from occurring.
C. A <? year old construction worker is brought to the hospital unconscious after falling from a +-
story building. ,hen assessing the client# the nurse would be most concerned if the assessment
reealed:
A. .eactie pupils
B. A depressed fontanel
!. Bleeding from ears
$. An eleated temperature
Answer: %!& Bleeding from ears
The nurse needs to perform a thorough assessment that could indicate alterations in cerebral function#
increased intracranial pressures# fractures and bleeding. Bleeding from the ears occurs only with basal
skull fractures that can easily contribute to increased intracranial pressure and brain herniation
13. ,hich of the ff. statements by the client to the nurse indicates a risk factor for !A$-
A. 1" e=ercise eery other day.4
B. 1My father died of Myasthenia 2rais.4
!. 1My cholesterol is 1B3.4
$. 1" smoke 1 1G+ packs of cigarettes per day.4
Answer: %$& 1" smoke 1 1G+ packs of cigarettes per day.4
5moking has been considered as one of the ma*or modifiable risk factors for coronary artery disease.
7=ercise and maintaining normal serum cholesterol leels help in its preention.
11. Mr. Braga was ordered $igo=in 3.+< mg. 8$. ,hich is poor knowledge regarding this drug-
A. "t has positie inotropic and negatie chronotropic effects
B. The positie inotropic effect will decrease urine output
!. To=i=ity can occur more easily in the presence of hypokalemia# lier and renal problems
$. $o not gie the drug if the apical rate is less than ?3 beats per minute.
Answer: %B& The positie inotropic effect will decrease urine output
"notropic effect of drugs on the heart causes increase force of its contraction. This increases cardiac
output that improes renal perfusion resulting in an improed urine output.
1+. Jalsala maneuer can result in bradycardia. ,hich of the following actiities will not stimulate
JalsalaXs maneuer-
A. 6se of stool softeners.
B. 7nema administration
!. 2agging while toothbrushing.
$. 0ifting heay ob*ects
Answer: %A& 6se of stool softeners.
5training or bearing down actiities can cause agal stimulation that leads to bradycardia. 6se of
stool softeners promote easy bowel eacuation that preents straining or the alsala maneuer.
1/. The nurse is teaching the patient regarding his permanent artificial pacemaker. ,hich information
gien by the nurse shows her knowledge deficit about the artificial cardiac pacemaker-
A. take the pulse rate once a day# in the morning upon awakening
B. may be allowed to use electrical appliances
!. hae regular follow up care
$. may engage in contact sports
Answer: %$& may engage in contact sports
The client should be adised by the nurse to aoid contact sports. This will preent trauma to the area
of the pacemaker generator.
1:. A patient with angina pectoris is being discharged home with nitroglycerine tablets. ,hich of the
following instructions does the nurse include in the teaching-
A. 1,hen your chest pain begins# lie down# and place one tablet under your tongue. "f the pain
continues# take another tablet in < minutes.4
B. 1(lace one tablet under your tongue. "f the pain is not relieed in 1< minutes# go to the hospital.4
!. 1!ontinue your actiity# and if the pain does not go away in 13 minutes# begin taking the nitro
tablets one eery < minutes for 1< minutes# then go lie down.4
$. 1(lace one )itroglycerine tablet under the tongue eery fie minutes for three doses. 2o to the
hospital if the pain is unrelieed.
Answer: %$& 1(lace one )itroglycerine tablet under the tongue eery fie minutes for three doses. 2o
to the hospital if the pain is unrelieed.
Angina pectoris is caused by myocardial ischemia related to decreased coronary blood supply. 2iing
nitroglycerine will produce coronary asodilation that improes the coronary blood flow in / F <
mins. "f the chest pain is unrelieed# after three tablets# there is a possibility of acute coronary
occlusion that re>uires immediate medical attention.
1<. A client with chronic heart failure has been placed on a diet restricted to +333mg. of sodium per
day. The client demonstrates ade>uate knowledge if behaiors are eident such as not salting food
and aoidance of which food-
A. ,hole milk
B. !anned sardines
!. (lain nuts
$. 7ggs
Answer: %B& !anned sardines
!anned foods are generally rich in sodium content as salt is used as the main preseratie.
1?. A student nurse is assigned to a client who has a diagnosis of thrombophlebitis. ,hich action by
this team member is most appropriate-
A. Apply a heating pad to the inoled site.
B. 7leate the clientXs legs C3 degrees.
!. "nstruct the client about the need for bed rest.
$. (roide actie range-of-motion e=ercises to both legs at least twice eery shift.
Answer: %!& "nstruct the client about the need for bed rest.
"n a client with thrombophlebitis# bedrest will preent the dislodgment of the clot in the e=tremity
which can lead to pulmonary embolism.
1@. A client receiing heparin sodium asks the nurse how the drug works. ,hich of the following
points would the nurse include in the e=planation to the client-
A. "t dissoles e=isting thrombi.
B. "t preents conersion of factors that are needed in the formation of clots.
!. "t inactiates thrombin that forms and dissoles e=isting thrombi.
$. "t interferes with itamin I absorption.
Answer: %B& "t preents conersion of factors that are needed in the formation of clots.
'eparin is an anticoagulant. "t preents the conersion of prothrombin to thrombin. "t does not
dissole a clot.
1B. The nurse is conducting an education session for a group of smokers in a 1stop smoking4 class.
,hich finding would the nurse state as a common symptom of lung cancer- :
A. $yspnea on e=ertion
B. Aoamy# blood-tinged sputum
!. ,heezing sound on inspiration
$. !ough or change in a chronic cough
Answer: %$& !ough or change in a chronic cough
!igarette smoke is a carcinogen that irritates and damages the respiratory epithelium. The irritation
causes the cough which initially maybe dry# persistent and unproductie. As the tumor enlarges#
obstruction of the airways occurs and the cough may become productie due to infection.
1C. ,hich is the most releant knowledge about o=ygen administration to a client with !8($-
A. 8=ygen at 1-+0Gmin is gien to maintain the hypo=ic stimulus for breathing.
B. 'ypo=ia stimulates the central chemoreceptors in the medulla that makes the client breath.
!. 8=ygen is administered best using a non-rebreathing mask
$. Blood gases are monitored using a pulse o=imeter.
Answer: %A& 8=ygen at 1-+0Gmin is gien to maintain the hypo=ic stimulus for breathing.
!8($ causes a chronic !8+ retention that renders the medulla insensitie to the !8+ stimulation for
breathing. The hypo=ic state of the client then becomes the stimulus for breathing. 2iing the
cliento=ygen in low concentrations will maintain the client9s hypo=ic drie.
+3. ,hen suctioning mucus from a clientXs lungs# which nursing action would be least appropriate-
A. 0ubricate the catheter tip with sterile saline before insertion.
B. 6se sterile techni>ue with a two-gloed approach
!. 5uction until the client indicates to stop or no longer than +3 second
$. 'ypero=ygenate the client before and after suctioning
Answer: %!& 5uction until the client indicates to stop or no longer than +3 second
8ne hazard encountered when suctioning a client is the deelopment of hypo=ia. 5uctioning sucks
not only the secretions but also the gases found in the airways. This can be preented by suctioning
the client for an aerage time of <-13 seconds and not more than 1< seconds and hypero=ygenating
the client before and after suctioning.
+1. $r. 5antos prescribes oral rifampin %.imactane& and isoniazid %")'& for a client with a positie
Tuberculin skin test. ,hen informing the client of this decision# the nurse knows that the purpose of
this choice of treatment is to
A. !ause less irritation to the gastrointestinal tract
B. $estroy resistant organisms and promote proper blood leels of the drugs
!. 2ain a more rapid systemic effect
$. $elay resistance and increase the tuberculostatic effect
Answer: %$& $elay resistance and increase the tuberculostatic effect
(ulmonary TB is treated primarily with chemotherapeutic agents for ?-1+ mons. A prolonged
treatment duration is necessary to ensure eradication of the organisms and to preent relapse. The
increasing prealence of drug resistance points to the need to begin the treatment with drugs in
combination. 6sing drugs in combination can delay the drug resistance.
++. Mario undergoes a left thoracotomy and a partial pneumonectomy. !hest tubes are inserted# and
one-bottle water-seal drainage is instituted in the operating room. "n the
postanesthesia care unit Mario is placed in AowlerXs position on either his right
side or on his back to
A. .educe incisional pain.
B. Aacilitate entilation of the left lung.
!. 7>ualize pressure in the pleural space.
$. "ncrease enous return
Answer: %B& Aacilitate entilation of the left lung.
5ince only a partial pneumonectomy is done# there is a need to promote e=pansion of this remaining
0eft lung by positioning the client on the opposite unoperated side.
+/. A client with !8($ is being prepared for discharge. The following are releant instructions to the
client regarding the use of an oral inhaler 7E!7(T
A. Breath in and out as fully as possible before placing the mouthpiece inside the mouth.
B. "nhale slowly through the mouth as the canister is pressed down
!. 'old his breath for about 13 seconds before e=haling
$. 5lowly breath out through the mouth with pursed lips after inhaling the drug.
Answer: %$& 5lowly breath out through the mouth with pursed lips after inhaling the drug.
"f the client breathes out through the mouth with pursed lips# this can easily force the *ust inhaled
drug out of the respiratory tract that will lessen its effectieness.
+:. A client is scheduled for a bronchoscopy. ,hen teaching the client what to e=pect afterward# the
nurseXs highest priority of information would be
A. Aood and fluids will be withheld for at least + hours.
B. ,arm saline gargles will be done > +h.
!. !oughing and deep-breathing e=ercises will be done >+h.
$. 8nly ice chips and cold li>uids will be allowed initially.
Answer: %A& Aood and fluids will be withheld for at least + hours.
(rior to bronchoscopy# the doctors sprays the back of the throat with anesthetic to minimize the gag
refle= and thus facilitate the insertion of the bronchoscope. 2iing the client food and drink after the
procedure without checking on the return of the gag refle= can cause the client to aspirate. The gag
refle= usually returns after two hours.
+<. The nurse enters the room of a client with chronic obstructie pulmonary disease. The clientXs
nasal cannula o=ygen is running at a rate of ? 0 per minute# the skin color is pink# and the respirations
are C per minute and shallow. ,hat is the nurse9s best initial action-
A. Take heart rate and blood pressure.
B. !all the physician.
!. 0ower the o=ygen rate.
$. (osition the client in a AowlerXs position.
Answer: %!& 0ower the o=ygen rate.
The client with !8($ is suffering from chronic !8+ retention. The hypo=ic drie is his chief
stimulus for breathing. 2iing 8+ inhalation at a rate that is more than +-/0Gmin can make the client
lose his hypo=ic drie which can be assessed as decreasing ...
+?. The nurse is preparing her plan of care for her patient diagnosed with pneumonia. ,hich is the
most appropriate nursing diagnosis for this patient-
A. Aluid olume deficit
B. $ecreased tissue perfusion.
!. "mpaired gas e=change.
$. .isk for infection
Answer: %!& "mpaired gas e=change.
(neumonia# which is an infection# causes lobar consolidation thus impairing gas e=change between
the aleoli and the blood. Because the patient would re>uire ade>uate hydration# this makes him
prone to fluid olume e=cess.
+@. A nurse at the weight loss clinic assesses a client who has a large abdomen and a rounded face.
,hich additional assessment finding would lead the nurse to suspect that the client has !ushing9s
syndrome rather than obesity-
A. large thighs and upper arms
B. pendulous abdomen and large hips
!. abdominal striae and ankle enlargement
$. posterior neck fat pad and thin e=tremities
Answer: %$& posterior neck fat pad and thin e=tremities
1Buffalo hump4 is the accumulation of fat pads oer the upper back and neck. Aat may also
accumulate on the face. There is truncal obesity but the e=tremities are thin. All these are noted in a
client with !ushing9s syndrome.
+B. ,hich statement by the client indicates understanding of the possible side effects of (rednisone
therapy-
A. 1" should limit my potassium intake because hyperkalemia is a side-effect of this drug.4
B. 1" must take this medicine e=actly as my doctor ordered it. " shouldn9t skip doses.4
!. 1This medicine will protect me from getting any colds or infection.4
$. 1My incision will heal much faster because of this drug.4
Answer: %B& 1" must take this medicine e=actly as my doctor ordered it. " shouldn9t skip doses.4
The possible side effects of steroid administration are hypokalemia# increase tendency to infection
and poor wound healing. !lients on the drug must follow strictly the doctor9s order since skipping the
drug can lower the drug leel in the blood that can trigger acute adrenal insufficiency or Addisonian
!risis
+C. A client# who is suspected of haing (heochromocytoma# complains of sweating# palpitation and
headache. ,hich assessment is essential for the nurse to make first-
A. (upil reaction
B. 'and grips
!. Blood pressure
$. Blood glucose
Answer: %!& Blood pressure
(heochromocytoma is a tumor of the adrenal medulla that causes an increase secretion of
catecholamines that can eleate the blood pressure.
/3. The nurse is attending a bridal shower for a friend when another guest# who happens to be a
diabetic# starts to tremble and complains of dizziness. The ne=t best action for the nurse to take is to:
A. 7ncourage the guest to eat some baked macaroni
B. !all the guest9s personal physician
!. 8ffer the guest a cup of coffee
$. 2ie the guest a glass of orange *uice
Answer: %$& 2ie the guest a glass of orange *uice
"n diabetic patients# the nurse should watch out for signs of hypoglycemia manifested by dizziness#
tremors# weakness# pallor diaphoresis and tachycardia. ,hen this occurs in a conscious client# he
should be gien immediately carbohydrates in the form of fruit *uice# hard candy# honey or# if
unconscious# glucagons or de=trose per "J.
/1. An adult# who is newly diagnosed with 2raes disease# asks the nurse# 1,hy do " need to take
(ropanolol %"nderal&-4 Based on the nurse9s understanding of the medication and 2rae9s
disease# the best response would be:
A. 1The medication will limit thyroid hormone secretion.4
B. 1The medication limit synthesis of the thyroid hormones.4
!. 1The medication will block the cardioascular symptoms of 2rae9s disease.4
$. 1The medication will increase the synthesis of thyroid hormones.4
Answer: %!& 1The medication will block the cardioascular symptoms of 2rae9s disease.4
(ropranolol %"nderal& is a beta-adrenergic blocker that controls the cardioascular manifestations
brought about by increased secretion of the thyroid hormone in 2rae9s disease.
/+. $uring the first +: hours after thyroid surgery# the nurse should include in her care:
A. !hecking the back and sides of the operatie dressing
B. 5upporting the head during mild range of motion e=ercise
!. 7ncouraging the client to entilate her feelings about the surgery
$. Adising the client that she can resume her normal actiities immediately
Answer: %A& !hecking the back and sides of the operatie dressing
Aollowing surgery of the thyroid gland# bleeding is a potential complication. This can best be
assessed by checking the back and the sides of the operatie dressing as the blood may flow towards
the side and back leaing the front dry and clear of drainage.
//. 8n discharge# the nurse teaches the patient to obsere for signs of surgically induced
hypothyroidism. The nurse would know that the patient understands the teaching when she states she
should notify the M$ if she deelops:
A. "ntolerance to heat
B. $ry skin and fatigue
!. (rogressie weight gain
$. "nsomnia and e=citability
Answer: %!& (rogressie weight gain
'ypothyroidism# a decrease in thyroid hormone production# is characterized by hypometabolism that
manifests itself with weight gain.
/:. ,hat is the best reason for the nurse in instructing the client to rotate in*ection sites for insulin-
A. 0ipodystrophy can result and is e=tremely painful
B. (oor rotation techni>ue can cause superficial hemorrhaging
!. 0ipodystrophic areas can result# causing erratic insulin absorption rates from these
$. "n*ection sites can neer be reused
Answer: %!& 0ipodystrophic areas can result# causing erratic insulin absorption rates from these
0ipodystrophy is the deelopment of fibrofatty masses at the in*ection site caused by repeated use of
an in*ection site. "n*ecting insulin into these scarred areas can cause the insulin to be poorly absorbed
and lead to erratic reactions.
/<. ,hich of the following would be inappropriate to include in a diabetic teaching plan-
A. !hange position hourly to increase circulation
B. "nspect feet and legs daily for any changes
!. Ieep legs eleated on + pillows while sleeping
$. Ieep the insulin not in use in the refrigerator
Answer: %!& Ieep legs eleated on + pillows while sleeping
The client with $M has decreased peripheral circulation caused by microangiopathy. Ieeping the
legs eleated during sleep will further cause circulatory impairment.
/?. "ncluded in the plan of care for the immediate post-gastroscopy period will be:
A. Maintain )2T to intermittent suction
B. Assess gag refle= prior to administration of fluids
!. Assess for pain and medicate as ordered
$. Measure abdominal girth eery : hours
Answer: %B& Assess gag refle= prior to administration of fluids
The client# after gastroscopy# has temporary impairment of the gag refle= due to the anesthetic that
has been sprayed into his throat prior to the procedure. 2iing fluids and food at this time can lead to
aspiration.
/?. "ncluded in the plan of care for the immediate post-gastroscopy period will be:
A. Maintain )2T to intermittent suction
B. Assess gag refle= prior to administration of fluids
!. Assess for pain and medicate as ordered
$. Measure abdominal girth eery : hours
Answer: %B& Assess gag refle= prior to administration of fluids
The client# after gastroscopy# has temporary impairment of the gag refle= due to the anesthetic that
has been sprayed into his throat prior to the procedure. 2iing fluids and food at this time can lead to
aspiration.
/@. ,hich description of pain would be most characteristic of a duodenal ulcer-
A. 2nawing# dull# aching# hungerlike pain in the epigastric area that is relieed by food intake
B. .6H pain that increases after meal
!. 5harp pain in the epigastric area that radiates to the right shoulder
$. A sensation of painful pressure in the midsternal area
Answer: %A& 2nawing# dull# aching# hungerlike pain in the epigastric area that is relieed by food
intake
$uodenal ulcer is related to an increase in the secretion of '!l. This can be buffered by food intake
thus the relief of the pain that is brought about by food intake.
/B. The client underwent Billroth surgery for gastric ulcer. (ost-operatiely# the drainage from his
)2T is thick and the olume of secretions has dramatically reduced in the last + hours and the client
feels like omiting. The most appropriate nursing action is to:
A. .eposition the )2T by adancing it gently )55
B. )otify the M$ of your findings
!. "rrigate the )2T with <3 cc of sterile
$. $iscontinue the low-intermittent suction
Answer: %B& )otify the M$ of your findings
The client9s feeling of omiting and the reduction in the olume of )2T drainage that is thick are
signs of possible abdominal distention caused by obstruction of the )2T. This should be reported
immediately to the M$ to preent tension and rupture on the site of anastomosis caused by gastric
distention.
/C. After Billroth "" 5urgery# the client deeloped dumping syndrome. ,hich of the following should
the nurse e=clude in the plan of care-
A. 5it upright for at least /3 minutes after meals
B. Take only sips of '+8 between bites of solid food
!. 7at small meals eery +-/ hours
$. .educe the amount of simple carbohydrate in the diet
Answer: %A& 5it upright for at least /3 minutes after meals
The dumping syndrome occurs within /3 mins after a meal due to rapid gastric emptying# causing
distention of the duodenum or *e*unum produced by a bolus of food. To delay the emptying# the client
has to lie down after meals. 5itting up after meals will promote the dumping syndrome.
:3. The laboratory of a male patient with (eptic ulcer reealed an eleated titer of 'elicobacter
pylori.
,hich of the following statements indicate an understanding of this data-
A. Treatment will include .anitidine and Antibiotics
B. )o treatment is necessary at this time
!. This result indicates gastric cancer caused by the organism
$. 5urgical treatment is necessary
Answer: %A& Treatment will include .anitidine and Antibiotics
8ne of the causes of peptic ulcer is '. (ylori infection. "t releases to=in that destroys the gastric and
duodenal mucosa which decreases the gastric epithelium9s resistance to acid digestion. 2iing
antibiotics will control the infection and .anitidine# which is a histamine-+ blocker# will reduce acid
secretion that can lead to ulcer.
:1. ,hat instructions should the client be gien before undergoing a paracentesis-
A. )(8 1+ hours before procedure
B. 7mpty bladder before procedure
!. 5trict bed rest following procedure
$. 7mpty bowel before procedure
Answer: %B& 7mpty bladder before procedure
(aracentesis inoles the remoal of ascitic fluid from the peritoneal caity through a puncture made
below the umbilicus. The client needs to oid before the procedure to preent accidental puncture of
a distended bladder during the procedure.
:+. The husband of a client asks the nurse about the protein-restricted diet ordered because of
adanced lier disease. ,hat statement by the nurse would best e=plain the purpose of the diet-
A. 1The lier cannot rid the body of ammonia that is made by the breakdown of protein in the
digestie system.4
B. 1The lier heals better with a high carbohydrates diet rather than protein.4
!. 1Most people hae too much protein in their diets. The amount of this diet is better for lier
healing.4
$. 1Because of portal hyperemesis# the blood flows around the lier and ammonia made from protein
collects in the brain causing hallucinations.4
Answer: %A& 1The lier cannot rid the body of ammonia that is made by the breakdown of protein in
the digestie system.4
The largest source of ammonia is the enzymatic and bacterial digestion of dietary and blood proteins
in the 2" tract. A protein-restricted diet will therefore decrease ammonia production.
:/. ,hich of the drug of choice for pain controls the patient with acute pancreatitis-
A. Morphine
B. )5A"$5
!. Meperidine
$. !odeine
Answer: %!& Meperidine
(ain in acute pancreatitis is caused by irritation and edema of the inflamed pancreas as well as spasm
due to obstruction of the pancreatic ducts. $emerol is the drug of choice because it is less likely to
cause spasm of the 5phincter of 8ddi unlike Morphine which is spasmogenic.
::. "mmediately after cholecystectomy# the nursing action that should assume the highest priority is:
A. encouraging the client to take ade>uate deep breaths by mouth
B. encouraging the client to cough and deep breathe
!. changing the dressing at least B"$
$. irrigate the T-tube fre>uently
Answer: %B& encouraging the client to cough and deep breathe
!holecystectomy re>uires a subcostal incision. To minimize pain# clients hae a tendency to take
shallow breaths which can lead to respiratory complications like pneumonia and atelectasis. $eep
breathing and coughing e=ercises can help preent such complications.
:<. A 5engstaken-Blakemore tube is inserted in the effort to stop the bleeding esophageal arices in a
patient with complicated lier cirrhosis. 6pon insertion of the tube# the client complains of difficulty
of breathing. The first action of the nurse is to:
A. $eflate the esophageal balloon
B. Monitor J5
!. 7ncourage him to take deep breaths
$. )otify the M$
Answer: %A& $eflate the esophageal balloon
,hen a client with a 5engstaken-Blakemore tube deelops difficulty of breathing# it means the tube
is displaced and the inflated balloon is in the oropharyn= causing airway obstruction
:?. The client presents with seere rectal bleeding# 1? diarrheal stools a day# seere abdominal pain#
tenesmus and dehydration. Because of these symptoms the nurse should be alert for other problems
associated with what disease-
A. !hrons disease
B. 6lceratie colitis
!. $ierticulitis
$. (eritonitis
Answer: %B& 6lceratie colitis
6lceratie colitis is a chronic inflammatory condition producing edema and ulceration affecting the
entire colon. 6lcerations lead to sloughing that causes stools as many as 13-+3 times a day that is
filled with blood# pus and mucus. The other symptoms mentioned accompany the problem.
:@. A client is being ealuated for cancer of the colon. "n preparing the client for barium enema# the
nurse should:
A. 2ie la=atie the night before and a cleansing enema in the morning before the test
B. .ender an oil retention enema and gie la=atie the night before
!. "nstruct the client to swallow ? radiopa>ue tablets the eening before the study
$. (lace the client on !B. a day before the study
Answer: %A& 2ie la=atie the night before and a cleansing enema in the morning before the test
Barium enema is the radiologic isualization of the colon using a die. To obtain accurate results in
this procedure# the bowels must be emptied of fecal material thus the need for la=atie and enema.
:B. The client has a good understanding of the means to reduce the chances of colon cancer when
he states:
A. 1" will e=ercise daily.4
B. 1" will include more red meat in my diet.4
!. 1" will hae an annual chest =-ray.4
$. 1" will include more fresh fruits and egetables in my diet.4
Answer: %$& 1" will include more fresh fruits and egetables in my diet.4
)umerous aspects of diet and nutrition may contribute to the deelopment of cancer. A low-fiber diet#
such as when fresh fruits and egetables are minimal or lacking in the diet# slows transport of
materials through the gut which has been linked to colorectal cancer.
:C. $ays after abdominal surgery# the client9s wound dehisces. The safest nursing interention when
this occurs is to
A. !oer the wound with sterile# moist saline dressing
B. Appro=imate the wound edges with tapes
!. "rrigate the wound with sterile saline
$. 'old the abdominal contents in place with a sterile gloed hand
Answer: %A& !oer the wound with sterile# moist saline dressing
$ehiscence is the partial or complete separation of the surgical wound edges. ,hen this occurs# the
client is placed in low Aowler9s position and instructed to lie >uietly. The wound should be coered to
protect it from e=posure and the dressing must be sterile to protect it from infection and moist to
preent the dressing from sticking to the wound which can disturb the healing process.
<3. An intraenous pyelogram reeals that (aulo# age /<# has a renal calculus. 'e is belieed to hae
a small stone that will pass spontaneously. To increase the chance of the stone passing# the nurse
would instruct the client to force fluids and to
A. 5train all urine.
B. Ambulate.
!. .emain on bed rest.
$. Ask for medications to rela= him.
Answer: %B& Ambulate.
Aree unattached stones in the urinary tract can be passed out with the urine by ambulation which can
mobilize the stone and by increased fluid intake which will flush out the stone during urination.
<1. A female client is admitted with a diagnosis of acute renal failure. 5he is awake# alert# oriented#
and complaining of seere back pain# nausea and omiting and abdominal cramps. 'er ital signs are
blood pressure 133G@3 mm 'g# pulse 113# respirations /3# and oral temperature 133.:RA %/BR!&. 'er
electrolytes are sodium 1+3 m7>G0# potassium <.+ m7>G0; her urinary output for the first B hours is
<3 ml. The client is displaying signs of which electrolyte imbalance-
A. 'yponatremia
B. 'yperkalemia
!. 'yperphosphatemia
$. 'ypercalcemia
Answer: %A& 'yponatremia
The normal serum sodium leel is 1/< F 1:< m7>G0. The client9s serum sodium is below normal.
'yponatremia also manifests itself with abdominal cramps and nausea and omiting
<+. Assessing the laboratory findings# which result would the nurse most likely e=pect to find in a
client with chronic renal failure-
A. B6) 13 to /3 mgGdl# potassium :.3 m7>G0# creatinine 3.< to 1.< mgGdl
B. $ecreased serum calcium# blood p' @.+# potassium ?.< m7>G0
!. B6) 1< mgGdl# increased serum calcium# creatinine l.3 mgGdl
$. B6) /< to :3 mgGdl# potassium /.< m7>G0# p' @./<# decreased serum calcium
Answer: %B& $ecreased serum calcium# blood p' @.+# potassium ?.< m7>G0
!hronic renal failure is usually the end result of gradual tissue destruction and loss of renal function.
,ith the loss of renal function# the kidneys ability to regulate fluid and electrolyte and acid base
balance results. The serum !a decreases as the kidneys fail to e=crete phosphate# potassium and
hydrogen ions are retained.
</. Treatment with hemodialysis is ordered for a client and an e=ternal shunt is created. ,hich
nursing action would be of highest priority with regard to the e=ternal shunt-
A. 'eparinize it daily.
B. Aoid taking blood pressure measurements or blood samples from the affected arm.
!. !hange the 5ilastic tube daily.
$. "nstruct the client not to use the affected arm.
Answer: %B& Aoid taking blood pressure measurements or blood samples from the affected arm.
"n the client with an e=ternal shunt# don9t use the arm with the ascular access site to take blood
pressure readings# draw blood# insert "J lines# or gie in*ections because these procedures may
rupture the shunt or occlude blood flow causing damage and obstructions in the shunt.
<:. .omeo $iaz# age @B# is admitted to the hospital with the diagnosis of benign prostatic hyperplasia
%B('&. 'e is scheduled for a transurethral resection of the prostate %T6.(&. "t would be inappropriate
to include which of the following points in the preoperatie teaching-
A. T6.( is the most common operation for B('.
B. 7=plain the purpose and function of a two-way irrigation system.
!. 7=pect bloody urine# which will clear as healing takes place.
$. 'e will be pain free.
Answer: %$& 'e will be pain free.
5urgical interentions inole an e=perience of pain for the client which can come in arying
degrees. Telling the pain that he will be pain free is giing him false reassurance.
<<. .o=y is admitted to the hospital with a possible diagnosis of appendicitis. 8n physical
e=amination# the nurse should be looking for tenderness on palpation at McBurney9s point# which is
located in the
A. left lower >uadrant
B. left upper >uadrant
!. right lower >uadrant
$. right upper >uadrant
Answer: %!& right lower >uadrant
To be e=act# the appendi= is anatomically located at the Mc Burney9s point at the right iliac area of
the right lower >uadrant.
<?. Mr. Jaldez has undergone surgical repair of his inguinal hernia. $ischarge teaching should
include
A. telling him to aoid heay lifting for : to ? weeks
B. instructing him to hae a soft bland diet for two weeks
!. telling him to resume his preious daily actiities without limitations
$. recommending him to drink eight glasses of water daily
Answer: %A& telling him to aoid heay lifting for : to ? weeks
The client should aoid lifting heay ob*ects and any strenuous actiity for :-? weeks after surgery to
preent stress on the inguinal area. There is no special diet re>uired. The fluid intake of eight glasses
a day is good adice but is not a priority in this case.
<@. A /3-year-old homemaker fell asleep while smoking a cigarette. 5he sustained seere burns of the
face#neck# anterior chest# and both arms and hands. 6sing the rule of nines# which is the best estimate
of total body-surface area burned-
A. 1BP
B. ++P
!. /1P
$. :3P
Answer: %!& /1P
6sing the .ule of )ine in the estimation of total body surface burned# we allot the following: CP -
head; CP - each upper e=tremity; 1BP- front chest and abdomen; 1BP - entire back; 1BP - each
lower e=tremity and 1P - perineum.
<B. )ursing care planning is based on the knowledge that the first +:-:B hours post-burn are
characterized by:
A. An increase in the total olume of intracranial plasma
B. 7=cessie renal perfusion with diuresis
!. Aluid shift from interstitial space
$. Aluid shift from intraascular space to the interstitial space
Answer: %$& Aluid shift from intraascular space to the interstitial space
This period is the burn shock stage or the hypoolemic phase. Tissue in*ury causes asodilation that
results in increase capillary permeability making fluids shift from the intraascular to the interstitial
space. This can lead to a decrease in circulating blood olume or hypoolemia which decreases renal
perfusion and urine output.
<C. "f a client has seere bums on the upper torso# which item would be a primary concern-
A. $ebriding and coering the wounds
B. Administering antibiotics
!. Are>uently obsering for hoarseness# stridor# and dyspnea
$. 7stablishing a patent "J line for fluid replacement
Answer: %!& Are>uently obsering for hoarseness# stridor# and dyspnea
Burns located in the upper torso# especially resulting from thermal in*ury related to fires can lead to
inhalation burns. This causes swelling of the respiratory mucosa and blistering which can lead to
airway obstruction manifested by hoarseness# noisy and difficult breathing. Maintaining a patent
airway is a primary concern.
?3. !ontractures are among the most serious long-term complications of seere burns. "f a burn is
located on the upper torso# which nursing measure would be least effectie to help preent
contractures-
A. !hanging the location of the bed or the TJ set# or both# daily
B. 7ncouraging the client to chew gum and blow up balloons
!. Aoiding the use of a pillow for sleep# or placing the head in a position of hypere=tension
$. 'elping the client to rest in the position of ma=imal comfort
Answer: %$& 'elping the client to rest in the position of ma=imal comfort
Mobility and placing the burned areas in their functional position can help preent contracture
deformities related to burns. (ain can immobilize a client as he seeks the position where he finds less
pain and proides ma=imal comfort. But this approach can lead to contracture deformities and other
complications.
?1. An adult is receiing Total (arenteral )utrition %T()&. ,hich of the following assessment is
essential-
A. ealuation of the peripheral "J site
B. confirmation that the tube is in the stomach
!. assess the bowel sound
$. fluid and electrolyte monitoring
Answer: %$& fluid and electrolyte monitoring
Total parenteral nutrition is a method of proiding nutrients to the body by an "J route. The
admi=ture is made up of proteins# carbohydrates# fats# electrolytes# itamins# trace minerals and
sterile water based on indiidual client needs. "t is intended to improe the clients nutritional status.
Because of its composition# it is important to monitor the clients fluid intake and output including
electrolytes# blood glucose and weight.
?+. ,hich drug would be least effectie in lowering a clientXs serum potassium leel-
A. 2lucose and insulin
B. (olystyrene sulfonate %Iaye=alate&
!. !alcium glucomite
$. Aluminum hydro=ide
Answer: %$& Aluminum hydro=ide
Aluminum hydro=ide binds dietary phosphorus in the 2" tract and helps treat hyperphosphatemia. All
the other medications mentioned help treat hyperkalemia and its effects.
?/. A nurse is directed to administer a hypotonic intraenous solution. 0ooking at the following
labeled solutions# she should choose
A. 3.:<P )a!l
B. 3.CP )a!l
!. $<,
$. $<)55
Answer: %A& 3.:<P )a!l
'ypotonic solutions like 3.:<P )a!l has a lower tonicity that the blood; 3.CP )a!l and $<, are
isotonic solutions with same tonicity as the blood; and $<)55 is hypertonic with a higher tonicity
thab the blood.
?:. A patient is hemorrhaging from multiple trauma sites. The nurse e=pects that compensatory
mechanisms associated with hypoolemia would cause all of the following symptoms 7E!7(T
A. hypertension
B. oliguria
!. tachycardia
$. tachypnea
Answer: %A& hypertension
"n hypoolemia# one of the compenasatory mechanisms is actiation of the sympathetic nerous
system that increases the .. W (. and helps restore the B( to maintain tissue perfusion but not cause
a hypertension. The 5)5 stimulation constricts renal arterioles that increases release of aldosterone#
decreases glomerular filtration and increases sodium W water reabsorption that leads to oliguria.
?<. Maria 5ison# :3 years old# single# was admitted to the hospital with a diagnosis of Breast !ancer.
5he was scheduled for radical mastectomy. )ursing care during the preoperatie period should
consist of
A. assuring Maria that she will be cured of cancer
B. assessing MariaXs e=pectations and doubts
!. maintaining a cheerful and optimistic enironment
$. keeping MariaXs isitors to a minimum so she can hae time for herself
Answer: %B& assessing MariaXs e=pectations and doubts
Assessing the client9s e=pectations and doubts will help lessen her fears and an=ieties. The nurse
needs to encourage the client to erbalize and to listen and correctly proide e=planations when
needed.
??. Maria refuses to acknowledge that her breast was remoed. 5he beliees that her breast is intact
under the dressing. The nurse should
A. call the M$ to change the dressing so Iathy can see the incision
B. recognize that Iathy is e=periencing denial# a normal stage of the grieing process
!. reinforce Iathy9s belief for seeral days until her body can ad*ust to stress of surgery.
$. remind Iathy that she needs to accept her diagnosis so that she can begin rehabilitation e=ercises.
Answer: %B& recognize that Iathy is e=periencing denial# a normal stage of the grieing process
A person griees to a loss of a significant ob*ect. The initial stage in the grieing process is denial#
then anger# followed by bargaining# depression and last acceptance. The nurse should show
acceptance of the patient9s feelings and encourage erbalization.
?@. A chemotherapeutic agent <A6 is ordered as an ad*unct measure to surgery. ,hich of the ff.
statements about chemotherapy is true-
A. it is a local treatment affecting only tumor cells
B. it affects both normal and tumor cells
!. it has been proen as a complete cure for cancer
$. it is often used as a palliatie measure.
Answer: %B& it affects both normal and tumor cells
!hemotherapeutic agents are gien to destroy the actiely proliferating cancer cells. But these agents
cannot differentiate the abnormal actiely proliferating cancer cells from those that are actiely
proliferating normal cells like the cells of the bone marrow# thus the effect of bone marrow
depression.
?B. ,hich is an incorrect statement pertaining to the following procedures for cancer diagnostics-
A. Biopsy is the remoal of suspicious tissue and the only definitie method to diagnose cancer
B. 6ltrasonography detects tissue density changes difficult to obsere by E-ray ia sound waes.
!. !T scanning uses magnetic fields and radio fre>uencies to proide cross-sectional iew of tumor
$. 7ndoscopy proides direct iew of a body caity to detect abnormality.
Answer: %!& !T scanning uses magnetic fields and radio fre>uencies to proide cross-sectional iew
of tumor
!T scan uses narrow beam =-ray to proide cross-sectional iew. M." uses magnetic fields and radio
fre>uencies to detect tumors.
?C. A post-operatie complication of mastectomy is lymphedema. This can be preented by
A. ensuring patency of wound drainage tube
B. placing the arm on the affected side in a dependent position
!. restricting moement of the affected arm
$. fre>uently eleating the arm of the affected side aboe the leel of the heart.
Answer: %$& fre>uently eleating the arm of the affected side aboe the leel of the heart.
7leating the arm aboe the leel of the heart promotes good enous return to the heart and good
lymphatic drainage thus preenting swelling.
@3. ,hich statement by the client indicates to the nurse that the patient understands precautions
necessary during internal radiation therapy for cancer of the ceri=-
A. 1" should get out of bed and walk around in my room.4
B. 1My @ year old twins should not come to isit me while "9m receiing treatment.4
!. 1" will try not to cough# because the force might make me e=pel the application.4
$. 1" know that my primary nurse has to wear one of those badges like the people in the =-ray
department# but they are not necessary for anyone else who comes in here.4
Answer: %B& 1My @ year old twins should not come to isit me while "9m receiing treatment.4
!hildren hae cells that are normally actiely diiding in the process of growth. .adiation acts not
only against the abnormally actiely diiding cells of cancer but also on the normally diiding cells
thus affecting the growth and deelopment of the child and een causing cancer itself.
@1. 'igh uric acid leels may deelop in clients who are receiing chemotherapy. This is caused by:
A. The inability of the kidneys to e=crete the drug metabolites
B. .apid cell catabolism
!. To=ic effect of the antibiotic that are gien concurrently
$. The altered blood ph from the acid medium of the drugs
Answer: %B& .apid cell catabolism
8ne of the oncologic emergencies# the tumor lysis syndrome# is caused by the rapid destruction of
large number of tumor cells. . "ntracellular contents are released# including potassium and purines#
into the bloodstream faster than the body can eliminate them. The purines are conerted in the lier to
uric acid and released into the blood causing hyperuricemia. They can precipitate in the kidneys and
block the tubules causing acute renal failure.
@+. ,hich of the following interentions would be included in the care of plan in a client with
cerical
implant-
A. Are>uent ambulation
B. 6nlimited isitors
!. 0ow residue diet
$. Jaginal irrigation eery shift
Answer: %!& 0ow residue diet
"t is important for the nurse to remember that the implant be kept intact in the ceri= during therapy.
Mobility and aginal irrigations are not done. A low residue diet will preent bowel moement that
could lead to dislodgement of the implant. (atient is also strictly isolated to protect other people from
the radiation emissions
@/. ,hich nursing measure would aoid constriction on the affected arm immediately after
mastectomy-
A. Aoid B( measurement and constricting clothing on the affected arm
B. Actie range of motion e=ercises of the arms once a day.
!. $iscourage feeding# washing or combing with the affected arm
$. (lace the affected arm in a dependent position# below the leel of the heart
Answer: %A& Aoid B( measurement and constricting clothing on the affected arm
A B( cuff constricts the blood essels where it is applied. B( measurements should be done on the
unaffected arm to ensure ade>uate circulation and enous and lymph drainage in the affected arm
@:. A client suffering from acute renal failure has an une=pected increase in urinary output to
1<3mlGhr. The nurse assesses that the client has entered the second phase of acute renal failure.
)ursing actions throughout this phase include obseration for signs and symptoms of
A. 'yperolemia# hypokalemia# and hypernatremia.
B. 'yperolemia# hyperkalemia# and hypernatremia.
!. 'ypoolemia# wide fluctuations in serum sodium and potassium leels.
$. 'ypoolemia# no fluctuation in serum sodium and potassium leels.
Answer: %!& 'ypoolemia# wide fluctuations in serum sodium and potassium leels.
The second phase of A.A is the diuretic phase or high output phase. The diuresis can result in an
output of up to 130Gday of dilute urine. 0oss of fluids and electrolytes occur.
@<. An adult has *ust been brought in by ambulance after a motor ehicle accident. ,hen assessing
the client# the nurse would e=pect which of the following manifestations could hae resulted from
sympathetic nerous system stimulation-
A. A rapid pulse and increased ..
B. $ecreased physiologic functioning
!. .igid posture and altered perceptual focus
$. "ncreased awareness and attention
Answer: %A& A rapid pulse and increased ..
The fight or flight reaction of the sympathetic nerous system occurs during stress like in a motor
ehicular accident. This is manifested by increased in cardioascular function and .. to proide the
immediate needs of the body for surial.
@?. Ms. 5y undergoes surgery and the abdominal aortic aneurysm is resected and replaced with a
graft. ,hen she arries in the .. she is still in shock. The nurseXs priority should be
A. placing her in a trendeleburg position
B. putting seeral warm blankets on her
!. monitoring her hourly urine output
$. assessing her J5 especially her ..
Answer: %$& assessing her J5 especially her ..
5hock is characterized by reduced tissue and organ perfusion and eentual organ dysfunction and
failure. !hecking on the J5 especially the ..# which detects need for o=ygenation# is a priority to
help detect its progress and proide for prompt management before the occurrence of complications.
@@. A ma*or goal for the client during the first :B hours after a seere bum is to preent hypoolemic
shock. The best indicator of ade>uate fluid balance during this period is
A. 7leated hematocrit leels.
B. 6rine output of /3 to <3 mlGhr.
!. !hange in leel of consciousness.
$. 7stimate of fluid loss through the burn eschar.
Answer: %B& 6rine output of /3 to <3 mlGhr.
'ypoolemia is a decreased in circulatory olume. This causes a decrease in tissue perfusion to the
different organs of the body. Measuring the hourly urine output is the most >uantifiable way of
measuring tissue perfusion to the organs. )ormal renal perfusion should produce 1mlGkg of B,Gmin.
An output of /3-<3 mlGhr is considered ade>uate and indicates good fluid balance.
@B. A thoracentesis is performed on a chest-in*ured client# and no fluid or air is found. Blood and
fluids is administered intraenously %"J&# but the clientXs ital signs do not improe. A central enous
pressure line is inserted# and the initial reading is +3 cm 'Y8. The most likely cause of these findings
is which of the following-
A. 5pontaneous pneumothora=
B. .uptured diaphragm
!. 'emothora=
$. (ericardial tamponade
Answer: %$& (ericardial tamponade
(ericardial tamponade occurs when there is presence of fluid accumulation in the pericardial space
that compresses on the entricles causing a decrease in entricular filling and stretching during
diastole with a decrease in cardiac output. . This leads to right atrial and enous congestion
manifested by a !J( reading aboe normal.
@C. "nterention for a pt. who has swallowed a Muriatic Acid includes all of the following e=cept
A. administering an irritant that will stimulate omiting
B. aspirating secretions from the pharyn= if respirations are affected
!. neutralizing the chemical
$. washing the esophagus with large olumes of water ia gastric laage
Answer: %A& administering an irritant that will stimulate omiting
5wallowing of corrosie substances causes seere irritation and tissue destruction of the mucous
membrane of the 2" tract. Measures are taken to immediately remoe the to=in or reduce its
absorption. Aor corrosie poison ingestion# such as in muriatic acid where burn or perforation of the
mucosa may occur# gastric emptying procedure is immediately instituted# This includes gastric laage
and the administration of actiated charcoal to absorb the poison. Administering an irritant with the
concomitant omiting to remoe the swallowed poison will further cause irritation and damage to the
mucosal lining of the digestie tract. Jomiting is only indicated when non-corrosie poison is
swallowed.
B3. ,hich initial nursing assessment finding would best indicate that a client has been successfully
resuscitated after a cardio-respiratory arrest-
A. 5kin warm and dry
B. (upils e>ual and react to light
!. (alpable carotid pulse
$. (ositie BabinskiXs refle=
Answer: %!& (alpable carotid pulse
(resence of a palpable carotid pulse indicates the return of cardiac function which# together with the
return of breathing# is the primary goal of !(.. (ulsations in arteries indicates blood flowing in the
blood essels with each cardiac contraction. 5igns of effectie tissue perfusion will be noted after.
B1. !hemical burn of the eye are treated with
A. local anesthetics and antibacterial drops for +: F /? hrs.
B. hot compresses applied at 1<-minute interals
!. Alushing of the lids# con*unctia and cornea with tap or preferably sterile water
$. cleansing the con*unctia with a small cotton-tipped applicator
Answer: %!& Alushing of the lids# con*unctia and cornea with tap or preferably sterile water
(rompt treatment of ocular chemical burns is important to preent further damage. "mmediate tap-
water eye irrigation should be started on site een before transporting the patient to the nearest
hospital facility. "n the hospital# copious irrigation with normal saline# instillation of local anesthetic
and antibiotic is done.
B+. The 'eimlich maneuer %abdominal thrust&# for acute airway obstruction# attempts to:
A. Aorce air out of the lungs
B. "ncrease systemic circulation
!. "nduce emptying of the stomach
$. (ut pressure on the ape= of the heart
Answer: %A& Aorce air out of the lungs
The 'eimlich maneuer is used to assist a person choking on a foreign ob*ect. The pressure from the
thrusts lifts the diaphragm# forces air out of the lungs and creates an artificial cough that e=pels the
aspirated material.
B/. Vohn# 1? years old# is brought to the 7. after a ehicular accident. 'e is pronounced dead on
arrial. ,hen his parents arrie at the hospital# the nurse should:
A. ask them to stay in the waiting area until she can spend time alone with them
B. speak to both parents together and encourage them to support each other and e=press their
emotions freely
!. 5peak to one parent at a time so that each can entilate feelings of loss without upsetting the other
$. ask the M$ to medicate the parents so they can stay calm to deal with their son9s death.
Answer: %B& speak to both parents together and encourage them to support each other and e=press
their emotions freely
5udden death of a family member creates a state of shock on the family. They go into a stage of
denial and anger in their grieing. Assisting them with information they need to know# answering
their >uestions and listening to them will proide the needed support for them to moe on and be of
support to one another.
B:. An emergency treatment for an acute asthmatic attack is Adrenaline 1:1333 gien hypodermically.
This is gien to:
A. increase B(
B. decrease mucosal swelling
!. rela= the bronchial smooth muscle
$. decrease bronchial secretions
Answer: %!& rela= the bronchial smooth muscle
Acute asthmatic attack is characterized by seere bronchospasm which can be relieed by the
immediate administration of bronchodilators. Adrenaline or 7pinephrine is an adrenergic agent that
causes bronchial dilation by rela=ing the bronchial smooth muscles.
B<. A nurse is performing !(. on an adult patient. ,hen performing chest compressions# the nurse
understands the correct hand placement is located oer the
A. upper half of the sternum
B. upper third of the sternum
!. lower half of the sternum
$. lower third of the sternum
Answer: %!& lower half of the sternum
The e=act and safe location to do cardiac compression is the lower half of the sternum. $oing it at the
lower third of the sternum may cause gastric compression which can lead to a possible aspiration.
B?. The nurse is performing an eye e=amination on an elderly client. The client states UMy ision is
blurred# and " don9t easily see clearly when " get into a dark room.4 The nurse best response is:
A. 1Kou should be grateful you are not blind.4
B. 1As one ages# isual changes are noted as part of degeneratie changes. This is normal.4
!. 1Kou should rest your eyes fre>uently.4
$. 1Kou maybe able to improe you ision if you moe slowly.4
Answer: %B& 1As one ages# isual changes are noted as part of degeneratie changes. This is normal.4
Aging causes less elasticity of the lens affecting accommodation leading to blurred ision. The
muscles of the iris increase in stiffness and the pupils dilate slowly and less completely so that it
takes the older person to ad*ust when going to and from light and dark enironment and needs
brighter light for close ision.
B@. ,hich of the following actiities is not encouraged in a patient after an eye surgery-
A. sneezing# coughing and blowing the nose
B. straining to hae a bowel moement
!. wearing tight shirt collars
$. se=ual intercourse
Answer: %$& se=ual intercourse
To reduce increases in "8(# teach the client and family about actiity restrictions. 5e=ual intercourse
can cause a sudden rise in "8(.
BB. ,hich of the following indicates poor practice in communicating with a hearing-impaired client-
A. 6se appropriate hand motions
B. Ieep hands and other ob*ects away from your mouth when talking to the client
!. 5peak clearly in a loud oice or shout to be heard
$. !onerse in a >uiet room with minimal distractions
Answer: %!& 5peak clearly in a loud oice or shout to be heard
5houting raises the fre>uency of the sound and often makes understanding the spoken words difficult.
"t is enough for the nurse to speak clearly and slowly.
BC. A client is to undergo lumbar puncture. ,hich is least important information about 0(-
A. 5pecimens obtained should be labeled in their proper se>uence.
B. "t may be used to in*ect air# dye or drugs into the spinal canal.
!. Assess moements and sensation in the lower e=tremities after the
$. Aorce fluids before and after the procedure.
Answer: %$& Aorce fluids before and after the procedure.
0( inoles the remoal of some amount of spinal fluid. To facilitate !5A production# the client is
instructed to increase fluid intake to /0# unless contraindicated# for +: to :B hrs after the procedure.
C3. A client diagnosed with cerebral thrombosis is scheduled for cerebral angiography. )ursing care
of the client includes the following 7E!7(T
A. "nform the client that a warm# flushed feeling and a salty taste may be
B. Maintain pressure dressing oer the site of puncture and check for
!. !heck pulse# color and temperature of the e=tremity distal to the site of
$. Iept the e=tremity used as puncture site fle=ed to preent bleeding.
Answer: %$& Iept the e=tremity used as puncture site fle=ed to preent bleeding.
Angiography inoles the threading of a catheter through an artery which can cause trauma to the
endothelial lining of the blood essel. The platelets are attracted to the area causing thrombi
formation. This is further enhanced by the slowing of blood flow caused by fle=ion of the affected
e=tremity. The affected e=tremity must be kept straight and immobilized during the duration of the
bedrest after the procedure. "ce bag can be applied intermittently to the puncture site.
C1. ,hich is considered as the earliest sign of increased "!( that the nurse should closely obsered
for-
A. abnormal respiratory pattern
B. rising systolic and widening pulse pressure
!. contralateral hemiparesis and ipsilateral dilation of the pupils
$. progression from restlessness to confusion and disorientation to lethargy
Answer: %$& progression from restlessness to confusion and disorientation to lethargy
The first ma*or effect of increasing "!( is a decrease in cerebral perfusion causing hypo=ia that
produces a progressie alteration in the 08!. This is initially manifested by restlessness.
C+. ,hich is irreleant in the pharmacologic management of a client with !JA-
A. 8smotic diuretics and corticosteroids are gien to decrease cerebral edema
B. Anticonulsants are gien to preent seizures
!. Thrombolytics are most useful within three hours of an occlusie !JA
$. Aspirin is used in the acute management of a completed stroke.
Answer: %$& Aspirin is used in the acute management of a completed stroke.
The primary goal in the management of !JA is to improe cerebral tissue perfusion. Aspirin is a
platelet deaggregator used in the preention of recurrent or embolic stroke but is not used in the acute
management of a completed stroke as it may lead to bleeding.
C/. ,hat would be the M85T therapeutic nursing action when a client9s e=pressie aphasia is
seere-
A. Anticipate the client wishes so she will not need to talk
B. !ommunicate by means of >uestions that can be answered by the client shaking the head
!. Ieep us a steady flow rank to minimize silence
$. 7ncourage the client to speak at eery possible opportunity.
Answer: %$& 7ncourage the client to speak at eery possible opportunity.
7=pressie or motor aphasia is a result of damage in the Broca9s area of the frontal lobe. "t is amotor
speech problem in which the client generally understands what is said but is unable to communicate
erbally. The patient can best he helped therefore by encouraging him to communicate and reinforce
this behaior positiely.
C:. A client with head in*ury is confused# drowsy and has une>ual pupils. ,hich of the following
nursing diagnosis is most important at this time-
A. altered leel of cognitie function
B. high risk for in*ury
!. altered cerebral tissue perfusion
$. sensory perceptual alteration
Answer: %!& altered cerebral tissue perfusion
The obserations made by the nurse clearly indicate a problem of decrease cerebral perfusion.
.estoring cerebral perfusion is most important to maintain cerebral functioning and preent further
brain damage.
C<. ,hich nursing diagnosis is of the highest priority when caring for a client with myasthenia
grais-
A. (ain
B. 'igh risk for in*ury related to muscle weakness
!. "neffectie coping related to illness
$. "neffectie airway clearance related to muscle weakness
Answer: %$& "neffectie airway clearance related to muscle weakness
Myasthenia grais causes a failure in the transmission of nere impulses at the neuromuscular
*unction which may be due to a weakening or decrease in acetylcholine receptor sites. This leads to
sporadic# progressie weakness or abnormal fatigability of striated muscles that eentually causes
loss of function. The respiratory muscles can become weak with decreased tidal olume and ital
capacity making breathing and clearing the airway through coughing difficult. The respiratory muscle
weakness may be seere enough to re>uire and emergency airway and mechanical entilation.
C?. The client has clear drainage from th
nose and ears after a head in*ury. 'ow can the nurse determine if the drainage is !5A-
A. Measure the ph of the fluid
B. Measure the specific graity of the fluid
!. Test for glucose
$. Test for chlorides
Answer: %!& Test for glucose
The !5A contains a large amount of glucose which can be detected by using glucosti=. A positie
result with the drainage indicate !5A leakage.
C@. The nurse includes the important measures for stump care in the teaching plan for a client with an
amputation. ,hich measure would be e=cluded from the teaching plan-
A. ,ash# dry# and inspect the stump daily.
B. Treat superficial abrasions and blisters promptly.
!. Apply a DshrinkerD bandage with tighter arms around the pro=imal end of the affected limb.
$. Toughen the stump by pushing it against a progressiely harder substance %e.g.# pillow on a foot-
stool&.
Answer: %!& Apply a DshrinkerD bandage with tighter arms around the pro=imal end of the affected
limb.
The 1shrinker4 bandage is applied to preent swelling of the stump. "t should be applied with the
distal end with the tighter arms. Applying the tighter arms at the pro=imal end will impair circulation
and cause swelling by reducing enous flow.
CB. A @3-year-old female comes to the clinic for a routine checkup. 5he is < feet : inches tall and
weighs 1B3 pounds. 'er ma*or complaint is pain in her *oints. 5he is retired and has had to gie up
her olunteer work because of her discomfort. 5he was told her diagnosis was osteoarthritis about <
years ago. ,hich would be e=cluded from the clinical pathway for this client-
A. $ecrease the calorie count of her daily diet.
B. Take warm baths when arising.
!. 5lide items across the floor rather than lift them.
$. (lace items so that it is necessary to bend or stretch to reach them.
Answer: %$& (lace items so that it is necessary to bend or stretch to reach them.
(atients with osteoarthritis hae decreased mobility caused by *oint pain. 8er-reaching and
stretching to get an ob*ect are to be aoided as this can cause more pain and can een lead to falls.
The nurse should see to it therefore that ob*ects are within easy reach of the patient.
CC. A client is admitted from the emergency department with seere-pain and edema in the right foot.
'is diagnosis is gouty arthritis. ,hen deeloping a plan of care# which action would hae the highest
priority-
A. Apply hot compresses to the affected *oints.
B. 5tress the importance of maintaining good posture to preent deformities.
!. Administer salicylates to minimize the inflammatory reaction.
$. 7nsure an intake of at least /333 ml of fluid per day.
Answer: %$& 7nsure an intake of at least /333 ml of fluid per day.
2outy arthritis is a metabolic disease marked by urate deposits that cause painful arthritic *oints. The
patient should be urged to increase his fluid intake to preent the deelopment of urinary uric acid
stones.
133. A client had a laminectomy and spinal fusion yesterday. ,hich statement is to be e=cluded from
your plan of care-
A. Before log rolling# place a pillow under the clientXs head and a pillow between the clientXs legs.
B. Before log rolling# remoe the pillow from under the clientXs head and use no pillows between the
clientXs legs.
!. Ieep the knees slightly fle=ed while the client is lying in a semi-AowlerXs position in bed.
$. Ieep a pillow under the clientXs head as needed for comfort.
Answer: %B& Before log rolling# remoe the pillow from under the clientXs head and use no pillows
between the clientXs legs.
Aollowing a laminectomy and spinal fusion# it is important that the back of the patient be maintained
in straight alignment and to support the entire ertebral column to promote complete healing.
131. The nurse is assisting in planning care for a client with a diagnosis of immune deficiency. The
nurse would incorporate which of the ff. as a priority in the plan of care-
A. proiding emotional support to decrease fear
B. protecting the client from infection
!. encouraging discussion about lifestyle changes
$. identifying factors that decreased the immune function
Answer: %B& protecting the client from infection
"mmunodeficiency is an absent or depressed immune response that increases susceptibility to
infection. 5o it is the nurse9s primary responsibility to protect the patient from infection.
13+. Voy# an obese /+ year old# is admitted to the hospital after an automobile accident. 5he has a
fractured hip and is brought to the 8. for surgery.
After surgery Voy is to receie a piggy-back of !lindamycin phosphate %!leocin& /33 mg in <3 ml of
$<,. The piggyback is to infuse in +3 minutes. The drop factor of the "J set is 13 gttGml. The nurse
should set the piggyback to flow at:
A. +< gttGmin
B. /3 gttGmin
!. /< gttGmin
$. :< gttGmin
Answer: %A& +< gttGmin
To get the correct flow rate: multiply the amount to be infused %<3 ml& by the drop factor %13& and
diide the result by the amount of time in minutes %+3&
13/. The day after her surgery Voy asks the nurse how she might lose weight. Before answering her
>uestion# the nurse should bear in mind that long-term weight loss best occurs when:
A. Aats are controlled in the diet
B. 7ating habits are altered
!. !arbohydrates are regulated
$. 7=ercise is part of the program
Answer: %B& 7ating habits are altered
Aor weight reduction to occur and be maintained# a new dietary program# with a balance of foods
from the basic four food groups# must be established and continued
13:. The nurse teaches Voy# an obese client# the alue of aerobic e=ercises in her weight reduction
program. The nurse would know that this teaching was effectie when Voy says that e=ercise will:
A. "ncrease her lean body mass
B. 0ower her metabolic rate
!. $ecrease her appetite
$. .aise her heart rate
Answer: %A& "ncrease her lean body mass
"ncreased e=ercise builds skeletal muscle mass and reduces e=cess fatty tissue.
13<. The physician orders non-weight bearing with crutches for Voy# who had surgery for a fractured
hip. The most important actiity to facilitate walking with crutches before ambulation begun is:
A. 7=ercising the triceps# finger fle=ors# and elbow e=tensors
B. 5itting up at the edge of the bed to help strengthen back muscles
!. $oing isometric e=ercises on the unaffected leg
$. 6sing the trapeze fre>uently for pull-ups to strengthen the biceps muscles
Answer: %A& 7=ercising the triceps# finger fle=ors# and elbow e=tensors
These sets of muscles are used when walking with crutches and therefore need strengthening prior to
ambulation.
13?. The nurse recognizes that a client understood the demonstration of crutch walking when she
places her weight on:
A. The palms and a=illary regions
B. Both feet placed wide apart
!. The palms of her hands
$. 'er a=illary regions
Answer: %!& The palms of her hands
The palms should bear the client9s weight to aoid damage to the neres in the a=illa %brachial
ple=us&
13@. Voey is a :? year-old radio technician who is admitted because of mild chest pain. 'e is < feet# B
inches tall and weighs 1C3 pounds. 'e is diagnosed with a myocardial infarct. Morphine sulfate#
$iazepam %Jalium& and 0idocaine are prescribed.
The physician orders B mg of Morphine 5ulfate to be gien "J. The ial on hand is labeled 1 mlG 13
mg. The nurse should administer:
A. B minims
B. 13 minims
!. 1+ minims
$. 1< minims
Answer: %!& 1+ minims
6sing ratio and proportion B mgG13 mg Q E minimsG1< minims 13 EQ 1+3 E Q 1+ minims The nurse
will administer 1+ minims intraenously e>uialent to Bmg Morphine 5ulfate
13B. Voey asks the nurse why he is receiing the in*ection of Morphine after he was hospitalized for
seere anginal pain. The nurse replies that it:
A. ,ill help preent erratic heart beats
B. .eliees pain and decreases leel of an=iety
!. $ecreases an=iety
$. $ilates coronary blood essels
Answer: %B& .eliees pain and decreases leel of an=iety
Morphine is a specific central nerous system depressant used to reliee the pain associated with
myocardial infarction. "t also decreases an=iety and apprehension and preents cardiogenic shock by
decreasing myocardial o=ygen demand.
13C. 8=ygen /0Gmin by nasal cannula is prescribed for Voey who is admitted to the hospital for chest
pain. The nurse institutes safety precautions in the room because o=ygen:
A. !onerts to an alternate form of matter
B. 'as unstable properties
!. 5upports combustion
$. "s flammable
Answer: %!& 5upports combustion
The nurse should know that 8=ygen is necessary to produce fire# thus precautionary measures are
important regarding its use.
113. Myra is ordered laboratory tests after she is admitted to the hospital for angina. The isoenzyme
test that is the most reliable early indicator of myocardial insult is:
A. 52(T
B. 0$'
!. !I-MB
$. A5T
Answer: %!& !I-MB
The cardiac marker# !reatinine phosphokinase %!(I& isoenzyme leels# especially the MB sub-unit
which is cardio-specific# begin to rise in /-? hours# peak in 1+-1B hours and are eleated :B hours
after the occurrence of the infarct. They are therefore most reliable in assisting with early diagnosis.
The cardiac markers eleate as a result of myocardial tissue damage.
111. An early finding in the 7I2 of a client with an infarcted mycardium would be:
A. $isappearance of H waes
B. 7leated 5T segments
!. Absence of ( wae
$. Alattened T waes
Answer: %B& 7leated 5T segments
This is a typical early finding after a myocardial infarct because of the altered contractility of the
heart. The other choices are not typical of M".
11+. Vose# who had a myocardial infarction + days earlier# has been complaining to the nurse about
issues related to his hospital stay. The best initial nursing response would be to:
A. Allow him to release his feelings and then leae him alone to allow him to regain his composure
B. .efocus the conersation on his fears# frustrations and anger about his condition
!. 7=plain how his being upset dangerously disturbs his need for rest
$. Attempt to e=plain the purpose of different hospital routines
Answer: %B& .efocus the conersation on his fears# frustrations and anger about his condition
This proides the opportunity for the client to erbalize feelings underlying behaior and helpful in
relieing an=iety. An=iety can be a stressor which can actiate the sympathoadrenal response causing
the release of catecholamines that can increase cardiac contractility and workload that can further
increase myocardial o=ygen demand.
11/. Twenty four hours after admission for an Acute M"# Vose9s temperature is noted at /C./ !. The
nurse monitors him for other adaptations related to the pyre=ia# including:
A. 5hortness of breath
B. !hest pain
!. 7leated blood pressure
$. "ncreased pulse rate
Answer: %$& "ncreased pulse rate
Aeer causes an increase in the body9s metabolism# which results in an increase in o=ygen
consumption and demand. This need for o=ygen increases the heart rate# which is reflected in the
increased pulse rate. "ncreased B(# chest pain and shortness of breath are not typically noted in feer.
11:. Vose# who is admitted to the hospital for chest pain# asks the nurse# 1"s it still possible for me to
hae another heart attack if " watch my diet religiously and aoid stress-4 The most appropriate initial
response would be for the nurse to:
A. 5uggest he discuss his feelings of ulnerability with his physician.
B. Tell him that he certainly needs to be especially careful about his diet and lifestyle.
!. Aoid giing him direct information and help him e=plore his feelings
$. .ecognize that he is frightened and suggest he talk with the psychiatrist or counselor.
Answer: %!& Aoid giing him direct information and help him e=plore his feelings
To help the patient erbalize and e=plore his feelings# the nurse must reflect and analyze the feelings
that are implied in the client9s >uestion. The focus should be on collecting data to minister to the
client9s psychosocial needs.
11<. Ana# << years old# is admitted to the hospital to rule out pernicious anemia. A 5chilling test is
ordered for Ana. The nurse recognizes that the primary purpose of the 5chilling test is to determine
the client9s ability to:
A. 5tore itamin B1+
B. $igest itamin B1+
!. Absorb itamin B1+
$. (roduce itamin B1+
Answer: %!& Absorb itamin B1+
(ernicious anemia is caused by the inability to absorb itamin B1+ in the stomach due to a lack of
intrinsic factor in the gastric *uices. "n the 5chilling test# radioactie itamin B1+ is administered and
its absorption and e=cretion can be ascertained through the urine.
11?. Ana is diagnosed to hae (ernicious anemia. The physician orders 3.+ mg of !yanocobalamin
%Jitamin B1+& "M. Aailable is a ial of the drug labeled 1 mlQ 133 mcg. The nurse should
administer:
A. 3.< ml
B. 1.3 ml
!. 1.< ml
$. +.3 ml
Answer: %$& +.3 ml
Airst conert milligrams to micrograms and then use ratio and proportion %3.+ mgQ +33 mcg& +33
mcg : 133 mcgQ E ml : ml 133 EQ +33 E Q + ml. "n*ect + ml. to gie 3.+ mg of !yanocobalamin.
11@. 'ealth teachings to be gien to a client with (ernicious Anemia regarding her therapeutic
regimen concerning Jit. B1+ will include:
A. 8ral tablets of Jitamin B1+ will control her symptoms
B. "M in*ections are re>uired for daily control
!. "M in*ections once a month will maintain control
$. ,eekly L-track in*ections proide needed control
Answer: %!& "M in*ections once a month will maintain control
$eep "M in*ections bypass B1+ absorption defect in the stomach due to lack of intrinsic factor# the
transport carrier component of gastric *uices. A monthly dose is usually sufficient since it is stored in
actie body tissues such as the lier# kidney# heart# muscles# blood and bone marrow
11B. The nurse knows that a client with (ernicious Anemia understands the teaching regarding the
itamin B1+ in*ections when she states that she must take it:
A. ,hen she feels fatigued
B. $uring e=acerbations of anemia
!. 6ntil her symptoms subside
$. Aor the rest of her life
Answer: %$& Aor the rest of her life
5ince the intrinsic factor does not return to gastric secretions een with therapy# B1+ in*ections will
be re>uired for the remainder of the client9s life.
11C. Arthur !ruz# a :< year old artist# has recently had an abdominoperineal resection and colostomy.
Mr. !ruz accuses the nurse of being uncomfortable during a dressing change# because his 1wound
looks terrible.4 The nurse recognizes that the client is using the defense mechanism known as:
A. .eaction Aormation
B. 5ublimation
!. "ntellectualization
$. (ro*ection
Answer: %$& (ro*ection
(ro*ection is the attribution of unacceptable feelings and emotions to others which may indicate the
patients nonacceptance of his condition.
1+3. ,hen preparing to teach a client with colostomy how to irrigate his colostomy# the nurse should
plan to perform the procedure:
A. ,hen the client would hae normally had a bowel moement
B. After the client accepts he had a bowel moement
!. Before breakfast and morning care
$. At least + hours before isitors arrie
Answer: %A& ,hen the client would hae normally had a bowel moement
"rrigation should be performed at the time the client normally defecated before the colostomy to
maintain continuity in lifestyle and usual bowel functionGhabit.
1+1. ,hen obsering an ostomate do a return demonstration of the colostomy irrigation# the nurse
notes that he needs more teaching if he:
A. 5tops the flow of fluid when he feels uncomfortable
B. 0ubricates the tip of the catheter before inserting it into the stoma
!. 'angs the bag on a clothes hook on the bathroom door during fluid insertion
$. $iscontinues the insertion of fluid after only <33 ml of fluid has been instilled
Answer: %!& 'angs the bag on a clothes hook on the bathroom door during fluid insertion
The irrigation bag should be hung 1+-1B inches aboe the leel of the stoma; a clothes hook is too
high which can create increase pressure and sudden intestinal distention and cause abdominal
discomfort to the patient.
1++. ,hen doing colostomy irrigation at home# a client with colostomy should be instructed to report
to his physician :
A. Abdominal cramps during fluid inflow
B. $ifficulty in inserting the irrigating tube
!. (assage of flatus during e=pulsion of feces
$. "nability to complete the procedure in half an hour
Answer: %B& $ifficulty in inserting the irrigating tube
$ifficulty of inserting the irrigating tube indicates stenosis of the stoma and should be reported to the
physician. Abdominal cramps and passage of flatus can be e=pected during colostomy irrigations.
The procedure may take longer than half an hour.
1+/. A client with colostomy refuses to allow his wife to see the incision or stoma and ignores most
of his dietary instructions. The nurse on assessing this data# can assume that the client is
e=periencing:
A. A reaction formation to his recent altered body image.
B. A difficult time accepting reality and is in a state of denial.
!. "mpotency due to the surgery and needs se=ual counseling
$. 5uicide thoughts and should be seen by psychiatrist
Answer: %B& A difficult time accepting reality and is in a state of denial.
As long as no one else confirms the presence of the stoma and the client does not need to adhere to a
prescribed regimen# the client9s denial is supported
1+:. The nurse would know that dietary teaching had been effectie for a client with colostomy when
he states that he will eat:
A. Aood low in fiber so that there is less stool
B. 7erything he ate before the operation but will aoid those foods that cause gas
!. Bland foods so that his intestines do not become irritated
$. 5oft foods that are more easily digested and absorbed by the large intestines
Answer: %B& 7erything he ate before the operation but will aoid those foods that cause gas
There is no special diets for clients with colostomy. These clients can eat a regular diet. 8nly gas-
forming foods that cause distention and discomfort should be aoided.
1+<. 7ddie# :3 years old# is brought to the emergency room after the crash of his priate plane. 'e
has suffered multiple crushing wounds of the chest# abdomen and legs. "t is feared his leg may hae
to be amputated.
,hen 7ddie arries in the emergency room# the assessment that assume the greatest priority are:
A. 0eel of consciousness and pupil size
B. Abdominal contusions and other wounds
!. (ain# .espiratory rate and blood pressure
$. Huality of respirations and presence of pulsesHuality of respirations and presence of pulses
Answer: %$& Huality of respirations and presence of pulsesHuality of respirations and presence of
pulses
.espiratory and cardioascular functions are essential for o=ygenation. These are top priorities to
trauma management. Basic life functions must be maintained or reestablished
1+?. 7ddie# a plane crash ictim# undergoes endotracheal intubation and positie pressure entilation.
The most immediate nursing interention for him at this time would be to:
A. Aacilitate his erbal communication
B. Maintain sterility of the entilation system
!. Assess his response to the e>uipment
$. (repare him for emergency surgery
Answer: %!& Assess his response to the e>uipment
"t is a primary nursing responsibility to ealuate effect of interentions done to the client. )othing is
achieed if the e>uipment is working and the client is not responding
1+@. A chest tube with water seal drainage is inserted to a client following a multiple chest in*ury. A
few hours later# the client9s chest tube seems to be obstructed. The most appropriate nursing action
would be to
A. (repare for chest tube remoal
B. Milk the tube toward the collection container as ordered
!. Arrange for a stat !hest =-ray film.
$. !lam the tube immediately
Answer: %B& Milk the tube toward the collection container as ordered
This assists in moing blood# fluid or air# which may be obstructing drainage# toward the collection
chamber
1+B. The obseration that indicates a desired response to thoracostomy drainage of a client with chest
in*ury is:
A. "ncreased breath sounds
B. !onstant bubbling in the drainage chamber
!. !repitus detected on palpation of chest
$. "ncreased respiratory rate
Answer: %A& "ncreased breath sounds
The chest tube normalizes intrathoracic pressure and restores negatie intra-pleural pressure# drains
fluid and air from the pleural space# and improes pulmonary function
1+C. "n the ealuation of a client9s response to fluid replacement therapy# the obseration that
indicates ade>uate tissue perfusion to ital organs is:
A. 6rinary output is /3 ml in an hour
B. !entral enous pressure reading of + cm '+8
!. (ulse rates of 1+3 and 113 in a 1< minute period
$. Blood pressure readings of <3G/3 and @3G:3 within /3 minutes
Answer: %A& 6rinary output is /3 ml in an hour
A rate of /3 mlGhr is considered ade>uate for perfusion of kidney# heart and brain.
1/3. A client with multiple in*ury following a ehicular accident is transferred to the critical care unit.
'e begins to complain of increased abdominal pain in the left upper >uadrant. A ruptured spleen is
diagnosed and he is scheduled for emergency splenectomy. "n preparing the client for surgery# the
nurse should emphasize in his teaching plan the:
A. !omplete safety of the procedure
B. 7=pectation of postoperatie bleeding
!. .isk of the procedure with his other in*uries
$. (resence of abdominal drains for seeral days after surgery
Answer: %$& (resence of abdominal drains for seeral days after surgery
$rains are usually inserted into the splenic bed to facilitate remoal of fluid in the area that could
lead to abscess formation.
1/1. To promote continued improement in the respiratory status of a client following chest tube
remoal after a chest surgery for multiple rib fracture# the nurse should:
A. 7ncourage bed rest with actie and passie range of motion e=ercises
B. 7ncourage fre>uent coughing and deep breathing
!. Turn him from side to side at least eery + hours
$. !ontinue obsering for dyspnea and crepitus
Answer: %B& 7ncourage fre>uent coughing and deep breathing
This nursing action preents atelectasis and collection of respiratory secretions and promotes
ade>uate entilation and gas e=change.
1/+. A client undergoes below the knee amputation following a ehicular accident. Three days
postoperatiely# the client is refusing to eat# talk or perform any rehabilitatie actiities. The best
initial nursing approach would be to:
A. 2ie him e=planations of why there is a need to >uickly increase his actiity
B. 7mphasize repeatedly that with as prosthesis# he will be able to return to his normal lifestyle
!. Appear cheerful and non-critical regardless of his response to attempts at interention
$. Accept and acknowledge that his withdrawal is an initially normal and necessary part of grieing
Answer: %$& Accept and acknowledge that his withdrawal is an initially normal and necessary part of
grieing
The withdrawal proides time for the client to assimilate what has occurred and integrate the change
in the body image. Acceptance of the client9s behaior is an important factor in the nurse9s
interention.
1//. The key factor in accurately assessing how body image changes will be dealt with by the client
is the:
A. 7=tent of body change present
B. 5uddenness of the change
!. 8biousness of the change
$. !lient9s perception of the change
Answer: %$& !lient9s perception of the change
"t is not reality# but the client9s feeling about the change that is the most important determinant of the
ability to cope. The client should be encouraged to his feelings.
1/:. 0arry is diagnosed as haing myelocytic leukemia and is admitted to the hospital for
chemotherapy. 0arry discusses his recent diagnosis of leukemia by referring to statistical facts and
figures. The nurse recognizes that 0arry is using the defense mechanism known as:
A. .eaction formation
B. 5ublimation
!. "ntellectualization
$. (ro*ection
Answer: %!& "ntellectualization
(eople use defense mechanisms to cope with stressful eents. "ntellectualization is the use of
reasoning and thought processes to aoid the emotional upsets.
1/<. The laboratory results of the client with leukemia indicate bone marrow depression. The nurse
should encourage the client to:
A. "ncrease his actiity leel and ambulate fre>uently
B. 5leep with the head of his bed slightly eleated
!. $rink citrus *uices fre>uently for nourishment
$. 6se a soft toothbrush and electric razor
Answer: %$& 6se a soft toothbrush and electric razor
5uppression of red bone marrow increases bleeding susceptibility associated with thrombocytopenia#
decreased platelets. Anemia and leucopenia are the two other problems noted with bone marrow
depression.
1/?. $ennis receies a blood transfusion and deelops flank pain# chills# feer and hematuria. The
nurse recognizes that $ennis is probably e=periencing:
A. An anaphylactic transfusion reaction
B. An allergic transfusion reaction
!. A hemolytic transfusion reaction
$. A pyrogenic transfusion reaction
Answer: %!& A hemolytic transfusion reaction
This results from a recipient9s antibodies that are incompatible with transfused .B!9s; also called
type "" hypersensitiity; these signs result from .B! hemolysis# agglutination# and capillary plugging
that can damage renal function# thus the flank pain and hematuria and the other manifestations.
1/@. A client *okes about his leukemia een though he is becoming sicker and weaker. The nurse9s
most therapeutic response would be:
A. 1Kour laugher is a coer for your fear.4
B. 1'e who laughs on the outside# cries on the inside.4
!. 1,hy are you always laughing-4
$. 1$oes it help you to *oke about your illness-4
Answer: %$& 1$oes it help you to *oke about your illness-4
This non-*udgmentally on the part of the nurse points out the client9s behaior.
1/B. "n dealing with a dying client who is in the denial stage of grief# the best nursing approach is to:
A. Agree with and encourage the client9s denial
B. .eassure the client that eerything will be okay
!. Allow the denial but be aailable to discuss death
$. 0eae the client alone to discuss the loss
Answer: %!& Allow the denial but be aailable to discuss death
This does not take away the client9s only way of coping# and it permits future moement through the
grieing process when the client is ready. $ying clients moe through the different stages of grieing
and the nurse must be ready to interene in all these stages.
1/C. $uring and B hour shift# Mario drinks two ? oz. cups of tea and omits 1+< ml of fluid. $uring
this B hour period# his fluid balance would be:
A. T<< ml
B. T1/@ ml
!. T+/< ml
$. T:B< ml
Answer: %!& T+/< ml
The client9s intake was /?3 ml %?oz = /3 ml& and loss was 1+< ml of fluid; loss is subtracted from
intake
1:3. Mr. 8ng is admitted to the hospital with a diagnosis of 0eft-sided !'A. "n the assessment# the
nurse should e=pect to find:
A. !rushing chest pain
B. $yspnea on e=ertion
!. 7=tensie peripheral edema
$. Vugular ein distention
Answer: %B& $yspnea on e=ertion
(ulmonary congestion and edema occur because of fluid e=traasation from the pulmonary capillary
bed# resulting in difficult breathing. 0eft-sided heart failure creates a backward effect on the
pulmonary system that leads to pulmonary congestion.
1:1. The physician orders on a client with !'A a cardiac glycoside# a asodilator# and furosemide
%0asi=&. The nurse understands 0asi= e=erts is effects in the:
A. $istal tubule
B. !ollecting duct
!. 2lomerulus of the nephron
$. Ascending limb of the loop of 'enle
Answer: %$& Ascending limb of the loop of 'enle
This is the site of action of 0asi= being a potent loop diuretic.
1:+. Mr. 8ng weighs +13 lbs on admission to the hospital. After + days of diuretic therapy he weighs
+3<.< lbs. The nurse could estimate that the amount of fluid he has lost is:
A. 3.< 0
B. 1.3 0
!. +.3 0
$. /.< 0
Answer: %!& +.3 0
8ne liter of fluid weighs appro=imately +.+ lbs. Therefore a :.< lbs weight loss e>uals appro=imately
+ 0iters.
1:/. Mr. 8ng# a client with !'A# has been receiing a cardiac glycoside# a diuretic# and a asodilator
drug. 'is apical pulse rate is :: and he is on bed rest. The nurse concludes that his pulse rate is most
likely the result of the:
A. $iuretic
B. Jasodilator
!. Bed-rest regimen
$. !ardiac glycoside
Answer: %$& !ardiac glycoside
A cardiac glycoside such as digitalis increases force of cardiac contraction# decreases the conduction
speed of impulses within the myocardium and slows the heart rate.
1::. The diet ordered for a client with !'A permits him to hae a 1C3 g of carbohydrates# C3 g of fat
and 133 g of protein. The nurse understands that this diet contains appro=imately:
A. ++33 calories
B. +333 calories
!. +B33 calories
$. 1?33 calories
Answer: %B& +333 calories
There are C calories in each gram of fat and : calories in each gram of carbohydrate and protein
1:<. After the acute phase of congestie heart failure# the nurse should e=pect the dietary
management of the client to include the restriction of:
A. Magnesium
B. 5odium
!. (otassium
$. !alcium
Answer: %B& 5odium
.estriction of sodium reduces the amount of water retention that reduces the cardiac workload
1:?. Vude deelops 2" bleeding and is admitted to the hospital. An important etiologic clue for the
nurse to e=plore while taking his history would be:
A. The medications he has been taking
B. Any recent foreign trael
!. 'is usual dietary pattern
$. 'is working patterns
Answer: %A& The medications he has been taking
5ome medications# such as aspirin and prednisone# irritate the stomach lining and may cause bleeding
with prolonged use
1:@. The meal pattern that would probably be most appropriate for a client recoering from 2"
bleeding is:
A. Three large meals large enough to supply ade>uate energy.
B. .egular meals and snacks to limit gastric discomfort
!. 0imited food and fluid intake when he has pain
$. A fle=ible plan according to his appetite
Answer: %B& .egular meals and snacks to limit gastric discomfort
(resence of food in the stomach at regular interals interacts with '!l limiting acid mucosal
irritation. Mucosal irritation can lead to bleeding.
1:B. A client with a history of recurrent 2" bleeding is admitted to the hospital for a gastrectomy.
Aollowing surgery# the client has a nasogastric tube to low continuous suction. 'e begins to
hyperentilate. The nurse should be aware that this pattern will alter his arterial blood gases by:
A. "ncreasing '!8/
B. $ecreasing (!8+
!. $ecreasing p'
$. $ecreasing (8+
Answer: %B& $ecreasing (!8+
'yperentilation results in the increased elimination of carbon dio=ide from the blood that can lead to
respiratory alkalosis.
1:C. .outine postoperatie "J fluids are designed to supply hydration and electrolyte and only
limited energy. Because 1 0 of a <P de=trose solution contains <3 g of sugar# / 0 per day would
apply appro=imately:
A. :33 Iilocalories
B. ?33 Iilocalories
!. B33 Iilocalories
$. 1333 Iilocalories
Answer: %B& ?33 Iilocalories
!arbohydrates proide : kcalG gram; therefore /0 = <3 gG0 = : kcalGg Q ?33 kcal; only about a third
of the basal energy need.
1<3. Thrombus formation is a danger for all postoperatie clients. The nurse should act independently
to preent this complication by:
A. 7ncouraging ade>uate fluids
B. Applying elastic stockings
!. Massaging gently the legs with lotion
$. (erforming actie-assistie leg e=ercises
Answer: %$& (erforming actie-assistie leg e=ercises
"nactiity causes enous stasis# hypercoagulability# and e=ternal pressure against the eins# all of
which lead to thrombus formation. 7arly ambulation or e=ercise of the lower e=tremities reduces the
occurrence of this phenomenon
1<1. An unconscious client is admitted to the "!6# "J fluids are started and a Aoley catheter is
inserted. ,ith an indwelling catheter# urinary infection is a potential danger. The nurse can best plan
to aoid this problem by:
A. 7mptying the drainage bag fre>uently
B. !ollecting a weekly urine specimen
!. Maintaining the ordered hydration
$. Assessing urine specific graity
Answer: %!& Maintaining the ordered hydration
(romoting hydration# maintains urine production at a higher rate# which flushes the bladder and
preents urinary stasis and possible infection
1<+. The nurse performs full range of motion on a bedridden client9s e=tremities. ,hen putting his
ankle through range of motion# the nurse must perform:
A. Ale=ion# e=tension and left and right rotation
B. Abduction# fle=ion# adduction and e=tension
!. (ronation# supination# rotation# and e=tension
$. $orsifle=ion# plantar fle=ion# eersion and inersion
Answer: %$& $orsifle=ion# plantar fle=ion# eersion and inersion
These moements include all possible range of motion for the ankle *oint
1</. A client has been in a coma for + months. The nurse understands that to preent the effects of
shearing force on the skin# the head of the bed should be at an angle of:
A. /3 degrees
B. :< degrees
!. ?3 degrees
$. C3 degrees
Answer: %A& /3 degrees
5hearing force occurs when + surfaces moe against each other; when the bed is at an angle greater
than /3 degrees# the torso tends to slide and causes this phenomenon. 5hearing forces are good
contributory factors of pressure sores.
1<:. .ene# age ?+# is scheduled for a T6.( after being diagnosed with a Benign (rostatic
'yperplasia %B('&. As part of the preoperatie teaching# the nurse should tell the client that after
surgery:
A. 6rinary control may be permanently lost to some degree
B. 6rinary drainage will be dependent on a urethral catheter for +: hours
!. Are>uency and burning on urination will last while the cystotomy tube is in place
$. 'is ability to perform se=ually will be permanently impaired
Answer: %B& 6rinary drainage will be dependent on a urethral catheter for +: hours
An indwelling urethral catheter is used# because surgical trauma can cause urinary retention leading
to further complications such as bleeding.
1<<. The transurethral resection of the prostate is performed on a client with B('. Aollowing surgery#
nursing care should include:
A. !hanging the abdominal dressing
B. Maintaining patency of the cystotomy tube
!. Maintaining patency of a three-way Aoley catheter for cystoclysis
$. 8bsering for hemorrhage and wound infection
Answer: %!& Maintaining patency of a three-way Aoley catheter for cystoclysis
(atency of the catheter promotes bladder decompression# which preents distention and bleeding.
!ontinuous flow of fluid through the bladder limits clot formation and promotes hemostasis
1<?. "n the early postoperatie period following a transurethral surgery# the most common
complication the nurse should obsere for is:
A. 5epsis
B. 'emorrhage
!. 0eakage around the catheter
$. 6rinary retention with oerflow
Answer: %B& 'emorrhage
After transurethral surgery# hemorrhage is common because of enous oozing and bleeding from
many small arteries in the prostatic bed.
1<@. Aollowing prostate surgery# the retention catheter is secured to the client9s leg causing slight
traction of the inflatable balloon against the prostatic fossa. This is done to:
A. 0imit discomfort
B. (roide hemostasis
!. .educe bladder spasms
$. (romote urinary drainage
Answer: %B& (roide hemostasis
The pressure of the balloon against the small blood essels of the prostate creates a tampon-like effect
that causes them to constrict thereby preenting bleeding.
1<B. Twenty-four hours after T6.( surgery# the client tells the nurse he has lower abdominal
discomfort. The nurse notes that the catheter drainage has stopped. The nurse9s initial action should
be to:
A. "rrigate the catheter with saline
B. Milk the catheter tubing
!. .emoe the catheter
$. )otify the physician
Answer: %B& Milk the catheter tubing
Milking the tubing will usually dislodge the plug and will not harm the client. A physician9s order is
not necessary for a nurse to check catheter patency.
1<C. The nurse would know that a post-T6.( client understood his discharge teaching when he says
1" should:4
A. 2et out of bed into a chair for seeral hours daily
B. !all the physician if my urinary stream decreases
!. Attempt to oid eery / hours when "9m awake
$. Aoid igorous e=ercise for ? months after surgery
Answer: %B& !all the physician if my urinary stream decreases
6rethral mucosa in the prostatic area is destroyed during surgery and strictures my form with healing
that causes partial or een complete ueinary obstruction.
1?3. 0ucy is admitted to the surgical unit for a subtotal thyroidectomy. 5he is diagnosed with 2rae9s
$isease. ,hen assessing 0ucy# the nurse would e=pect to find:
A. 0ethargy# weight gain# and forgetfulness
B. ,eight loss# protruding eyeballs# and lethargy
!. ,eight loss# e=opthalmos and restlessness
$. !onstipation# dry skin# and weight gain
Answer: %!& ,eight loss# e=opthalmos and restlessness
!lassic signs associated with hyperthyroidism are weight loss and restlessness because of increased
basal metabolic rate. 7=opthalmos is due to peribulbar edema.
1?1. 0ucy undergoes 5ubtotal Thyroidectomy for 2rae9s $isease. "n planning for the client9s return
from the 8.# the nurse would consider that in a subtotal thyroidectomy:
A. The entire thyroid gland is remoed
B. A small part of the gland is left intact
!. 8ne parathyroid gland is also remoed
$. A portion of the thyroid and four parathyroids are remoed
Answer: %B& A small part of the gland is left intact
.emaining thyroid tissue may proide enough hormone for normal function. Total thyroidectomy is
generally done in clients with Thyroid !a.
1?+. Before a post- thyroidectomy client returns to her room from the 8.# the nurse plans to set up
emergency e>uipment# which should include:
A. A crash cart with bed board
B. A tracheostomy set and o=ygen
!. An airway and rebreathing mask
$. Two ampules of sodium bicarbonate
Answer: %B& A tracheostomy set and o=ygen
Acute respiratory obstruction in the post-operatie period can result from edema# subcutaneous
bleeding that presses on the trachea# nere damage# or tetany.
1?/. ,hen a post-thyroidectomy client returns from surgery the nurse assesses her for unilateral
in*ury of the laryngeal nere eery /3 to ?3 minutes by:
A. 8bsering for signs of tetany
B. !hecking her throat for swelling
!. Asking her to state her name out loud
$. (alpating the side of her neck for blood seepage
Answer: %!& Asking her to state her name out loud
"f the recurrent laryngeal nere is damaged during surgery# the client will be hoarse and hae difficult
speaking.
1?:. 8n a post-thyroidectomy client9s discharge# the nurse teaches her to obsere for signs of
surgically induced hypothyroidism. The nurse would know that the client understands the teaching
when she states she should notify the physician if she deelops:
A. "ntolerance to heat
B. $ry skin and fatigue
!. (rogressie weight loss
$. "nsomnia and e=citability
Answer: %B& $ry skin and fatigue
$ry skin is most likely caused by decreased glandular function and fatigue caused by decreased
metabolic rate. Body functions and metabolism are decreased in hypothyroidism.
1?<. A client9s e=opthalmos continues inspite of thyroidectomy for 2rae9s $isease. The nurse
teaches her how to reduce discomfort and preent corneal ulceration. The nurse recognizes that the
client understands the teaching when she says: 1" should:
A. 7leate the head of my bed at night
B. Aoid moing my e=tra-ocular muscles
!. Aoid using a sleeping mask at night
$. Aoid e=cessie blinking
Answer: %!& Aoid using a sleeping mask at night
The mask may irritate or scratch the eye if the client turns and lies on it during the night.
1??. !lara is a /@-year old cook. 5he is admitted for treatment of partial and full-thickness burns of
her entire right lower e=tremity and the anterior portion of her right upper e=tremity. 'er respiratory
status is compromised# and she is in pain and an=ious.
(erforming an immediate appraisal# using the rule of nines# the nurse estimates the percent of !lara9s
body surface that is burned is:
A. :.<P
B. CP
!. 1B P
$. ++.<P
Answer: %$& ++.<P
The entire right lower e=tremity is 1BP the anterior portion of the right upper e=tremity is :.<P
giing a total of ++.<P
1?@. The nurse applies mafenide acetate %5ulfamylon cream& to !lara# who has second and third
degree burns on the right upper and lower e=tremities# as ordered by the physician. This medication
will:
A. "nhibit bacterial growth
B. .eliee pain from the burn
!. (reent scar tissue formation
$. (roide chemical debridement
Answer: %A& "nhibit bacterial growth
5ulfamylon is effectie against a wide ariety of gram positie and gram negatie organisms
including anaerobes
1?B. Aorty-eight hours after a burn in*ury# the physician orders for the client + liters of "J fluid to be
administered >1+ h. The drop factor of the tubing is 13 gttGml. The nurse should set the flow to
proide:
A. 1B gttGmin
B. +B gttGmin
!. /+ gttGmin
$. /? gttGmin
Answer: %B& +B gttGmin
This is the correct flow rate; multiply the amount to be infused %+333 ml& by the drop factor %13& and
diide the result by the amount of time in minutes %1+ hours = ?3 minutes&
1?C. !lara# a burn client# receies a temporary heterograft %pig skin& on some of her burns. These
grafts will:
A. $ebride necrotic epithelium
B. Be sutured in place for better adherence
!. .eliee pain and promote rapid epithelialization
$. Are>uently be used concurrently with topical antimicrobials.
Answer: %!& .eliee pain and promote rapid epithelialization
The graft coers nere endings# which reduces pain and proides a framework for granulation that
promotes effectie healing.
1@3. A client with burns on the chest has periodic episodes of dyspnea. The position that would
proide for the greatest respiratory capacity would be the:
A. 5emi-fowler9s position
B. 5ims9 position
!. 8rthopneic position
$. 5upine position
Answer: %!& 8rthopneic position
The orthopneic position lowers the diaphragm and proides for ma=imal thoracic e=pansion
1@1. Vane# a +3- year old college student is admiited to the hospital with a tentatie diagnosis of
myasthenia grais. 5he is scheduled to hae a series of diagnostic studies for myasthenia grais#
including a Tensilon test. "n preparing her for this procedure# the nurse e=plains that her response to
the medication will confirm the diagnosis if Tensilon produces:
A. Brief e=aggeration of symptoms
B. (rolonged symptomatic improement
!. .apid but brief symptomatic improement
$. 5ymptomatic improement of *ust the ptosis
Answer: %!& .apid but brief symptomatic improement
Tensilon acts systemically to increase muscle strength; with a peak effect in /3 seconds# "t lasts
seeral minutes.
1@+. The initial nursing goal for a client with myasthenia grais during the diagnostic phase of her
hospitalization would be to:
A. $eelop a teaching plan
B. Aacilitate psychologic ad*ustment
!. Maintain the present muscle strength
$. (repare for the appearance of myasthenic crisis
Answer: %!& Maintain the present muscle strength
6ntil diagnosis is confirmed# primary goal should be to maintain ade>uate actiity and preent
muscle atrophy
1@/. The most significant initial nursing obserations that need to be made about a client with
myasthenia include:
A. Ability to chew and speak distinctly
B. $egree of an=iety about her diagnosis
!. Ability to smile an to close her eyelids
$. .espiratory e=change and ability to swallow
Answer: %$& .espiratory e=change and ability to swallow
Muscle weakness can lead to respiratory failure that will re>uire emergency interention and inability
to swallow may lead to aspiration
1@:. 'elen is diagnosed with myasthenia grais and pyridostigmine bromide %Mestinon& therapy is
started. The Mestinon dosage is fre>uently changed during the first week. ,hile the dosage is being
ad*usted# the nurse9s priority interention is to:
A. Administer the medication e=actly on time
B. Administer the medication with food or mild
!. 7aluate the client9s muscle strength hourly after medication
$. 7aluate the client9s emotional side effects between doses
Answer: %!& 7aluate the client9s muscle strength hourly after medication
(eak response occurs 1 hour after administration and lasts up to B hours; the response will influence
dosage leels.
1@<. 'elen# a client with myasthenia grais# begins to e=perience increased difficulty in swallowing.
To preent aspiration of food# the nursing action that would be most effectie would be to:
A. !hange her diet order from soft foods to clear li>uids
B. (lace an emergency tracheostomy set in her room
!. Assess her respiratory status before and after meals
$. !oordinate her meal schedule with the peak effect of her medication# Mestinon
Answer: %$& !oordinate her meal schedule with the peak effect of her medication# Mestinon
$ysphagia should be minimized during peak effect of Mestinon# thereby decreasing the probability of
aspiration. Mestinon can increase her muscle strength including her ability to swallow.
*aternity Nursing Question & Answer w/ rationale
MAT7.)"TK )6.5")2
1. Kou performed the leopold9s maneuer and found the following: breech presentation# fetal back at
the right side of the mother. Based on these findings# you can hear the fetal heart beat %(M"& B75T in
which location-
A. 0eft lower >uadrant
B. .ight lower >uadrant
!. 0eft upper >uadrant
$. .ight upper >uadrant
Answer: %B& .ight lower >uadrant
.ight lower >uadrant. The landmark to look for when looking for (M" is the location of the fetal back
in relation to the right or left side of the mother and the presentation# whether cephalic or breech. The
best site is the fetal back nearest the head.
+. "n 0eopold9s maneuer step Z1# you palpated a soft broad mass that moes with the rest of the
mass. The correct interpretation of this finding is:
A. The mass palpated at the fundal part is the head part.
B. The presentation is breech.
!. The mass palpated is the back
$. The mass palpated is the buttocks.
Answer: %$& The mass palpated is the buttocks.
The palpated mass is the fetal buttocks since it is broad and soft and moes with the rest of the mass.
/. "n 0eopold9s maneuer step Z / you palpated a hard round moable mass at the supra pubic area.
The correct interpretation is that the mass palpated is:
A. The buttocks because the presentation is breech.
B. The mass palpated is the head.
!. The mass is the fetal back.
$. The mass palpated is the fetal small part
Answer: %B& The mass palpated is the head.
,hen the mass palpated is hard round and moable# it is the fetal head.
:. The hormone responsible for a positie pregnancy test is:
A. 7strogen
B. (rogesterone
!. 'uman !horionic 2onadotropin
$. Aollicle 5timulating hormone
Answer: %!& 'uman !horionic 2onadotropin
'uman chorionic gonadotropin %'!2& is the hormone secreted by the chorionic illi which is the
precursor of the placenta. "n the early stage of pregnancy# while the placenta is not yet fully
deeloped# the ma*or hormone that sustains the pregnancy is '!2.
<. The hormone responsible for the maturation of the graafian follicle is:
A. Aollicle stimulating hormone
B. (rogesterone
!. 7strogen
$. 0uteinizing hormone
Answer: %A& Aollicle stimulating hormone
The hormone that stimulates the maturation if the of the graafian follicle is the Aollicle 5timulating
'ormone which is released by the anterior pituitary gland.
@. The most common normal position of the fetus in utero is:
A. Transerse position
B. Jertical position
!. 8bli>ue position
$. )one of the aboe
Answer: %B& Jertical position
Jertical position means the fetal spine is parallel to the maternal spine thus making it easy for the
fetus to go out the birth canal. "f transerse or obli>ue# the fetus can9t be deliered normally per
agina.
B. "n the later part of the /rd trimester# the mother may e=perience shortness of breath. This complaint
maybe e=plained as:
A. A normal occurrence in pregnancy because the fetus is using more o=ygen
B. The fundus of the uterus is high pushing the diaphragm upwards
!. The woman is haing allergic reaction to the pregnancy and its hormones
$. The woman maybe e=periencing complication of pregnancy
Answer: %B& The fundus of the uterus is high pushing the diaphragm upwards
Arom the /+nd week of the pregnancy# the fundus of the enlarged uterus is pushing the respiratory
diaphragm upwards. Thus# the lungs hae reduced space for e=pansion conse>uently reducing the
o=ygen supply.
C. ,hich of the following findings in a woman would be consistent with
a pregnancy of two months duration-
A. ,eight gain of ?-13 lbs. and presence of striae graidarum
B. Aullness of the breast and urinary fre>uency
!. Bra=ton 'icks contractions and >uickening
$. "ncreased respiratory rate and ballottement
Answer: %B& Aullness of the breast and urinary fre>uency
Aullness of the breast is due to the increased amount of progesterone in pregnancy. The urinary
fre>uency is caused by the compression of the urinary bladder by the graid uterus which is still
within the pelic caity during the first trimester.
13. ,hich of the following is a positie sign of pregnancy-
A. Aetal moement felt by mother
B. 7nlargement of the uterus
!. %T& pregnancy test
$. %T& ultrasound
Answer: %$& %T& ultrasound
A positie ultrasound will definitely confirm that a woman is pregnant since the fetus in utero is
directly isualized.
11. ,hat eent occurring in the second trimester helps the e=pectant mother to accept the pregnancy-
A. 0ightening
B. Ballotment
!. (seudocyesis
$. Huickening
Answer: %$& Huickening
Huickening is the first fetal moement felt by the mother makes the woman realize that she is truly
pregnant. "n early pregnancy# the fetus is moing but too weak to be felt by the mother. "n the 1Bth-
+3th week of gestation# the fetal moements become stronger thus the mother already feels the
moements.
1+. 5hoes with low# broad heels# plus a good posture will preent which prenatal discomfort-
A. Backache
B. Jertigo
!. 0eg cramps
$. )ausea
Answer: %A& Backache
Backache usually occurs in the lumbar area and becomes more problematic as the uterus enlarges.
The pregnant woman in her third trimester usually assumes a lordotic posture to maintain balance
causing an e=aggeration of the lumbar curature. 0ow broad heels proide the pregnant woman with
a good support.
1/. ,hen a pregnant woman e=periences leg cramps# the correct nursing interention to reliee the
muscle cramps is:
A. Allow the woman to e=ercise
B. 0et the woman walk for a while
!. 0et the woman lie down and dorsifle= the foot towards the knees
$. Ask the woman to raise her legs
Answer: %!& 0et the woman lie down and dorsifle= the foot towards the knees
0eg cramps is caused by the contraction of the gastrocnimeus %leg muscle&. Thus# the interention is
to stretch the muscle by dosifle=ing the foot of the affected leg towards the knee.
1:. Arom the //rd week of gestation till full term# a healthy mother should hae prenatal check up
eery:
A. week
B. + weeks
!. / weeks
$. : weeks
Answer: %A& week
"n the Cth month of pregnancy the mother needs to hae a weekly isit to the prenatal clinic to
monitor fetal condition and to ensure that she is ade>uately prepared for the impending labor and
deliery.
1<. The e=pected weight gain in a normal pregnancy during the /rd trimester is
A. 1 pound a week
B. + pounds a week
!. 13 lbs a month
$. 13 lbs total weight gain in the /rd trimester
Answer: %A& 1 pound a week
$uring the /rd trimester the fetus is gaining more subcutaneous fat and is growing fast in preparation
for e=tra uterine life. Thus# one pound a week is e=pected.
1?. "n the Batholonew9s rule of :# when the leel of the fundus is midway between the umbilicus and
=yphoid process the estimated age of gestation %A82& is:
A. <th month
B. ?th month
!. @th month
$. Bth month
Answer: %!& @th month
"n Bartholomew9s .ule of :# the landmarks used are the symphysis pubis# umbilicus and =yphoid
process. At the leel of the umbilicus# the A82 is appro=imately < months and at the leel of the
=yphoid process C months. Thus# midway between these two landmarks would be considered as @
months A82.
1@. The following are ways of determining e=pected date of deliery %7$$& when the 0M( is
unknown 7E!7(T:
A. )aegele9s rule
B. Huickening
!. Mc $onald9s rule
$. Batholomew9s rule of :
Answer: %A& )aegele9s rule
)aegele9s .ule is determined based on the last menstrual period of the woman.
1B. "f the 0M( is Van. /3# the e=pected date of deliery %7$$& is
A. 8ct. @
B. 8ct. +:
!. )o. @
$. )o. B
Answer: %!& )o. @
Based on the last menstrual period# the e=pected date of deliery is )o. @. The formula for the
)aegele9s .ule is subtract / from the month and add @ to the day.
1C. Iegel9s e=ercise is done in pregnancy in order to:
A. 5trengthen perineal muscles
B. .eliee backache
!. 5trengthen abdominal muscles
$. (reent leg aricosities and edema
Answer: %A& 5trengthen perineal muscles
Iegel9s e=ercise is done by contracting and rela=ing the muscles surrounding the agina and anus in
order to strengthen the perineal muscles
+3. (elic rocking is an appropriate e=ercise in pregnancy to reliee which discomfort-
A. 0eg cramps
B. 6rinary fre>uency
!. 8rthostatic hypotension
$. Backache
Answer: %$& Backache
Backache is caused by the stretching of the muscles of the lower back because of the pregnancy.
(elic rocking is good to reliee backache.
+1. The main reason for an e=pected increased need for iron in pregnancy is:
A. The mother may hae physiologic anemia due to the increased need for red blood cell mass as
well as the fetal re>uires about /<3-:33 mg of iron to grow
B. The mother may suffer anemia because of poor appetite
!. The fetus has an increased need for .B! which the mother must supply
$. The mother may hae a problem of digestion because of pica
Answer: %A& The mother may hae physiologic anemia due to the increased need for red blood cell
mass as well as the fetal re>uires about /<3-:33 mg of iron to grow
About :33 mgs of "ron is needed by the mother in order to produce more .B! mass to be able to
proide the needed increase in blood supply for the fetus. Also# about /<3-:33 mgs of iron is need for
the normal growth of the fetus. Thus# about @<3-B33 mgs iron supplementation is needed by the
mother to meet this additional re>uirement.
++. The diet that is appropriate in normal pregnancy should be high in
A. (rotein# minerals and itamins
B. !arbohydrates and itamins
!. (roteins# carbohydrates and fats
$. Aats and minerals
Answer: %A& (rotein# minerals and itamins
"n normal pregnancy there is a higher demand for protein %body building foods&# itamins %esp.
itamin A# B# !# folic acid& and minerals %esp. iron# calcium# phosphorous# zinc# iodine# magnesium&
because of the need of the growing fetus.
+:. ,hich of the following signs will re>uire a mother to seek immediate medical attention-
A. ,hen the first fetal moement is felt
B. )o fetal moement is felt on the ?th month
!. Mild uterine contraction
$. 5light dyspnea on the last month of gestation
Answer: %B& )o fetal moement is felt on the ?th month
Aetal moement is usually felt by the mother during :.< F < months. "f the pregnancy is already in its
?th month and no fetal moement is felt# the pregnancy is not normal either the fetus is already dead
intra-uterine or it is an '-mole.
+<. Kou want to perform a pelic e=amination on one of your pregnant clients. Kou prepare your
client for the procedure by:
A. Asking her to oid
B. Taking her ital signs and recording the readings
!. 2iing the client a perineal care
$. $oing a aginal prep
Answer: %A& Asking her to oid
A pelic e=amination includes abdominal palpation. "f the pregnant woman has a full bladder# the
manipulation may cause discomfort and accidental urination because of the pressure applied during
the abdominal palpation. Also# a full bladder can impede the accuracy of the e=amination because the
bladder %which is located in front of the uterus& can block the uterus.
+?. ,hen preparing the mother who is on her :th month of pregnancy for abdominal ultrasound# the
nurse should instruct her to:
A. 8bsere )(8 from midnight to aoid omiting
B. $o perineal flushing properly before the procedure
!. $rink at least + liters of fluid + hours before the procedure and not oid until the procedure is done
$. Joid immediately before the procedure for better isualization
Answer: %!& $rink at least + liters of fluid + hours before the procedure and not oid until the
procedure is done
$rinking at least + liters of water + hours before the procedure will result to a distended bladder. A
full bladder is needed when doing an abdominal ultrasound to sere as a 1window4 for the ultrasonic
sound waes to pass through and allow isualization of the uterus %located behind the urinary
bladder&.
+@. The nursing interention to reliee 1morning sickness4 in a pregnant woman is by giing
A. $ry carbohydrate food like crackers
B. 0ow sodium diet
!. "ntraenous infusion
$. Antacid
Answer: %A& $ry carbohydrate food like crackers
Morning sickness maybe caused by hypoglycemia early in the morning thus giing carbohydrate food
will help.
+B. The common normal site of nidationGimplantation in the uterus is
A. 6pper uterine portion
B. Mid-uterine area
!. 0ower uterine segment
$. 0ower cerical segment
Answer: %A& 6pper uterine portion
The embryo9s normal nidation site is the upper portion of the uterus. "f the implantation is in the
lower segment# this is an abnormal condition called placenta preia.
+C. Mrs. 5antos is on her <th pregnancy and has a history of abortion in the :th pregnancy and the
first pregnancy was a twin. 5he is considered to be
A. 2 : ( /
B. 2 < ( /
!. 2 < ( :
$. 2 : ( :
Answer: %B& 2 < ( /
2raida refers to the total number of pregnancies including the current one. (ara refers to the number
of pregnancies that hae reached iability. Thus# if the woman has had one abortion# she would be
considered (ara /. Twin pregnancy is counted only as 1.
/3. The following are skin changes in pregnancy 7E!7(T:
A. !hloasma
B. 5triae graidarum
!. 0inea negra
$. !hadwickXs sign
Answer: %$& !hadwickXs sign
!hadwickXs sign is bluish discoloration of the aginal mucosa as a result of the increased
ascularization in the area.
/1. ,hich of the following statements is T.67 of conception-
A. ,ithin +-: hours after intercourse conception is possible in a fertile woman
B. 2enerally# fertilization is possible : days after oulation
!. !onception is possible during menstruation in a long menstrual cycle
$. To aoid conception# intercourse must be aoided < days before and / days after menstruation
Answer: %A& ,ithin +-: hours after intercourse conception is possible in a fertile woman
The sperms when deposited near the cerical os will be able to reach the fallopian tubes within :
hours. "f the woman has *ust oulated %within +:hours after the rupture of the graafian follicle&#
fertilization is possible.
/+. ,hich of the following are the functions of amniotic fluid- 1.!ushions the fetus from abdominal
trauma +.5eres as the fluid for the fetus /.Maintains the internal temperature :.Aacilitates fetal
moement
A. 1 W /
B. 1# /# :
!. 1# +# /
$. All of the aboe
Answer: %$& All of the aboe
All the four functions enumerated are true of amniotic fluid.
//. Kou are performing abdominal e=am on a Cth month pregnant woman. ,hile lying supine# she
felt breathless# had pallor# tachycardia# and cold clammy skin. The correct assessment of the woman9s
condition is that she is
A. 7=periencing the beginning of labor
B. 'aing supine hypotension
!. 'aing sudden eleation of B(
$. 2oing into shock
Answer: %B& 'aing supine hypotension
5upine hypotension is characterized by breathlessness# pallor# tachycardia and cold clammy skin.
This is due to the compression of the abdominal aorta by the graid uterus when the woman is on a
supine position.
/:. 5moking is contraindicated in pregnancy because
A. )icotine causes asodilation of the mother9s blood essels
B. !arbon mono=ide binds with the hemoglobin of the mother reducing aailable hemoglobin for the
fetus
!. The smoke will make the fetus and the mother feel dizzy
$. )icotine will cause asoconstriction of the fetal blood essels
Answer: %B& !arbon mono=ide binds with the hemoglobin of the mother reducing aailable
hemoglobin for the fetus
!arbon mono=ide is one of the substances found in cigarette smoke. This substance diminishes the
ability of the hemoglobin to bind with o=ygen thus reducing the amount of o=ygenated blood
reaching the fetus.
/<. ,hich of the following is the most likely effect on the fetus if the woman is seerely anemic
during pregnancy-
A. 0arge for gestational age %02A& fetus
B. 'emorrhage
!. 5mall for gestational age %52A& baby
$. 7rythroblastosis fetalis
Answer: %!& 5mall for gestational age %52A& baby
Anemia is a condition where there is a reduced amount of hemoglobin. 'emoglobin is needed to
supply the fetus with ade>uate o=ygen. 8=ygen is needed for normal growth and deelopment of the
fetus.
/?. ,hich of the following signs and symptoms will most likely make the nurse suspect that the
patient is haing hydatidiform mole-
A. 5light bleeding
B. (assage of clear esicular mass per agina
!. Absence of fetal heart beat
$. 7nlargement of the uterus
Answer: %B& (assage of clear esicular mass per agina
'ydatidiform mole %'-mole& is characterized by the degeneration of the chorionic illi wherein the
illi becomes esicle-like. These esicle-like substances when e=pelled per agina and is a definite
sign that the woman has '-mole.
/@. 6pon assessment the nurse found the following: fundus at + fingerbreadths aboe the umbilicus#
last menstrual period %0M(& < months ago# fetal heart beat %A'B& not appreciated. ,hich of the
following is the most possible diagnosis of this condition-
A. 'ydatidiform mole
B. Missed abortion
!. (elic inflammatory disease
$. 7ctopic pregnancy
Answer: %A& 'ydatidiform mole
'ydatidiform mole begins as a pregnancy but early in the deelopment of the embryo degeneration
occurs. The proliferation of the esicle-like substances is rapid causing the uterus to enlarge bigger
than the e=pected size based on ages of gestation %A82&. "n the situation gien# the pregnancy is only
< months but the size of the uterus is already aboe the umbilicus which is compatible with @ months
A82. Also# no fetal heart beat is appreciated because the pregnancy degenerated thus there is no
appreciable fetal heart beat.
/B. ,hen a pregnant woman goes into a conulsie seizure# the M85T immediate action of the nurse
to ensure safety of the patient is:
A. Apply restraint so that the patient will not fall out of bed
B. (ut a mouth gag so that the patient will not bite her tongue and the tongue will not fall back
!. (osition the mother on her side to allow the secretions to drain from her mouth and preent
aspiration
$. !heck if the woman is also haing a precipitate labor
Answer: %!& (osition the mother on her side to allow the secretions to drain from her mouth and
preent aspiration
(ositioning the mother on her side will allow the secretions that may accumulate in her mouth to
drain by graity thus preenting aspiration pneumonia. (utting a mouth gag is not safe since during
the conulsie seizure the *aw will immediately lock. The mother may go into labor also during the
seizure but the immediate concern of the nurse is the safety of the baby. After the seizure# check the
perineum for signs of precipitate labor.
/C. A graido-cardiac mother is adised to obsere bedrest primarily to
A. Allow the fetus to achiee normal intrauterine growth
B. Minimize o=ygen consumption which can aggraate the condition of the compromised heart of the
mother
!. (reent perinatal infection
$. .educe incidence of premature labor
Answer: %B& Minimize o=ygen consumption which can aggraate the condition of the compromised
heart of the mother
Actiity of the mother will re>uire more o=ygen consumption. 5ince the heart of a graido-cardiac is
compromised# there is a need to put a mother on bedrest to reduce the need for o=ygen.
:3. A pregnant mother is admitted to the hospital with the chief complaint of profuse aginal
bleeding# A82 /? wks# not in labor. The nurse must always consider which of the following
precautions:
A. The internal e=am is done only at the deliery under strict asepsis with a double set-up
B. The preferred manner of deliering the baby is aginal
!. An emergency deliery set for aginal deliery must be made ready before e=amining the patient
$. "nternal e=am must be done following routine procedure
Answer: %A& The internal e=am is done only at the deliery under strict asepsis with a double set-up
(ainless aginal bleeding during the third trimester maybe a sign of placenta praeia. "f internal
e=amination is done in this kind of condition# this can lead to een more bleeding and may re>uire
immediate deliery of the baby by cesarean section. "f the bleeding is due to soft tissue in*ury in the
birth canal# immediate aginal deliery may still be possible so the set up for aginal deliery will be
used. A double set-up means there is a set up for cesarean section and a set-up for aginal deliery to
accommodate immediately the necessary type of deliery needed. "n both cases# strict asepsis must be
obsered.
:1. ,hich of the following signs will distinguish threatened abortion from imminent abortion-
A. 5eerity of bleeding
B. $ilation of the ceri=
!. )ature and location of pain
$. (resence of uterine contraction
Answer: %B& $ilation of the ceri=
"n imminent abortion# the pregnancy will definitely be terminated because the ceri= is already open
unlike in threatened abortion where the ceri= is still closed.
:+. The nursing measure to reliee fetal distress due to maternal supine hypotension is:
A. (lace the mother on semi-fowler9s position
B. (ut the mother on left side lying position
!. (lace mother on a knee chest position
$. Any of the aboe
Answer: %B& (ut the mother on left side lying position
,hen a pregnant woman lies on supine position# the weight of the graid uterus would be
compressing on the ena caa against the ertebrae obstructing blood flow from the lower
e=tremities. This causes a decrease in blood return to the heart and conse>uently immediate decreased
cardiac output and hypotension. 'ence# putting the mother on side lying will reliee the pressure
e=erted by the graid uterus on the ena caa.
:/. To preent preterm labor from progressing# drugs are usually prescribed to halt the labor. The
drugs commonly gien are:
A. Magnesium sulfate and terbutaline
B. (rostaglandin and o=ytocin
!. (rogesterone and estrogen
$. $e=amethasone and prostaglandin
Answer: %A& Magnesium sulfate and terbutaline
Magnesium sulfate acts as a !)5 depressant as well as a smooth muscle rela=ant. Terbutaline is a
drug that inhibits the uterine smooth muscles from contracting. 8n the other hand# o=ytocin and
prostaglandin stimulates contraction of smooth muscles.
::. "n placenta praeia marginalis# the placenta is found at the:
A. "nternal cerical os partly coering the opening
B. 7=ternal cerical os slightly coering the opening
!. 0ower segment of the uterus with the edges near the internal cerical os
$. 0ower portion of the uterus completely coering the ceri=
Answer: %!& 0ower segment of the uterus with the edges near the internal cerical os
(lacenta marginalis is a type of placenta preia wherein the placenta is implanted at the lower
segment of the uterus thus the edges of the placenta are touching the internal cerical openingGos. The
normal site of placental implantation is the upper portion of the uterus.
:<. "n which of the following conditions can the causatie agent pass through the placenta and affect
the fetus in utero-
A. 2onorrhea
B. .ubella
!. !andidiasis
$. moniliasis
Answer: %B& .ubella
.ubella is caused by a irus and iruses hae low molecular weight thus can pass through the
placental barrier. 2onorrhea# candidiasis and moniliasis are conditions that can affect the fetus as it
passes through the aginal canal during the deliery process.
:?. ,hich of the following can lead to infertility in adult males-
A. 2erman measles
B. 8rchitis
!. !hicken po=
$. .ubella
Answer: %B& 8rchitis
8rchitis is a complication that may accompany mumps in adult males. This condition is characterized
by unilateral inflammation of one of the testes which can lead to atrophy of the affected testis. About
+3-/3P of males who gets mumps after puberty may deelop this complication.
:@. (apanicolaou smear is usually done to determine cancer of
A. !eri=
B. 8aries
!. Aallopian tubes
$. Breast
Answer: %A& !eri=
(apanicolaou %(aps& smear is done to detect cerical cancer. "t can9t detect cancer in oaries and
fallopian tubes because these organs are outside of the uterus and the abnormal cells from these
organs will not be detected from a smear done on the ceri=.
:B. ,hich of the following causes of infertility in the female is primarily psychological in origin-
A. Jaginismus
B. $yspareunia
!. 7ndometriosis
$. "mpotence
Answer: %A& Jaginismus
Jaginismus is primarily psychological in origin. 7ndometriosis is a condition that is caused by
organic abnormalities. $yspareunia is usually caused by infection# endometriosis or hormonal
changes in menopause although may sometimes be psychological in origin.
:C. Before giing a repeat dose of magnesium sulfate to a pre-eclamptic patient# the nurse should
assess the patient9s condition. ,hich of the following conditions will re>uire the nurse to temporarily
suspend a repeat dose of magnesium sulfate-
A. 133 cc. urine output in : hours
B. Inee *erk refle= is %T&+
!. 5erum magnesium leel is 13m7gG0.
$. .espiratory rate of 1?Gmin
Answer: %A& 133 cc. urine output in : hours
The minimum urine output e=pected for a repeat dose of Mg58: is /3 ccGhr. "f in : hours the urine
output is only 133 cc this is low and can lead to poor e=cretion of Magnesium with a possible
cumulatie effect# which can be dangerous to the mother.
<3. ,hich of the following is T.67 in .h incompatibility-
A. The condition can occur if the mother is .h%T& and the fetus is .h%-&
B. 7ery pregnancy of an .h%-& mother will result to erythroblastosis fetalis
!. 8n the first pregnancy of the .h%-& mother# the fetus will not be affected
$. .ho2am is gien only during the first pregnancy to preent incompatibility
Answer: %!& 8n the first pregnancy of the .h%-& mother# the fetus will not be affected
8n the first pregnancy# the mother still has no contact with .h%T& blood thus it has not antibodies
against .h%T&. After the first pregnancy# een if terminated into an abortion# there is already the
possibility of mi=ing of maternal and fetal blood so this can trigger the maternal blood to produce
antibodies against .h%T& blood. The fetus takes it9s blood type usually form the father.
<1. ,hich of the following conditions will lead to a small-for-gestational age fetus due to less blood
supply to the fetus-
A. $iabetes in the mother
B. Maternal cardiac condition
!. (remature labor
$. Abruptio placenta
Answer: %B& Maternal cardiac condition
"n general# when the heart is compromised such as in maternal cardiac condition# the condition can
lead to less blood supply to the uterus conse>uently to the placenta which proides the fetus with the
essential nutrients and o=ygen. Thus if the blood supply is less# the baby will suffer from chronic
hypo=ia leading to a small-for-gestational age condition.
<+. The lower limit of iability for infants in terms of age of gestation is:
A. +1-+: weeks
B. +<-+@ weeks
!. +B-/3 weeks
$. /B-:3 weeks
Answer: %A& +1-+: weeks
Jiability means the capability of the fetus to lieGsurie outside of the uterine enironment. ,ith the
present technological and medical adances# +1 weeks A82 is considered as the minimum fetal age
for iability.
</. ,hich proision of our 1CB@ constitution guarantees the right of the unborn child to life from
conception is
A. Article "" section 1+
B. Article "" section 1<
!. Article E""" section 11
$. Article E""" section 1<
Answer: %A& Article "" section 1+
The (hilippine !onstitution of 1CB@ guarantees the right of the unborn child from conception e>ual to
the mother as stated in Article "" 5tate (olicies# 5ection 1+.
<:. "n the (hilippines# if a nurse performs abortion on the mother who wants it done and she gets paid
for doing it# she will be held liable because
A. Abortion is immoral and is prohibited by the church
B. Abortion is both immoral and illegal in our country
!. Abortion is considered illegal because you got paid for doing it
$. Abortion is illegal because ma*ority in our country are catholics and it is prohibited by the church
Answer: %B& Abortion is both immoral and illegal in our country
"nduced Abortion is illegal in the country as stated in our (enal !ode and any person who performs
the act for a fee commits a grae offense punishable by 13-1+ years of imprisonment.
The preferred manner of deliering the baby in a graido-cardiac is aginal deliery assisted by
forceps under epidural anesthesia. The main rationale for this is:
A. To allow atraumatic deliery of the baby
B. To allow a gradual shifting of the blood into the maternal circulation
!. To make the deliery effort free and the mother does not need to push with contractions
$. To preent perineal laceration with the e=pulsion of the fetal head
Answer: %!& To make the deliery effort free and the mother does not need to push with contractions
Aorceps deliery under epidural anesthesia will make the deliery process less painful and re>uire
less effort to push for the mother. (ushing re>uires more effort which a compromised heart may not
be able to endure.
<?. ,hen giing narcotic analgesics to mother in labor# the special consideration to follow is:
A. The progress of labor is well established reaching the transitional stage
B. 6terine contraction is progressing well and deliery of the baby is imminent
!. !erical dilatation has already reached at least B cm. and the station is at least %T&+
$. 6terine contractions are strong and the baby will not be deliered yet within the ne=t / hours.
Answer: %$& 6terine contractions are strong and the baby will not be deliered yet within the ne=t /
hours.
)arcotic analgesics must be gien when uterine contractions are already well established so that it
will not cause stoppage of the contraction thus protracting labor. Also# it should be gien when
deliery of fetus is imminent or too close because the fetus may suffer respiratory depression as an
effect of the drug that can pass through placental barrier.
<@. The cerical dilatation taken at B:33 A.M. in a 21(3 patient was ? cm. A repeat ".7. done at 13
A.M. showed that cerical dilation was @ cm. The correct interpretation of this result is:
A. 0abor is progressing as e=pected
B. The latent phase of 5tage 1 is prolonged
!. The actie phase of 5tage 1 is protracted
$. The duration of labor is normal
Answer: %!& The actie phase of 5tage 1 is protracted
The actie phase of 5tage " starts from :cm cerical dilatation and is e=pected that the uterus will
dilate by 1cm eery hour. 5ince the time lapsed is already + hours# the dilatation is e=pected to be
already B cm. 'ence# the actie phase is protracted.
<B. ,hich of the following techni>ues during labor and deliery can lead to uterine inersion-
A. Aundal pressure applied to assist the mother in bearing down during deliery of the fetal head
B. 5trongly tugging on the umbilical cord to delier the placenta and hasten placental separation
!. Massaging the fundus to encourage the uterus to contract
$. Applying light traction when deliering the placenta that has already detached from the uterine
wall
Answer: %B& 5trongly tugging on the umbilical cord to delier the placenta and hasten placental
separation
,hen the placenta is still attached to the uterine wall# tugging on the cord while the uterus is rela=ed
can lead to inersion of the uterus. 0ight tugging on the cord when placenta has detached is alright in
order to help delier the placenta that is already detached.
<C. The fetal heart rate is checked following rupture of the bag of waters in order to:
A. !heck if the fetus is suffering from head compression
B. $etermine if cord compression followed the rupture
!. $etermine if there is utero-placental insufficiency
$. !heck if fetal presenting part has ade>uately descended following the rupture
Answer: %B& $etermine if cord compression followed the rupture
After the rupture of the bag of waters# the cord may also go with the water because of the pressure of
the rupture and flow. "f the cord goes out of the cerical opening# before the head is deliered
%cephalic presentation&# the head can compress on the cord causing fetal distress. Aetal distress can be
detected through the fetal heart tone. Thus# it is essential do check the A'B right after rupture of bag
to ensure that the cord is not being compressed by the fetal head.
?3. 6pon assessment# the nurse got the following findings: + perineal pads highly saturated with
blood within + hours post partum# (.Q B3 bpm# fundus soft and boundaries not well defined. The
appropriate nursing diagnosis is:
A. )ormal blood loss
B. Blood olume deficiency
!. "nade>uate tissue perfusion related to hemorrhage
$. 'emorrhage secondary to uterine atony
Answer: %$& 'emorrhage secondary to uterine atony
All the signs in the stem of the >uestion are signs of hemorrhage. "f the fundus is soft and boundaries
not well defined# the cause of the hemorrhage could be uterine atony.
?1. The following are signs and symptoms of fetal distress 7E!7(T:
A. Aetal heart rate %A'.& decreased during a contraction and persists een after the uterine
contraction ends
B. The A'. is less than 1+3 bpm or oer 1?3 bpm
!. The pre-contraction A'. is 1/3 bpm# A'. during contraction is 11B bpm and A'. after uterine
contraction is 1+? bpm
$. A'. is 1?3 bpm# weak and irregular
Answer: %!& The pre-contraction A'. is 1/3 bpm# A'. during contraction is 11B bpm and A'. after
uterine contraction is 1+? bpm
The normal range of A'. is 1+3-1?3 bpm# strong and regular. $uring a contraction# the A'. usually
goes down but must return to its pre-contraction rate after the contraction ends.
?+. "f the labor period lasts only for / hours# the nurse should suspect that the following conditions
may occur:
1.0aceration of ceri=
+.0aceration of perineum
/.!ranial hematoma in the fetus
:.Aetal ano=ia
A. 1 W +
B. + W :
!. +#/#:
$. 1#+#/#:
Answer: %$& 1#+#/#:
all the aboe conditions can occur following a precipitate labor and deliery of the fetus because
there was little time for the baby to adapt to the passageway. "f the presentation is cephalic# the fetal
head seres as the main part of the fetus that pushes through the birth canal which can lead to cranial
hematoma# and possible compression of cord may occur which can lead to less blood and o=ygen to
the fetus %hypo=ia&. 0ikewise the maternal passageway %ceri=# aginal canal and perineum& did not
hae enough time to stretch which can lead to laceration.
?/. The primary power inoled in labor and deliery is
A. Bearing down ability of mother
B. !erical effacement and dilatation
!. 6terine contraction
$. Jalsala techni>ue
Answer: %!& 6terine contraction
6terine contraction is the primary force that will e=pel the fetus out through the birth canal Maternal
bearing down is considered the secondary powerGforce that will help push the fetus out.
?:. The proper techni>ue to monitor the intensity of a uterine contraction is
A. (lace the palm of the hands on the abdomen and time the contraction
B. (lace the finger tips lightly on the suprapubic area and time the contraction
!. (ut the tip of the fingers lightly on the fundal area and try to indent the abdominal wall at the
height of the contraction
$. (ut the palm of the hands on the fundal area and feel the contraction at the fundal area
Answer: %!& (ut the tip of the fingers lightly on the fundal area and try to indent the abdominal wall
at the height of the contraction
"n monitoring the intensity of the contraction the best place is to place the fingertips at the fundal
area. The fundus is the contractile part of the uterus and the fingertips are more sensitie than the
palm of the hand.
?<. To monitor the fre>uency of the uterine contraction during labor# the right techni>ue is to time the
contraction
A. Arom the beginning of one contraction to the end of the same contraction
B. Arom the beginning of one contraction to the beginning of the ne=t contraction
!. Arom the end of one contraction to the beginning of the ne=t contraction
$. Arom the deceleration of one contraction to the acme of the ne=t contraction
Answer: %B& Arom the beginning of one contraction to the beginning of the ne=t contraction
Are>uency of the uterine contraction is defined as from the beginning of one contraction to the
beginning of another contraction.
??. The peak point of a uterine contraction is called the
A. Acceleration
B. Acme
!. $eceleration
$. A=iom
Answer: %B& Acme
Acme is the technical term for the highest point of intensity of a uterine contraction.
?@. ,hen determining the duration of a uterine contraction the right techni>ue is to time it from
A. The beginning of one contraction to the end of the same contraction
B. The end of one contraction to the beginning of another contraction
!. The acme point of one contraction to the acme point of another contraction
$. The beginning of one contraction to the end of another contraction
Answer: %A& The beginning of one contraction to the end of the same contraction
$uration of a uterine contraction refers to one contraction. Thus it is correctly measure from the
beginning of one contraction to the end of the same contraction and not of another contraction.
?B. ,hen the bag of waters ruptures# the nurse should check the characteristic of the amniotic fluid.
The normal color of amniotic fluid is
A. !lear as water
B. Bluish
!. 2reenish
$. Kellowish
Answer: %A& !lear as water
The normal color of amniotic fluid is clear like water. "f it is yellowish# there is probably .h
incompatibility. "f the color is greenish# it is probably meconium stained.
?C. ,hen the bag of waters ruptures spontaneously# the nurse should inspect the aginal introitus for
possible cord prolapse. "f there is part of the cord that has prolapsed into the aginal opening the
correct nursing interention is:
A. (ush back the prolapse cord into the aginal canal
B. (lace the mother on semifowler9s position to improe circulation
!. !oer the prolapse cord with sterile gauze wet with sterile )55 and place the woman on
trendellenberg position
$. (ush back the cord into the agina and place the woman on sims position
Answer: %!& !oer the prolapse cord with sterile gauze wet with sterile )55 and place the woman on
trendellenberg position
The correct action of the nurse is to coer the cord with sterile gauze wet with sterile )55. 8bsere
strict asepsis in the care of the cord to preent infection. The cord has to be kept moist to preent it
from drying. $on9t attempt to put back the cord into the agina but reliee pressure on the cord by
positioning the mother either on trendellenberg or sims position
@3. The fetal heart beat should be monitored eery 1< minutes during the +nd stage of labor. The
characteristic of a normal fetal heart rate is
A. The heart rate will decelerate during a contraction and then go back to its pre-contraction rate after
the contraction
B. The heart rate will accelerate during a contraction and remain slightly aboe the pre-contraction
rate at the end of the contraction
!. The rate should not be affected by the uterine contraction.
$. The heart rate will decelerate at the middle of a contraction and remain so for about a minute after
the contraction
Answer: %A& The heart rate will decelerate during a contraction and then go back to its pre-
contraction rate after the contraction
The normal fetal heart rate will decelerate %go down& slightly during a contraction because of the
compression on the fetal head. 'oweer# the heart rate should go back to the pre-contraction rate as
soon as the contraction is oer since the compression on the head has also ended.
@1. The mechanisms inoled in fetal deliery is
A. $escent# e=tension# fle=ion# e=ternal rotation
B. $escent# fle=ion# internal rotation# e=tension# e=ternal rotation
!. Ale=ion# internal rotation# e=ternal rotation# e=tension
$. "nternal rotation# e=tension# e=ternal rotation# fle=ion
Answer: %B& $escent# fle=ion# internal rotation# e=tension# e=ternal rotation
The mechanism of fetal deliery begins with descent into the pelic inlet which may occur seeral
days before true labor sets in the primigraida. Ale=ion# internal rotation and e=tension are
mechanisms that the fetus must perform as it accommodates through the passagewayGbirth canal.
7ternal rotation is done after the head is deliered so that the shoulders will be easily deliered
through the aginal introitus.
@+. The first thing that a nurse must ensure when the baby9s head comes out is
A. The cord is intact
B. )o part of the cord is encircling the baby9s neck
!. The cord is still attached to the placenta
$. The cord is still pulsating
Answer: %B& )o part of the cord is encircling the baby9s neck
The nurse should check right away for possible cord coil around the neck because if it is present# the
baby can be strangulated by it and the fetal head will hae difficulty being deliered.
@/. To ensure that the baby will breath as soon as the head is deliered# the nurse9s priority action is
to
A. 5uction the nose and mouth to remoe mucous secretions
B. 5lap the baby9s buttocks to make the baby cry
!. !lamp the cord about ? inches from the base
$. !heck the baby9s color to make sure it is not cyanotic
Answer: %A& 5uction the nose and mouth to remoe mucous secretions
5uctioning the nose and mouth of the fetus as soon as the head is deliered will remoe any
obstruction that maybe present allowing for better breathing. Also# if mucus is in the nose and mouth#
aspiration of the mucus is possible which can lead to aspiration pneumonia. %.emember that only the
baby9s head has come out as gien in the situation.&
@:. ,hen doing perineal care in preparation for deliery# the nurse should obsere the following
7E!7(T
A. 6se up-down techni>ue with one stroke
B. !lean from the mons eneris to the anus
!. 6se mild soap and warm water
$. (aint the inner thighs going towards the perineal area
Answer: %$& (aint the inner thighs going towards the perineal area
(ainting of the perineal area in preparation for deliery of the baby must always be done but the
stroke should be from the perineum going outwards to the thighs. The perineal area is the one being
prepared for the deliery and must be kept clean
@<. ,hat are the important considerations that the nurse must remember after the placenta is
deliered-
1.!heck if the placenta is complete including the membranes
+.!heck if the cord is long enough for the baby
/.!heck if the umbilical cord has / blood essels
:.!heck if the cord has a meaty portion and a shiny portion
A. 1 and /
B. + and :
!. 1# /# and :
$. + and /
Answer: %A& 1 and /
The nurse after deliering the placenta must ensure that all the cotyledons and the membranes of the
placenta are complete. Also# the nurse must check if the umbilical cord is normal which means it
contains the / blood essels# + eins and 1 artery.
@?. The following are correct statements about false labor 7E!7(T
A. The pain is irregular in intensity and fre>uency.
B. The duration of contraction progressiely lengthens oer time
!. There is no aginal bloody discharge
$. The ceri= is still closed.
Answer: %B& The duration of contraction progressiely lengthens oer time
"n false labor# the contractions remain to be irregular in intensity and duration while in true labor# the
contractions become stronger# longer and more fre>uent.
@@. The passageway in labor and delier of the fetus include the following 7E!7(T
A. $istensibility of lower uterine segment
B. !erical dilatation and effacement
!. $istensibility of aginal canal and introitus
$. Ale=ibility of the pelis
Answer: %$& Ale=ibility of the pelis
The pelis is a bony structure that is part of the passageway but is not fle=ible. The lower uterine
segment including the ceri= as well as the aginal canal and introitus are all part of the passageway
in the deliery of the fetus.
@B. The normal umbilical cord is composed of:
A. + arteries and 1 ein
B. + eins and 1 artery
!. + arteries and + eins
$. none of the aboe
Answer: %A& + arteries and 1 ein
the umbilical cord is composed of + arteries and 1 ein.
@C. At what stage of labor and deliery does a primigraida differ mainly from a multigraida-
A. 5tage 1
B. 5tage +
!. 5tage /
$. 5tage :
Answer: %A& 5tage 1
"n stage 1 during a normal aginal deliery of a erte= presentation# the multigraida may hae about
B hours labor while the primigraida may hae up to 1+ hours labor.
B3. The second stage of labor begins with OOO and ends with OO-
A. Begins with full dilatation of ceri= and ends with deliery of placenta
B. Begins with true labor pains and ends with deliery of baby
!. Begins with complete dilatation and effacement of ceri= and ends with deliery of baby
$. Begins with passage of show and ends with full dilatation and effacement of ceri=
Answer: %!& Begins with complete dilatation and effacement of ceri= and ends with deliery of baby
5tage + of labor and deliery process begins with full dilatation of the ceri= and ends with the
deliery of baby. 5tage 1 begins with true labor pains and ends with full dilatation and effacement of
the ceri=.
B1. The following are signs that the placenta has detached 7E!7(T:
A. 0engthening of the cord
B. 6terus becomes more globular
!. 5udden gush of blood
$. Mother feels like bearing down
Answer: %$& Mother feels like bearing down
(lacental detachment does not re>uire the mother to bear down. A normal placenta will detach by
itself without any effort from the mother.
B+. ,hen the shiny portion of the placenta comes out first# this is called the OOO mechanism.
A. 5chultze
B. .itgens
!. $uncan
$. Marmets
Answer: %A& 5chultze
There are + mechanisms possible during the deliery of the placenta. "f the shiny portion comes out
first# it is called the 5chultze mechanism; while if the meaty portion comes out first# it is called the
$uncan mechanism.
B/. ,hen the baby9s head is out# the immediate action of the nurse is
A. !ut the umbilical cord
B. ,ipe the baby9s face and suction mouth first
!. !heck if there is cord coiled around the neck
$. $elier the anterior shoulder
Answer: %!& !heck if there is cord coiled around the neck
The nurse should check if there is a cord coil because the baby will not be deliered safely if the cord
is coiled around its neck. ,iping of the face should be done seconds after you hae ensured that there
is no cord coil but suctioning of the nose should be done after the mouth because the baby is a 1nasal
obligate4 breather. "f the nose is suctioned first before the mouth# the mucus plugging the mouth can
be aspirated by the baby.
B:. ,hen deliering the baby9s head the nurse supports the mother9s perineum to preent tear. This
techni>ue is called
A. Marmet9s techni>ue
B. .itgen9s techni>ue
!. $uncan maneuer
$. 5chultze maneuer
Answer: %B& .itgen9s techni>ue
.itgen9s techni>ue is done to preent perineal tear. This is done by the nurse by support the perineum
with a sterile towel and pushing the perineum downard with one hand while the other hand is
supporting the baby9s head as it goes out of the aginal opening.
B<. The basic deliery set for normal aginal deliery includes the following instrumentsGarticles
7E!7(T:
A. + clamps
B. (air of scissors
!. Iidney basin
$. .etractor
Answer: %$& .etractor
Aor normal aginal deliery# the nurse needs only the instruments for cutting the umbilical cord such
as: + clamps %straight or cure& and a pair of scissors as well as the kidney basin to receie the
placenta. The retractor is not part of the basic set. "n the hospital setting# needle holder and tissue
forceps are added especially if the woman deliering the baby is a primigraida wherein episiotomy
is generally done.
B?. As soon as the placenta is deliered# the nurse must do which of the following actions-
A. "nspect the placenta for completeness including the membranes
B. (lace the placenta in a receptacle for disposal
!. 0abel the placenta properly
$. 0eae the placenta in the kidney basin for the nursing aide to dispose properly
Answer: %A& "nspect the placenta for completeness including the membranes
The placenta must be inspected for completeness to include the membranes because an incomplete
placenta could mean that there is retention of placental fragments which can lead to uterine atony. "f
the uterus does not contract ade>uately# hemorrhage can occur.
B@. "n aginal deliery done in the hospital setting# the doctor routinely orders an o=ytocin to be
gien to the mother parenterally. The o=ytocin is usually gien after the placenta has been deliered
and not before because:
A. 8=ytocin will preent bleeding
B. 8=ytocin can make the ceri= close and thus trap the placenta inside
!. 8=ytocin will facilitate placental deliery
$. 2iing o=ytocin will ensure complete deliery of the placenta
Answer: %B& 8=ytocin can make the ceri= close and thus trap the placenta inside
The action of o=ytocin is to make the uterus contract as well make the ceri= close. "f it is gien prior
to placental deliery# the placenta will be trapped inside because the action of the drug is almost
immediate if gien parentally.
BB. "n a graido-cardiac mother# the first + hours postpartum %:th stage of labor and deliery&
particularly in a cesarean section is a critical period because at this stage
A. There is a fluid shift from the placental circulation to the maternal circulation which can oerload
the compromised heart.
B. The maternal heart is already weak and the mother can die
!. The deliery process is strenuous to the mother
$. The mother is tired and weak which can distress the heart
Answer: %A& There is a fluid shift from the placental circulation to the maternal circulation which can
oerload the compromised heart.
$uring the pregnancy# there is an increase in maternal blood olume to accommodate the need of the
fetus. ,hen the baby and placenta hae been deliered# there is a fluid shift back to the maternal
circulation as part of physiologic adaptation during the postpartum period. "n cesarean section# the
fluid shift occurs faster because the placenta is taken out right after the baby is deliered giing it less
time for the fluid shift to gradually occur.
BC. The drug usually gien parentally to enhance uterine contraction is:
A. Terbutalline
B. (itocin
!. Magnesium sulfate
$. 0idocaine
Answer: %B& (itocin
The common o=ytocin gien to enhance uterine contraction is pitocin. This is also the drug gien to
induce labor.
C3. The partograph is a tool used to monitor labor. The maternal parameters measuredGmonitored are
the following 7E!7(T:
A. Jital signs
B. Aluid intake and output
!. 6terine contraction
$. !erical dilatation
Answer: %B& Aluid intake and output
(artograph is a monitoring tool designed by the ,orld 'ealth 8rganization for use by health workers
when attending to mothers in labor especially the high risk ones. Aor maternal parameters all of the
aboe is placed in the partograph e=cept the fluid intake since this is placed in a separate monitoring
sheet.
C1. The following are natural childbirth procedures 7E!7(T:
A. 0amaze method
B. $ick-.ead method
!. .itgen9s maneuer
$. (sychoprophylactic method
Answer: %!& .itgen9s maneuer
.itgen9s method is used to preent perineal tearGlaceration during the deliery of the fetal head.
0amaze method is also known as psychoprophylactic method and $ick-.ead method are commonly
known natural childbirth procedures which adocate the use of non-pharmacologic measures to
reliee labor pain.
C+. The following are common causes of dysfunctional labor. ,hich of these can a nurse# on her own
manage-
A. (elic bone contraction
B. Aull bladder
!. 7=tension rather than fle=ion of the head
$. !erical rigidity
Answer: %B& Aull bladder
Aull bladder can impede the descent of the fetal head. The nurse can readily manage this problem by
doing a simple catheterization of the mother.
C/. At what stage of labor is the mother is adised to bear down-
A. ,hen the mother feels the pressure at the rectal area
B. $uring a uterine contraction
!. "n between uterine contraction to preent uterine rupture
$. Anytime the mother feels like bearing down
Answer: %B& $uring a uterine contraction
The primary power of labor and deliery is the uterine contraction. This should be augmented by the
mother9s bearing down during a contraction.
C:. The normal dilatation of the ceri= during the first stage of labor in a nullipara is
A. 1.+ cm.Ghr
B. 1.< cm.Ghr.
!. 1.B cm.Ghr
$. +.3 cm.Ghr
Answer: %A& 1.+ cm.Ghr
Aor nullipara the normal cerical dilatation should be 1.+ cmGhr. "f it is less than that# it is considered
a protracted actie phase of the first stage. Aor multipara# the normal cerical dilatation is 1.< cmGhr.
C<. ,hen the fetal head is at the leel of the ischial spine# it is said that the station of the head is
A. 5tation F1
B. 5tation 134
!. 5tation T1
$. 5tation T+
Answer: %B& 5tation 134
5tation is defined as the relationship of the fetal head and the leel of the ischial spine. At the leel of
the ischial spine# the station is 134. Aboe the ischial spine it is considered %-& station and below the
ischial spine it is %T& station.
C?. $uring an internal e=amination# the nurse palpated the posterior fontanel to be at the left side of
the mother at the upper >uadrant. The interpretation is that the position of the fetus is:
A. 08A
B. .8(
!. 08(
$. .8A
Answer: %A& 08A
The landmark used in determine fetal position is the posterior fontanel because this is the nearest to
the occiput. 5o if the nurse palpated the occiput %8& at the left %0& side of the mother and at the
upperGanterior %A& >uadrant then the fetal position is 08A.
C@. The following are types of breech presentation 7E!7(T:
A. Aootling
B. Arank
!. !omplete
$. "ncomplete
Answer: %$& "ncomplete
Breech presentation means the buttocks of the fetus is the presenting part. "f it is only the footGfeet# it
is considered footling. "f only the buttocks# it is frank breech. "f both the feet and the buttocks are
presenting it is called complete breech.
CB. ,hen the nurse palpates the suprapubic area of the mother and found that the presenting part is
still moable# the right term for this obseration that the fetus is
A. 7ngaged
B. $escended
!. Aloating
$. "nternal .otation
Answer: %!& Aloating
The term floating means the fetal presenting part has not enteredGdescended into the pelic inlet. "f
the fetal head has entered the pelic inlet# it is said to be engaged.
CC. The placenta should be deliered normally within OOO minutes after the deliery of the baby.
A. < minutes
B. /3 minutes
!. :< minutes
$. ?3 minutes
Answer: %B& /3 minutes
The placenta is deliered within /3 minutes from the deliery of the baby. "f it takes longer# probably
the placenta is abnormally adherent and there is a need to refer already to the obstetrician.
133. ,hen shaing a woman in preparation for cesarean section# the area to be shaed should be
from OOO to OOO
A. 6nder breast to mid-thigh including the pubic area
B. The umbilicus to the mid-thigh
!. Eyphoid process to the pubic area
$. Aboe the umbilicus to the pubic area
Answer: %A& 6nder breast to mid-thigh including the pubic area
5haing is done to preent infection and the area usually shaed should sufficiently coer the area for
surgery# cesarean section. The pubic hair is definitely to be included in the shaing
131. (ostpartum (eriod:
The fundus of the uterus is e=pected to go down normally postpartally about OO cm per day.
A. 1.3 cm
B. +.3 cm
!. +.< cm
$. /.3 cm
Answer: %A& 1.3 cm
The uterus will begin inolution right after deliery. "t is e=pected to regressGgo down by 1 cm. per
day and becomes no longer palpable about 1 week after deliery.
13+. The lochia on the first few days after deliery is characterized as
A. (inkish with some blood clots
B. ,hitish with some mucus
!. .eddish with some mucus
$. 5erous with some brown tinged mucus
Answer: %!& .eddish with some mucus
.ight after deliery# the aginal discharge called lochia will be reddish because there is some blood#
endometrial tissue and mucus. 5ince it is not pure blood it is non-clotting.
13/. 0ochia normally disappears after how many days postpartum-
A. < days
B. @-13 days
!. 1B-+1 days
$. +B-/3 days
Answer: %B& @-13 days
)ormally# lochia disappears after 13 days postpartum. ,hat9s important to remember is that the color
of lochia gets to be lighter %from reddish to whitish& and scantier eeryday.
13:. After an .h%-& mother has deliered her .h %T& baby# the mother is gien .ho2am. This is done
in order to:
A. (reent the recurrence of .h%T& baby in future pregnancies
B. (reent the mother from producing antibodies against the .h%T& antigen that she may hae gotten
when she deliered to her .h%T& baby
!. 7nsure that future pregnancies will not lead to maternal illness
$. To preent the newborn from haing problems of incompatibility when it breastfeeds
Answer: %B& (reent the mother from producing antibodies against the .h%T& antigen that she may
hae gotten when she deliered to her .h%T& baby
"n .h incompatibility# an .h%-& mother will produce antibodies against the fetal .h %T& antigen which
she may hae gotten because of the mi=ing of maternal and fetal blood during labor and deliery.
2iing her .ho2am right after birth will preent her immune system from being permanently
sensitized to .h antigen.
13<. To enhance milk production# a lactating mother must do the following interentions 7E!7(T:
A. "ncrease fluid intake including milk
B. 7at foods that increases lactation which are called galactagues
!. 7=ercise ade>uately like aerobics
$. 'ae ade>uate nutrition and rest
Answer: %!& 7=ercise ade>uately like aerobics
All the aboe nursing measures are needed to ensure that the mother is in a healthy state. 'oweer#
aerobics does not necessarily enhance lactation.
13?. The nursing interention to reliee pain in breast engorgement while the mother continues to
breastfeed is
A. Apply cold compress on the engorged breast
B. Apply warm compress on the engorged breast
!. Massage the breast
$. Apply analgesic ointment
Answer: %B& Apply warm compress on the engorged breast
,arm compress is applied if the purpose is to reliee pain but ensure lactation to continue. "f the
purpose is to reliee pain as well as suppress lactation# the compress applied is cold.
13@. A woman who deliered normally per agina is e=pected to oid within OOO hours after deliery.
A. / hrs
B. : hrs.
!. ?-B hrs
$. 1+-+: hours
Answer: %!& ?-B hrs
A woman who has had normal deliery is e=pected to oid within ?-B hrs. "f she is unable to do so
after B hours# the nurse should stimulate the woman to oid. "f nursing interentions to stimulate
spontaneous oiding don9t work# the nurse may decide to catheterize the woman.
13B. To ensure ade>uate lactation the nurse should teach the mother to:
A. Breast feed the baby on self-demand day and night
B. Aeed primarily during the day and allow the baby to sleep through the night
!. Aeed the baby eery /-: hours following a strict schedule
$. Breastfeed when the breast are engorged to ensure ade>uate supply
Answer: %A& Breast feed the baby on self-demand day and night
Aeeding on self-demand means the mother feeds the baby according to baby9s need. Therefore# this
means there will be regular emptying of the breasts# which is essential to maintain ade>uate lactation.
13C. An appropriate nursing interention when caring for a postpartum mother with thrombophlebitis
is:
A. 7ncourage the mother to ambulate to reliee the pain in the leg
B. "nstruct the mother to apply elastic bondage from the foot going towards the knee to improe
enous return flow
!. Apply warm compress on the affected leg to reliee the pain
$. 7leate the affected leg and keep the patient on bedrest
Answer: %$& 7leate the affected leg and keep the patient on bedrest
"f the mother already has thrombophlebitis# the nursing interention is bedrest to preent the possible
dislodging of the thrombus and keeping the affected leg eleated to help reduce the inflammation.
113. The nurse should anticipate that hemorrhage related to uterine atony may occur postpartally if
this condition was present during the deliery:
A. 7=cessie analgesia was gien to the mother
B. (lacental deliery occurred within thirty minutes after the baby was born
!. An episiotomy had to be done to facilitate deliery of the head
$. The labor and deliery lasted for 1+ hours
Answer: %A& 7=cessie analgesia was gien to the mother
7=cessie analgesia can lead to uterine rela=ation thus lead to hemorrhage postpartally. Both B and $
are normal and ! is at the aginal introitus thus will not affect the uterus.
111. According to .ubin9s theory of maternal role adaptation# the mother will go through / stages
during the post partum period. These stages are:
A. 2oing through# ad*ustment period# adaptation period
B. Taking-in# taking-hold and letting-go
!. Attachment phase# ad*ustment phase# adaptation phase
$. Taking-hold# letting-go# attachment phase
Answer: %B& Taking-in# taking-hold and letting-go
.ubin9s theory states that the / stages that a mother goes through for maternal adaptation are: taking-
in# taking-hold and letting-go. "n the taking-in stage# the mother is more passie and dependent on
others for care. "n taking-hold# the mother begins to assume a more actie role in the care of the child
and in letting-go# the mother has become adapted to her maternal role.
11+. The neonate of a mother with diabetes mellitus is prone to deeloping hypoglycemia because:
A. The pancreas is immature and unable to secrete the needed insulin
B. There is rapid diminution of glucose leel in the baby9s circulating blood and his pancreas is
normally secreting insulin
!. The baby is reacting to the insulin gien to the mother
$. 'is kidneys are immature leading to a high tolerance for glucose
Answer: %B& There is rapid diminution of glucose leel in the baby9s circulating blood and his
pancreas is normally secreting insulin
"f the mother is diabetic# the fetus while in utero has a high supply of glucose. ,hen the baby is born
and is now separate from the mother# it no longer receies a high dose of glucose from the mother. "n
the first few hours after deliery# the neonate usually does not feed yet thus this can lead to
hypoglycemia.
11/. ,hich of the following is an abnormal ital sign in postpartum-
A. (ulse rate between <3-?3Gmin
B. B( diastolic increase from B3 to C<mm 'g
!. B( systolic between 133-1+3mm 'g
$. .espiratory rate of 1?-+3Gmin
Answer: %B& B( diastolic increase from B3 to C<mm 'g
All the ital signs gien in the choices are within normal range e=cept an increase of 1<mm 'g in the
diastolic which is a possible sign of hypertension in pregnancy.
11:. The uterine fundus right after deliery of placenta is palpable at
A. 0eel of Eyphoid process
B. 0eel of umbilicus
!. 0eel of symphysis pubis
$. Midway between umbilicus and symphysis pubis
Answer: %B& 0eel of umbilicus
"mmediately after the deliery of the placenta# the fundus of the uterus is e=pected to be at the leel
of the umbilicus because the contents of the pregnancy hae already been e=pelled. The fundus is
e=pected to recede by 1 fingerbreadths %1cm& eeryday until it becomes no longer palpable aboe the
symphysis pubis.
11<. After how many weeks after deliery should a woman hae her postpartal check-up based on the
protocol followed by the $8'-
A. + weeks
B. / weeks
!. ? weeks
$. 1+ weeks
Answer: %!& ? weeks
According to the $8' protocol postpartum check-up is done ?-B weeks after deliery to make sure
complete inolution of the reproductie organs has be achieed.
11?. "n a woman who is not breastfeeding# menstruation usually occurs after how many weeks-
A. +-: weeks
B. ?-B weeks
!. ? months
$. 1+ months
Answer: %B& ?-B weeks
,hen the mother does not breastfeed# the normal menstruation resumes about ?-B weeks after
deliery. This is due to the fact that after deliery# the hormones estrogen and progesterone gradually
decrease thus triggering negatie feedback to the anterior pituitary to release the Aolicle-5timulating
'ormone %A5'& which in turn stimulates the oary to again mature a graafian follicle and the
menstrual cycle post pregnancy resumes.
11@. The following are nursing measures to stimulate lactation 7E!7(T
A. Are>uent regular breast feeding
B. Breast pumping
!. Breast massage
$. Application of cold compress on the breast
Answer: %$& Application of cold compress on the breast
To stimulate lactation# warm compress is applied on the breast. !old application will cause
asoconstriction thus reducing the blood supply conse>uently the production of milk.
11B. ,hen the uterus is firm and contracted after deliery but there is aginal bleeding# the nurse
should suspect
A. 0aceration of soft tissues of the ceri= and agina
B. 6terine atony
!. 6terine inersion
$. 6terine hypercontractility
Answer: %A& 0aceration of soft tissues of the ceri= and agina
,hen uterus is firm and contracted it means that the bleeding is not in the uterus but other parts of
the passageway such
as the ceri= or the agina.
11C. The following are interentions to make the fundus contract postpartally 7E!7(T
A. Make the baby suck the breast regularly
B. Apply ice cap on fundus
!. Massage the fundus igorously for 1< minutes until contracted
$. 2ie o=ytocin as ordered
Answer: %!& Massage the fundus igorously for 1< minutes until contracted
Massaging the fundus of the uterus should not be igorous and should only be done until the uterus
feel firm and contracted. "f massaging is igorous and prolonged# the uterus will rela= due to oer
stimulation.
1+3. The following are nursing interentions to reliee episiotomy wound pain 7E!7(T
A. 2iing analgesic as ordered
B. 5itz bath
!. (erineal heat
$. (erineal care
Answer: %$& (erineal care
(erineal care is primarily done for personal hygiene regardless of whether there is pain or not;
episiotomy wound or not.
1+1. (ostpartum blues is said to be normal proided that the following characteristics are present.
These are
1. ,ithin /-13 days only;
+. ,oman e=hibits the following symptoms- episodic tearfulness# fatigue# oersensitiity# poor
appetite;
/. Maybe more seere symptoms in primpara
A. All of the aboe
B. 1 and +
!. + only
$. + and /
Answer: %A& All of the aboe
All the symptoms 1-/ are characteristic of postpartal blues. "t will resole by itself because it is
transient and is due to a number of reasons like changes in hormonal leels and ad*ustment to
motherhood. "f symptoms lasts more than + weeks# this could be a sign of abnormality like
postpartum depression and needs treatment.
1++. The neonatal circulation differs from the fetal circulation because
A. The fetal lungs are non-functioning as an organ and most of the blood in the fetal circulation is
mi=ed blood.
B. The blood at the left atrium of the fetal heart is shunted to the right atrium to facilitate its passage
to the lungs
!. The blood in left side of the fetal heart contains o=ygenated blood while the blood in the right side
contains uno=ygenated blood.
$. )one of the aboe
Answer: %A& The fetal lungs are non-functioning as an organ and most of the blood in the fetal
circulation is mi=ed blood.
The fetal lungs is fluid-filled while in utero and is still not functioning. "t only begins to function in
e=tra uterine life. 7=cept for the blood as it enters the fetus immediately from the placenta# most of
the fetal blood is mi=ed blood.
1+/. The normal respiration of a newborn immediately after birth is characterized as:
A. 5hallow and irregular with short periods of apnea lasting not longer than 1< seconds# /3-?3
breaths per minute
B. +3-:3 breaths per minute# abdominal breathing with actie use of intercostals muscles
!. /3-?3 breaths per minute with apnea lasting more than 1< seconds# abdominal breathing
$. /3-<3 breaths per minute# actie use of abdominal and intercostal muscles
Answer: %A& 5hallow and irregular with short periods of apnea lasting not longer than 1< seconds# /3-
?3 breaths per minute
A newly born baby still is ad*usting to =tra uterine life and the lungs are *ust beginning to function as
a respiratory organ. The respiration of the baby at this time is characterized as usually shallow and
irregular with short periods of apnea# /3-?3 breaths per minute. The apneic periods should be brief
lasting not more than 1< seconds otherwise it will be considered abnormal.
1+:. The anterior fontanelle is characterized as:
A. /-: cm antero-posterior diameter and +-/ cm transerse diameter# diamond shape
B. +-/ cm antero-posterior diameter and /-: cm transerse diameter and diamond shape
!. +-/ cm in both antero-posterior and transerse diameter and diamond shape
$. none of the aboe
Answer: %A& /-: cm antero-posterior diameter and +-/ cm transerse diameter# diamond shape
The anterior fontanelle is diamond shape with the antero-posterior diameter being longer than the
transerse diameter. The posterior fontanelle is triangular shape.
1+<. The ideal site for itamin I in*ection in the newborn is:
A. .ight upper arm
B. 0eft upper arm
!. 7ither right or left buttocks
$. Middle third of the thigh
Answer: %$& Middle third of the thigh
)eonates do not hae well deeloped muscles of the arm. 5ince Jitamin I is gien intramuscular# the
site must hae sufficient muscles like the middle third of the thigh.
1+?. At what A(2A. score at < minutes after birth should resuscitation be initiated-
A. 1-/
B. @-B
!. C-13
$. ?-@
Answer: %A& 1-/
An A(2A. of 1-/ is a sign of fetal distress which re>uires resuscitation. The baby is alright if the
score is B-13.
1+@. .ight after birth# when the skin of the baby9s trunk is pinkish but the soles of the feet and palm
of the hands are bluish this is called:
A. 5yndactyly
B. Acrocyanosis
!. (eripheral cyanosis
$. !ephalo-caudal cyanosis
Answer: %B& Acrocyanosis
Acrocyanosis is the term used to describe the baby9s skin color at birth when the soles and palms are
bluish but the trunk is pinkish.
1+B. The minimum birth weight for full term babies to be considered normal is:
A. +#333gms
B. 1#<33gms
!. +#<33gms
$. /#333gms
Answer: %!& +#<33gms
According to the ,'8 standard# the minimum normal birth weight of a full term baby is +#<33 gms
or +.< Ig.
1+C. The procedure done to preent ophthalmia neonatorum is:
A. Marmet9s techni>ue
B. !rede9s method
!. .itgen9s method
$. 8phthalmic wash
Answer: %B& !rede9s method
!rede9s methodGprophyla=is is the procedure done to preent ophthalmia neonatorum which the baby
can ac>uire as it passes through the birth canal of the mother. 6sually# an ophthalmic ointment is
used.
1/3. ,hich of the following characteristics will distinguish a postmature neonate at birth-
A. (lenty of lanugo and erni= caseosa
B. 0anugo mainly on the shoulders and erni= in the skin folds
!. (inkish skin with good turgor
$. Almost leather-like# dry# cracked skin# negligible erni= caseosa
Answer: %$& Almost leather-like# dry# cracked skin# negligible erni= caseosa
A post mature fetus has the appearance of an old person with dry wrinkled skin and the erni=
caseosa has already diminished.
1/1. According to the (hilippine )ursing 0aw# a registered nurse is allowed to handle mothers in
labor and deliery with the following considerations:
1. The pregnancy is normal.;
+. The labor and deliery is uncomplicated;
/. 5uturing of perineal laceration is allowed proided the nurse had special training;
:. As a deliery room nurse she is not allowed to insert intraenous fluid unless she had special
training for it.
A. 1 and +
B. 1# +# and /
!. / and :
$. 1# +# and :
Answer: %B& 1# +# and /
To be allowed to handle delieries# the pregnancy must be normal and uncomplicated. And in
.AC1@+# the nurse is now allowed to suture perineal lacerations proided sGhe has had the special
training. Also# in this law# there is no longer an e=plicit proision stating that the nurse still needs
special training for "J insertion.
1/+. Birth !ontrol Methods and "nfertility:
"n basal body temperature %BBT& techni>ue# the sign that oulation has occurred is an eleation of
body temperature by
A. 1.3-1.: degrees centigrade
B. 3.+-3.: degrees centigrade
!. +.3-:.3 degrees centigrade
$. 1.3-:.3 degrees centigrade
Answer: %B& 3.+-3.: degrees centigrade
The release of the hormone progesterone in the body following oulation causes a slight eleation of
basal body temperature of about 3.+ F 3.: degrees centigrade
1//. 0actation Amenorrhea Method%0AM& can be an effectie method of natural birth control if
A. The mother breast feeds mainly at night time when oulation could possibly occur
B. The mother breastfeeds e=clusiely and regularly during the first ? months without giing
supplemental feedings
!. The mother uses mi=ed feeding faithfully
$. The mother breastfeeds regularly until 1 year with no supplemental feedings
Answer: %B& The mother breastfeeds e=clusiely and regularly during the first ? months without
giing supplemental feedings
A mother who breastfeeds e=clusiely and regularly during the first ? months benefits from lactation
amenorrhea. There is eidence to support the obseration that the benefits of lactation amenorrhea
lasts for ? months proided the woman has not had her first menstruation since deliery of the baby.
1/:. "ntra-uterine deice preents pregnancy by the ff. mechanism 7E!7(T
A. 7ndometrium inflames
B. Aundus contracts to e=pel uterine contents
!. !opper embedded in the "6$ can kill the sperms
$. 5perms will be barred from entering the fallopian tubes
Answer: %$& 5perms will be barred from entering the fallopian tubes
An intrauterine deice is a foreign body so that if it is inserted into the uterine caity the initial
reaction is to produce inflammatory process and the uterus will contract in order to try to e=pel the
foreign body. 6sually "6$s are coated with copper to sere as spermicide killing the sperms
deposited into the female reproductie tract. But the "6$ does not completely fill up the uterine
caity thus sperms which are microscopic is size can still pass through.
1/<. 8ral contraceptie pills are of different types. ,hich type is most appropriate for mothers who
are breastfeeding-
A. 7strogen only
B. (rogesterone only
!. Mi=ed type- estrogen and progesterone
$. +1-day pills mi=ed type
Answer: %B& (rogesterone only
"f mother is breastfeeding# the progesterone only type is the best because estrogen can affect
lactation.
1/?. The natural family planning method called 5tandard $ays %5$M&# is the latest type and easy to
use method. 'oweer# it is a method applicable only to women with regular menstrual cycles
between OOO to OOO days.
A. +1-+? days
B. +?-/+ days
!. +B-/3 days
$. +:- /? days
Answer: %B& +?-/+ days
5tandard $ays Method %5$M& re>uires that the menstrual cycles are regular between +?-/+ days.
There is no need to monitor temperature or mucus secretion. This natural method of family planning
is ery simple since all that the woman pays attention to is her cycle. ,ith the aid of !ycleBeads# the
woman can easily monitor her cycles.
1/@. ,hich of the following are signs of oulation-
1. Mittelschmerz;
+. 5pinnabarkeit;
/. Thin watery cerical mucus;
:. 7leated body temperature of :.3 degrees centigrade
A. 1 W +
B. 1# +# W /
!. / W :
$. 1# +# /# :
Answer: %B& 1# +# W /
Mittelschmerz# spinnabarkeit and thin watery cerical mucus are signs of oulation. ,hen oulation
occurs# the hormone progesterone is released which can cause a slight eleation of temperature
between 3.+-3.: degrees centigrade and not : degrees centigrade.
1/B. The following methods of artificial birth control works as a barrier deice 7E!7(T:
A. !ondom
B. !erical cap
!. !erical $iaphragm
$. "ntrauterine deice %"6$&
Answer: %$& "ntrauterine deice %"6$&
"ntrauterine deice preents pregnancy by not allowing the fertilized oum from implanting on the
endometrium. 5ome "6$s hae copper added to it which is spermicidal. "t is not a barrier since the
sperms can readily pass through and fertilize an oum at the fallopian tube.
1/C. ,hich of the following is a T.67 statement about normal oulation-
A. "t occurs on the 1:th day of eery cycle
B. "t may occur between 1:-1? days before ne=t menstruation
!. 7ery menstrual period is always preceded by oulation
$. The most fertile period of a woman is + days after oulation
Answer: %B& "t may occur between 1:-1? days before ne=t menstruation
)ot all menstrual cycles are oulatory. )ormal oulation in a woman occurs between the 1:th to the
1?th day before the )7ET menstruation. A common misconception is that oulation occurs on the
1:th day of the cycle. This is a misconception because oulation is determined )8T from the first
day of the cycle but rather 1:-1? days B7A8.7 the ne=t menstruation.
1:3. "f a couple would like to enhance their fertility# the following means can be done:
1. Monitor the basal body temperature of the woman eeryday to determine peak period of fertility;
+. 'ae ade>uate rest and nutrition;
/. 'ae se=ual contact only during the dry period of the woman;
:. 6ndergo a complete medical check-up to rule out any debilitating disease
A. 1 only
B. 1 W :
!. 1#+#:
$. 1#+#/#:
Answer: %!& 1#+#:
All of the aboe are essential for enhanced fertility e=cept no. / because during the dry period the
woman is in her infertile period thus een when se=ual contact is done# there will be no oulation#
thus fertilization is not possible.
1:1. "n sympto-thermal method# the parameters being monitored to determine if the woman is fertile
or infertile are:
A. Temperature# cerical mucus# cerical consistency
B. .elease of oum# temperature and agina
!. Temperature and wetness
$. Temperature# endometrial secretion# mucus
Answer: %A& Temperature# cerical mucus# cerical consistency
The / parameters measuredGmonitored which will indicate that the woman has oulated are-
temperature increase of about 3.+-3.: degrees centigrade# softness of the ceri= and cerical mucus
that looks like the white of an egg which makes the woman feel 1wet4.
1:+. The following are important considerations to teach the woman who is on low dose %mini-pill&
oral contraceptie 7E!7(T:
A. The pill must be taken eeryday at the same time
B. "f the woman fails to take a pill in one day# she must take + pills for added protection
!. "f the woman fails to take a pill in one day# she needs to take another temporary method until she
has consumed the whole pack
$. "f she is breast feeding# she should discontinue using mini-pill and use the progestin-only type
Answer: %B& "f the woman fails to take a pill in one day# she must take + pills for added protection
"f the woman fails to take her usual pill for the day# taking a double dose does not gie additional
protection. ,hat she needs to do is to continue taking the pills until the pack is consumed and use at
the time another temporary method to ensure that no pregnancy will occur. ,hen a new pack is
started# she can already discontinue using the second temporary method she employed.
1:/. To determine if the cause of infertility is a blockage of the fallopian tubes# the test to be done is
A. 'uhner9s test
B. .ubin9s test
!. (ostcoital test
$. )one of the aboe
Answer: %B& .ubin9s test
.ubin9s test is a test to determine patency of fallopian tubes. 'uhner9s test is also known as post-
coital test to determine compatibility of the cerical mucus with sperms of the se=ual partner.
1::. "nfertility can be attributed to male causes such as the following 7E!7(T:
A. !ryptorchidism
B. 8rchitis
!. 5perm count of about +3 million per milliliter
$. (remature e*aculation
Answer: %!& 5perm count of about +3 million per milliliter
5perm count must be within normal in order for a male to successfully sire a child. The normal sperm
count is +3 million per milliliter of seminal fluid or <3 million per e*aculate.
1:<. 5pinnabarkeit is an indicator of oulation which is characterized as:
A. Thin watery mucus which can be stretched into a long strand about 13 cm
B. Thick mucus that is detached from the ceri= during oulation
!. Thin mucus that is yellowish in color with fishy odor
$. Thick mucus aginal discharge influence by high leel of estrogen
Answer: %A& Thin watery mucus which can be stretched into a long strand about 13 cm
At the midpoint of the cycle when the estrogen leel is high# the cerical mucus becomes thin and
watery to allow the sperm to easily penetrate and get to the fallopian tubes to fertilize an oum. This
is called spinnabarkeit. And the woman feels 1wet4. ,hen progesterone is secreted by the oary# the
mucus becomes thick and the woman will feel 1dry4.
1:?. Jasectomy is a procedure done on a male for sterilization. The organ inoled in this procedure
is
A. (rostate gland
B. 5eminal esicle
!. Testes
$. Jas deferens
Answer: %$& Jas deferens
Jasectomy is a procedure wherein the as deferens of the male is ligated and cut to preent the
passage of the sperms from the testes to the penis during e*aculation.
1:@. Breast self e=amination is best done by the woman on herself eery month during
A. The middle of her cycle to ensure that she is oulating
B. $uring the menstrual period
!. .ight after the menstrual period so that the breast is not being affected by the increase in hormones
particularly estrogen
$. Vust before the menstrual period to determine if oulation has occurred
Answer: %!& .ight after the menstrual period so that the breast is not being affected by the increase in
hormones particularly estrogen
The best time to do self breast e=amination is right after the menstrual period is oer so that the
hormonal leel is low thus the breasts are not tender.
1:B. A woman is considered to be menopause if she has e=perienced cessation of her menses for a
period of
A. ? months
B. 1+ months
!. 1B months
$. +: months
Answer: %B& 1+ months
"f a woman has not had her menstrual period for 1+ consecutie months# she is considered to be in
her menopausal stage.
1:C. ,hich of the following is the correct practice of self breast e=amination in a menopausal
woman-
A. 5he should do it at the usual time that she e=periences her menstrual period in the past to ensure
that her hormones are not at its peak
B. Any day of the month as long it is regularly obsered on the same day eery month
!. Anytime she feels like doing it ideally eery day
$. Menopausal women do not need regular self breast e=am as long as they do it at least once eery ?
months
Answer: %B& Any day of the month as long it is regularly obsered on the same day eery month
Menopausal women still need to do self e=amination of the breast regularly. Any day of the month is
alright proided that she practices it monthly on the same day that she has chosen. The hormones
estrogen and progesterone are already diminished during menopause so there is no need to consider
the time to do it in relation to the menstrual cycle.
1<3. "n assisted reproductie technology %A.T&# there is a need to stimulate the oaries to produce
more than one mature oa. The drug commonly used for this purpose is:
A. Bromocriptine
B. !lomiphene
!. (roera
$. 7srogen
Answer: %B& !lomiphene
!lomiphene or !lomid acts as an oarian stimulant to promote oulation. The mature oa are
retrieed and fertilized outside the fallopian tube %in-itro fertilization& and after :B hours the
fertilized oum is inserted into the uterus for implantation.
,aplan Sample N!LE-.%N /uestions
5ample )!07E-.) Huiz
5afe and 7ffectie !are 7nironment
1. A ?B-year-old woman is diagnosed with thrombocytopenia due to acute lymphocytic leukemia. 5he
is admitted to the hospital for treatment. The nurse should assign the patient
%A& to a priate room so she will not infect other patients and health care workers.
%B& to a priate room so she will not be infected by other patients and health care workers.
%!& to a semipriate room so she will hae stimulation during her hospitalization.
%$& to a semipriate room so she will hae the opportunity to e=press her feelings about her illness.
+. The nurse teaches a group of mothers of toddlers how to preent accidental poisoning. ,hich of
the following suggestions should the nurse gie regarding medications-
%A& 0ock all medications in a cabinet.
%B& !hild proof all the caps to medication bottles.
%!& 5tore medications on the highest shelf in a cupboard.
%$& (lace medications in different containers.
/. ,hile inserting a nasogastric tube# the nurse should use which of the following protectie
measures-
%A& 2loes# gown# goggles# and surgical cap.
%B& 5terile gloes# mask# plastic bags# and gown.
%!& 2loes# gown# mask# and goggles.
%$& $ouble gloes# goggles# mask# and surgical cap.
:. A ?-year-old boy is returned to his room following a tonsillectomy. 'e remains sleepy from the
anesthesia but is easily awakened. The nurse should place the child in which of the following
positions-
%A& 5imsX.
%B& 5ide-lying.
%!& 5upine.
%$& (rone.
<. A nursing team consists of an .)# an 0()G0J)# and a nursing assistant. The nurse should assign
which of the following patients to the 0()G0J)-
%A& A @+-year-old patient with diabetes who re>uires a dressing change for a stasis ulcer.
%B& A :+-year-old patient with cancer of the bone complaining of pain.
%!& A <<-year-old patient with terminal cancer being transferred to hospice home care.
%$& A +/-year-old patient with a fracture of the right leg who asks to use the urinal.
!lient )eed 1:
5afe and 7ffectie !are 7nironment
1. The correct answer is B.
Huestion: ,hat are the needs of the patient with acute lymphocytic leukemia and thrombocytopenia-
)eeded "nfo: 0ymphocytic leukemia# disease characterized by proliferation of immature ,B!s.
"mmature cells unable to fight infection as competently as mature white cells. Treatment:
chemotherapy# antibiotics# blood transfusions# bone marrow transplantation. )ursing responsibilities:
priate room# no raw fruits or egs# small fre>uent meals# 8+# good skin care.
%A& to a priate room so she will not infect other patients and health care workers [ poses little or no
threat
%B& to a priate room so she will not be infected by other patients and health care workers [
!8..7!T: protects patient from e=ogenous bacteria# risk for deeloping infection from others due
to depressed ,B! count# alters ability to fight infection
%!& to a semipriate room so she will hae stimulation during her hospitalization [ should be placed
in a room alone
%$& to a semipriate room so she will hae the opportunity to e=press her feelings about her illness [
ensure that patient is proided with opportunities to e=press feelings about illness
+. The correct answer is A.
Huestion: ,hat is the B75T way to preent accidental poisoning in children-
5trategy: (icture toddlers at play.
%A& 0ock all medications in a cabinet [ !8..7!T: improper storage most common cause of
poisoning; highest incidence in two-year-olds
%B& !hild proof all the caps to medication bottles [ children can open
%!& 5tore medications on the highest shelf in a cupboard [ toddlers climb
%$& (lace medications in different containers [ keep in original container
/. The correct answer is !.
Huestion: ,hat is the correct uniersal precaution-
5trategy: Think about each answer choice. 'ow is each measure protecting the nurse-
)eeded "nfo: Mask# eye protection# face shield protect mucous membrane e=posure; used if actiities
are likely to generate splash or sprays. 2owns used if actiities are likely to generate splashes or
sprays.
%A& 2loes# gown# goggles# and surgical cap [ surgical caps offer protection to hair but arenXt
re>uired.
%B& 5terile gloes# mask# plastic bags# and gown [ plastic bags proide no direct protection and
arenXt part of uniersal precautions
%!& 2loes# gown# mask# and goggles [ !8..7!T: must use uniersal precautions on A00
patients; preent skin and mucous membrane e=posure when contact with blood or other body fluids
is anticipated
%$& $ouble gloes# goggles# mask# and surgical cap [ surgical cap not re>uired; unnecessary to
double gloe
:. The correct answer is B.
Huestion: ,hat is the best position after tonsillectomy to help with drainage of oral secretions-
5trategy: (icture the patient as described.
%A& 5imsX [ on side with top knee fle=ed and thigh drawn up to chest and lower knee less sharply
fle=ed: used for aginal or rectal e=amination
%B& 5ide-lying [ !8..7!T: most effectie to facilitate drainage of secretions from the mouth and
pharyn=; reduces possibility of airway obstruction.
%!& 5upine [ increased risk for aspiration# would not facilitate drainage of oral secretions
%$& (rone [ risk for airway obstruction and aspiration# unable to obsere the child for signs of
bleeding such as increased swallowing
<. The correct answer is A.
Huestion: ,hich patient is an appropriate assignment for the 0()G0J)-
5trategy: Think about the skill leel inoled in each patientXs care.
)eeded "nfo: 0()G0J): assists with implementation of care; performs procedures; differentiates
normal from abnormal; cares for stable patients with predictable conditions; has knowledge of asepsis
and dressing changes; administers medications %aries with educational background and state nurse
practice act&.
%A& A @+-year-old patient with diabetes who re>uires a dressing change for a stasis ulcer [
!8..7!T: stable patient with an e=pected outcome
%B& A :+-year-old patient with cancer of the bone complaining of pain [ re>uires assessment; .) is
the appropriate caregier
%!& A <<-year-old patient with terminal cancer being transferred to hospice home care [ re>uires
nursing *udgement; .) is the appropriate caregier
%$& A +/-year-old patient with a fracture of the right leg who asks to use the urinal [ standard
unchanging procedure; assign to the nursing assistant
!lient )eed +:
'ealth (romotion and Maintenance
1. An 1B-year-old woman comes to the physicianXs office for a routine prenatal checkup at /: weeks
gestation. Abdominal palpation reeals the fetal position as right occipital anterior %.8A&. At which
of the following sites would the nurse e=pect to find the fetal heart tone-
%A& Below the umbilicus# on the motherXs left side.
%B& Below the umbilicus# on the motherXs right side.
%!& Aboe the umbilicus# on the motherXs left side.
%$& Aboe the umbilicus# on the motherXs right side.
+. The nurse in an outpatient clinic is superising student nurses administering influenza
accinations. The nurse should >uestion the administration of the accine to which of the following
clients-
%A& A :<-year-old male who is allergic to shellfish.
%B& A ?3-year-old female who says she has a sore throat.
%!& A ??-year-old female who lies in a group home.
%$& A @3-year-old female with congestie heart failure.
/. The nurse performs a home isit on a client who deliered two days ago. The client states that she
is bottle-feeding her infant. The nurse notes white# curd-like patches on the newbornXs oral mucous
membranes. The nurse should take which of the following actions-
%A& $etermine the babyXs blood glucose leel.
%B& 5uggest that the newbornXs formula be changed.
%!& .emind the caretaker not to let the infant sleep with the bottle.
%$& 7=plain that the newborn will need to receie some medication.
:. A two-month-old infant is brought to the pediatricianXs office for a well-baby isit. $uring the
e=amination# congenital sublu=ation of the left hip is suspected. The nurse knows that symptoms of
congenital hip dislocation include
%A& lengthening of the limb on the affected side.
%B& deformities of the foot and ankle.
%!& asymmetry of the gluteal and thigh folds.
%$& plantar fle=ion of the foot.
<. The nurse teaches a +3-year-old primigraida how to measure the fre>uency of uterine
contractions. The nurse should e=plain to the patient that the fre>uency of uterine contractions is
determined
%A& from the beginning of one contraction to the end of the ne=t contraction.
%B& from the beginning of one contraction to the end of the same contraction.
%!& by the strength of the contraction at its peak.
%$& by the number of contractions that occur within a gien period of time
!lient )eed +:
'ealth (romotion and Maintenance
1. The answer is B.
Huestion: The fetus is .8A. ,here should the nurse listen for the A'T-
5trategy: (icture the situation described. "t may be helpful for you to draw this out so that you can
imagine where the heartbeat would be found.
)eeded "nfo: $escribing fetal position: practice of defining position of baby relatie to motherXs
pelis. The point of ma=imum intensity %(M"& of the fetus: point on the motherXs abdomen where the
A'T is the loudest# usually oer the fetal back. $iide the motherXs pelis into : parts or >uadrants:
right and left anterior# which is the front# and right and left posterior# which is the back. Abbreiated:
. and 0 for right and left# and A and ( for anterior and posterior. The head# particularly the occiput# is
the most common presenting part# and is abbreiated 8. 08A is most common fetal position and
A'T heard on left side. "n a erte= presentation# A'T is heard below the umbilicus. "n a breech
presentation# A'T is heard aboe the umbilicus.
%A& Below the umbilicus# on the motherXs left side [ found on right not left side
%B& Below the umbilicus# on the motherXs right side [ !8..7!T: occiput and back are pressing
against right side of motherXs abdomen; A'T would be heard below umbilicus on right side
%!& Aboe the umbilicus# on the motherXs left side [ found in breech presentation
%$& Aboe the umbilicus# on the motherXs right side [ found in breech presentation
+. The correct answer is B.
Huestion: ,hat is a contraindication to receiing flu accine-
5trategy: Think about what each answer choice means.
)eeded "nfo: "nfluenza accine: gien yearly# preferably 8ct.-)o.; recommended for people age ?<
or older; people under ?< with heart disease# lung disease# diabetes# immuno-suppression# chronic
care facility residents.
%A& A :<-year-old male who is allergic to shellfish [ allergy to eggs is a contraindication
%B& A ?3-year-old female who says she has a sore throat [ !8..7!T: accine deferred in presence
of acute respiratory disease
%!& A ??-year-old female who lies in a group home [ accine deferred only if patient has an actie
immunization
%$& A @3-year-old female with congestie heart failure [ no contraindication
/. The correct answer is $.
Huestion: ,hat is the treatment for thrush-
5trategy: $etermine the outcome of each answer choice.
)eeded "nfo: Thrush %oral candidiasis&: white pla>ue on oral mucous membranes# gums# or tongue;
treatment includes good handwashing# nystatin %Mycostatin&.
%A& $etermine the babyXs blood glucose leel [ thrush in newborns caused by poor handwashing or
e=posure to an infected agina during birth
%B& 5uggest that the newbornXs formula be changed [ not related to thrush
%!& .emind the caretaker not to let the infant sleep with the bottle [ not related to thrush
%$& 7=plain that the newborn will need to receie some medication [ !8..7!T: thrush most often
treated with nystatin %Mycostatin&
:. The correct answer is !.
Huestion: ,hat will you see with congenital hip dislocation-
5trategy: Aorm a mental image of the deformity.
)eeded "nfo: 5ublu=ation: most common type of congenital hip dislocation. 'ead of femur remains
in contact with acetabulum but is partially displaced. $iagnosed in infant less than : weeks old 5G5:
unleel gluteal folds# limited abduction of hip# shortened femur affected side# 8rtolaniXs sign %click&.
Treatment: abduction splint# hip spica cast# BryantXs traction# open reduction.
%A& lengthening of the limb on the affected side [ inaccurate
%B& deformities of the foot and ankle [ inaccurate
%!& asymmetry of the gluteal and thigh folds [ !8..7!T: restricted moement on affected side
%$& plantar fle=ion of the foot [ seen with clubfoot
<. The correct answer is $.
Huestion: 'ow do you determine the fre>uency of uterine contractions-
)eeded "nfo: There must be at least / contractions to establish fre>uency.
%A& from the beginning of one contraction to the end of the ne=t contraction [ not accurate
%B& from the beginning of one contraction to the end of the same contraction [ defines duration
%!& by the strength of the contraction at its peak [ describes intensity
%$& by the number of contractions that occur within a gien period of time [ !8..7!T
!lient )eed /:
(sychosocial "ntegrity
1. An adolescent male being treated for depression arries with his family at the Adolescent $ay
Treatment !enter for an initial therapy meeting with the staff. The nurse e=plains that one of the
goals of the family meeting is to encourage the adolescent to:
%A& trust the nurse who will sole his problem.
%B& learn to lie with an=iety and tension.
%!& accept responsibility for his actions and choices.
%$& use the members of the therapeutic milieu to sole his problems.
+. A +/-year-old-woman comes to the emergency room stating that she had been raped. ,hich of the
following statements B75T describes the nurseXs responsibility concerning written consent-
%A& The nurse should e=plain the procedure to the patient and ask her to sign the consent form.
%B& The nurse should erify that the consent form has been signed by the patient and that it is
attached to her chart.
%!& The nurse should tell the physician that the patient agrees to hae the e=amination.
%$& The nurse should erify that the patient or a family member has signed the consent form.
/. The nurse cares for an elderly patient with moderate hearing loss. The nurse should teach the
patientXs family to use which of the following approaches when speaking to the patient-
%A& .aise your oice until the patient is able to hear you.
%B& Aace the patient and speak >uickly using a high oice.
%!& Aace the patient and speak slowly using a slightly lowered oice.
%$& 6se facial e=pressions and speak as you would normally.
:. A <+-year-old man is admitted to a hospital after sustaining a seere head in*ury in an automobile
accident. ,hen the patient dies# the nurse obseres the patientXs wife comforting other family
members. ,hich of the following interpretations of this behaior is M85T *ustifiable-
%A& 5he has already moed through the stages of the grieing process.
%B& 5he is repressing anger related to her husbandXs death.
%!& 5he is e=periencing shock and disbelief related to her husbandXs death.
%$& 5he is demonstrating resolution of her husbandXs death.
<. After two weeks of recieing lithium therapy# a patient in the psychiatric unit becomes depressed.
,hich of the following ealuations of the patientXs behaior by the nurse would be M85T accurate-
%A& The treatment plan is not effectie; the patient re>uires a larger dose of lithium.
%B& This is a normal response to lithium therapy; the patient should continue with the current
treatment plan.
%!& This is a normal response to lithium therapy; the patient should be monitored for suicidal
behaior.
%$& The treatment plan is not effectie; the patient re>uires an antidepressant.
!lient )eed /:
(sychosocial "ntegrity
1. The correct answer is !.
Huestion: ,hat is the goal of family therapy-
)eeded "nfo: 5ymptoms of depression: a low self-esteem# obsessie thoughts# regressie behaior#
unkempt appearance# a lack of energy# weight loss# decreased concentration# withdrawn behaior.
%A& trust the nurse who will sole his problem [ not realistic
%B& learn to lie with an=iety and tension [ minimizes concerns
%!& accept responsibility for his actions and choices [ !8..7!T
%$& use the members of the therapeutic milieu to sole his problems [ must do it himself
+. The correct answer is B.
Huestion: ,hat is your responsibility concerning informed consent-
)eeded "nfo: (hysicianXs responsibility to obtain informed consent.
%A& The nurse should e=plain the procedure to the patient and ask her to sign the consent form [
(hysician should get patient to sign consent
%B& The nurse should erify that the consent form has been signed by the patient and that it is
attached to her chart [ !8..7!T
%!& The nurse should tell the physician that the patient agrees to hae the e=amination [ (hysician
should e=plain procedure and get consent form signed
%$& The nurse should erify that the patient or a family member has signed the consent form [ must
be signed by patient unless unable to do
/. The correct answer is !.
Huestion: ,hat should you do to communicate with a person with a moderate hearing loss-
)eeded "nfo: (resbycusis: age-related hearing loss due to inner ear changes. $ecreased ability to hear
high sounds.
%A& .aise your oice until the patient is able to hear you [ would result in high tones patient unable
to hear
%B& Aace the patient and speak >uickly using a high oice [ usually unable to hear high tones
%!& Aace the patient and speak slowly using a slightly lowered oice [ !8..7!T: also decrease
background noise; speak at a slow pace# use nonerbal cues
%$& 6se facial e=pressions and speak as you would normally [ nonerbal cues help# but need low
tones
:. The correct answer is !.
Huestion: ,hat is the reason for the wifeXs behaior-
)eeded "nfo: 5tages of grief: 1& shock and disbelief# +& awareness of pain and loss# /& restitution.
Acute period: :-B weeks# usual resolution: 1 year.
%A& 5he has already moed through the stages of the grieing process [ takes one year
%B& 5he is repressing anger related to her husbandXs death [ not accurate; second stage: crying#
regression
%!& 5he is e=periencing shock and disbelief related to her husbandXs death [ !8..7!T: denial first
stage; inability to comprehend reality of situation
%$& 5he is demonstrating resolution of her husbandXs death [ too soon
<. The correct answer is !.
Huestion: "s the depression normal# or something to be concerned about-
%A& The treatment plan is not effectie; the patient re>uires a larger dose of lithium [ not accurate
%B& This is a normal response to lithium therapy; the patient should continue with the current
treatment plan [ does not address safety needs
%!& This is a normal response to lithium therapy; the patient should be monitored for suicidal
behaior [ !8..7!T: delay of 1-/ weeks before med benefits seen
%$& The treatment plan is not effectie; the patient re>uires an antidepressant [ normal response
!lient )eed ::
(hysiological "ntegrity
1. A ?<-year-old patient with pneumonia is receiing garamycin %2entamicin&. "t would be M85T
important for a nurse to monitor which of the following laboratory alues in this patient-
%A& 'emoglobin and hematocrit.
%B& B6) and creatinine.
%!& (latelet count and clotting time.
%$& 5odium and potassium.
+. A ++-year-old man is admitted to the hospital with complaints of fatigue and weight loss. (hysical
e=amination reeals pallor and multiple bruises on his arms and legs. The results of the patients tests
reeal acute lymphocytic leukemia and thrombocytopenia. ,hich of the following nursing diagnoses
M85T accurately reflects his condition-
%A& (otential for in*ury.
%B& 5elf-care deficit.
%!& (otential for self-harm.
%$& Alteration in comfort.
/. To enhance the percutaneous absorption of nitroglycerine ointment# it would be M85T important
for the nurse to select a site that is
%A& muscular.
%B& near the heart.
%!& non-hairy.
%$& oer a bony prominence.
:. A man is admitted to the Telemetry 6nit for ealuation of complaints of chest pain. 7ight hours
after admission# the patient goes into entricular fibrillation. The physician defibrillates the patient.
The nurse understands that the purpose of defibrillation is to:
%A& increase cardiac contractility and cardiac output.
%B& cause asystole so the normal pacemaker can recapture.
%!& reduce cardiac ischemia and acidosis.
%$& proide energy for depleted myocardial cells.
<. A patient is to receie /#333 ml of 3.CP )a!l "J in +: hours. The intraenous set deliers 1< drops
per milliliter. The nurse should regulate the flow rate so that the patient receies how many drops of
fluid per minute-
%A& +1
%B& +B
%!& /1
%$& :+
!lient )eed ::
(hysiological "ntegrity
1. The correct answer is B.
Huestion: ,hich lab alues should you monitor for a patient receiing 2entamicin-
)eeded "nfo: 2entamicin: broad spectrum antibiotic. 5ide effects: neuromuscular blockage# ototo=ic
to eighth cranial nere %tinnitus# ertigo# ata=ia# nystagmus# hearing loss&# nephroto=ic. )ursing
responsibilities: monitor renal function# force fluids# monitor hearing acuity. $raw blood for peak
leels 1 hr. after "M and /3 min - 1 hr. after "J infusion# draw blood for trough *ust before ne=t dose.
%A& 'emoglobin and hematocrit [ can cause anemia; less common
%B& B6) and creatinine [ !8..7!T: nephroto=ic; will see proteinuria# oliguria# hematuria# thirst#
increased B6)# decreased creatine clearance
%!& (latelet count and clotting time [ do not usually change
%$& 5odium and potassium [ hypokalemia infre>uent problem
+. The correct answer is A.
Huestion: ,hat nursing diagnosis is seen with acute lymphocytic leukemia and thromocytopenia-
)eeded "nfo: Thromocytopenia: decreased platelet count increases the patientXs risk for in*ury# normal
count: +33#333-:33#333 per mm/. 0eukemia: group of malignant disorders inoling oerproduction
of immature leukocytes in bone marrow. This shuts down normal bone marrow production of
erythrocytes# platelets# normal leukocytes. !auses anemia# leukopenia# and thrombocytopenia leading
to infection and hemorrhage. 5ymptoms: pallor of nail beds and con*unctia# petechiae %small
hemorrhagic spot on skin&# tachycardia# dyspnea# weight loss# fatigue. Treatment: chemotherapy#
antibiotics# blood transfusions# bone marrow transplantation. )ursing responsibilities: priate room#
no raw fruits or egs# small fre>uent meals# 8+# good skin care.
%A& (otential for in*ury [ !8..7!T: low platelet increases risk of bleeding from een minor
in*uries. 5afety measures: shae with an electric razor# use soft tooth brush# aoid 5H or "M meds and
inasie procedures %urinary drainage catheter or a nasogastric tube&# side-rails up# remoe sharp
ob*ects# fre>uently assess for signs of bleeding# bruising# hemorrhage.
%B& 5elf-care deficit [ may feel weak# doesnXt address condition
%!& (otential for self-harm [ implies risk for purposeful self-in*ury# not gien any info# assumption
%$& Alteration in comfort [ patient is not comfortable# and comfort measures would address problem
/. The correct answer is !.
Huestion: ,hat is the best site for nitroglycerine ointment-
5trategy: Think about each site.
)eeded "nfo: )itroglycerine: used in treatment of angina pectoris to reduce ischemia and reliee pain
by decreasing myocardial o=ygen consumption; dilates eins and arteries. 5ide effects: throbbing
headache# flushing# hypotension# tachycardia. )ursing responsibilities: teach appropriate
administration# storage# e=pected pain relief# side effects. 8intment applied to skin; sites rotated to
aoid skin irritaion. (rolonged effect up to +: hours.
%A& muscular [ not most important
%B& near the heart [ not most important
%!& non-hairy [ !8..7!T: skin site free of hair will increase absorption; aoid distal part of
e=tremities due to less than ma=imal absorption
%$& oer a bony prominence [ most important is that the site be non-hairy
:. The correct answer is B.
Huestion: ,hy is a patient defibrillated-
5trategy: Think about each answer choice.
)eeded "nfo: $efibrillation: produces asystole of heart to proide opportunity for natural pacemaker
%5A node& to resume as pacer of heart actiity.
%A& increase cardiac contractility and cardiac output [ inaccurate
%B& cause asystole so the normal pacemaker can recapture [ !8..7!T: allows 5A node to resume
as pacer of heart actiity
%!& reduce cardiac ischemia and acidosis [ inaccurate
%$& proide energy for depleted myocardial cells [ inaccurate
<. The correct answer is !.
Huestion: 'ow should you regulate the "J flow rate-
5trategy: 6se formula and aoid making math errors.
)eeded "nfo: total olume = the drop factor diided by the total time in minutes.
%A& +1 [ inaccurate
%B& +B [ inaccurate
%!& /1 [ !8..7!T: /#333 = 1< diided by +: = ?3
%$& :+ [ inaccurate
Esta0lishing Priorities
7stablishing (riorities
A.(rioritizing - decisions of which needs# problems re>uire immediate attention or action and which
ones could be delayed until a later time since they are not urgent
B.)eeds that are life-threatening or could result in harm to the client if left untreated are high
priorities
!.Actual problemsGneeds hae higher priority than potential problemsGneeds
$.(roblemsGneeds identified by client are of a higher priority
7.(rinciples of Maslow or the AB!s may guide decisions
A.Mutual decision-making for priorities may be made with the client based on the clientXs needs#
desires# and safety
$riage 1nclex2 $ips
!ontents
1. "ntroduction Wbackground
+. 2oals of Triage
/. .ole of Triage (ersonnel
2eneral Triage 2uidelines
Triage interiew
)ursing process
$ocumentation standards
Triage nurse Hualification
:. Triage WAcuity 5cale definitions
<. 5etting 6p the triage Area
?. Triage orientation 5chedule
@. Huick look summary F Triage categories
1.")T.8$6!T"8) W BA!I2.86)$
,hat is triage W why do we do it-
Triage in the simplest term is the sorting or prioritizing of items %client# patients# tasks#..& AG7
$epartment is a busy facility associated with long >ueue and waiting time# attending to patients with
ma*or or minor illnesses. !arrying with them the concept of a Uone stop conenience9. "n an effort to
cope with this increasing demand and ensuring smooth client flow# triage systems and protocols hae
been utilized.
The word triage is deried from the Arench erb 1trier4# which means 1to pick or to sort4. )urses are
generally not comfortable with triaging and as a result are often inconsistent "n their triage decision.
This is mainly due to their ine=perience and inade>uate knowledge.
This study aims to identify the difficulties e=perienced by nurse in triaging# and the possible solution
to oercome them.
Ma*ority of the literature aailable address the problem of long waiting time. Aew hae looked into
the difficulties encountered by the triage nurses. The authors perceied that local triage nurses are
faced with the problems of communication breakdown# lack of training in triage and inade>uate
orientation and induction programs. As such they could be psychologically unprepared to adopt the
demanding role of triaging.
+.28A0 8A T."A27
\ To rapidly identify patients with urgent# life threatening conditions.
\ To determine the most appropriate area for patients presenting to the AG7.
\ To decrease congestion in emergency treatment areas.
\ To proide ongoing assessment of patients.
\ To proide information to patients and families regarding serices e=pected care and waiting
times.
\ To contribute information that helps to define departmental acuity.
.apid access to assessment by a health care proider increases patient satisfaction and enhances
public relations. An efficient triage system should reduce client an=iety and increase satisfaction by
reducing length of stay and waiting time in the emergency department.
Aactors# which influence triage design and operation# include;
1. )umber of patient isits
+. )umber of patients re>uiring rapid interention
/. Aailability of health care proiders in the AG7 treatment area
:. Aailability of specialty serices
<. 7nironmental# legal and administratie issues
?. Aailability of community care resources
@. computer system used for admit# discharge# transfer# and patient care
/..807 8A T."A27 (7.58))70
A- 27)7.A0 T."A27 26"$70")75
The triage nurse should hae rapid access or be in iew of the registration and waiting area at all
time.
1. 2reets client and family in a warm empathetic manner.
+. (erforms brief isual assessments.
/. $ocuments the assessments.
:. Triage clients into priority groups using appropriate guidelines.
<. Transports client to treatment area when necessary.
?. Ieeps patientsGfamilies aware of delays.
@. .eassesses waiting clients as necessary.
B. "nstruct clients to notify triage nurse of any change in condition.
Accurate assignment of triage leels is based on;
\ (ractical knowledge gained through e=perience and training.
\ !orrect identification of signs or symptoms.
\ 6se of guidelines and triage protocols.
,hen the triage nurse has categorized more than / urgent patients# it is hisGher responsibility to
prioritize these patients for the treatment nurseG
7mergency physician.
Triage is a dynamic process; A patient9s condition may improe 8. deteriorate during the wait for
entry to the treatment area.
The Triage (rocess:
There can be confusion about the amount of detail re>uired to assign a triage leel. A short primary
surey may be necessary to ensure patient flow and reduce delays to first contact with a health
proider.
1. All patients should be assessed %at least isually& within 13 minutes of arrial.
+. Aull patient assessments should not be done in the triage area unless there are no patients waiting to
be seen. 8nly information re>uired to assign a triage leel should be recorded.
/. A primary surey %rapid assessment& should be used when there are + or more patients waiting to
be triaged. After all patients hae had some assessment done# leel "J and J patients the hae been
sent to the waiting area should hae a more complete assessment done by the triage personnel or
treatment nurse.
:. The priority for car may change following a more complete assessment or as patient9s signs and
symptoms change. There should be documentation of the initial triage as well as any changes. The
initial triage leel is still used for administratie purposes.
<. 0eel "# ""# patients should be in a treatment area and hae the complete primary nursing
assessment done immediately.
The triage assessment:
1. !hief complaint patient9s statement of the problem.
+. Jalidation and assessment of chief complaint.
A. 5ub*ectie: 8nsetG!ourseG$uration
\ ,hen did it start %be e=act with time&- ,hat were you doing when it started-
\ 'ow long did it last-
\ $ose it come and go-
\ "s it still present-
\ ,here is the problem- $escribe character and seerity if painful %pain scale&.
\ .adiation-
\ Aggraating or alleiating factors-
\ "f pain is or was present# character and intensity %pain scale& to be documented.
\ (reious history of same- "f yes# what was the diagnosis-
B. 8b*ectie: this part of the triage assessment may be deferred to the treatment area if the patient
re>uires rapid access to careGinterentions %leel "# ""# """&.
\ (hysical appearance Fcolor# skin# actiities
\ $egree of distress: seere distress; )A$ %no acute distress&
\ 7motional response: an=ious# indifferent
\ !omplete ital signs if time allows or necessary for assignment of triage leel% 0eel "# "J#J&
\ (hysical assessment
!. Additional "nformation:
1. Allergies
+. Medications:
\ 0ist by name# if aailable
\ 0ist by category if patient doesn9t know name; BG(# heart# stomach# nere# etc
Triage is not a static process. "t is important to remember that triage is a dynamic process and patients
my moe up or down on the urgency continuum while waiting for access to treatment areas# Triage
systems should be accompanied by protocol on;
\ 'ow >uickly a patient is to be seen by the health care proider for specific complaint types-
\ 'ow often patients in each triage category will be reassessed and where that information should be
documented-
\ 'ow patients with defined signs and symptom are categorized i.e# chief complaint
\ ,hat types of interention are e=pected to be initiated in triage-
\ ,hat types of reassessments should be done- The options ary from a >uick oeriew of the
waiting room patients# to a repeat primary surey and repeat ital signs.
\ $esignating time frames and methods of reassessment in your guidelines proides a framework for
ealuating >ualityGoutcomes and preenting patient deterioration
.eassessment
8b*ecties for time to time to nursing reassessment is related to triage leel
0eel " 0eel "" 0eel """ 0eel "J 0eel J
!ontinuous care 7ery1<min 7ery /3min 7ery?3min 7ery1+3min
1. There should be a nursing reassessment on all patients at time interals recommended for physician
assessment.
+. ,hen patients hae a medical diagnosis or are considered Ustabilized9 the fre>uency of nursing
assessment and care will depend on the e=isting care protocol or M$ orders.
/. ,hen patients hae e=ceeded the time ob*ectie for M$ assessment for their triage leel they
should be up triage to aoid unfair bumping and long delay to M$ assessment.
B- T"(5 A8. T'7 T."A27 ")T7.J"7,
8pen ended >uestions help elicit feeling and perceptions along with information. !losed >uestion
%with yes or no answers& are useful for obtaining facts. "n general# initial >uestions should be open F
ended %sub*ectie assessment&# whereas closed >uestions %ob*ectie assessment& can be used to
alidate information. Triage proiders deelop interiew techni>ues that suit their communication
style# the clientele# and the enironment. Many factors influence effectie communication at triage;
0anguage barriers# age# pain leel# hearing disability# mental competency. )on- erbal information is
also an important source of information.
(hysical assessment accompanies the triage interiew# chiefly through obseration. Assessment my
begin with the obseration that the patient can speak and therefore has a patent airway.
(hysical assessment must be rapid# concise# and focused. "n some patients ob*ectie measures such as
ital signs andGor 8+ saturation may be reasonable while in others it would be a description of
physical signs.
7ffectie triage re>uires the use of sight# hearing# smell and touch. There are many non-erbal clues;
facial grimaces# cyanosis# fear# M listen to what the patient is saying and pay attention to >uestions
they are reluctant or unable to answer. 0isten for a cough# hoarseness# laboured respirationM. Touch
the patient; assess heart rate and skin temperature and moisture. )otice odours such as the smell of
ketones# alcohol# or infection.
.emember that the purpose of the triage interiew is to gather enough information to make a clinical
*udgment for priority of care# not a final medical diagnosis. 8ften# the most time consuming task of
triage is to allay patient and family an=iety.
Attitude and empathy are important aspects of the triage nurse9s demeanor. .emaining consistent and
non-*udgmental toward all patients is important. $ifficult patients such as those who are into=icated
and combatie re>uire special care. Any element of pre*udice# leading to a moral *udgment of
patients# can increase patient risk due to incorrect assignment of triage leels# to low care needs
priority. $o not to pre*udge patients based on appearance or attitude.
!- )6.5")2 (.8!755
Assessment:-sub*ectieGob*ectie data
\ +-< minute interiew
\ )ot a head to toe assessment %treatment nurse should complete&.
\ )eed enough critical information to determine patient acuity and any immediate care needs.
Jital signs;
Jital signs %J5& will be done on patients if re>uired for categorization or if time permits. 8therwise
J5 are the responsibility of the treatment nurse. Any patient presenting to the 7$ who is leel " or ""
will be taken immediately to an appropriate treatment area. "t is the treatment nurse9s responsibility to
do a full assessment %primary nursing assessment& including J5.
(ain 5cale:
5hould be attempted on all patients with pain. "t is used# in con*unction with the presenting
complaint# to assign patients with similar complaints# to different triage leel. (ain scales are not
absolute# but do allow the patient to communicate the intensity of a problem from their perspectie.
The more intense the pain %B-13G13& the more the care proider should be concerned about the need to
identify or e=clude serious illnesses and attempt to offer empathy or interentions that will diminish
unnecessary pain and suffering. Because pain perception is ery indiidual and may be influenced by
age and cultural differences# it would be unwise to e=clude serious problems when pain is not
described as seere. The scales are less helpful%or reliable& at the e=tremes of age.
!ontinued seer pain should lead to a reconsideration of the diagnosis and treatment. (ain scales are
dependent on preious painful e=periences.
$- $8!6M7)TAT"8) 5TA)$A.$5
1. $ate and time of triage assessment.
+. )urse9s name.
/. !hief complaint or presenting concerns.
:. 0imited sub*ectie history; onset of in*uryGsymptoms
<. 8b*ectie obseration.
?. Triage leel
@. 0ocation in the department.
B. .eport to treatment nurse.
C. Allergies.
13. Medications.
11. $iagnostic# first aid measures# therapeutic# interentions.
1+. .eassessment.
7- T."A27 )6.57 H6A0"A"!AT"8)5
1. !ommunication skills are crucial. (roider must interact with patient-family-police-7MT-isitors.
+. Must hae tact# patience# understanding# and discretion.
/. 8rganizational skills- patient line- ups# in>uiries# etc. %!onstantly under patient scrutiny&
:. Abel to perform in hectic situations.
!an recognize who is sick. %$epends on e=perience# skill and e=pert clinical *udgment&.
:- T."A27 W A!6"TK 5!A07 !AT728.K
These lists of presenting complaints or case scenarios are not be all inclusie or absolute in their
application. Triage personnel are always encouraged to use their e=perience W instincts to Uup triage9
priority# een if the patient does not seem to fit e=actly with the facts or definitions on the triage scale
Uif they look sick then they probably are9.
0eel " .esuscitation
!ondition that are threats to life or limb %or imminent risk of deterioration& re>uiring immediate
aggressie interentions.
Time to physician; "MM7$"AT7
6sual presentations;
1. !odeGarrest; patients with cardiac andGor pulmonary arrest %or appears to be imminent&
+. Ma*or trauma; 5eere in*ury of any single body system or multiple system in*ury# 5eere burns#
!hestGabdominal in*ury with any or all of; altered mental state# hypotension# tachycardia# seer pain#
respiratory signs or symptoms.
/. 5hock states; !onditions where there is an imbalance between 8=ygen supply %cardiogenic#
pulmonary# blood loss#& and demand or utilization. 'ypotension and or tachycardia and possibly
bradycardia.
:. 6nconscious; "nto=icationGoerdoses# !)5 eents# can all hae an alteration of mental function
from disorientationGconfusion to completely unresponsie or actiely seizuring.
<. 5eere .espiratory $istress; There are many causes for respiratory distress but benign reasons can
only be diagnosed by e=clusion. 5erious intracranial eents# pneumothora=# near death asthma
.!8($ e=acerbations# !'A# anaphyla=is and seere metabolic disturbances %renal failure# diabetic
ketoacidosis&.
Typical patients;
\ )on responsie
\ Jital signs absentGunstable
\ 5eere dehydration
\ 5eere respiratory distress.
0eel "" 7mergent
!onditions that are a potential threat to life limb or function# re>uiring rapid medical interention or
delegated acts.
Time to physician assessmentGinteriew ]1< min.
6sual presentations;
1. Altered mental state; infectious# inflammatory# ischemic# traumatic# poisoning# drug effects#
metabolic disorders# dehydrationM. !an all affect sensorium from simple cognitie deficits to
agitation# lethargy# confusion# seizures# paralysis# coma.
+. 'ead in*ury; this problem appears in seeral triage leels
/. 5eere trauma;
:. 7ye pain; pain scale B-13G13. !hemical e=posures %acid or alkali& cause seere pain and blurred
ision.
<. !hest pain; This is one of the most difficult presenting symptoms for triage nurses and emergency
physicians. There are so many ways in which cardiac ischemia presents that we are fre>uently faced
with long and detailed assessments that don9t always lead to a definite conclusion. (atients with non-
traumatic# isceral pain are most likely to hae significant coronary syndromes%M"# 6nstable angina&.
\ Jisceral pain is continuous %more than a few seconds and almost always more than +-< min& and is
described as pressure# ache# s>ueezing# heaens# burning# or *ust a 1discomfort4. "f there are
associated symptoms %such as sweat# nausea# and shortness of breath&
\ 5udden sharp pains; can be associated with chest wall problem# but can also be duo to pulmonary
embolus# aortic dissection# pneumonia# pneumothora=.
\ (reious M"# Angina or (ulmonary embolus;(atients with a prior history of these conditions should
be leel "" no matter what the character of the pain.
?. 8erdose; these patients re>uire early physician assessment.
@. Abdominal pain; (ain seerity alone# cannot predict whether serious surgical or medical condition
are present. Jisceral pains %constant# ache# pressure# burning# s>ueezing& with associated symptoms
%nausea# omiting# sweat# radiation# bump or reerberating pain& with ital sign abnormalities
hypertension# hypotension# tachycardia# feer& are much more likely to be serious problems. !rampy#
intermittent or sharp brief pains without ital sign abnormality usually may be delayed.
B. 2" Bleed; 6pper 2" causes are more likely to cause instability. Jomiting gross blood# coffee
ground emesis and melena are typical of 62" sources.
C. !JA ; (atients with ma*or neurological deficits may re>uire airway protection or emergent !T
scanning.
13. Asthma; 5eere asthma is best defined with a combination of ob*ecties measures and clinical
factors which relate to the seerity of symptoms.
11. $yspnoea; This is sub*ectie and may correlate poorly with lung function or deficits in o=ygen
uptake and deliery. $epending on the age# preious history and physical assessment.
1+. Anaphyla=is; 5eere allergic reactions can deteriorate rapidly. (atients with a history of asthma
are at particularly high risk of death.
1/. 5erious infection; (atients with bacterial infections or sepsis syndrome usually appear unwell.
1:. Aeer; Temperatures ^/C with signs of lethargy.
1<. Jomiting and diarrhoea; ,ith suspicion or signs of dehydration.
1?. Acute psychosisGe=treme agitation;
1@. $iabetes; diabetics with hyper or hypoglycemia. Altered mental state# blurred ision# feer#
omiting# abnormal pulse and respiration.
1B. 'ypertension or 'ypotension; should prompt immediate physician notification or assessment.
1C. 'eadache; This presenting complaint appears in multiple triage leels.
+3. AbuseGneglectGassault; These patients may not hae life threatening problems but hae ery
special needs that relate to their mental well being and specific re>uirements for the collection of
samples for eidence# or the actiation of local protocols for the use of assault teams and community
serices.
+1. $rug withdrawal-seere-%$elirium tremens or other&; these patients may be sometimes mistaken
for acute psychiatric problems. 5eizures# coma# hallucinations# confusion# agitation %shakes# tremors&#
tachycardia# hypertension# hyperpyre=ia&# chestGabdominal pain# omiting# diarrhoea.
++. !hemotherapy; (atients on chemotherapy or immunocompromised patients %'"J# known immune
deficiency# malignancy& with or without a feer are at higher risk of serious problems. These patients
can deteriorate >uickly.
0eel """ 6rgent
!ondition that could potentially progress to a serious problem re>uiring emergency interention. May
be associated with significant discomfort or affecting ability to function at work or actiities of daily
liing.
Time to physician ]/3 min.
1. 'ead in*ury; these patients may hae had a high- risk mechanism. The y should be alert %2!51<&
moderate pain %]BG13& and nausea or omiting. 5hould be changed to leel "" if deteriorating or *ust
appears unwell.
+. Moderate trauma; (atients with fractures or dislocations or spines with seere pain %B-13G13&.
$islocations should be reduced promptly# so physician assessment should occur in ]/3 min.
/. Asthma# mildGmoderate; (atients with mild F moderate shortness of breath with the e=ertion#
fre>uent cough or awakening %unable to lie down flat without symptoms&. Mild asthmatics can hae
seere attacks W seere asthmatics can hae mild attacks.
:. $yspneoa# moderate ; patients with pneumonia # !8($ # 6."5 # croupM. May complain of # or
appear to be short of breath.
<. !hest pain; sharp localized pains# worse with deep breathing# cough# moement or palpitation not
associated with shortness of breath or other signs that might suggest significant heart or lung disease.
Theses are usually due to chest wall problems or irritation on one of the 1 linings 1 inside %pleurisy or
een pericarditis&. "f a patient is elderly or has had an AM" or angina# W hae this type of pain they
should still probably be triaged as leel "".
?. 2" bleed; upper or lower 2" bleed# not actiely bleeding # with normal ital signs. There is always
potential for deterioration # so a repeat set of ital signs should be done within /3 min. or if there is
any change in statusGsymptoms.
@. 5eizure; known seizure disorders or new onset but brief .
B. Acute psychosis WGor suicidal ; psychiatric problems# not really agitated but some uncertainly as to
whether they are threat to themseles or others .
C. Acute pain seere % B-13G13&; patient with minor problems but self reported intense pain%B-13G13&
should hae either nursing interention or early access to erbal physician assessment . (atient with
discogenic back pain usually hae a ery sudden pain while lifting or bending. .adiation of pain to
the legs is common. "f neurological problems may be present and urgent physician assessment is
necessary.
13.Acute pain moderate%:-@G13&; patients with migraine or renal colic can present with moderate pain
but deteriorate rapidly. These patients would probably benefit from earlier interention.
11. $ialysis %or transplant patients&; 7lectrolyte and fluid balance problems are common in these
patients. This increases the risk for arrhythmias and rapid deterioration.
0eel "J 0ess 6rgent
!onditions that related to patient age# distress# or potential for deterioration or complications would
benefit from interention or reassurance within 1-+hours.
Time to physician] 1 hour.
1. 'ead "n*ury; Minor head in*ury# alert %2!5 1<&# on omiting# neck symptom and normal ital
signs# may re>uire brief period of obseration# depending on time of in*ury in relation to 7$ isit.
"f time interal from accident ^:-? hours and has remained free of symptom# a neuro check and head
routine sheet may be all that necessary.
+. Minor trauma; Minor fractures# sprains# contusions# abrasions# lacerations# re>uiring inestigation
or interention. )ormal ital signs# moderate %:-@G13&.
/. Abdominal pain; Acute pain of moderate intensity %:-@G13&. The seerity of pain for appendicitis or
cholecystitis or other potentially serious problems is not a reliable means of e=cluding these
problems. Jital signs should be normal and the patient should not appear to in acute distress.
!onstipation can cause ery seere pain or on occasion be confused with other more serious
problems.
:. 'eadache; )ot sudden# not seere# not migraine# no associated high- risk features %see leel "" W"""
headache&. "nfectious problems like sinusitis# 6."# or flu like illnesses may cause these. (ain should
no more than %:-@G13& W normal ital signs.
<. 7ar ache; 8titis media W e=terna can cause moderate %:-@G13& to seere%B-13G13& pain W these
patients should receie analgesics either as part of nursing protocolG interention or with a erbal
order from the physician. if the patient either has seere pain or is in acute distress# the triage leel
should be """ .
?. !hest pain; These patients should hae no acute distress# pain %:-@G13&# no shortness of breath# no
isceral features# no preious heart problems# normal ital signs.
@. 5uicidalG $epressed; (atients complaining of suicidal thoughts or hae made gestures but do not
seem agitated. )ormal ital signs. All proiders should show empathy W try to hae the patients
placed in a >uiet W secure area.
B. !orneal Aoreign body; "f pain is mild or moderate %:-@G13& W no change in isual acuity.
C. Back pain# chronic; These patients may be ery challenging Wshould always be assessed as though
their problem has neer been seen before. 8ccasionally patients may hae substance abuse problems
and the sole purpose of the isit is to seek a narcotic prescription. "t is unwise to label people or be
*udgmental unless there is clear eidence that you are dealing with substance abuse as opposed to
drug addiction W chronic pain syndromes.
13. 6." symptoms; (atients with upper airway congestion# cough# aches# feer# sore throat are
fre>uent isitors to 7$9s. 6nfortunately patients with strep throat# mono# peritonsillar abscess#
epiglottitis# pneumonia#
8r other serious illnesses can not always be identified in routine or >uick look assessments. Alu like
illnesses with generalized symptoms can be serious for patients who are elderly.
11. Jomiting W or diarrhoea no signs of dehydration; The risk of dehydration increases with omiting
W diarrhoea together.
The >uestion in triage should attempt to clearly define the onset W course of the episodes of diarrhoea
W omiting. Inowing how many times someone had omited# whether it occurred only when eating
or drinking W when the last episode was %e=act times&# The same for diarrhoea. "f there are less than <
loose bowel moements per day then dehydration or electrolyte imbalances are unlikely. "t is also
important to appreciate that omiting can be a sign of other problems such as !)5 abnormalities#
cardiac disease# drug effect# renal failure# hepatic disturbances# diabetes# disorders of pregnancyM
0eel J )on 6rgent
!onditions that may be acute but non-urgent as well as conditions which may be part of a chronic
problem with or without eidence of deterioration.
Time to physician ] + hours.
1. Minor trauma; contusions# abrasions# minor lacerations% not re>uiring closure by any means&#
oeruse syndromes %tendonitis&# W sprains.
+. 5ore throat# 6."; (atients with minor complaints# not seere W no respiratory
symptomsGcompromise. Typical iral illnesses# with normal ital signs or low grade feer ] /C
/. Abdominal pain; Mild pain %] :& which is chronic or recurring# with normal ital signs
:. Jomiting alone# $iarrhoea alone; no signs of dehydration. These patients should hae normal
mental status W ital signs.
(atient who are hard to group;
"f a patient seems difficult to assign a triage leel because they don9t seem to fit any of the categories#
the proider needs to either discuss the case with a colleague or make a *udgment based on their
e=perience or instinct. The fundamental principle# when deciding triage leel# is that patient should be
treated as through they were close friends or family members. (atients who hae a similar
Uadministratie presentation9 such as Urecheck9 or for Utest9 or Ubooked procedures9 are not all the
same in terms of there need for care or amount of resources.
(earl of wisdom; "f patients look sick W you are not sure# triage them as leel " or "".
<- 57TT")2 6( T'7 T."A27 A.7A
Because it generally is the first area a patients iews# it can make a lasting impression. !onsideration
should be gien to comfort# priacy W a pleasing atmosphere. 'oweer# the nurse must hae easy
access W iew of the arriing patients. $oors must accommodate wheelchairs W stretchers. 5inks W
other e>uipment are needed to support uniersal precautions. A phone should be aailable# but only
used for basic communication to registration desk or treatment areas. The waiting room should hae
ample seating for patientsG isitors.
.est rooms# pay phones W ending machines may be needed. 5ecurity arrangements must also be in
place to ensure patient W proider safety.
sweet poison a must read
5,77T (8"58)
A M65T .7A$
"n 8ctober of +331# my sister started getting ery sick. 5he had stomach spasms and she was haing a
hard time getting around. ,alking was a ma*or chore. "t took eerything she had *ust to get out of
bed; she was in so much pain.
By March +33+# she had undergone seeral tissue and muscle biopsies and was on +: arious
prescription medications. The doctors could not determine what was wrong with her. 5he was in so
much pain# and so sick.she *ust knew she was dying. 5he put her house# bank accounts# life insurance#
etc.# in her oldest daughterXs name# and made sure that her younger children were to be taken care of.
5he also wanted her last hooray# so she planned a trip to Alorida %basically in a wheelchair& for March
++nd .
8n March 1C " called her to ask how her most recent tests went# and she said they didnXt find anything
on the test# but they beliee she had M5.
" recalled an article a friend of mine e-mailed to me and " asked my sister if she drank diet soda- 5he
told me that she did.. As a matter of fact# she was getting ready to crack one open that moment.
" told her not to open it# and to stop drinking the diet sodaN
" e-mailed her the article my friend# a lawyer# had sent.
My sister called me within /+ hours after our phone conersation and told me she had stopped
drinking the diet soda A)$ she could walkN The muscle spasms went away. 5he said she didnXt feel
133P but she sure felt a lot better. 5he told me she was going to her doctor with this article and
would call me when she got home.
,ell# she called me# and said her doctor was amazedN 'e is going to call all of his M5 patients to find
out if they consumed artificial sweeteners of any kind.
"n a nutshell# she was being poisoned by the Aspartame in the diet soda...and literally dying a slow
and miserable death.
,hen she got to Alorida March ++# all she had to take was one pill# and that was a pill for the
Aspartame poisoningN 5he is well on her way to a complete recoery.
And she is walkingN )o wheelchairN This article saed her life.
"f it says X562A. A.77X on the label; $8 )8T 7J7) T'")I AB86T "TN
" hae spent seeral days lecturing at the ,8.0$ 7)J".8)M7)TA0 !8)A7.7)!7 on
DA5(A.TAM7#D marketed as X)utra5weet#X X7>ual#X and X5poonful.X
"n the keynote address by the 7(A# it was announced that in the 6nited 5tates in +331 there is an
epidemic of multiple sclerosis and systemic lupus. "t was difficult to determine e=actly what to=in
was causing this to be rampant.
" stood up and said that " was there to lecture on e=actly that sub*ect.
" will e=plain why Aspartame is so dangerous: ,hen the temperature of this sweetener e=ceeds B?
degrees A# the wood alcohol in A5(A.TAM7 conerts to formaldehyde and then to formic acid#
which in turn causes metabolic acidosis. Aormic acid is the poison found in the sting of fire ants. The
methanol to=icity mimics# among other conditions# multiple sclerosis and systemic lupus. Many
people were being diagnosed in error. Although multiple sclerosis is not a death sentence# Methanol
to=icity isN
5ystemic lupus has become almost as rampant as multiple sclerosis# especially with $iet !oke and
$iet (epsi drinkers. The ictim usually does not know that the Aspartame is the culprit. 'e or she
continues its use; irritating the lupus to such a degree that it may become a life-threatening condition.
,e hae seen patients with systemic lupus become asymptotic# once taken off diet sodas.
"n cases of those diagnosed with Multiple 5clerosis# most of the symptoms disappear. ,eXe seen
many cases where ision loss returned and hearing loss improed markedly.
This also applies to cases of tinnitus and fibromyalgia.
$uring a lecture# " said# D"f you are using A5(A.TAM7 %)utra5weet# 7>ual# 5poonful# etc& and you
suffer from fibromyalgia symptoms# spasms# shooting# pains# numbness in your legs# cramps# ertigo#
dizziness# headaches# tinnitus# *oint pain# une=plainable depression# an=iety attacks# slurred speech#
blurred ision# or memory loss you probably hae A5(A.TAM7 poisoningND
(eople were *umping up during the lecture saying# D" hae some of these symptoms. "s it reersible-D
KesN KesN KesN 5T8( drinking diet sodas and be alert for Aspartame on food labelsN Many products
are fortified with itN This is a serious problem.
$r. 7spart %one of my speakers& remarked that so many people seem to be symptomatic for M5 and
during his recent isit to a hospice# a nurse stated that si= of her friends# who were heay $iet !oke
addicts# had all been diagnosed with M5. This is beyond coincidenceN
$iet soda is )8T a diet productN "t is a chemically altered# multiple 58$"6M %salt& and
A5(A.TAM7 containing product that actually makes you crae carbohydrates. "t is far more likely
to make you 2A") weightN
These products also contain formaldehyde# which stores in the fat cells# particularly in the hips and
thighs. Aormaldehyde is an absolute to=in andis used primarily to presere Dtissue specimens.D Many
products we use eery day contain this chemical but we 5'860$ )8T store it ") our bodyN
$r. '. V. .oberts stated in his lectures that once free of the Ddiet productsD and with no significant
increase in e=ercise; his patients lost an aerage of 1C pounds oer a trial period.
Aspartame is especially dangerous for diabetics.
,e found that some physicians# who belieed that they had a patient with retinopathy# in fact# had
symptoms caused by Aspartame.
The Aspartame dries the bloodsugar out of control. Thus diabetics may suffer acute memory loss
due to the fact that aspartic acid and phenylalanine are )76.8T8E"! when taken without the other
amino acids necessary for a good balance.
Treating diabetes is all about BA0A)!7. 7specially with diabetics# the Aspartame passes the
bloodGbrain barrierand it then deteriorates the neurons of the brain; causing arious leels of brain
damage# seizures# depression# manic depression# panic attacks# uncontrollable anger and rage.
!onsumption of Aspartame causes these same symptoms in non-diabetics as well.
$ocumentation and obseration also reeal that thousands of children diagnosed with A$$ and
A$'$ hae had complete turnarounds in their behaior when these chemicals hae been remoed
from their diet. 5o called Dbehaior modification prescription drugsD %.italin and others& are no
longer needed. Truth be told# they were neer )77$7$ in the first placeN Most of these children
were being DpoisonedD on a daily basis with the ery foods that were Dbetter for them than sugar.D
"t is also suspected that the Aspartame in thousands of pallets of diet !oke and diet (epsi consumed
by men and women fighting in the 2ulf ,ar# may be partially to blame for the well-known 2ulf ,ar
5yndrome.
$r. .oberts warns that it can cause birth defects# i.e. mental retardation# if taken at the time of
conception and during early pregnancy.
!hildren are especially at risk for neurological disorders and should )7J7. be gien artificial
sweeteners. There are many different case histories to relate of children suffering grand mal seizures
and other neurological disturbances talking about a plague of neurological diseases directly caused by
the use of this deadly poison.D
'erein lies the problem:
There were !ongressional 'earings when Aspartame was included 133 different products and strong
ob*ection was made concerning its use. 5ince this initial hearing# there hae been two subse>uent
hearings# and still nothing has been done. The drug and chemical lobbies hae ery deep pockets.
5adly# M8)5A)T8X5 patent on Aspartame has 7E(".7$N
There are now oer <#333 products on the market that contain this deadly chemical and there will be
thousands more introduced. 7erybody wants a Dpiece of the Aspartame pie.D " assure you that
M8)5A)T8# the creator of Aspartame# knows how deadly it is.
And isnXt it ironic that M8)5A)T8 funds# among others# the American $iabetes Association# the
American $ietetic Association and the !onference of the American !ollege of (hysicians-
This has been recently e=posed in the )ew K ork Times.
These _organizations` cannot criticize any addities or coney their link to M8)5A)T8 because
they take money from the food industry and are re>uired to endorse their products.
5enator 'oward Metzenbaum wrote and presented a bill that would re>uire label warnings on
products containing Aspartame# especially regarding pregnant women# children and infants. The bill
would also institute independent studies on the known dangers and the problems e=isting in the
general population regarding seizures# changes in brain chemistry# neurological changes and
behaioral symptoms.
The bill was killed.
"t is known that the powerful drug and chemical lobbies are responsible for this# letting loose the
hounds of disease and death on an unsuspecting and uninformed public. ,ell# youXre "nformed nowN
K86 'AJ7 A ."2'T T8 I)8,N
(lease print this out andGor e-mail to your family and friends.
They hae a right to know too
Article on !ancer 1Eliminate !ancer using an alternati3e way2
aAAT7. K7A.5 8A T700")2 (78(07 !'7M8T'7.A(K "5 T'7 8)0K ,AK T8
70"M")AT7 !A)!7.# V8') '8(I")5 "5 A")A00K 5TA.T")2 T8 T700 K86 T'7.7
"5 A) A0T7.)AT"J7 ,AK
1. 7ery person has cancer cells in the body. These cancer cells do
not show up in the standard tests until they hae multiplied to a few
billion. ,hen doctors tell cancer patients that there are no more
cancer cells in their bodies after treatment# it *ust means the tests
are unable to detect the cancer cells because they hae not reached
the detectable size.
+. !ancer cells occur between ? to more than 13 times in a personXs
lifetime.
/. ,hen the personXs immune system is strong the cancer cells will be
destroyed and preented from multiplying and forming tumours.
:. ,hen a person has cancer it indicates the person has multiple
nutritional deficiencies. These could be due to genetic#
enironmental# food and lifestyle factors.
<. To oercome the multiple nutritional deficiencies# changing diet
and including supplements will strengthen the immune system.
?. !hemotherapy inoles poisoning the rapidly-growing cancer cells
and also destroys rapidly-growing healthy cells in the bone marrow#
gastro-intestinal tract etc# and can cause organ damage# like lier#
kidneys# heart# lungs etc.
@. .adiation while destroying cancer cells also burns# scars and
damages healthy cells# tissues and organs.
B. "nitial treatment with chemotherapy and radiation will often
reduce tumor size. 'oweer prolonged use of chemotherapy and
radiation do not result in more tumor destruction.
C. ,hen the body has too much to=ic burden from chemotherapy and
radiation the immune system is either compromised or destroyed# hence
the person can succumb to arious kinds of infections and
complications.
13. !hemotherapy and radiation can cause cancer cells to mutate and
become resistant and difficult to destroy. 5urgery can also cause
cancer cells to spread to other sites.
11. An effectie way to battle cancer is to stare the cancer cells
by not feeding it with the foods it needs to multiply.
,'AT !A)!7. !7005 A77$ 8):
a. 5ugar is a cancer-feeder. By cutting off sugar it cuts off
one important food supply to the cancer cells. 5ugar substitutes like
)utra5weet# 7>ual#5poonful# etc are made with Aspartame and it is
harmful. A better natural substitute would be Manuka honey or
molasses but only in ery small amounts. Table salt has a chemical
added to make it w h i te in colour. Better alternatie is BraggXs
aminos or sea salt.
b. Milk causes the body to produce mucus# especially in the
gastro-intestinal tract. !ancer feeds on mucus. By cutting off milk
and substituting with unsweetened soy milk# cancer cells are being
stared.
c. !ancer cells thrie in an acid enironment. A meat-based
diet is acidic and it is best to eat fish# and a little chicken
rather than beef or pork. Meat also contains liestock antibiotics#
growth hormones and parasites# which are all harmful# especially to
people with cancer.
d. A diet made of B3P fresh egetables and *uice# whole grains#
seeds# nuts and a little fruits help put the body into an alkaline
enironment. About +3P can be from cooked food including beans.
Aresh egetable *uices proide lie enzymes that are easily absorbed
and reach down to cellular leels within 1< minutes t o no urish and
enhance growth of healthy cells. To obtain lie enzymes for building
healthy cells try and drink fresh egetable *uice %most egetables
including bean sprouts& and eat some raw egetables + or / times a
day. 7nzymes are destroyed at temperatures of 13: degrees A %:3
degrees !&.
e. Aoid coffee# tea# and chocolate# which hae high caffeine.
2reen tea is a better alternatie and has cancer-fighting properties.
,ater-best to drink purified water# or filtered# to aoid known
to=ins and heay metals in tap water. $istilled water is acidic#
aoid it.
1+. Meat protein is difficult to digest and re>uires a lot of
digestie enzymes. 6ndigested meat remaining in the intestines become
putrified and leads to more to=ic buildup.
1/. !ancer cell walls hae a tough protein coering. By refraining
from or eating less meat it frees more e nzymes to attack the protein
walls of cancer cells and allows the bodyXs killer ce lls to destroy
the cancer cells.
1:. 5ome supplements build up the immune system %"(?# Alor-ssence#
7ssiac# anti-o=idants# itamins# minerals# 7AAs etc.& to enable the
bodyXs own killer cells to destroy cancer cells. 8ther supplements
like itamin 7 are known to cause apoptosis# or programmed cell
death# the bodyXs normal method of disposing of damaged# unwanted# or
unneeded cells.
1<. !ancer is a disease of the mind# body# and spirit. A proactie
and positie spirit will help the cancer warrior be a surior.
Anger# unforgieness and bitterness put the body into a stressful and
acidic enironment. 0earn to hae a loing and forgiing spirit.
0earn to rela= and en*oy life.
1?. !ancer cells cannot thrie in an o=ygenated enironment.
7=ercising daily# and deep breathing help to get more o=ygen down to
the cellular leel. 8=ygen therapy is another means employed to
destroy cancer cells.
44a 5ew o5 Nurses6 %ules44
" wanted to share these few notes with you about rules of being a nurse.. " got this little book way
back college days# if " could remember that was after my classes# thereXs these two persons who were
selling different books about nursing at our buildingXs lobby... ,hen " first saw this book# " got
strucked by itXs title# DA 0"TT07 B88I 8A )6.575X .6075D by .osalie 'ammerschmidt# ..).
and !lifton I. Meador# M.$.
This little book tackles about nurses# both our serious and lighter sides. "t contains rules about our
practice styles# our patients# our colleagues# our profession# and mostly about ourseles.
The book contains more than a hundred rules and counting for the ne=t edition.. allow me to type
here as many as i can...
5o# letXs get started...
1. 5it down when you talk with patients; whether it is a nursing history# a patient education session# or
discharge instructions.
+. The good nurse knows what she does not know.
/. Be wary of patients who are oerly complimentary of you as a nurse# especially on first meetings.
:. 5"2)5 8A A BA$ 5'"AT
An 7... stretcher is sticking out in the hallway.
The emergency code cart is coered with 7I2 paper and empty syringes# and all drawers are open.
Kou meet a city policeman on the eleator who asks directions to your unit.
A nurse is filling out / incident reports.
Bloody sheets and pillows are flowing into the hallway from a patientXs room.
The head nurse is asking in a loud oice if anyone wants oertime.
<. Always e=amine the part that the patient complains about. (ut ur hand on the area.
?. The only way to determine a patientXs needs is to:
listen#
look carefully# and
ask good >uestions.
@. ,atch patients carefully who are being treated with a second drug to correct a reaction to a first
drug.
B. ,hen patients are admitted to the hospital# they bring their dignity with them. Make sure no one
robs them of it.
C. Touch patients each time you see them# een if you only hold thier hands or feel the pulse.
$o this especially with older people.
!auton: 5ome patients prefer to reach out and touch you first.
13. Act responsibly.
.emember# improperly discarded needles can be deadly for colleagues.
11. ,hen a patient is taking drugs you are not familiar with# find time to read about each one.
1+. .ead A Short Life of Florence Nightingale.a
1/. Being assertie is not being aggressie.
0earn the difference.
Assertieness reflects a postie self-image.
"t is the foundation of good communication.
Aggressieness reflects frustration and anger.
"t is counterproductie when dealing with people.
1:. Inow those things you can change.
Inow those things you cannot change.
$eelop the wisdom to tell the difference.
1<. A patientXs resistance to receiing therapy needs to be respected# listened to# and dealt with.
1?. )eer ask the patient# D'ow are we doing-D
Kou should already know how you are doing.
1@. $o not tell a patient# DThere is nothing wrong with you.D
"t is demeaning and insulting.
1B. 0earn something from eery patient you meet.
1C. Many patients do not understand milligrams# milliters# centimeters# or een ounces. 6se terms
they understand and be sure the measuring deice is the units they will use at home.
+3. ,hen you meet a patient for the first time# allow a few minutes for the patient to tell you what is
on his or her mind.
Kou will learn alot.
+1. $o not write in the chart and talk with a patient at the same time.
++. 0earn what collaboratie practice is.
)urses and doctors share the responsibility for the patient.
+/. ,e all hae a uni>ue way of e=pressing our thoughts. Ad*ust your thinking to the patientXs pace
and style.
+:. 0isten for what the patient is )8T telling you.
+<. !heck on the legal status of incident reports in your hospital and in your state.
Be careful what you write and how you write it.
Be accurate.
Be factual.
Be scrupulously honest.
.emember# your incident repots can make ery good plaintiff reading from the witness stand.
+?. )eer appear shocked by anything a patient tells you.
+@. "t is all right for a patient to get angry.
+B. A watched ".J. bag neer runs out.
+C. )eer make an ssumption about a drug dosage. "f you or others cannot read a doctorXs
handwriting# call the doctor and ask.
/3. "ntake and output are ital bits of clinical information. Measure carefully and accurately.
/1. $rug reactions can be uni>ue to a single patient.
/+. )eer say irregardless.
//. 5uperior nurses know the se>uence of what is important.
/:. )eer point or shake your finger at a patient. "f you do that# please stop it.
/<. The first step in effectie communication is to gain the full attention of the other person.
5ometimes this re>uires long periods of silence.
/?. The ma*or concern of the nurse is to know the person with the disease as a person.
/@. $o not tolerate doctors who throw instruments or charts. Aind the time to confront this behaior
in an assertie# positie way.
/B. Always check for a $rug Allergy Alert before giing any drug.
/C. )eer tell a patient# D$onXt worry.D
:3. Ieep an open mind. )ew ideas become aailable to you when you do.
:1. A hospital is a dangerous place.
"t should be used wisely and as briefly as possible.
:+. Always introduce yourself to your patients. )ame tags are difficult to read# especially when the
patient is ery sick and without glasses.
:/. The one mark of a professional nurse: !ommit yourself to gie the highest possible >uality care
to all your patients.
::. Be wary of seductie patients.
0earn how to deal with them in a straightforward manner.
:<. ,hen you gie instructions# ask the patient to repeat what you hae said.
:?. 7ery system of health care should be patient-centered.
:@. 7ach nurse has the same properties as a drug. 0earn the pharmacology of being a nurse.
:B. 0earn when and when not to call a physician.
:C. Always call the physician when:
There is a significant deterioration in the clinical state of the patient.
The patient threatens to leae the hospital.
The wrong dose or drug has been gien.
A laboratory test result is greatly abnormal or at life-threatening leel.
The patient has a seizure.
The patient falls out of bed.
The patient refuses to accept treatments.
The patient or the family do not know what is going on.
The patient or family member become so angry that you are unable to assauge it.
and . . .
7specially when a patient looks you in the eye and says he is going to die before morning.
<3. There are times when scientific medicine has nothing more to offer a patient.
This is the uni>ue time when nurses hae eerything to offer:
comfort#
compassion#
caring#
understanding# and
empathy.
$est Prep %e3iew6s N!LE- Question o5 the (ay
Huestions:
2ie a summary of what nutrition means
Answer:
)utrition inoles the recognition and realization of nutrients and how they are utilized in the body
for proper homeostasis and normal bodily functions on a daily basis. )utrition affects bodily
functions as they relate to decision making processes# functional ability# cognitie processes# our
social abilities to interact# form# and maintain relationships as well as cultural beliefs that guide our
daily decision making. ,ithout proper nutritional intake muscles will not function to support daily
actiities# the brain and neurological system will not hae the re>uired nutrients to function in
decision making and proide proper neurological functioning mechanisms needed for normal actiity.
8ur emotions are guided by balanced or homeostatic nutritional balance that maintains proper
functioning of hormone leels such as insulin.
7hat (o ou Need $o ,now A0out Nursing Pro5ession
)urses perhaps the best friend of a patient. Though they get paid for their *ob# yet the care and
concern they e=hibit for the patient is unparalleled and remarkable. The nursing territory generally
belongs to females. But een men like women can take up this profession after ade>uate training.
'oweer# since past few years a decline is seen in the number of people taking up nursing as a career.
There can be many reasons behind it. 5o# the primary task of this article will be to enumerate these
arious causes along with the conse>uences of shrinking number of registered nurses day by day.
7=ploring the different causes:
0ess number of schools can be a foremost factor. There are not many schools that run programs to
make future nurses.
Adding to the plight is the fact that the schools that e=ist are in an awful condition. There is not *ust
lack of funds# laboratories and clinical e>uipments here but the faculty too is not enough and well
>ualified. These issues preclude many people from entering into this profession. ,hile those who
enter the program confront problems at all stages and at times end up giing it up or leaing it in the
middle.
The age factor is another drawback. The aerage age for the registered nurses is significantly high.
5o# the moment these registered nurses retire# there occurs an acute shortage of new ones.
)o appropriate measures are taken to train new nurses. 7en the hospitals that take up this task are
reluctant to spend good amount on training nurses. The medical and other facilities are ery poor.
This entails reluctance on the part of indiiduals to seek employment as a nurse.
)oel and adanced courses- many new and adanced courses like MBA# Mass !ommunication and
so forth are picking pace these days. They are usually e>uipped with best facilities and funds and are
seen fetching rich *obs. 5o more guys and gals are willing to make a wealthy career ia such courses.
The restricted scope for growth# relatiely low salary structure and tremendous workload are also the
debarring features. The *ob of a nurse is deemed to be >uite a stressful *ob nowadays# that re>uires
prolonged working een at odd hours.
The 8utcomes:
A surge in demographic leels has resulted in more number of big and small diseases and so large
number of patients. But the shortage of nurses adersely affects patients in hospitals. They fail to get
ade>uate care and igilance. 5tudies hae reealed that in past few years# greater numbers of patients
are dying in hospitals due to negligence. The ailing men and women do not take medicines on time
and there are no nurses to keep an eye on them all round the clock and instigate them to take their
doses regularly. Thus# the health care has receied a ma*or setback due to the diminishing number of
registered nurses these days.
The dip in nursing career has gien birth to temporary and contract nursing. This type of nursing has
proed to be a little help in meeting the scarcity of registered nurses.
Nursing %esumes
,hat to "nclude in )ursing .esumes
)ursing resumes are slightly different from eery other resume that you would send out. Being that
nursing is a specialized profession# you need to remember a few things when putting together your
first resume. )ursing resumes can be difficult to write because they will not include the same
information as a standard resume trying to secure an office position. .ead through the tips below
before you start sending out your resume to potential employers.
Airst off# remember that nursing resumes will not include all past work e=perience. ,hen applying
for an office *ob# you usually show all of your past work e=perience# no matter how irreleant it may
sound. But remember that nursing is a specialized profession. Kou want to make sure that you put
down your e=perience relatie to nursing and downplay the rest of your work e=perience. This is not
to say that you cannot include other work e=perience on nursing resumes# *ust be sure to not let those
*obs oershadow your nursing e=perience.
.emember to include all nursing related e=perience on your resume. Anything that pertains to
nursing# or caring for people should be highlighted on your resume so that it stands head and
shoulders aboe the rest. This can include any olunteer work that you may hae completed# or any
nursing work that you did while in college. )ursing resumes often include information about the
rotations that you did while completing your degree. This shows that you hae e=perience in the field
and are capable of working full time.
)ursing resumes should always include your educational achieements as well. Be proud of what you
accomplished. "f you were elected into the )ational 'onors 5ociety for nursing ma*ors be sure to
include this information. "f you had a high 2(A# include that also.
)ursing resumes may be difficult to write# but if you follow the tips aboe you will be able to put
together an intriguing package for hiring managers. 5ample nursing resumes can also be found on
numerous online sites.
$he 8uture +5 Nursing: Nursing "ome 9o0s
According to the 8ccupational 8utlook guide# the nursing profession is among the fastest growing of
all career paths. ,ithin nursing# the single specialty e=pected to grow by leaps and bounds is
gerontology. The aging of the baby boomers has increased the aerage age of the typical patient.
According to one surey# patients oer ?< make up ?3 percent of adult primary isits# :B percent of
inpatient hospital admissions and B< percent of nursing home residents. By the year +3+3 F less than
1< years from now F a study from 8ccupational 'ealth and 5afety Administration predicts that the
need for registered nurses in nursing homes will increase ??P# for licensed practical and ocational
nurses by @+P and the need for certified nursing assistants will increase by ?CP. Aor nurses working
in home health settings F which include Umanaged care9 nursing home settings F those numbers are
een higher F well aboe +<3P increase in nurses needed at eery leel of licensing.
"n other words# if you9re planning a career in nursing or are already a nurse# there are thousands of
*obs aailable for you in nursing homes and chronic care facilities. The face of geriatric nursing has
also changed considerably oer the past decades. "f your image of a nursing home is one of bleak
halls and hopeless# helpless patients# then a isit to many of today9s nursing homes will offer an
une=pected and pleasant surprise.
)ursing 'ome Vobs "n the )ew Millennium
This generation of seniors is more actie and more determined than any other that has come before
them. "t9s led to ma*or changes in the practice of long term elder care. "f you decide that a nursing
home *ob is for you# here are some of the options that you can e=plore.
8n 5ite )urse in 5enior 'ousing
Many seniors don9t need round the clock nursing care# but do need some nursing superision. 5enior
housing communities often hae an on-site nurse who is aailable to help residents with medication
problems# take care of routine medical care and be aailable in case of an emergency. The nurse on
site will also often consult with doctors who work with indiidual residents to help manage any
medical care that they need. The pay scale is generally >uite good# and the hours closer to a regular
work week than in many other geriatric nursing *obs.
!ontinuing !are .etirement !ommunity )ursing Vobs
6nlike traditional nursing homes# residents of !!.!s hae and maintain their own apartments with
whateer support they re>uire to remain as independent as possible. )ursing *ob opportunities in
!!.!s range from managed care nursing similar to the duties of a head nurse in a hospital to
proiding personal care to indiidual residents. !!.!s offer opportunities for skilled nursing care#
medical case management and licensed practical nursing.
.ehabilitation Aacilities
)ot all nursing homes cater to long-term geriatric patients. As hospital costs hae risen# the trend has
been to discharge patients to rehab facilities and conalescent homes rather than keep them in the
hospital until they9re ready to go home. )urses in rehab facilities and conalescent homes get to be
part of the recoery process# and many take great pride and *oy in watching a patient adance and
recoer. !onalescent home *obs include charge nurses# floor nurses and nursing assistants as well as
physical and occupational therapy specialists.
Traditional )ursing 'ome Vobs
7en traditional nursing homes are far different than they were a few decades ago. A nurse
specializing in gerontology in a nursing home can e=pect to work with patients in the long term. The
*obs aailable range from head nurses for an entire facility through floor charge nurses who are
responsible for oerseeing the care and medical needs of one wing or floor and certified nursing
assistants who do much of the hands on nursing care.
Ner3ous: !ranial Ner3es Exam
Setup
(atient sitting oer edge of bed.
CN I: Olfactory
6sually not tested.
.ash# deformity of nose.
Test each nostril with essence bottles of coffee# anilla# peppermint.
CN II: Optic
,ith patient wearing glasses# test each eye separately on eye chartG card using an eye coer.
7=amine isual fields by confrontation by wiggling fingers 1 foot from ptXs ears# asking which they
see moe.
\ Ieep e=aminerXs head leel with patientXs head.
"f poor isual acuity# map fields using fingers and a >uadrant-coering card.
0ook into fundi.
Aor more detail# 5ee 7ye 7=am.
CN III, IV, VI: Oculomotor, Trochlear, Abducens
0ook at pupils: shape# relatie size# ptosis.
5hine light in from the side to gauge pupilXs light reaction.
\ Assess both direct and consensual responses.
\ Assess afferent pupillary defect by moing light in arc from pupil to pupil. unne&. 8ptionally: as do
arc test# hae pt place a flat hand e=tending ertically from his face# between his eyes# to act as a
blinder so light can only go into one eye at a time.
DAollow finger with eyes without moing headD: test the ? cardinal points in an ' pattern.
\ 0ook for failure of moement# nystagmus _pause to check it during upwardG lateral gaze`.
!onergence by moing finger towards bridge of ptXs nose.
Test accommodation by pt looking into distance# then a hat pin /3cm from nose.
"f M2 suspected: pt. gazes upward at $rXs finger to show worsening ptosis.
CN V: Trigeminal
!orneal refle=: patient looks up and away.
\ Touch cotton wool to other side.
\ 0ook for blink in both eyes# ask if can sense it.
\ .epeat other side _tests J sensory# J"" motor`.
Aacial sensation: sterile sharp item on forehead# cheek# *aw.
\ .epeat with dull ob*ect. Ask to report sharp or dull.
\ "f abnormal# then temperature _heatedG water-cooled tuning fork`# light touch _cotton`.
Motor: pt opens mouth# clenches teeth %pterygoids&.
\ (alpate temporal# masseter muscles as they clench.
Test *aw *erk:
$rXs finger on tip of *aw.
2rip patellar hammer halfway up shaft and tap $rXs finger lightly.
6sually nothing happens# or *ust a slight closure.
"f increased closure# think 6M)0# esp pseudobulbar palsy.
CN VII: Facial
"nspect facial droop or asymmetry.
Aacial e=pression muscles: pt looks up and wrinkles forehead.
\ 7=amine wrinkling loss.
\ Aeel muscle strength by pushing down on each side _6M)0 presered because of bilateral
inneration`.
(t shuts eyes tightly: compare each side.
(t grins: compare nasolabial grooes.
Also: frown# show teeth# puff out cheeks.
!orneal refle= already done. 5ee !) J.
CN VIII: Vestibulocochlear !earing, Vestibular rarely"
$rXs hands arms length by each ear of pt.
\ .ub one handXs fingers with noise on one side# other hand noiselessly.
\ Ask pt. which ear they hear you rubbing.
\ .epeat with louder intensity# watching for abnormality.
,eberXs test: 0ateralization
\ <1+G 13+: 'z _+<? if deaf` ibrating fork on top of patients headG forehead.
\ D,here do you hear sound coming from-D
\ )ormal reply is midline.
.inneXs test: Air s. Bone !onduction
\ <1+G 13+: 'z _+<? if deaf` ibrating fork on mastoid behind ear. Ask when stop hearing it.
\ ,hen stop hearing it# moe to the patients ear so can hear it.
\ )ormal: air conduction _ear` better than bone conduction _mastoid`.
"f indicated# look at e=ternal auditory canals# eardrums.
CN I#, #: $lossopharyngeal, Vagus
Joice: hoarse or nasal.
(t. swallows# coughs %boine cough: recurrent laryngeal&.
7=amine palate for uular displacement. %unilateral lesion: uula drawn to normal side&.
(t says DAhD: symmetrical soft palate moement.
2ag refle= _sensory "E# motor E`:
\ 5timulate back of throat each side.
\ )ormal to gag each time.
CN #I: Accessory
Arom behind# e=amine for trapezius atrophy# asymmetry.
(t. shrugs shoulders %trapezius&.
(t. turns head against resistance: watch# palpate 5!M on opposite side.
CN #II: !ypoglossal
0isten to articulation.
"nspect tongue in mouth for wasting# fasciculations.
(rotrude tongue: unilateral deiates to affected side.
'lossary o5 Nursing/*edical (egrees.!erti5ications & Allied "eath !erti5ications
Below you will find many nursing and medical acronyms for degrees and certification. " know this is
not a complete list# so if you hae suggestions or reisions# please post a reply and we will try to
update it on a regular basis. Thanks and 7n*oyN
-----------------
AA: Associate of %or in& Arts degree; an AssociateXs degree is generally a two-year degree %the term is
used in the 65; in !anada# the term usually used for e>uialent education is DdiplomaD&.
AA5: Associate of %or in& Applied 5cience degree; an AssociateXs degree is generally a two-year
degree %the term is used in the 65; in !anada# the term usually used for e>uialent education is
DdiplomaD&.
ABA: American Board of Anesthesiology
ABA#: American Board of Allergy W "mmunology
AB!%S: American Board of !olon and .ectal 5urgery
AB(: American Board of $ermatology
ABE*: American Board of 7mergency Medicine
AB8P: American Board of Aamily (ractice
AB#*: American Board of "nternal Medicine
AB*': American Board of Medical 2enetics
ABN*: American Board of )uclear Medicine
ABNS: American Board of )eurological 5urgery
AB+': American Board of 8bstetrics and 2ynecology
AB+P: American Board of 8phthalmology
AB+S: American Board of 8rthopaedic 5urgery
AB+to: American Board of 8tolaryngology
ABP: American Board of (athology
ABP: American Board of (ediatrics
ABP*: American Board of (reentie Medicine
ABP*%: American Board of (hysical Medicine W .ehabilitation
ABPN: American Board of (sychiatry and )eurology
ABPS: American Board of (lastic 5urgery
AB%: American Board of .adiology
ABS: American Board of 5urgery
AB$S: American Board of Thoracic 5urgery
AB&: American Board of 6rology
A!"%N: Adanced !ertified 'yperbaric )urse; a credential offered by the Baromedical )urses
Association %B)A&
A!%N: A"$5 !ertified .egistered )urse; a credential offered by the Association of )urses in A"$5
!are %A)A!&
A(: AssociateXs degree; an AssociateXs degree is generally a two-year degree %the term is used in the
65; in !anada# the term usually used for e>uialent education is DdiplomaD&.
ANP: Adult )urse (ractitioner; generally an acronym for a program name %e.g. A)( (rogram& or
title; the credential is usually either A(.)#B! %offered by the American )urses !redentialing !enter
_A)!!`&# or )(-! %offered by the American Academy of )urse (ractitioners _AA)(` !ertification
(rogram&.
A+!N: Adanced 8ncology !ertified )urse; a credential offered by the 8ncology )ursing
!ertification !orporation %8)!!&.
A+!NP: Adanced 8ncology !ertified )urse (ractitioner; a credential offered by the 8ncology
)ursing !ertification !orporation %8)!!&.
A+!NS: Adanced 8ncology !ertified !linical )urse 5pecialist; a credential offered by the
8ncology )ursing !ertification !orporation %8)!!&.
P%N)B! or AB%N) B!: An adanced practice certification for nurse practitioners# clinical nurse
specialists# and specialists in adanced diabetes management# offered by the American )urses
!redentialing !enter %A)!!&.
AP%N)B!.P!* or AP%N) B!.P!*: Adanced (ractice .egistered )urse# Board !ertified-
(alliatie !are Management; a credential offered by the 'ospice and (alliatie )urses Association
%'()A& in association with the American )urses !redentialing !enter %A)!!&.
ASN: Associate in 5cience in )ursing degree; generally a + year degree.
BA: Bachelor of Arts# also called a baccalaureate; generally a four-year degree %see e=ception below&.
BA1"ons2: 'onours Bachelor of Arts; in some *urisdictions %e.g. 8ntario# !anada&; this means a
four-year degree F it does not mean the same thing as academic honors# such as Dsumma cum laudeD;
in these *urisdictions# a three-year DBachelorXs degreeD is referred to as an 8rdinary BA.
BB1AS!P2: Technologist in Blood Banking certified by the American 5ociety for !linical (athology
Board of .egistry.
B(entSci) B(Sc: Bachelor of $ental 5cience
B(S: Bachelor of $ental 5urgery
B"S: Bachelor of 'ealth 5cience
B"yg: Bachelor of 'ygiene
B* or B*ed: Bachelor of Medicine; doctor designation in some *urisdictions %e.g. Australia&;
usually a <-year degree %see also BM B!'# !B# !hB# MB# MBB5# MB!hB# BM !hB&.
B* B!": Bachelor of Medicine and Bachelor of 5urgery; the D!hD is from the 0atin for surgeon#
chirurgia# which is from the 2reek cheirourgia %see also BM# BMed# !B# !hB# MB# MBB5# MB!hB#
BM !hB&.
B*edBiol: Bachelor of Medical Biology
B*edSci or B*S: Bachelor of Medical 5cience
B*ic: Bachelor of Microbiology
B*$: Bachelor of Medical Technology
BSN: Bachelor of 5cience )ursing
B+: Bachelor of 8steopathy. 8steopathy
BP or BPharm: Bachelor of (harmacy
BP": Bachelor of (ublic 'ealth
BP"Eng: Bachelor of (ublic 'ealth 7ngineering
BP"N: Bachelor of (ublic 'ealth )ursing
BS or BSc: Bachelor of 5cience; generally a four-year degree %see e=ception below&.
BS1"ons2 or BSc1"ons2: 'onours Bachelor of 5cience; in some *urisdictions %e.g. 8ntario# !anada&;
this means a four-year degree F it does not mean the same thing as academic honors# such as Dsumma
cum laudeD; in these *urisdictions# a three-year DBachelorXs degreeD is referred to as an 8rdinary B5
or B5c.
BS* or BSc*: Bachelor of 5cience in Medicine
BScN or BSN: Bachelor of 5cience in )ursing
BScPh or BSPh: Bachelor of 5cience in (harmacy
BS7: Bachelor of 5ocial ,ork
B:*S: Bachelor of Jeterinary Medicine and 5cience
B:Sc: Bachelor of Jeterinary 5cience
!1AS!P2: Technologist in !hemistry certified by the American 5ociety for !linical (athology Board
of .egistry.
!APA: !ertified Ambulatory (erianesthesia )urse; a credential offered by the American Board of
(erianesthesia )ursing !ertification# "nc. %AB(A)!&.
!B or !hB: Bachelor of 5urgery; the D!D and D!hD are from the 0atin for surgeon# chirurgia# which
is from the 2reek cheirourgia. %see also BM# BMed# MB# MBB5# MB!hB# BM !hB&
!B#: !ertificate in Breast "maging; a credential offered by the !anadian Association of Medical
.adiation Technologists %!AM.T&.
!!*: !ertified !ase Manager; a credential offered by the !ommission for !ase Manager
!ertification %!!M!&.
!!NS: !ritical !are )urse 5pecialist; a credential offered by the American Association of !ritical-
!are )urses %AA!)&.
!!%N: !ritical !are .egistered )urse; a credential offered by the American Association of !ritical-
!are )urses %AA!)&.
!(A: !ertified $ental Assistant; length of educational program to obtain credential is generally C-1+
months %see also $A&.
!(E: !ertified $iabetes 7ducator; a credential offered by the )ational !ertification Board for
$iabetes 7ducators %)!B$7&.
!(N: !ertified $ialysis )urse; a credential offered by the )ephrology )ursing !ertification
!ommission %))!!&.
!EN: !ertified 7mergency )urse; a credential offered by the Board of !ertification for 7mergency
)ursing %B!7)&.
!8%N: !ertified 7mergency Alight )urse; a credential offered by the Board of !ertification for
7mergency )ursing %B!7)&.
!'%N: !ertified 2astroenterology .egistered )urse; a credential offered by the !ertifying Board of
2astroenterology )urses and Associates# "nc. %!B2)A&.
!h(: $octor of 5urgery; a post-medical degree specialty program; the D!hD is from the 0atin for
surgeon# chirurgia# which is from the 2reek cheirourgia %see also $!h&.
!h* or !*: Master of 5urgery; a post-medical degree specialty program; the D!hD and D!D are
from the 0atin for surgeon# chirurgia# which is from the 2reek cheirourgia %see also M!# M5&.
!"PN: !ertified 'ospice and (alliatie )urse; a credential offered by the 'ospice and (alliatie
)urses Association %'()A& in association with the American )urses !redentialing !enter %A)!!&.
!"%N: !ertified 'yperbaric )urse; a credential offered by the Baromedical )urses Association
%B)A&.
!#": !ertificate in "ndustrial 'ealth
!LS: !linical 0aboratory 5cientist; a medical laboratory credential which may be obtained after
earning a BachelorXs degree.
!LS1N!A2: !linical 0aboratory 5cientist holding the credential through the )ational !ertification
Agency for Medical 0aboratory (ersonnel %)!A&; a medical laboratory credential which may be
obtained after earning a releant BachelorXs degree and clinical laboratory training.
!L$: !ertified 0aboratory Technician
!L$1N!A2: !ertified 0aboratory Technician holding the )ational !ertification Agency for Medical
0aboratory (ersonnel %)!A&; a medical laboratory credential which may be obtained after earning a
releant AssociateXs degree and clinical laboratory training.
!*A: !ertified Medical Assistant; a non-licensed healthcare worker performing clerical#
administratie# and basic clinical support to doctors; the credential that can be obtained after
completing a medical assistant program %either ia a one-year certificate or diploma program# or ia a
two-year AssociateXs degree&; %see also .MA&.
!*: !ertified Midwife; a credential offered by The American !ollege of )urse-Midwies
!ertification !ouncil %A!!&.
!*S: !ertificate in Management 5tudies; a credential offered by the !anadian Association of
Medical .adiation Technologists %!AM.T&.
!*S%N: !ertified Medical-5urgical .egistered )urse; a credential offered by the Academy of
Medical-5urgical )urses %AM5)&.
!N*: !ertified )urse Midwife; a credential offered by The American !ollege of )urse-Midwies
!ertification !ouncil %A!!&.
!N*$: !ertified )uclear Medicine Technologist; a credential offered by the )uclear Medicine
Technology !ertification Board %)MT!B&.
!NN: !ertified )ephrology )urse; a credential offered by the )ephrology )ursing !ertification
!ommission %))!!&.
!N%N: !ertified )euroscience .egistered )urse; a credential offered by the American Association
of )euroscience )urses %AA))&.
!NS: !linical )urse 5pecialist; usually used as an acronym for a *ob title where a nurse works in an
adanced practice capacity; the actual credential is usually longer and incorporates D!)5D# e.g.
!ritical !are )urse 5pecialist %!!)5& %offered by the American Association of !ritical-!are )urses
_AA!)`&# !ertified 6rologic !linical )urse 5pecialist %!6!)5& %offered by the 5ociety of 6rologic
)urses and Associates _56)A`&# etc.
!N+%: This acronym does not stand for anything specific# it signifies only that an indiidual has
met all the education# e=amination# or e=perience re>uirements necessary to be certified in operating
room nursing by the !ertification Board (erioperatie )ursing of the Association of peri8peratie
.egistered )urses %A8.)&.
!+!N: !ertified !ontinence !are )urse; a credential offered by the ,ound 8stomy !ontinence
)ursing !ertification Board %,8!)!B&.
!+$A: !ertified 8ccupational Therapy Assistant; credential that can be obtained by the )ational
Board for !ertification in 8ccupational Therapy# "nc. %)B!8T&# after earning an AssociateXs degree
in occupational therapy.
!PAN: !ertified (ost Anesthesia )urse; a credential offered by the American Board of
(erianesthesia )ursing !ertification# "nc. %AB(A)!&.
!P8$: !ertified (ulmonary Aunction Technologist; a credential offered by the )ational Board for
.espiratory !are %)B.!&.
!PN: !ertified (ediatric )urse; a credential offered by the )ational !ertification Board of (ediatric
)urse (ractitioners and )urses# "nc. %)!B()(G)&.
!P+N: !ertified (ediatric 8ncology )urse; a credential offered by the 8ncology )ursing
!ertification !orporation %8)!!&.
!PNP: !ertified (ediatric )urse (ractitioner; a credential offered by the )ational !ertification
Board of (ediatric )urse (ractitioners and )urses# "nc. %)!B()(G)&.
!%!S: !anadian .egistered !ardiac 5onographer; a credential offered by the !anadian Association
of .egistered $iagnostic 6ltrasound (rofessionals %!A.$6(&.
!%'S: !anadian .egistered 2eneral 5onographer; a credential offered by the !anadian Association
of .egistered $iagnostic 6ltrasound (rofessionals %!A.$6(&.
!%N: !redential for nurses who hae written the !ertification 7=amination for .adiologic )ursing#
offered by the American .adiological )urses Association %A.)A&.
!%NA: !ertified .egistered )urse Anesthetist; a credential offered by the American Association of
)urse Anesthetists %AA)A&.
!%N8A: !ertified .egistered )urse Airst Assistant; an operating certification offered by the
!ertification Board (erioperatie )ursing of the Association of peri8peratie .egistered )urses
%A8.)&.
!%N#: !ertified .egistered )urse "nfusion; a credential offered by the "nfusion )urses !ertification
!orporation of the "nfusion )urses 5ociety %")5&.
!%%N: !ertified .ehabilitation .egistered )urse; a credential offered by the Association of
.ehabilitation )urses %A.)&.
!%%N.A: !ertified .ehabilitation .egistered )urse F Adanced; a credential offered by the
Association of .ehabilitation )urses %A.)&.
!%$: !ertified .espiratory Therapist; a credential offered by the )ational Board for .espiratory
!are %)B.!&.
!%$$: !ertified .espiratory Therapy Technician; sometimes used as a *ob title# but sometimes used
to mean !.T.
!%:S: !anadian .egistered Jascular 5onographer; a credential offered by the !anadian Association
of .egistered $iagnostic 6ltrasound (rofessionals %!A.$6(&.
!$1AS!P2: !ytotechnologist certified by the American 5ociety for !linical (athology Board of
.egistry.
!$#!: !omputed Tomography "maging !ertificate; a credential offered by the !anadian Association
of Medical .adiation Technologists %!AM.T&.
!&!NS: !ertified 6rologic !linical )urse 5pecialist; a credential offered by the 5ociety of 6rologic
)urses and Associates %56)A&.
!&NP: !ertified 6rologic )urse (ractitioner; a credential offered by the 5ociety of 6rologic )urses
and Associates %56)A&.
!&%N: !ertified 6rologic .egistered )urse; a credential offered by the 5ociety of 6rologic )urses
and Associates %56)A&.
!7!N: !ertified ,ound !are )urse; a credential offered by the ,ound 8stomy !ontinence
)ursing !ertification Board %,8!)!B&.
!7+!N: !ertified ,ound# 8stomy and !ontinence )urse; a credential offered by the ,ound
8stomy !ontinence )ursing !ertification Board %,8!)!B&.
(A: $ental Assistant %see also !$A&
(!: $octor of !hiropractic
(!": $iploma in !hild 'ealth
(!h: $octor of 5urgery; the D!hD is from the 0atin for surgeon# chirurgia# which is from the 2reek
cheirourgia %see also !h$&.
(!h+: $octor of 8phthalmic 5urgery; the D!hD is from the 0atin for surgeon# chirurgia# which is
from the 2reek cheirourgia.
(!*: $octor of !omparatie Medicine
(!P: $iploma in !linical (athology# or $iploma in !linical (sychology
((%: $iploma in $iagnostic .adiology
((S: $octor of $ental 5urgery
((Sc: $octor of $ental 5cience
(8"om: $iploma from a Aaculty of 'omeopathy; homeopathy is an alternatie medicine practice in
which a condition is treated using small amounts of substances that# when used in large amounts in
healthy people# produce symptoms similar to those being treated.
$'g# $'y# $'yg# or $r'yg: $octor of 'ygiene
(ip: $iplomate or $iploma
(ipBact: $iploma in Bacteriology
(ip!hem: $iploma in !hemistry
(ip!linPath: $iploma in !linical (athology
(ip*icro0iol: $iploma in Microbiology
(ipPhys or (Phys: $iploma in (hysiotherapy
(ipSoc*ed: $iploma in 5ocial Medicine
(L*1AS!P2: $iplomate in 0aboratory Management certified by the American 5ociety for !linical
(athology Board of .egistry.
(*(: $octor of $ental Medicine
(*$: $octor of Medical Technology
(*:: $octorat en Mbdecine Jbtbrinaire %see also $JM# $JM5# $J5# $J5c&
(+: $octor of 8ptometry %see also 8$&
(+: $octor of 8steopathy. 8steopathy is Da system of therapy M based on the theory that the body
can make its own remedies against disease and other to=ic conditions when it is in normal structural
relationship and has faorable enironmental conditions and ade>uate nutrition. "t uses generally
accepted physical# medicinal# and surgical methods of diagnosis and therapy# while placing chief
emphasis on maintenance of normal body mechanics and on manipulatie methods of detecting and
correcting faulty structure.D %$orlandXs "llustrated Medical $ictionary&
(N: $octor of )ursing
(NE: $octor of )ursing 7ducation
(NS or (NSc: $octor of )ursing 5cience
(N!: $ermatology )urse !ertified; a credential offered by the $ermatology )ursesX Association
%$)A&.
(+N: $irector of )ursing
(+S or (+Sc: $octor of 8cular 5cience
(+S or (+Sc: $octor of 8ptical 5cience
(P: $octor of (harmacy %see also (harm$ and ($&
(P: $octor of (odiatry %see also $(M&
(P": $octor of (ublic 'ealth
(P": $octor of (ublic 'ygiene %see also $r('&
(Ph!: $octor of (harmaceutical !hemistry
(P"N: $octor of (ublic 'ealth )ursing
(P*: $octor of (odiatric Medicine %see also $(&
(P*: $octor of (hysical Medicine
(P*: $octor of (reentie Medicine
(P*: $octor of (sychiatric Medicine
(r*ed: $octor of Medicine %see also M$&; in some *urisdictions# the degree of $octor of Medicine
is a higher doctorate than DM$#D resered for those who hae contributed significantly to the study of
medicine.
(rP": $octor of (ublic 'ealth
(rP": $octor of (ublic 'ygiene %see also $('&
(Sc: $octor of 5cience
(SE: $octor of 5anitary 7ngineering
(S#* or (Sc#*: $octor of 5cience in "ndustrial Medicine
(SSc: $iploma in 5anitary 5cience
(:*: $octor of Jeterinary Medicine %see also $MJ# $JM5# $J5# $J5c# MJ$&
(:*S: $octor of Jeterinary Medicine and 5urgery %see also $MJ# $JM# $J5# $J5c# MJ$&
(:%: $octor of Jeterinary .adiology
(:S or (:Sc: $octor of Jeterinary 5cience %see also $MJ# $JM# $JM5# MJ$&
Ed(: $octor of 7ducation
ENP!: 7mergency )ursing (ediatric !ourse# a 1?-hour post-.) course; offered by the Board of
!ertification for 7mergency )ursing %B!7)&.
E$: 7nterostomal Therapist; the ,ound 8stomy !ontinence )ursing !ertification Board
%,8!)!B& offers credentialing in this specialty# including: !ertified ,ound# 8stomy and
!ontinence )urse %!,8!)& and !ertified 8stomy !are )urse %!8!)&.
8AAN: Aellow of the American Academy of )ursing
8A!AA#: Aellow of the American !ollege of Allergy# Asthma W "mmunology
8A!!: Aellow of the American !ollege of !ardiology
8A!(: Aellow of the American !ollege of $entists
8AA8P: Aellow of the American Academy of Aamily (hysicians
8A!': Aellow of the American !ollege of 2astroenterology
8A!+': Aellow of the American !ollege of 8bstetricians and 2ynecologists
8A!P: Aellow of the American !ollege of (hysicians
8A!P*: Aellow of the American !ollege of (reentie Medicine
8A!S: Aellow of the American !ollege of 5urgeons
8A!S*: Aellow of the American !ollege of 5ports Medicine
8A*A: Aellow of the American Medical Association
8A+$A: Aellow of the American 8ccupational Therapy Association
8APA: Aellow of the American (sychiatric Association
8AP"A: Aellow of the American (ublic 'ealth Association
8!AP: Aellow of the !ollege of American (athologists
8!!P: Aellow of the American !ollege of !hest (hysicians
8!PS: Aellow of the !ollege of (hysicians and 5urgeons
8(S: Aellow in $ental 5urgery
8(S%!SEng: Aellow in $ental 5urgery of the .oyal !ollege of 5urgeons of 7ngland
8#!(: Aellow of the "nternational !ollege of $entists
8#*L$: Aellow of the "nstitute of Medical 0aboratory Technology; generally a title used outside of
)orth America.
8NP: Aamily )urse (ractitioner; generally an acronym for a program name %e.g. A)( (rogram& or
title; the credential is usually either A(.)#B! %offered by the American )urses !redentialing !enter
_A)!!`&# or )(-! %offered by the American Academy of )urse (ractitioners _AA)(` !ertification
(rogram&.
8%!'P: Aellow of the .oyal !ollege of 2eneral (ractitioners %6I&
8%!+': Aellow of the .oyal !ollege of 8bstetricians and 2ynaecologists %6I&
8%!P: Aellow of the .oyal !ollege of (hysicians %6I&
8%!Path: Aellow of the .oyal !ollege of (athologists %6I&
8%!P! or 8%!P1!2: Aellow of the .oyal !ollege of (hysicians of !anada
A.!5: Aellow of the .oyal !ollege of 5urgeons of 7ngland
A.!5! or A.!5%!&: Aellow of the .oyal !ollege of 5urgeons of !anada
'NP: 2erontological )urse (ractitioner; generally an acronym for a program name %e.g. 2)(
(rogram& or title; the credential is usually A(.)#B! %offered by the American )urses !redentialing
!enter %A)!!&.
'P: 2eneral (ractitioner; an acronym for a title# not a credential
"1AS!P2: Medical Technologist in 'ematology certified by the American 5ociety for !linical
(athology Board of .egistry.
"P1AS!P2: 'emapheresis (ractitioner certified by the American 5ociety for !linical (athology
Board of .egistry.
"$1AS!P2: 'istotechnician certified by the American 5ociety for !linical (athology Board of
.egistry.
"$L1AS!P2: 'istotechnologist certified by the American 5ociety for !linical (athology Board of
.egistry.
"N!: !ertified 'olistic )urse; a credential offered by the American 'olistic )urses Association
%A')A&.
"N!: 'yperbaric )urse !linician; a credential offered by the Baromedical )urses Association
%B)A&.
#1AS!P2: Medical Technologist in "mmunology certified by the American 5ociety for !linical
(athology Board of .egistry; will be discontinued after 1+G/1G+33:.
9(: $octor of Vurisprudence %or simply# $octor of 0aws&; the reason itXs reersed# V$ rather than $V#
is due to the titleXs 0atin roots. "n 0atin# itXs Vuris $octor F thus# V$.
L*!!: 0icentiate of the Medical !ouncil of !anada
LN!!: 0egal )urse !onsultant !ertified; a credential offered by the American 0egal )urse
!onsultant !ertification Board %A0)!!B&.
LPN: 0icensed (ractical )urse %in some locations known as an 0J)&; a graduate from a %usually&
one-year diplomaGcertificate program at a ocationalGtechnical school.
LPN) !L$!: 0icensed (ractical )urse certified in 0ong-Term !are by the )ational Association for
(ractical )urse 7ducation W 5erice# "nc. %)A()75&.
LPN) N!P: 0icensed (ractical )urse certified in (harmacology by the )ational Association for
(ractical )urse 7ducation W 5erice# "nc. %)A()75&.
L:N: 0icensed Jocational )urse %in some locations known as an 0()&; a graduate from a %usually&
one-year diplomaGcertificate program at a ocationalGtechnical school.
L:N) !L$!: 0icensed Jocational )urse certified in 0ong-Term !are by the )ational Association
for (ractical )urse 7ducation W 5erice# "nc. %)A()75&.
L:N) N!P: 0icensed Jocational )urse certified in (harmacology by the )ational Association for
(ractical )urse 7ducation W 5erice# "nc. %)A()75&.
*A: Master of Arts
*1AS!P2: Medical Technologist in Microbiology certified by the American 5ociety for !linical
(athology Board of .egistry.
*B: Bachelor of Medicine %see also BM# BMed# !B# !hB# MB!hB# BM !hB&
*BBS: Bachelor of Medicine and Bachelor of 5urgery %see also BM# BM !hB# BMed# !B# !hB#
MB# MB!hB&
*B!hB: Bachelor of Medicine# Bachelor of 5urgery; doctor designation in some *urisdictions %e.g.
the 6I&; usually a <-year degree; the D!hD is from the 0atin for surgeon# chirurgia# which is from the
2reek cheirourgia %see also BM# BM !hB# BMed# !B# !hB# MB# MBB5&.
*!: Master of 5urgery; the D!D is from the 0atin for surgeon# chirurgia# which is from the 2reek
cheirourgia; %see also !hM# !M# M5&.
*!PS: Member of the !ollege of (hysicians and 5urgeons
*(: $octor of Medicine F the reason itXs reersed# M$ rather than $M# is due to the titleXs 0atin
roots. "n 0atin# itXs Medicinae $octor F thus# M$. %see also $rMed&
*(entSc: Master of $ental 5cience %see also M5c$&
*(S: Master of $ental 5urgery
*L$: Medical 0aboratory Technician %in the 65&; sometimes in other countries# Medical 0aboratory
Technologist.
*L$1AS!P2: Medical 0aboratory Technician certified by the American 5ociety for !linical
(athology Board of .egistry.
*Ph: Master of (harmacy %see also M(harm&
*P": Master of (ublic 'ealth
*P1AS!P2: Medical Technologist in Molecular (athology certified by the American 5ociety for
!linical (athology Board of .egistry.
*Pharm: Master of (harmacy %see also M(h&
*%ad: Master of .adiology
*%!P1&,2: Membership in the .oyal !ollege of (hysicians %6I&
*%L: Medical .ecords 0ibrarian
*S: Master of 5urgery %see also !hM# !M# M!&
*S or *Sc: Master of 5cience
*Sc(: Master of $ental 5cience %see also M$ent5c&
*ScN or *SN: Master of 5cience in )ursing %see also M)&
*N: Master of )ursing %see also M5c) or M5)&
*ScP" or *SP": Master of 5cience in (ublic 'ealth
*SPh) *ScPh) *SPharm) or *ScPharm: Master of 5cience in (harmacy
*S7: Master of 5ocial ,ork
*$: Medical Technologist
*$1AS!P2: Medical Technologist certified by the American 5ociety for !linical (athology Board of
.egistry.
*:(: $octor of Jeterinary Medicine %see also $MJ# $JM5# $J5# $J5c&
N!$: )uclear !ardiology Technologist; a credential offered by the )uclear Medicine Technology
!ertification Board %)MT!B&.
N(: $octor of )ursing
N(: $octor of )aturopathy
N*$: )uclear Medicine Technologist
NP: )urse (ractitioner; generally an acronym for a program name %e.g. a )( (rogram& or title; the
credential is offered through a credentialing body# such as the American )urses !redentialing !enter
%A)!!&.
NP.!: A credential for nurse practitioners in all specialties# offered by the American Academy of
)urse (ractitioners %AA)(& !ertification (rogram.
+!N: 8ncology !ertified )urse; a credential offered by the 8ncology )ursing !ertification
!orporation %8)!!&.
+(: $octor of 8ptometry %see also $8&
+N!: 8rthopaedic )urse !ertified; a credential offered by the )ational Association of 8rthopaedic
)ursesX %)A8)& 8rthopaedic )urses !ertification Board.
+$: 8ccupational Therapist; generally an acronym for the position of 8ccupational Therapist# not a
credential.
+$% or +$%eg: .egistered 8ccupational Therapist
PA: (hysician Assistant; (A generally an acronym for the position of (hysician Assistant# not a
credential; (As are indiiduals licensed to practice medicine with physician superision;
responsibilities include: performing physicals# diagnosingGtreating illnesses# orderingGinterpreting
tests; assisting with surgery# writing prescriptions %most states&# etc.; the aerage (A training program
lasts +? months# and the typical applicant to the program has a BachelorXs degree and four years of
healthcare e=perience.
PA.!: (hysician Assistant-!ertified; a credential offered by the )ational !ommission on the
!ertification of (hysician Assistants %)!!(A&.
P!P: (rimary !are (hysician; generally an acronym for the position of (rimary !are (hysician# not
a credential.
P(: $octor of (harmacy; the reason itXs reersed# ($ rather than $(# is due to the titleXs 0atin roots.
"n 0atin# itXs (harmaciae $octor F thus# ($. %see also (harm$ and $(&
Pharm(: $octor of (harmacy F the reason itXs reersed# (harm$ rather than $(harm# is due to the
titleXs 0atin roots. "n 0atin# itXs (harmaciae $octor F thus# (harm$. %see also $( and ($&
Ph(: $octor of (hilosophy F the reason itXs reersed# (h$ rather than $(h# is due to the titleXs 0atin
roots. "n 0atin# itXs (hilosophiae $octor F thus# (h$.
PNP: (ediatric )urse (ractitioner; generally an acronym for the position of (ediatric )urse
(ractitioner# not a credential.
P$: (hysical Therapist or (hysiotherapist; generally an acronym for the position of (hysical
Therapist or (hysiotherapist# not a credential.
%(A: .egistered $ental Assistant
%(A Le3el #: .egistered $ental Assistant 0eel "; in some *urisdictions %e.g. Alberta# !anada&; this
means indiiduals who are registered to perform chairside assisting and reception duties# but hae not
completed any intra-oral training.
%(A Le3el ##: .egistered $ental Assistant 0eel ""; in some *urisdictions %e.g. Alberta# !anada&; this
means indiiduals who are registered in any or all of the legal intra-oral duties after completion of an
in-school formal training program.
%(!S: .egistered $iagnostic !ardiac 5onographer; a credential offered by the American
Association of $iagnostic Medical 5onographers %A.$M5&.
%(*S: .egistered $iagnostic Medical 5onographer; a credential offered by the American
Association of $iagnostic Medical 5onographers %A.$M5&.
%*A: .egistered Medical Assistant; a non-licensed healthcare worker performing clerical#
administratie# and basic clinical support to doctors; the credential that can be obtained after
completing a medical assistant program %either ia a one-year certificate or diploma program# or ia a
two-year AssociateXs degree&. %see also !MA&
%N: .egistered )urse
%N)B! or %N) B!: A basic certification for baccalaureate %or higher& nurses# offered by the
American )urses !redentialing !enter %A)!!&.
%N)! or %N) !: A certification for Associate degree or diploma nurses# offered by the American
)urses !redentialing !enter %A)!!&.
%NA: .egistered )urse Anesthetist
%NA: .egistered )ursing Assistant
%N!: A credential offered by the )ational !ertification !orporation %)!!& for arious nursing
specialists# including ,omenXs 'ealth !are )urse (ractitioner and )eonatal )urse (ractitioner; the
following specialists also receie D.)!D credential# but would include the additional DlettersD
indicated: "npatient 8bstetric )ursing %")(T&; Maternal )ewborn )ursing %M)&; 0ow .isk )eonatal
)ursing %0.)&; )eonatal "ntensie !are )ursing %)"!&; Telephone )ursing (ractice %T)(&.
%+&B: .egistered 8phthalmic 6ltrasound Biometrist; a credential offered by the American
Association of $iagnostic Medical 5onographers %A.$M5&.
%Ph: .egistered (harmacist
%P8$: .egistered (ulmonary Aunction Technologist; a credential offered by the )ational Board for
.espiratory !are %)B.!&.
%P$: .egistered (hysical Therapist or .egistered (hysiotherapist
%%A: .egistered .ecord 0ibrarian or .egistered .ecords 0ibrarian
%%$: .egistered .espiratory Therapist; a credential offered by groups such as the )ational Board for
.espiratory !are %)B.!& and the !anadian 5ociety of .espiratory Therapists %!5.T&.
%$: .espiratory Therapist or .adiological Technologist; generally an acronym for the positions# not a
credential.
%$*%: .egistered Technologist in Magnetic .esonance; a credential offered by the !anadian
Association of Medical .adiation Technologists %!AM.T&.
%$N1A%%$2: .egistered )uclear Medicine Technologist; a credential offered by the American
.egistry of .adiologic Technologists %A..T&.
%$N*: .egistered Technologist in )uclear Medicine; a credential offered by the !anadian
Association of Medical .adiation Technologists %!AM.T&.
%$%: .egistered Technologist in .adiological Technology; a credential offered by the !anadian
Association of Medical .adiation Technologists %!AM.T&.
%$%1A%%$2: .egistered .adiography Technologist; a credential offered by the American .egistry
of .adiologic Technologists %A..T&.
%$$: .egistered Technologist in .adiation Therapy; a credential offered by the !anadian
Association of Medical .adiation Technologists %!AM.T&.
%$$1A%%$2: .egistered .adiation Therapist; a credential offered by the American .egistry of
.adiologic Technologists %A..T&.
%:$: .egistered Jascular Technologist; a credential offered by the American Association of
$iagnostic Medical 5onographers %A.$M5&.
SBB1AS!P2: 5pecialist in Blood Banking certified by the American 5ociety for !linical (athology
Board of .egistry.
S!1AS!P2: 5pecialist in !hemistry certified by the American 5ociety for !linical (athology Board
of .egistry.
S!$1AS!P2: 5pecialist in !ytotechnology certified by the American 5ociety for !linical (athology
Board of .egistry.
S"1AS!P2: 5pecialist in 'ematology certified by the American 5ociety for !linical (athology
Board of .egistry.
SLS1AS!P2: 5pecialist in 0aboratory 5afety certified by the American 5ociety for !linical
(athology Board of .egistry.
S*1AS!P2: 5pecialist in Microbiology certified by the American 5ociety for !linical (athology
Board of .egistry.
S:1AS!P2: 5pecialist in Jirology certified by the American 5ociety for !linical (athology Board of
.egistry.
S7: 5ocial ,orker; generally an acronym for the position of 5ocial ,orker# not a credential.
$N!!: Trauma )ursing !ore !ourse; a 1?- to +3-hour post-.) course; offered by the Board of
!ertification for 7mergency )ursing %B!7)&.