A RANDOMLY affinity for hemoglobin that is about 220

STAR-FILLED
COME AT times that of oxygen.
REVIEWER FROM ME, nle!
A GALAXY FAR Carboxyhemoglobin (product formed) cannot
FAR AWAY! Here are some transport oxygen.
things I have gathered which -Presence of carboxyhemoglobin interferes with
the dissociation of oxygen from the remaining
hopefully can help you pass this Board
oxyhemoglobin, thus reducing the transfer of
Exam! Again! Good Luck! oxygen to tissues.
o Brain and heart are the most affected.
1. A town in Syria was exposed to a First Sign: headache
chemicals known as Irreversible
acetylcholinesterase inhibitor. These could
cause death to those who inhale it
a. Sarin & Soman
b. Mercury & Cadmium
c. Carbon Monoxide
d. Nitrous Oxide

Correct Answer: Sarin & Soman.

Both are known as Irreversible
acetylcholinesterase inhibitor. These are
known as Organophosphates that undergo
aging in a short period of time, once aging: Treatment:
covalent linking. When theres a covalent 1. Remove from exposure site
bond, body is still able to use oxygen, but 2. Prompt administration of high flow and high
cant use it because of the permanent concentration oxygen
binding of sarin and soman. 3. Mechanical ventilation if needed
CYANIDE POISONING
-Carbon Monoxide binds to red blood cells.
-Highly toxic chemicals
-Mercury enters cells and cause damage
-Formed from burning plastics, wool, etc
through reactive oxygen species -Natural sources: Cassava, seeds of apples,
-Cadmium can damage the respiratory, apricots, peach
reproductive, kidneys, and skeletal system, -Uses: Rodenticide, method of execution, illegal
but is not an irreversibel ACHase inhibitor fishing
-Nitrous Oxide: It is a relatively insoluble Characteristic: Severe Metabolic acidosis
deep lung irritant capable of producing CYANIDE: Inhibits mitochondrial cytochrome C
pulmonary edema oxidase to prevent cellular respiration
-> cells cant utilize oxygen
-> The mucous membranes are usually bright pink
2. Mary is in a fully air conditioned car while
and the blood will be a characteristic bright
stuck in an EDSA traffic. She stayed inside cherry red.
the car after arriving at her destination to
watch multiple Korean Drama Episodes.
Later on, she died inside the car. What could
have caused her death?
a. Cyanide poisoning
b. Carbon Monoxide Poisoning
c. Carbon Dioxide Poisoning
d. A, B, & C

Correct Answer: B
Carbon monoxide
Combines reversibly with the oxygen-
binding sites of hemoglobin and has an

God bless & Good Luck!!


3. Bran was at a party and he met some
guys who seemed like they were taking
drugs. All of them were wearing sunglasses
at night. They were probably high on
cocaine, and amphetamine. Bran expects
their eyes to exhibit:
a. horizontal nystagmus
b. constricted pupils
c. dilated pupils
d. ptosis
Correct answer: C
EYES:
Miosis: (PCCO) Phenothiazines, Clonidine,
Cholinesterase Inhibitors, Opioids
Mydriasis: (CALA) Cocaine,
Amphetamines, LSD, Atropine
Horizontal Nystagmus: (BAP) Barbiturates,
Alcohols, Phenytoin
Horizontal and Vertical Nystagmus
Phencyclidine
Ptosis and Ophthalmoplegia- Botulism
(also myasthenia gravis)
4. Nurse Cait was listening to her patients
bowel sounds. She described it as Audible
intestinal rumbling sound. What is this
called?
a. Bruit
b. Murmurs
c. Succusion Splash
d. Borborygmi
Correct Answer: D
Borborygmi
Audible intestinal rumbling sound
Intestinal obstruction, hunger pangs
Bruit/ murmurs
Indicates turbulent blood flow
Abdominal aortic aneurysm
o Prolonged uncontrolled hypertension
o Atherosclerosis
Renal artery stenosis
Hepatoma: blood flow due to
neovascularization
Abscess
Succussion splash
Combination of air and fluid
Drinking large volume on empty stomach
Normal gas emptying (disappears) in 2-4 hrs.
A very loud splash + distention suggests
obstruction in stomach w/gastric dilatation
5. Nurse Dany was educating a bunch of
tourists who are about to go to Palawan
about Malaria. All are correct except?
a. It is transmitted by Anopheles species of
mosquitoes
b. These are night-biter mosquitoes, that
can transmit malaria between Between
4pm to 4am.
c. Anopheles mosquitoes breed best in fast-
running waters like rivers
d. All are Correct
Correct Answer: C
ANOPHELES: vectors of malaria
Night Biters: Feed on animals blood at night;
Between 4pm to 4am
-Anopheles breed best in slow-running, clean,
and shaded waters: Rivers, creeks, stream
-Not in salt water-> Salinity of water could kill the
eggs; Larva of the Anopheles mosquito cannot
breed in fast-running water
- Essence in the Medical Field: If we want to
control the infection in a particular place, you
must diminish the vectors-> How? DESTROY THE
BREEDING PLACES
You cannot be a donor if you came from an
endemic place within 6 months because they
can remain dormant in the liver
Its Tebow Time! Good Luck!

The anopheles sp. carry malaria:
BASED ON SEVERITY (Most severe to less severe)
1. Plasmodium falciparum
2. Plasmodium vivax
3. Plasmodium ovale
4. Plasmodium malariae
Anopheles Mosquito, the one that transmits
Malaria, is having their hind part pointed upward
(2nd picture).
Aedes/Culex Mosquitoes cannot transmit
Malaria; Only Anopheles Mosquitoes because
their life span is enough to support the life and
development of the parasite in them. Instead,
the Aedes are responsible for carrying dengue
fever.
-Take note that Filarial womrs, the ones that
causes Filariasis, Exhibit nocturnal periodicity:
Most abundant between 10:00pm and 2:00am
Vectors of Filariasis (W. bancrofti: Species of
Aedes, Anopheles, Culex, and Mansonia
Medicine for Malaria:
Tetracycline: Not necessarily an Anti-Malarial
drug, it is an antibiotic but somehow it can affect
the organism
-If you administer Anti-Malarial drugs with a high
dosage, patient might end up having SEIZURE
-When you look at the Intrahepatic Stages, which
among the drugs will have the greatest ability to
kill the parasite? PRIMAQUINE. This is alos given so
that the gametocytes would die, which are
important in their life cycle.
Take note because they may ask this too for
the exam:
Prophylactic Malaria Medication for
Travelers:
Chloroquine : If the place has NO resistant P.
falciparum -500 mg weekly
Malarone: if the place has Chloroquine
resistant P. falciparum
-1 tab ( 250 mg Atovaquone/100 mg
Proguanil) AtoQ, ProG
Mefloquine: With chloroquine resistant P
falciparum - 250 mg weekly
Doxycycline: MULTIDRUG resistant P
falciparum -100 mg daily
Primaquine: Terminal prophylaxis: P vivax P
ovale ; alt for 1 prevention
- 52.6 mg ( 30 mg base) daily for 14 days
after travel, for 1 prevention, 52.6 mg ( 30
mg base)
General Instructions for taking prophylaxis:
*Begin 1-2 weeks before departure ( except
2 days before for Doxycycline & Malarone),
and continue for 4 weeks after leaving
endemic area ( except 1 week for
Malarone) & continue for 4 weeks after
leaving endemic area ( except 1 week for
Malarone).
6. Mommy Tin noticed that her 4-yr. old
daughter keeps on scratching her anus at
night. Sometimes it is painful. Nurse Ray
described it as nocturnal pruritis ani. What
kind of parasite could have caused this
itchiness?
a. Hookworm
b. Pinworm
c. Tapeworm
d. Whipworm
Correct Answer: B
Pinworm or Enterobius vermicularis. AKA
seatworm, the female worms lay their eggs
near the anus at night, when the host is least
active so it causes intense itching that can be
perceived as pain at times.
Its Tebow Time! Good Luck!
For tapeworm, or Taenia saginata/solium, it
causes itching when the host is active, but not at
night ( coz not active).
Whipworm, or Trichuris trichiura can cause allergy
in the colon, or mechanically cause irritation by
affecting plexuses of nerves in the intestinal walls
resulting to relaxation of anal sphncter muscles.
Hookworm ( Necator americanus) can cause skin
irration "ground-itch lesion" or may affect the
lungs (pneumonitis, fever) and the intestines ( inc
in peristalsis), or anemia
7. Nurse Kelly has a patient with Parkinsons
Disease who is taking Carbidopa-Levadopa
(Sinemet). To help increase absorption of the
drug, Nurse Kelly should tell her patient to
avoid eating the following foods while
taking Sinemet EXCEPT:
a. Waffles
b. Egg Sandwich
c. Fruit Shake
d. Cheesy Eggdesal
Correct Answer: C
All EXCEPT C contain protein.
Levodopa provides a dopamine replacement in
Parkinson's disease.
It is Rapidly absorbed from the SI, BUT Food
delays absorption -> Amino acids (PROTEIN) in
the food compete w/ the drug (so don't take it
with food as needed!)
Parkinsons Disease:
Genetic, <50 y/o in 10-15% of cases
Mutation of -synuclein gene at 4q21 handwriting.
Sucleinopathy
Environmental or endogenous toxins
Increase risk in health care, teaching,
farming, Pb & Mg exposure, and Vitamin D
deficiency
Drug induced: antipsychotics and MPTP
Reduced level of Dopamine in the basal
ganglia
The main pathological feature of Parkinsons
disease is the loss of the dopaminergic
nigrostriatal pathway.
- Dopaminergic neurons in the substantia nigra
that normally inhibit the output of GABAergic
cells in the striatum are lost.
- 80% of the Dopamine producing cells must be
lost before symptoms begin to show
GOALS OF TREATMENT
- Pharmacologic attempt to restore
dopaminergic activity w/ Levodopa and
dopamine agonists.
- Restore normal balance of cholinergic &
dopaminergic influences on the basal ganglia
Also, there would be a period when the drugs
taken for Parkinsons temporarily stops working.
FYI: Take note of the following for
ABNORMAL MOVEMENTS:
1. TREMOR: rhythmic oscillatory movement
around a joint
- Can be physiologic (anxiety, etc.)
- At rest: Parkinsonism (pill-rolling tremors)
- Postural tremor: benign essential tremor
- Intention tremor: cerebellum tremor, alcohol,
drug abuse
2. CHOREA: Irregular, unpredictable involuntary
jerks; signifies impaired voluntary activity
*Ballismus: violent jerks
3. ATHETOSIS: slow & writhing abnormal
movements
4. DYSTONIA: sustained abnormal postures
5. TICS: sudden coordinated abnormal
movements about the face and head
- ex: Repetitive sniffing, Shoulder shrugging, Gilles
de la Tourette Syndrome
6. Bradykinesia: Difficulty initiating and
continuing movement
7. Postural instability: Forward flexion of neck,
hips, knees, and elbows leads to poor balance.
8. Gait disorders: Shuffling, small steps described
as festination, reduced arm swing, and sudden
freezing spells lead to problems in walking.
9. Handwriting micrographia ( patients with
Parkinsons have smaller than their usual
8. Hiro, was extremely nervous before his big
speech, so he was given diazepam orally. Which
of the follow is NOT an expected effect of the
drug?
a. calming effect with reduction in anxiety
b. Increases REM (Rapid Eye Movement) sleep
c. May cause anterograde amnesia
d. Reduce Anxiety, stress, & tension
Correct Answer: B. It INCREASES REM sleep ( part
of stages of sleeping).
Benzodiazepines (drugs that end in "pam" or
"lam" like diazepam or midazolam: their Action is
to increase the frequency of opening of GABA-
mediated chloride ion channel opening. You
know how GABA causes inhbition? so by inc
GABA, the pateint can become relaxed. That is
also why diazepam is used for seizures, because
in seizures, there is an active firing of Glutamate.
This is different from BARBITURATES which Increase
duration of the GABA-gated channels opening
Its Tebow Time! Good Luck!
such as "TAL" drugs like phenobarbital or NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTI)
thiopental. Abacavir
Didanosine
Emtricitabine
Lamivudine
Stavudine
Tenofovir
Zidovudine

ENTRY INHIBITORS
Enfuvirtide
Maraviroc

NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITOR

(NNRTI) vir-
Delavirdine
Efavirenz
Etravirine
Nevirapine
Rilpivirine

INTEGRASE STRAND TRANSFER INHIBITORS (INSTI)

-gravir
Dolutegravir
Elvitegravir
Raltegravir

PROTEASE INHIBITORS (PI) -navir

Atazanavir
Darunavir
Fosamprenevir
Indinavir
Lopinavir
FYI: Antidote for benzodiazepine is FLUMAZENIL. Nelfinavir
Approved for use in reversing the central nervous Ritonavir
system depressant effects of benzodiazepine Saquinavir
overdose and to hasten recovery following use of Tipranavir
these drugs in anesthetic and diagnostic
procedures. Also, take note that when someone is HIV positive, the
results cant be disclosed to them without having a
counselor with them during the disclosure.
9. Nurse Mary is an HIV Counselor at an HIV Hub.
She is discussing how a combination therapy of 10. Nurse Jane was at th ER. The doctor is suspecting
HIV drugs must be taken by her patient to that the patient who just walked it has hyperglycemia
effectively combat HIV. HAART (highly active due to diabetes. What type of blood sugar test should
antiretroviral therapy), which is the Standard Nurse Jane anticipate?
Care where 3-4 agents (NRTI + NNRTI + PI +
Fusion inhibitors) are to be used by the patient. a. Fasting Blood Glucose
Which is an example of an NRTI drug? b. Glucose Challenge Test
c. Random Blood Sugar
a. Zidovudine
d. OGTT
b. Efavirenz
c. Darunavir Correct Answer: C. Also, take note that if a random
d. Maraviroc blood sugar will be taken, it could be a false normal
when taken through capillary blood sugar testing
Correct Answer: A because whole blood 15% lower than plasma, so to be
NRTI drugs have no specific pattern. accurate, PLASMA must be used.
Protease Inhibitors end in "Navir"
NNRTI has -vir- in the middle of the word Test for hyperglycemia
Integrase inhibitors have -tegravir ending. - Random Blood Sugar (RBS)- no preparation, ER
request, <140mg/dL
These are very NICE TO KNOW ONLY. Here in Philippines, - Fasting Blood Sugar (FBS)- 8 hour fast (no drugs, water,
we still use Zidovudine because not a lot of HIV + food); patient usually
people have developed resistance against HIV drugs. starts after dinner and go to laboratory in the morning;
most often used for screening and diagnosis of DM
- 2 hour post prandial - 2 hours after eating, used for

Its Tebow Time! Good Luck!

screening and diagnosis of DM in patients who have
difficulty fasting
OGTT
- Patient fasts for 8 hours
- Baseline blood sample taken
- 75 grams (WHO) or 100 grams of glucose consumed
within 5 minutes
- Blood extracted at 1 and 2 hours
- fasting 95 mg/dL
- 1 hour 180 mg/dL
- 2 hours 155 mg/dL
- 3 hours 140 mg/dL
* used to differentiate pre diabetes from DM, GDM
Glucose challenge test
- Done between 24th and 28th week
- Screening for pregnant who:
has had GDM during previous pregnancy
gave birth to a baby who weighed >8.8 lbs
> 25 yo
overweight before pregnancy
- Plasma glucose measured 1 hour after a 50 gram
glucose load
- no fasting - (+) 140 mg/Dl
Also, at our Board exam in 2015, they used the unit
mmol, so take note!
11. Nurse Darren was assisting a doctor here in
Philippines in checking a patients arterial blood gases.
What should be the most important step to be done first
before the procedure?
a. Perform Fluid Wave Test
b. Check blood pressure of patient
c. Perform Modified Allens Test
d. None of the above.
Correct Answer: C! Check first if site where ABGs will be
taken is patent!
Perform Modified Allens test check for patency of
ulnar artery by occluding the radial artery. *Allens test
patency of both ulnar and radial artery.
- To ensure that ulnar artery is patent so that there will
be collateral circulation in case of thrombosis or else
pxs arm will lose blood supply.
Instruct the px to clench his/her fist (if not capable,
clench their fist). Using your fingers, apply occlusive
pressure to ulnar and radial arteries. Have the px open
his/her hand. Pxs hand must be
blanched/whiter/paler. Release the pressure on ulnar
artery, the hand should flush. (+) hand flushes w/in 5-
15secs after release. (-) hand does not flush w/in 5-
15secs after release.
Performing Allens test on your own:
Occlude radial artery and flex your arm as tight as
possible then extend your arm while still holding radial
artery. Feel the rush of blood.
-Also, take note if the patient is taking OXYGEN! It will
affect the results!
Sites for Arterial Puncture: (order of preference: to )
- Radial - preferred site; very accessible; easy to
palpate the pulse and not embarrassing for the patient.
- Femoral - next choice for AB collection; big but
located in a very secret spot. Relatively easy but
makes px uncomfortable; hard to control the bleeding.
- Brachial very hard to access; sometimes resort to a
cut-down in order to expose blood vessel.
There will be like 10 questions related to interpreting
ABGs, so know it!
Reference Values (memorize by heart! )
pH 7.35 7.45
pO2 85 100mmHg
pCO2 35 -35mmHg
Base excess +/- 5 (not significant yet)
HCO3 21 28 meq/L
pH of life (max &min pH) 6.8 7.8
Steps in Interpretation
1. Evaluate the pH (if normal, dont stop, continue to
other parameters) pH < 7.35 = acidosis pH > 7.45 =
alkalosis
2. Evaluate the Ventilation (CO2 = Acid) pCO2 <
35mmHg = Hyperventilation (alkalotic) pCO2 >
45mmHg = Hypoventilation (acidotic)
3. Evaluate the Metabolic Process HCO3 < 21meq/L
(acidosis)
o acid accumation
o production of HCO3 HCO3 > 28meq/L (alkalosis)
o acid accumulation
o production of HCO3
Compensation
- When you have respiratory problem; HCO3 will
compensate
- When you have a HCO3 problem; respiratory will
compensate
1. Uncompensated only 2 values are abnormal:
o pH
o pCO2 or HCO3 (never both)
2. Partial Compensation 3 values are abnormal:
o pH (getting closer to normal)
o pCO2 and HCO3
3. Full Compensation pH is NORMAL 2 values are
abnormal: o pCO2 and HCO3
Example:
Its Tebow Time! Good Luck!
12. Nurse Philip was caring for patient who was has
Muay Thai & boxing as a hobby. While taking vital signs,
the patient complained of a headache that is 10/10 on
the pain scale. He yelled, Shiz! This is the WORST
headache Ive ever had in my life! What should Nurse
Philip say?
a. Hold on, let me call the doctor!
b. Lets wait a little bit, maybe it will go away.
c. Just put your head down so it will get better.
d. Let me get your pain medication.
Correct Answer: A, Headache that is so severe that is
often described as the WORST Headache can be
subarachnoid hemorrhage, especially if there is a
traumatic injury.
Headache Warning Signs:
-Progressively frequent or severe over a 3-month period
-Sudden onset like a "thunderclap" or "worst headache
of my life"
-New onset after age 50 years
-Precipitated by Valsalva maneuver (coughing/
sneezing)
-Associated symptoms of fever, night sweats, weight
loss, Recent head trauma
-Papilledema, neck stiffness
13. Nurse Jonel was taking his patients history of
smoking. The patient somkes 1 pack per day for
40 years. Calculate the pack-year history of this
patient.
a. 20 pack years
b. 30 pack years
c. 40 pack years
d. None of the above
Correct Answer: C.
Pack years is aclcualted as
No of years smoking x (sticks per day divided by
20)
14. Nurse Dannah was at the Mental Hospital at
Mandaluyong. During a therapeutic
communication with a mental patient, the patient
told Nurse Dannah that he will kill his neighbor
when he gets out of the Mental Hospital. He even
discussed the complete name to Nurse Dannah.
What should Nurse Dannah do?
a. Laugh and play along
b. Report it to the Nurse-on-duty
c. Provide an extensive therapeutic
communication & write everything that the
patient said on her confidential nursing
paperwork
d. Ignore the comment and change the topic
Correct Answer: B
The patient WILL HARM THE NEIGHBOOR when he
comes out! The neighbor must be warned!
-When the information provided by the patient
can be dangerous to others or himself, the
dilemma of protective privilege vs public peril
ARISES.
EX: if a patient informs his therapist that he is
planning to kill Mr. X, should the psychiatrist
inform Mr. X or the police, so that protective
measures could be taken? Similarly, if a bus or
train driver suffering psychosis poses threat to the
public safety, should the psychiatrist inform the
police or remain silent?
CONFIDENTIALITY ENCOURAGES CARE FOR
MENTAL ILLNESS
-During therapy, patients reveal their innermost
emotions, fears, and fantasies. Maintaining
confidentiality respects the personal and
sensitive nature of such information, encourages
patients to seek mental health care and to be
candid with physicians, and protects patients
from stigma and discrimination.
-Special protection to psychotherapy notes
require specific patient authorization to disclose
them. (Federal privacy regulations, some state
laws)
15. Nurse Taliyah is tending to a pregnant patient
who has a cancerous uterus. She needs an
abortion. What type of abortion is this, and is it
licit or illicit?
a. Direct Abortion, licit
b. Indirect Abortion, licit
c. Therapeutic Abortion, illicit
b. Eugenic Abortion, illicit
Correct Answer: B. Licit= anything pro-life &
justifiable. Illicit= Bad!
INDIRECT ABORTION
The ethical principle to follow, it is maintained,
is to save the life of the mother, if both lives
cannot be saved.
It would be unreasonable not to remove the
fetus and let both human lives perish.
Its Tebow Time! Good Luck!
 Right reason, it is contended, dictates that it is b. Stage 3
better to save one life than to let both human c. Stage 4
beings die d. Stage 5
Double Effect Principle (a good effect as well as Correct Answer: D This is Stage 5: adjustment to
an evil effect will result from a good cause) permanency of outcome
Not every evil effect must be avoided simply
because it flows from a good cause. Some evil Impact of Illness
effects, voluntary in cause, ma be permitted to EFFECTS OF ILLNESS
occur provided certain conditions are fulfilled.
Nice to know, other types of abortion:

NATURAL ABORTION
Expulsion of the fetus through natural or
accidental causes
Lay peoples term Miscarriage or Nakunan
Unintentional and involuntary leisure
Devoid of moral significance
transmission
DIRECT OR INTENTIONAL ABORTION e whole family suffers
Deliberately induced expulsion of a living fetus OUTCOME OF IMPACT OF ILLNESS
before it has
become viable. -> disequilibrium
With intention of inducing abortion -Rate at which the family recovers and the level
Intentional and voluntary of functioning during and after the crisis are
EUGENIC ABORTION indications of family health
Recommended in cases where certain defects petal (support towards patient) vs
are discovered in the developing fetus. centrifugal (away from patient)
The argument is that it is better for a child not to
be born than for it to lead a miserable life, - How family respond to normative and non-
burdened with crippling genetic normative
disorders.
It is meant to get rid of abnormal babies (birth
defects and deformities), and thus prevent them s and life
from contaminating the human species. cycle stage
Also known as Selective abortion or Abortion - Acute or chronic disease
on fetal indications in the sense that it is only
recommended on a caseto- case basis, STRESS-ILLNESS-FAMILY (Engle)
depending upon the gravity of fetal indications
or abnormalities.
THERAPEUTIC ABORTION
Deliberately induced expulsion of a living fetus
in order to save ILLNESS TRAJECTORY
the mother from the danger of death brought on 1. Stage 1 onset of illness
by pregnancy.
The health and life of the mother are
considered paramount in this case.
**Do not confuse Indirect & therapeutic abortion. provide influence to meaning of illness
In Therapeutic, moms life is paramount. In
indirect, there removal of the fetus occurs as a Acute serious illness/death
secondary effect of a legitimate or licit action will affect
coping mechanism
16. Nurse Nicky was tending to a family who had -of-phase" phenomenon
a member who had an amputation of Lower Left - upheaval of rules
leg. She noticed that the the family had fully and roles
realized and accepted the permanet disabilty of
that member. What STAGE of ILLNESS TRAJECTORY
is this? Chronic illness - Chronic phase
a. Stage 1

Its Tebow Time! Good Luck!

abnormal circumstances management skills
fatigue

member Chronic/gradual

doctor family - increasing task

- caregiver fatigue
4. Stage 4 early adjustments to outcome -
symptom soon enough recovery
- suspected
malingering patients (patients pretending sick - sick role to some form of
even if without illness) recovery or adaptation
2. Stage 2 reaction to diagnosis - impact phase e family
Anticipated outcome
clinical judgement
-amount of info patient can absorb given his 5. Stage 5 adjustment to permanency of
present level of anxiety (how much the patient outcome
want to know, do not bombard patient with
knowledge)
Red flags
-patient and family may not be able to receive
much info
-give small dose of info over time
ease and appropriate treatment
-terms that patient can understand, avoid
medical jargons, slang words and euphemism
Emotional plane

depression, acceptance)
Acceptance and accommodation
-important in the implementation of therapeutic
plan
Cognitive plane
-enable to mobilize resources
-family should be helped to anticipate such
feelings
-make realistic efforts to relieve self-blame
through careful explaining of etiology
3. Stage 3 major therapeutic efforts
medical practice
Psychological state (patient and family)
-Beliefs, cost of treatment, lifestyle, cultural
characteristics
-Stressful effect of hospitalization (surgery)
Acute (stroke)
e to adjust
make the dysfunction more pronounced
of the family because they
are our closest allies in the care of our patient
17. Nurse Belldandy was talking to a post-surgery
patient who also has tons of problems to deal
with in real life. Belldandy said, "While you were
talking about your dog, I noticed you were
clenching and unclenching your fist. What does
that mean?"
This is an example of?
a. Paraphrasing
b. Perception Check
c. Reflecting Feeling
d. Reflecting Experience
Correct Answer: D
Reflecting Experience
h reflect some
emotional state, but the feeling is not articulated
- The nurse can mirror the nonverbal behavior back to
the patient and ask for clarification as to what the
behaviour means
Other examples of Reflecting Skills:
a. Reflecting Content
o Paraphrasing
summary of the basic message

Its Tebow Time! Good Luck!


which the patient has not mentioned
o Perception Check
you heard
patient about the accuracy of your
perception of what was said
if it was inaccurate
b. Reflecting Feeling
tients
essential feelings, stated or strongly implied
EXAMPLE: Post-MI Husband
I really love my wife. She does many things for me
constantly. She reminds me of my medicines, she sees to it
that I get to sleep early, she fusses about my food, she
keeps track of where I am all the time because she said
that she is worried about me. Sometimes, though, I cant
breathe because of all these things.
Paraphrase: You appreciate all these things that your wife
is doing for you, but it kind of suffocates you.
Perception Check: You appreciate all these things that
your wife is doing for you, but it kind of suffocates. Is that
right?
Reflecting Feeling: You appreciate your wifes 6. Attentive Silence
attentiveness, but it somehow irritates you, doesnt it
Reflecting Experience: While you were talking about your
wife, I noticed that you were clenching and unclenching
your fist. What do you thing could that mean?
Other Active Listening Skills! Must Know!
A. Opening Skills
Use of opening skills gives the physician a clear picture
of the patients problems (biomedical and
psychosocial)
Aids in building physician-patient rapport which can lay
the foundation for patient counselling (if necessary)
Consists of:
1. Attending Skills
Involves the listener giving his/her physical attention
to the speaker
Form of nonverbal communication
Indicates that the listener is focusing his/her complete
attention on the speaker
Includes:
a. An attentive, open posture
b. Appropriate body movement
c. Appropriate eye contact with speaker
d. An open and receptive facial expression
e. Establishing a non-distracting environment
2. Bracketing
Form of psychological attending
Mental skill which involves suspending ones own
judgements and feelings and then setting aside them
for a while in order to listen more fully to the patient
3. Leading Skills
a. Indirect Lead
Open invitation by the doctor to the patient to talk
about whatever concerns him
What would you like to talk about? 8-10: Highly functional
What can I do for you? 4-7: Moderately dysfunctional
Includes minimal nonverbal encouragers like: Yes, 0-3: Severely dysfunctional
Go on, And then?, Uh-hmm, I see, Mm-mm =
indicates that the listener is listening and following what
the speaker is saying
Encourages the speaker to continue talking
b. Direct Lead
Doctor chooses direction in which to go
Tell me more about...
Lets talk about
Im wondering about
4. Focusing
Ask the patient to do the choosing of what is most
important to him
Example: So you feel afraid, angry, guilty, and
frustrated. But of these four, which is the feeling that is
giving you the most pain?
5. Probes
Questions that the doctor can ask in order to find
more about how the patient is reacting to the illness
Ask open-ended questions that cannot be answered
by yes or no
Avoid why questions
Better to use how, what, could you please
explain
It is better to probe the feeling than to probe the
event
How does that make you feel?
Tell me more about that feeling
Hardest skill to master: WHY? Because people often
feel uncomfortable with silence and feel the
compulsion to jump in and fill the silence
Times during an interaction when silence is the most
appropriate response:
a. When the speaker is thinking and searching for a
response If the silence comes in too quickly, he/she
will prevent the speaker finding his/her response
b. When the speaker is emotionally distressed Silence
allows him/her to experience the distress, regain
composure and continue the communication
c. Minimal encourager followed by silence Indicates
to the speaker that you would like him or her to
continue talking
18. During an interview with a assigned patient in the
community, Nurse AR was performing Family APGAR.
When the patient said I can turn to family for help
when something troubles me, This is an example of:
a. Adaptation
b. Growth
c. Affection
d. Resolve
Correct Answer: A
Adaptation is the familys Capability - to utilize and
share inherent
resources, whether intra- or extra-familial
Family APGAR Smilkstein
O To assess family function or dysfunction
O Part I APGAR score based on 5 questions
Scoring:
Almost always - 2
Sometimes 1
Hardly ever 0
Points:
Its Tebow Time! Good Luck!
 It can be seen when: members speaking for one
ADAPTATION I can turn to Capability of family another, continual interruption when one is speaking,
family for help to utilize and share high levels of emotionality, and unwillingness to discuss
when something inherent conflict where family members flare up angrily with
troubles me resources, whether
slgiht provocation.
intra- or extra-familial
PARTNERSHIP I am satisfied with Sharing of decision
-Kids have no freedom to express oneself, can't fulfill
the way my family making. roles.
shares Measures the Seen in adults kids that are still puppets to their parents
problems (etc) w satisfaction attained Disengagement- Rigid Boundaries, Emotionally distant,
me in solving Unresponsive to each other. Ex: a child had a fracture,
problems by all members are too busy to care of him.
communicating
GROWTH I am satisfied that Physical and
20. Riou is a comatose patient, not yet brain dead. He
my family accepts emotional growth
and Measures satisfaction could possibly die within the next few months. He was
supports my wishes of available freedom disconnected from the mechanical ventilator, but food
to take on new to is still given through enteral feeding. Which of the
directions and change following is TRUE?
activities. a. It is okay to maintain him on enteral feeding
AFFECTION I am satisfied w Measures members because it is an ordinary means of preserving life
the way my fam satisfaction with the
b. It is not okay to disconnect him from the mechanical
expresses intimacy
affection and and emotional
ventilator because all extraordinary means to keep
responds to my interaction that exist someone alive must be done at all cost
emotions in the family c. It is not ok to stop providing treatments for this
RESOLVE I am satisfied with Refers to how time, patient especially since there is a good chance of
the way my family space, and money recovery.
and I spend are shared. d. All of the above are true
time together. Measures members Correct Answer: A
satisfaction with the
commitment made
-It is ok to discontinue extraordinary means of
by other members of preserving life ( mechanical ventilator), especially if the
the family outcome of the patients care would be poor. It is NOT
OPart II APGAR Questions: okay to discontinue the ordinary means of preserving
1. Who lives in your home? Include Relationship, Age life ( food, water) especially since theres no exact
Sex. date when patient will die.
2. How well do you get along? -One can stop providing treatment especially if the
3. If you dont live w family, who do you turn to for prognosis seems poor & no way of returning the patient
help? Include Relationship, Age, Sex. to previous health.
4. How do you get along?

19. Harry, Hermione, and Ron are siblings. Ron

and Harry had a fight and refuses to speak to one
another so Hermione serves as a bridge between
the two when arguing. What term in the family
process best describes this situation?
a. Enmeshment
b. Scapegoating
c. Triangulation
d. Disengagement

Correct Answer: C.
Triangulation- Conflict avoidance, Two ppl in an
argument involve a third person in their
mess to avoid talking about their real problems
Scapegoating- is when one member bears the blame
for the problems confronting the family
Enabling: any conscious or unconscious behavior that
encourages an individual to continue acting in a
specific manner-> shielding a person from the
consequence of the behavior. "Pinagtatanggol, hindi
Good luck & God bless! Transcribed by Jezreel
hinaharap that the person had done something Bon Juanitez from various notes for learning
wrong. purposes only.
Enmeshment: too much cohesiveness. Famility
members are overprotective and overreactive, they
control situations by not making other members
explain.

Its Tebow Time! Good Luck!