Contoh soal

6. As you are working you suspect that another licensed practical nurse is
verbally and physically abusing a patient. What is the first thing that you will
do?

A. Nothing because you are not certain that it is occurring

B. Nothing because you only suspect the abuse
C. Call the police or the security department
D. Report your suspicions to the charge nurse

Answer: D. Nurses and other healthcare providers are mandated by law to report all suspected abuse
and neglect. You do NOT have to be certain about it; an expert will perform the investigation. You do
not contact the police or the security department; the charge nurse will follow established procedures
for notifications not the licensed practical nurse.

During which phase of the nursing process does data get collected and validated
with the patient and/or family members by the nurse?

A. The implementation phase

B. The assessment phase
C. The evaluation phase
D. The planning phase

Answer: Correct Response: B

Subjective, objective, primary and secondary data is collected and validated with the patient
and/or family members by the nurse during the assessment phase of the nursing process. The
implementation phase is the actual care of the patient; the evaluation phase includes the
comparison of current data to expected outcomes to determine if the patient has achieved the pre-
established goals and the planning phase consists of priority setting and care planning.

3. Which of the following is the best worded expected outcome?

A. “The nurse will provide for adequate hydration”

B. “The nurse will insure that the patient is safe”
C. “The patient will cough and deep breathe every two hours”
D. “The patient will value health”

Answer: Correct Response: C

“The patient will cough and deep breathe every two hours” is the best worded expected patient
outcome. This outcome or goal is specific, measurable, achievable, realistic, within a specified
timeframe, trackable and it should be agreed to by the patient. All expected outcomes are worded
in terms of what the patient, not the nurse, will do and it should also be specific and measurable.
“The patient will value health” is not measurable.

After your patient has been told that they have Cushing’s syndrome, the patient
asks you what Cushing’s syndrome is. How would you respond to this patient’s
question?

A. “Cushing’s syndrome is a type of irritable bowel syndrome.”

B. “Cushing’s syndrome is a disorder of the adrenal gland.”
C. “Cushing’s syndrome often occurs among patients who are getting radiation therapy.”
D. “Cushing’s syndrome often occurs among patients who are chemotherapy.”

Answer: Correct Response: B

Cushing’s syndrome is a disorder of the adrenal gland. It results from the chronic hypersecretion
of glucocorticoids from the adrenal cortex. It is Crohn’s disease, not Cushing’s syndrome, that is
a type of irritable bowel syndrome and, there is no relationship between Cushing’s syndrome and
radiation or chemotherapy.

You are working in a pediatric unit of the hospital and caring for a six year old
boy who is hospitalized with cystic fibrosis and respiratory compromise. Which
developmental task is the challenge for this boy at his age?

A. To cough, deep breathe and improve respiratory status

B. To establish industry and self confidence
C. To develop autonomy and self control
D. To develop initiative and a sense of purpose

Answer: Correct Response: D

According to Erik Erikson, a developmental psychologist, the preschool child is challenged with
initiative, the development of confidence and a sense of purpose. The other age groups along the
life span and their developmental tasks are listed below:

Infant: Trust
Toddler: Autonomy, self control and will power
School Age Child: Industry, self-confidence and competency
Adolescent: Identity formation and a sense of self
Young Adult: Intimacy, affection and love
Middle Aged Adult: Generativity, productivity and concern about others
Older Adults: Ego integrity, wisdom and satisfaction with life

49. What is the single most important thing that nurses do in order to prevent the
spread of infection?
 A. Applying standard precautions
B. Using personal protective equipment
C. Adhering to the principles of asepsis
D. Handwashing

Answer: Correct Response: Handwashing is the single, most important thing that nurses, and
other healthcare professionals, can do in order to prevent the spread of infection. Applying
standard precautions, using personal protective equipment, as indicated, and adhering to the
principles of asepsis also prevent the spread of infections; however, handwashing is the single
most important thing to prevent the spread of infection.

Your 54 year old male HIV positive patient has just expired. How should you
care for this deceased patient?

A. Bathe the patient but it is no longer necessary to use standard precautions because the
patient is deceased.
B. Place the patient in an negative pressure isolated area of the morgue.
C. Double shroud the patient to prevent the spread of infection.
D. Bathe the patient using the same standard precautions you used when he was alive.

Answer: Correct Response: D

You should bathe your patient as part of post mortem care using the same standard precautions
that you did when the patient was alive. The patient is still infectious. Similarly, all patients are
bathed after death using standard precautions. Double shrouding and an isolation area in the
morgue with negative air pressure are not necessary.

69. You have just learned that another nurse was fired for taking photographs of
patients without their permission using a cell phone and posting them on Face
book. This nurse was fired because the nurse has:

A. Violated the law

B. Acted in a negligent manner
C. Not completed the proper documentation
D. Violated an ethical principle

Correct Response: A. This nurse was fired because the nurse has violated a federal law,
namely, the U.S. government’s Health Insurance Portability and Accountability Act
(HIPAA). This law protects the patients’ rights to the privacy and confidentiality of all
medical information, including written, oral electronic information, and personal identity
information like photograph taking unless the client has expressly consented to it in
writing. Negligence is failing to do something in the proper manner; this invasion of
patient privacy is far more serious than a breach of an ethical principle. Lastly,
 photographs and Facebook posting should never be done so proper documentation is not
required. It is still illegal documented or not.

Which of the following is a life threatening acute complication of diabetes

mellitus?

A. Neuropathy
B. Hypoglycemia
C. Retinopathy
D. Impaired microcirculation

Answer: Correct Response: B

Hypoglycemia is an acute complication of diabetes which can be life threatening. The immediate
treatment with glucose is necessary to preserve life. Retinopathy, neuropathy and impaired
microcirculation are examples of the long term, rather than acute, complications of diabetes.

74. Seorang laki – laki berumur 55 tahun sejak tahun 2010 sudah terkena
penyakit TBC
dan mendapat pengobatan OAT yang diberikan oleh dokter puskesmas . Menurut
informasi keluarganya yang menjadi PMO orang tersebut tidak minum obatnya,
bahkan masih suka mengkonsumsi makanan yang asin dan berlemak.

Apa yang seharusnya anda jelaskan mengenai tugas utama seorang PMO?

A. Memberi penyuluhan pada keluarga klien tentang TBC

B. Mengingatkan penderita untuk pemeriksaan kesehatan setelah obatnya habis
C. Mengawasi penderita dalam berobat ke palayanan kesehatan (Puskesmas)
D. Memberi dorongan kepada keluarga untuk mendapatkan biaya pengobatan HT
E. Mengingatkan klien agar menelan obat secara teratur sesuai dosis