Medical 5th Floor Ward Flavier Building, Baguio General Hospital and Medical Center

(Rotational Exam for NDA2)

Prepared by: Joel C. Pascua

Name of Student: ______________________________

Instruction: This is an open resources exam. Answer all the questions correctly indicating justification or rationale
proving your answers are correct. Indicate the resources where you got the answers and justification. This is a Right
minus wrong type of exam so please do read your resources and study hard.
1. Blood transfusion must be administered immediately because of loss of blood volume due to trauma. Luther’s
blood type is O. As Luther’s nurse, you recognize which of the following statements to be TRUE?
A. Type O blood has both types of antibodies
B. Persons with Type O blood can also receive Type A blood
C. Type O blood has no antibodies
D. Persons with Type O blood are also called universal recipients

2. Alejandro came to the hospital with chest pain and fever. After thorough assessment by the doctor, he was
admitted for pericarditis management. The nurse positions the client to reduce pain and discomfort. Describe
this position.
A. Prone position with one pillow to support the head
B. Put two pillows to elevate the head and one pillow under the knees
C. Sit the client upright and lean forward
D. Supine lying on either left or right side with one pillow to elevate the head

3. The nurse is aware that pericarditis pain varies from mild to severe and is typically aggravated by:
A. Coughing, talking and eating
B. Inspiration, coughing and movement of the upper body
C. Coughing, inspiration and movement of the lower extremities
D. C. Breathing, coughing and voiding

4. The nurse wants to know if the client is aware of the side effects of NSAID. What would be the most appropriate
question of the nurse?
A. “Are you aware that you can be addicted to the drug?”
B. “Have you ever vomited blood or noticed very black stools?
C. “How familiar are you with the drug?”
D. “Have you noticed something unusual with your urination?

5. The physician prescribed Furosemide (Lasix) 40 mg IV STAT. as the nurse who will administer the drug, which of
the following actions will you do after 20 minutes to determine if the desired outcome of the prescription has
been achieved?
A. Check cardiac monitor for signs of atrial fibrillation C. Auscultate heart and breath sounds
B. Measure central venous pressure D. Monitor urine output

SITUATION: Mr. Custodio, 52 years old, known diabetic (TYPE 2) is admitted with symptoms of high blood pressure of
190/100 mmHg, an unhealed wound on his right big toe and has bi-pedal edema. He is on insulin. Co-management by
the health team is recommended in the care of Mr. Custodio.

6. Based on the presenting condition of the client upon admission, the nurse would immediately refer Mr.
Custodio to a/an:
A. Endocrinologist for management of diabetes mellitus
 B. Dietitian for nutritional management
C. Cardiologist to stabilize blood pressure
D. Diabetes nurse educator for self-management of symptoms

7. The head nurse calls for a meeting of the staff nurses to plan care management for Mr. Custodio. The priority
nursing action in the care of the client would be:
A. Accurate insulin administration C. Accurate measurement of fluid intake and output
B. Blood glucose monitoring D. Monitoring of blood pressure

8. Upon assessment of the client’s lower extremities, the nurses notes the unhealed condition of the client’s
infected toe wound. The nurse would:
A. Prepare equipment to wash and disinfect the affected toe
B. Refer to attending physician for proper wound management
C. Call the head nurse for assistance as the nurse starts wound debridement
D. Call relative to gather information about cause of wound infection

9. The nurse learns that the client does not regularly do blood glucose monitoring and still has not learned how to
do self-administration of insulin. To learn these you will refer the client to:
A. Pharmacist C. Medical intern
B. Advance practice nurse D. Diabetes nurse educator

10. Mr. Custodio’s condition improves and discharge planning is initiated. This includes planning his nutritional
regimen to encourage compliance. The client will MOST likely be referred to:
Nutritionist B. Cardiologist C. Endocrinologist D. Dietician

SITUATION: An understanding of the infectious process and appropriate methods to protect the health workers and
client from disease is important. The following questions pertain to preventing transmission of infection.

11. The nurse is explaining standard protection to the client. This includes which of the following actions?
A. Wearing protective equipment when doing any nursing procedures
B. Hand washing using antimicrobial soap and water
C. Recapping of used needles with both hands then place in puncture resistant container
D. Using clean gloves to handle contaminated items, blood and excretions

12. The nurse is changing the wound dressing of the client. The MOST appropriate action of the nurse would be to:
A. Remove old dressing with sterile gloves
B. Wear sterile gloves whenever in contact with the area
C. Open the sterile dressings with sterile gloves
D. Pour antiseptic solution out of the container with sterile gloves

13. The client has an order for contact precaution. The nurse is to give her a bath. The precautionary measure that
the nurse observes is to use:
A. Face mask and gloves C. Gloves and gowns
B. Sterile gloves and cap D. Cap and face mask

14. The clinical instructor in the Surgical Unit is teaching the nursing students about the prevention of spread of
diseases in the care environment. Which of the following is the MOST important practical way to prevent the
spread of diseases?
A. Consistently washing hands C. Wearing gloves whenever giving care
B. Isolating infected clients D. Wearing cap and gown
 15. An active woman in her mid-twenties has been on weight loss diet of low carbohydrates and high protein diet.
She is successful in losing weight but is experiencing constipation. Which of the following should the nurse
advice the client to AVOID constipation?
A. Take over-the-counter laxatives to ease bowel movement
B. Try another type of diet that have less animal fat, like fish, chicken and low carbohydrates
C. Eat nutrient-dense food that are low calorie but have high nutrient value and fiber like broccoli, berries
D. Increase exercise activities to improve peristalsis

16. The nurse prepares the following equipment for blood transfusion EXCEPT:
A. 0.9% normal saline solution
B. IV infusion set with gauge with 22 needle
C. Blood product properly typed and cross matched with patient
D. Y type filter transfusion set

17. The nurse understands that normal saline solution is used to initiate the intravenous infusion rather than
dextrose solution before blood transfusion to:
A. Avoid cardiac overload
B. Maintain adequate hemoglobin content
C. Prevent increasing the blood sugar of the client
D. Avoid hemolysis and clumping of red cells

18. The nurse stays and observes closely the client after the start of the blood transfusion for possible transfusion
reaction which includes the following EXCEPT:
A. Hypovolemic reaction
B. Hemolytic transfusion reaction
C. Febrile reaction
D. Allergic reaction

19. After starting blood transfusion, the nurse should make sure that the blood is transfused to the patient with how
many hours from the time it started?
A. 12 hours B. 8 hours C. 10 hours D. 4 hours

SITUATION: The Philippines ranks ninth among the 22 high-burden countries for pulmonary tuberculosis (PTB). However,
there has been a significant decline in the tuberculosis burden ten years after the DOTS therapy was initiated.

20. A client exposed to tuberculosis is taking Isoniazid (INH) and develops signs and symptoms of the disease. The
client is instructed to add Rifampicin and Pyrazinamide to the medication regimen. A nurse explains to the client
that the purpose of adding this second medication is:
A. Rifampicin offsets the side effects of Isoniazid
B. To be certain that resistant organisms are eliminated
C. These medications potentiate each other
D. Isoniazid offsets the side effects of Rifampicin

21. A nurse has given a client, who is taking Ethambutol, information about this medication. The nurse determines
that the client understands the instructions if the client states and immediately reports:
A. Epigastric pain C. Orange-red discoloration of body secretions
B. Impaired sense of hearing D. Difficulty in discriminating the color red from green
22. Staff nurses learn that a client they have been caring for during the last few weeks has just been diagnosed with
tuberculosis. When the nurse expresses concern about contracting tuberculosis themselves, the charge nurse’s
response should be based on which of the following statements?
A. Tuberculosis is easily treated with short course of antibiotics.
B. The Mantoux test is used to confirm diagnosis of tuberculosis.
C. Tuberculosis is not highly infectious when standard precautions are followed.
D. Vaccination with BCG will be used to immunize the nurses against infection.

23. A client who is taking INH, Rifampicin, PZA and Pyridoxine for the treatment of tuberculosis asks a nurse why the
Vitamin B6 (pyridoxine) is necessary. The nurse would respond that:
A. “Vitamin B6 is necessary for the absorption of INH.”
B. “Vitamin B6 activates the metabolism of INH.”
C. “INH competes with the absorption of Vitamin B6, which leads to depletion.”
D. “INH causes nausea and vomiting which leads to inadequate intake of Vitamin B6.”

24. The client with TB is to be discharged home with community health nurse follow-up. Of the following
interventions, which would be the highest priority?
A. Offering the client emotional support
B. Teaching the client about the disease and its treatment
C. Coordinating various agency services
D. Assessing the client’s environment for sanitation

25. The nurse enters the room of a client with chronic obstructive pulmonary disease. The client's nasal cannula
oxygen is running at a rate of 6 L per minute, the skin color is pink, and the respirations are 9 per minute and
shallow. What is the nurse’s best initial action?
A. Take heart rate and blood pressure. C. Lower the oxygen rate.
B. Call the physician. D. Position the client in a Fowler's position.

26. The nurse is preparing her plan of care for her patient diagnosed with pneumonia. Which is the most
appropriate nursing diagnosis for this patient?
A. Fluid volume deficit C. Impaired gas exchange.
B. Decreased tissue perfusion. D. Risk for infection

27. Which of the following is the most commonly cause of Pneumonia in adult?
A. Mycobacterium Pneumoniae
B. Mycobacterium Tuberculosis
C. Streptococcus Pneumoniae
D. Haemophilus Influenzae

28. 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 next best action for the nurse to take is to:
A. Encourage the guest to eat some baked macaroni
B. Call the guest’s personal physician
C. Offer the guest a cup of coffee
D. Give the guest a glass of orange juice

29. What is the best reason for the nurse in instructing the client to rotate injection sites for insulin?
A. Lipodystrophy can result and is extremely painful
 B. Poor rotation technique can cause superficial hemorrhaging
C. Lipodystrophic areas can result, causing erratic insulin absorption rates from these
D. Injection sites can never be reused

30. Which of the following would be inappropriate to include in a diabetic teaching plan?
A. Change position hourly to increase circulation
B. Inspect feet and legs daily for any changes
C. Keep legs elevated on 2 pillows while sleeping
D. Keep the insulin not in use in the refrigerator

31. What instructions should the client be given before undergoing a paracentesis?
A. NPO 12 hours before procedure C. Strict bed rest following procedure
B. Empty bladder before procedure D. Empty bowel before procedure

32. The husband of a client asks the nurse about the protein-restricted diet ordered because of advanced liver
disease. What statement by the nurse would best explain the purpose of the diet?
A. “The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive
system.”
B. “The liver heals better with a high carbohydrates diet rather than protein.”
C. “Most people have too much protein in their diets. The amount of this diet is better for liver healing.”
D. “Because of portal hyperemesis, the blood flows around the liver and ammonia made from protein
collects in the brain causing hallucinations.”

33. A Sengstaken-Blakemore tube is inserted in the effort to stop the bleeding esophageal varices in a patient with
complicated liver cirrhosis. Upon insertion of the tube, the client complains of difficulty of breathing. The first
action of the nurse is to:
A. Deflate the esophageal balloon C. Encourage him to take deep breaths
B. Monitor VS D. Notify the MD

34. A client complains of tickling in the throat and a bubbling sensation in the chest, then coughs up bright red,
frothy blood mixed with sputum. The nurse documents that the client is experiencing which of the following?
A. Hematemesis C. Intercostal retraction
B. Orthopnea D. Hemoptysis

35. The client has been receiving total parenteral nutrition (TPN) for several days. The central venous access device
became dislodged and the nurse notes that the client's IV has not been running for several hours. The nurse
would monitor the client for which of the following complications related to the stopped infusion?
A. Hypocalcemia C. Sepsis
B. Hypoglycemia D. Hyperkalemia

36. Which of the following is the most common cause of Liver Cirrhosis?
A. Diabetes Mellitus
B. Diabetiic Insepidus
C. Severe Alcoholism
D. Chronic Kidney Disease

37. Which of the following causes grave concern with patient suffering from Acute Kidney Disease?
A. Hypernatremia C. Hyperkalaemia
 B. Hyperglycaemia D. Hypoglycaemia

38. Which of the following is the reason why Hydrocortisone is given to patient Bronchial Asthma?
A. To decrease immune response to lessen spasm in bronchus.
B. To increase immune response to lessen spasm in bronchus.
C. To decrease immune response to promote healing in bronchus
D. To increase immune response to promote healing in bronchus.

39. Which of the following is a form of Upper Gastrointestinal Bleeding?

A. Hematemesis C. Hematochesia
B. Melena D. Occult Blood

40. An elderly patient complains of Difficulty of breathing. You are a student nurse assigned to this patient. Which of
the following is the initial action you should do?
A. Apply oxygen via nasal cannula
B. Refer to physician because these might be a case of a more severe condition.
C. Position patient in a fowlers position
D. Administer medication as prescribed

41. As a nurse assisting a patient who will undergo Paracentesis, you are correct when you are correct when you
position the patient to which of the following?
A. Left Lateral Sims position
B. Standing position
C. Sitting position with foot supported
D. Lying position

42. You are a nurse assigned in medical unit when a patient ask you about Ascites. Which of the following is an
incorrect response regarding ascites?
A. It’s a condition where an excess fluids accumulates in the peritoneal cavity.
B. It’s a condition that makes a patient experience difficulty of breathing in some cases.
C. It’s a condition that requires fluid restriction
D. It’s a condition that can cause blindness.

43. Which of the following condition is known as Pink Puffer?

A. Emphysema C. Chronic Bronhcitis
B. Asthma D. Bronchiectasis

44. You are a nurse assessing a patient with complaint of Difficulty of Breathing. Upon assessment. You notice that
the patient has a wheezing sounds upon auscultation? Which of the following condition should you suspect?
A. Emphysema C. Chronic Bronhcitis
B. Asthma D. Bronchiectasis

45. Which of the following fluids is most compatible with blood?

A. D5LRS C. D5W
B. PNSS D. D5050

46. You are administering blood transfusion to an elderly with Anemia when she suddenly complains difficulty of
breathing. You suspect that the patient is experiencing Hypersensitity reaction. Which of the following is your
initial step?
 A. Stop the infusion and refer to physician
B. Stop transfusion and open main line
C. Continue assessing the patient
D. Refer immediately to physician

47. An order is written for 0.05 g Aldactone (spironolactone) to be given orally (PO). The Aldactone is available in 25-
mg tablets. How many tablets would you have to give? Show and write your solution.

48. An order has been written for 250 mg of sulfisoxazole. The bottle states that the solution contains 125 mg/5 mL.
How much of the liquid should you give? Show and write your solution.

49. An order has been written for a patient to receive 400 mL of 5% dextrose in water (D5W) over a period of 4
hours in a standard microdrip system (i.e., 60 drops/mL). Calculate the correct setting (drops per minute).

50. A patient needs to take 0.75 g of tetracycline PO. The drug comes in 250-mg tablets. How many tablets should
the patient take?
A. 2 tablets
B. 3 tablets
C. 4 tablets
D. 30 tablets