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NP 4 Flashcards

1
Q

Situation: After an abdominal surgery, the circulating
and scrub nurses have critical responsibility about
sponge and instrument count.
1. Counting is performed thrice: During the
preincision phase, the operative phase and
closing phase. Who counts the sponges, needles
and instruments?
a. The scrub nurse only
b. The circulating nurse only
c. The surgeon and the assistant surgeon
d. The scrub nurse and the circulating
nurse

A

d. The scrub nurse and the circulating
nurse

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2
Q
  1. The layer of the abdomen is divided into 5.
    Arrange the following from the first layer going
    to the deepest layer:
  2. Fascia
  3. Muscle
  4. Peritoneum
  5. Subcutaneous/Fat
  6. Skin
    a. 5,4,3,2,1
    b. 5,4,1,3,2
    c. 5,4,2,1,3
    d. 5,4,1,2,3
A

d. 5,4,1,2,3

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3
Q
  1. When is the first sponge/instrument count
    reported?
    a. Before closing the subcutaneous layer
    b. Before peritoneum is closed
    c. Before closing the skin
    d. Before the fascia is sutured
A

b. Before peritoneum is closed

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4
Q

Like any nursing interventions, counts should be
documented. To whom does the scrub nurse
report any discrepancy of counts so that
immediate and appropriate action is instituted?
a. Anaesthesiologists
b. Surgeon
c. OR nurse supervisor
d. Circulating nurse

A

b. Surgeon

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5
Q

Which of the following are 2 interventions of the
surgical team when an instrument was
confirmed missing?
a. MRI and Incidence report
b. CT Scan, MRI, Incidence report
c. X-RAY and Incidence report
d. CT Scan and Incidence report

A

c. X-RAY and Incidence report

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6
Q

Which of the following are 2 interventions of the
surgical team when an instrument was
confirmed missing?
a. MRI and Incidence report
b. CT Scan, MRI, Incidence report
c. X-RAY and Incidence report
d. CT Scan and Incidence report

A

c. X-RAY and Incidence report

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7
Q
  1. To obtain specimen for sputum culture and
    sensitivity, which of the following instruction is
    best?
    a. Upon waking up, cough deeply and
    expectorate into container
    b. Cough after pursed lip breathing
    c. Save sputum for two days in covered
    container
    d. After respiratory treatment, expectorate
    into a container
A

a. Upon waking up, cough deeply and
expectorate into container

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8
Q
  1. The best time for collecting the sputum
    specimen for culture and sensitivity is:
    a. Before retiring at night
    b. Anytime of the day
    c. Upon waking up in the morning
    d. Before meals
A

c. Upon waking up in the morning

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9
Q
  1. When suctioning the endotracheal tube, the
    nurse should:
    a. Explain procedure to patient; insert
    catheter gently applying suction.
    Withdrawn using twisting motion
    b. Insert catheter until resistance is met,
    and then withdraw slightly, applying
    suction intermittently as catheter is
    withdrawn
    c. Hyperoxygenate client insert catheter
    using back and forth motion
    d. Insert suction catheter four inches into
    the tube, suction 30 seconds using twirling motion as catheter is withdrawn
A

b. Insert catheter until resistance is met,
and then withdraw slightly, applying
suction intermittently as catheter is
withdrawn

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10
Q
  1. The purpose of NGT IMMEDIATELY after an
    operation is:
    a. For feeding or gavage
    b. For gastric decompression
    c. For lavage, or the cleansing of the
    stomach content
    d. For the rapid return of peristalsis
A

b. For gastric decompression

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11
Q

Situation - Mr. Santos, 50, is to undergo cystoscopy due
to multiple problems like scantly urination, hematuria
and dysuria.
11. You are the nurse in charge in Mr. Santos. When
asked what are the organs to be examined
during cystoscopy, you will enumerate as
follows:
a. Urethra, kidney, bladder, urethra
b. Urethra, bladder wall, trigone, ureteral
opening
c. Bladder wall, uterine wall, and urethral
opening
d. Urethral open

A

b. Urethra, bladder wall, trigone, ureteral
opening

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12
Q
  1. In the OR, you will position Mr. Santos who is
    cystoscopy in:
    a. Supine
    b. Lithotomy
    c. Semi-fowler
    d. Trendelenburg
A

b. Lithotomy

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13
Q
  1. After cystoscopy, Mr. Santos asked you to
    explain why there is no incision of any kind.
    What do you tell him?
    a. “Cystoscopy is direct visualization and
    examination by urologist”.
    b. “Cystoscopy is done by x-ray
    visualization of the urinary tract”.
    c. “Cystoscopy is done by using lasers on
    the urinary tract”.
    d. “Cystoscopy is an endoscopic procedure
    of the urinary tract”.
A

d. “Cystoscopy is an endoscopic procedure
of the urinary tract”.

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14
Q
  1. Within 24-48 hours post cystoscopy, it is normal
    to observe one the following:
    a. Pink-tinged urine
    b. Distended bladder
    c. Signs of infection
    d. Prolonged hematuria
A

a. Pink-tinged urine

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15
Q

Leg cramps are NOT uncommon post cystoscopy. Nursing intervention includes:
a. Bed rest
b. Warm moist soak
c. Early ambulation
d. Hot sitz bath

A

b. Warm moist soak

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16
Q

Situation – Mang Felix, a 79 year old man who is brought
to the Surgical Unit from PACU after a transurethral
resection. You are assigned to receive him. You noted
that he has a 3-way indwelling urinary catheter for
continuous fast drip bladder irrigation which is
connected to a straight drainage.
16. Immediately after surgery, what would you
expect his urine to be?
a. Light yellow
b. Bright red
c. Amber
d. Pinkish to red

A

d. Pinkish to red

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17
Q

The purpose of the continuous bladder irrigation
is to:
a. Allow continuous monitoring of the fluid
output status
b. Provide continuous flushing of clots and
debris from the bladder
c. Allow for proper exchange of
electrolytes and fluid
d. Ensure accurate monitoring of intake
and output

A

b. Provide continuous flushing of clots and
debris from the bladder

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18
Q
  1. Mang Felix informs you that he feels some
    discomfort on the hypogastric area and he has to
    void. What will be your most appropriate action?
    a. Remove his catheter then allow him to
    void on his own
    b. Irrigate his catheter
    c. Tell him to “Go ahead and void. You
    have an indwelling catheter.”
    d. Assess color and rate of outflow, if
    there is changes refer to urologist for
    possible irrigation.
A

d. Assess color and rate of outflow, if
there is changes refer to urologist for
possible irrigation

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19
Q

You decided to check on Mang Felix’s IV fluid
infusion. You noted a change in flow rate, pallor
and coldness around the insertion site. What is
your assessment finding?
a. Phlebitis
b. Infiltration to subcutaneous tissue
c. Pyrogenic reaction
d. Air embolism

A

b. Infiltration to subcutaneous tissue

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20
Q
  1. Knowing that proper documentation of assessment findings and interventions are
    important responsibilities of the nurse during
    first post-operative day, which of the following is
    the LEAST relevant to document in the case of
    Mang Felix?
    a. Chest pain and vital signs
    b. Intravenous infusion rate
    c. Amount, color, and consistency of
    bladder irrigation drainage
    d. Activities of daily living started
A

d. Activities of daily living started

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21
Q

Situation: Melamine contamination in milk has brought
worldwide crisis both in the milk production sector as
well as the health and economy. Being aware of the
current events is one quality that a nurse should possess
to prove that nursing is a dynamic profession that will
adapt depending on the patient’s needs.
21. Melamine is a synthetic resin used for
whiteboards, hard plastics and jewellery box
covers due to its fire retardant properties. Milk
and food manufacturers add melamine in order
to:
a. It has a bacteriostatic property leading
to increase food and milk life as a way of
preserving the foods
b. Gives a glazy and more edible look on
foods
c. Make milks more tasty and creamy
d. Create an illusion of a high protein
content on their products

A

d. Create an illusion of a high protein
content on their products

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22
Q
  1. Most of the milks contaminated by Melamine
    came from which country?
    a. India
    b. China
    c. Philippines
    d. Korea
A

b. China

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23
Q
  1. Which government agency is responsible for
    testing the melamine content of foods and food
    products?
    a. DOH
    b. MMDA
    c. NBI
    d. BFAD
A

d. BFAD

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24
Q
  1. Infants are the most vulnerable to melamine
    poisoning. Which of the following is NOT a sign
    of melamine poisoning?
    a. Irritability, Back ache, Urolithiasis
    b. High blood pressure, fever
    c. Anuria, Oliguria or Hematuria
A

d. Fever, Irritability and a large output of
diluted urine

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25
Q
  1. What kind of renal failure will melamine
    poisoning cause?
    a. Chronic, Prerenal
    b. Chronic, Intrarenal
    c. Acute, Postrenal
    d. Acute, Prerenal
A

c. Acute, Postrenal

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26
Q

Situation: Leukemia is the most common type of
childhood cancer. Acute Lymphoid Leukemia is the cause
of almost 1/3 of all cancer that occurs in children under
age 15.
26. The survival rate for Acute Lymphoid Leukemia is
approximately:
a. 25%
b. 40%
c. 75%
d. 95%

A

c. 75%

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27
Q
  1. Whereas acute nonlymphoid leukemia has a
    survival rate of:
    a. 25%
    b. 40%
    c. 75%
    d. 95%
A

b. 40%

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28
Q
  1. The three main consequence of leukemia that
    cause the most danger is:
    a. Neutropenia causing infection, anemia
    causing impaired oxygenation and
    thrombocytopenia leading to bleeding
    tendencies
    b. Central nervous system infiltration,
    anemia causing impaired oxygenation
    and thrombocytopenia leading to
    bleeding tendencies
    c. Splenomegaly, hepatomegaly, fractures
    d. Invasion by the leukemic cells to the
    bone causing severe bone pain
A

a. Neutropenia causing infection, anemia
causing impaired oxygenation and
thrombocytopenia leading to bleeding
tendencies

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29
Q
  1. Gold standard in the diagnosis of leukemia is by
    which of the following?
    a. Blood culture and sensitivity
    b. Bone marrow biopsy
    c. Blood biopsy
    d. CSF aspiration and examination
A

b. Bone marrow biopsy

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30
Q

Adriamycin,Vincristine,Prednisone and L
asparaginase are given to the client for long
term therapy. One common side effect, especially of adriamycin is alopecia. The child
asks: “Will I get my hair back once again?” The
nurse best respond is by saying:
a. “Don’t be silly, ofcourse you will get your
hair back”
b. “We are not sure, let’s hope it’ll grow”
c. “This side effect is usually permanent,
But I will get the doctor to discuss it for
you”
d. “Your hair will regrow in 3 to 6 months
but of different color, usually darker
and of different texture”

A

d. “Your hair will regrow in 3 to 6 months
but of different color, usually darker
and of different texture”

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31
Q

Situation: Breast Cancer is the 2nd most common type of
cancer after lung cancer and 99% of which, occurs in
woman. Survival rate is 98% if this is detected early and
treated promptly. Carmen is a 53 year old patient in the
high risk group for breast cancer was recently diagnosed
with Breast cancer.
31. All of the following are factors that said to
contribute to the development of breast cancer
except:
a. Prolonged exposure to estrogen such as
an early menarche or late menopause,
nulliparity and childbirth after age 30
b. Genetics
c. Increasing Age
d. Prolonged intake of Tamoxifen
(Nolvadex)

A

Situation: Breast Cancer is the 2nd most common type of
cancer after lung cancer and 99% of which, occurs in
woman. Survival rate is 98% if this is detected early and
treated promptly. Carmen is a 53 year old patient in the
high risk group for breast cancer was recently diagnosed
with Breast cancer.
31. All of the following are factors that said to
contribute to the development of breast cancer
except:
a. Prolonged exposure to estrogen such as
an early menarche or late menopause,
nulliparity and childbirth after age 30
b. Genetics
c. Increasing Age
d. Prolonged intake of Tamoxifen
(Nolvadex)

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32
Q
  1. Protective factors for the development of breast
    cancer includes which of the following except:
    a. Exercise
    b. Breast feeding
    c. Prophylactic Tamoxifen
    d. Alcohol intake
A

d. Alcohol intake

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33
Q
  1. A patient diagnosed with breast cancer has been
    offered the treatment choices of breast
    conservation surgery with radiation or a
    modified radical mastectomy. When questioned
    by the patient about these options, the nurse
    informs the patient that the lumpectomy with
    radiation:
    a. reduces the fear and anxiety that
    accompany the diagnosis and treatment
    of cancer
    b. has about the same 10-year survival rate
    as the modified radical mastectomy
    c. provides a shorter treatment period with
    a fewer long term complications
    d. preserves the normal appearance and sensitivity of the breast.
A

d. preserves the normal appearance and sensitivity of the breast

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34
Q
  1. Carmen, who is asking the nurse the most
    appropriate time of the month to do her selfexamination
    of the breast. The MOST
    appropriate reply by the nurse would be:
    a. the 26th day of the menstrual cycle
    b. 7 to 8 days after conclusion of the
    menstrual period
    c. during her menstruation
    d. the same day each month
A

b. 7 to 8 days after conclusion of the
menstrual period

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35
Q
  1. Carmen being treated with radiation therapy.
    What should be included in the plan of care to
    minimize skin damage from the radiation
    therapy?
    a. Cover the areas with thick clothing
    materials
    b. Apply a heating pad to the site
    c. Wash skin with water after the therapy
    d. Avoid applying creams and powders to
    the area
A

d. Avoid applying creams and powders to
the area

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36
Q
  1. Based on the DOH and World Health
    Organization (WHO) guidelines, the mainstay for
    early detection method for breast cancer that is
    recommended for developing countries is:
    a. a monthly breast self-examination (BSE)
    and an annual health worker breast
    examination (HWBE)
    b. an annual hormone receptor assay
    c. an annual mammogram
    d. a physician conduct a breast clinical
    examination every 2 years
A

a. a monthly breast self-examination (BSE)
and an annual health worker breast
examination (HWBE)

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37
Q
  1. The purpose of performing the breast selfexamination
    (BSE) regularly is to discover:
    a. fibrocystic masses
    b. areas of thickness or fullness
    c. cancerous lumps
    d. changes from previous BSE
A

d. changes from previous BSE

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38
Q
  1. If you are to instruct a postmenopausal woman
    about BSE, when would you tell her to do BSE:
    a. on the same day of each month
    b. on the first day of her menstruation
    c. right after the menstrual period
    d. on the last day of her menstruation
A

a. on the same day of each month

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39
Q
  1. During breast self-examination, the purpose of
    standing in front of the mirror it to observe the
    breast for:
    a. thickening of the tissue
    b. lumps in the breast tissue
    c. axillary lymphnodes
    d. change in size and contour
A

d. change in size and contour

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40
Q
  1. When preparing to examine the left breast in a
    reclining position, the purpose of placing a small
    folded towel under the client’s left shoulder is
    to:
    a. bring the breast closer to the examiner’s
    right hand
    b. tense the pectoral muscle
    c. balance the breast tissue more evenly
    on the chest wall
    d. facilitate lateral positioning of the breast
A

c. balance the breast tissue more evenly
on the chest wall

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41
Q

Situation – Radiation therapy is another modality of
cancer management. With emphasis on multidisciplinary
management you have important responsibilities as
nurse.
41. Albert is receiving external radiation therapy and
he complains of fatigue and malaise. Which of
the following nursing interventions would be
most helpful for Albert?
a. Tell him that sometimes these feelings
can be psychogenic
b. Refer him to the physician
c. Reassure him that these feelings are
normal
d. Help him plan his activities

A

d. Help him plan his activities

42
Q
  1. Albert is admitted with a radiation induced
    thrombocytopenia. As a nurse you should
    observe the following symptoms:
    a. Petechiae, ecchymosis, epistaxis
    b. Weakness, easy fatigability, pallor
    c. Headache, dizziness, blurred vision
    d. Severe sore throat, bacteremia,
    hepatomegaly
A

a. Petechiae, ecchymosis, epistaxis

43
Q
  1. What nursing diagnosis should be of highest
    priority?
    a. Knowledge deficit regarding
    thrombocytopenia precautions
    b. Activity intolerance
    c. Impaired tissue integrity
    d. Ineffective tissue perfusion, peripheral,
    cerebral, cardiovascular,
    gastrointestinal, renal
A

c. Impaired tissue integrity

44
Q
  1. What intervention should you include in your
    care plan?
    a. Inspect his skin for petechiae, bruising,
    GI bleeding regularly
    b. Place Albert on strict isolation
    precaution
    c. Provide rest in between activities
    d. Administer antipyretics if his
    temperature exceeds 38C
A

a. Inspect his skin for petechiae, bruising,
GI bleeding regularly

45
Q

Situation: Burn are cause by transfer of heat source to
the body. It can be thermal, electrical, radiation or
chemical.
46. A burn characterized by Pale white appearance,
charred or with fat exposed and painlessness is:
a. Superficial partial thickness burn
b. Deep partial thickness burn
c. Full thickness burn
d. Deep full thickness burn

A

c. Full thickness burn

46
Q
  1. Which of the following BEST describes superficial
    partial thickness burn or first degree burn?
    a. Structures beneath the skin are damage
    b. Dermis is partially damaged
    c. Epidermis and dermis are both damaged
    d. Epidermis is damaged
A

b. Dermis is partially damaged

47
Q
  1. A burn that is said to be “WEEPING” is classified
    as:
    a. Superficial partial thickness burn
    b. Deep partial thickness burn
    c. Full thickness burn
    d. Deep full thickness burn
A

c. Full thickness burn

48
Q

Immediately following the radiation teletherapy,
Albert is
a. Considered radioactive for 24 hrs
b. Given a complete bath
c. Placed on isolation for 6 hours
d. Free from radiation

A

d. Free from radiation

49
Q
  1. During the Acute phase of the burn injury, which
    of the following is a priority?
    a. wound healing
    b. emotional support
    c. reconstructive surgery
    d. fluid resuscitation
A

a. wound healing

50
Q
  1. While in the emergent phase, the nurse knows
    that the priority is to:
    a. Prevent infection
    b. Prevent deformities and contractures
    c. Control pain
    d. Return the hemodynamic stability via
    fluid resuscitation
A

d. Return the hemodynamic stability via
fluid resuscitation

51
Q
  1. The MOST effective method of delivering pain
    medication during the emergent phase is:
    a. intramuscularly
    b. orally
    c. subcutaneously
A

d. intravenously

52
Q
  1. When a client accidentally splashes chemicals to
    his eyes, The initial priority care following the
    chemical burn is to:
    a. irrigate with normal saline for 1 to 15
    minutes
    b. transport to a physician immediately
    c. irrigate with water for 15 minutes or
    longer
    d. cover the eyes with a sterile gauze
A

c. irrigate with water for 15 minutes or
longer

53
Q
  1. Which of the following can be a fatal
    complication of upper airway burns?
    a. stress ulcers
    b. shock
    c. hemorrhage
    d. laryngeal spasms and swelling
A

d. laryngeal spasms and swelling

54
Q
  1. When a client will rush towards you and he has a
    burning clothes on, It is your priority to do which
    of the following first?
    a. log roll on the grass/ground
    b. slap the flames with his hands
    c. Try to remove the burning clothes
    d. Splash the client with 1 bucket of cool
    water
A

a. log roll on the grass/ground

55
Q
  1. Once the flames are extinguished, it is most
    important to:
    a. cover clientwith a warm blanket
    b. give him sips of water
    c. calculate the extent of his burns
    d. assess the Sergio’s breathing
A

d. assess the Sergio’s breathing

56
Q
  1. During the first 24 hours after the thermal injury,
    you should asses Sergio for:
    a. hypokalemia and hypernatremia
    b. hypokalemia and hyponatremia
    c. hyperkalemia and hyponatremia
    d. hyperkalemia and hypernatremia
A

c. hyperkalemia and hyponatremia

57
Q
  1. A client who sustained deep partial thickness
    and full thickness burns of the face, whole
    anterior chest and both upper extremities two
    days ago begins to exhibit extreme restlessness.
    You recognize that this most likely indicates that the client is developing:
    a. Cerebral hypoxia
    b. metabolic acidosis
    c. Hypervolemia
    d. Renal failure
A

a. Cerebral hypoxia

58
Q
  1. A 165 lbs trauma client was rushed to the
    emergency room with full thickness burns on the
    whole face, right and left arm, and at the
    anterior upper chest sparing the abdominal area.
    He also has superficial partial thickness burn at
    the posterior trunk and at the half upper portion
    of the left leg. He is at the emergent phase of
    burn. Using the parkland’s formula, you know
    that during the first 8 hours of burn, the amount
    of fluid will be given is:
    a. 5,400 ml
    b. 9, 450 ml
    c. 10,800 ml
    d. 6,750 ml
A

a. 5,400 ml

59
Q
  1. The doctor incorporated insulin on the client’s
    fluid during the emergent phase. The nurse
    knows that insulin is given because:
    a. Clients with burn also develops
    Metabolic acidosis
    b. Clients with burn also develops
    hyperglycemia
    c. Insulin is needed for additional energy
    and glucose burning after the stressful
    incidence to hasten wound healing,
    regain of consciousness and rapid return
    of hemodynamic stability
    d. For hyperkalemia
A

d. For hyperkalemia

60
Q
  1. The IV fluid of choice for burn as well as
    dehydration is:
    a. 0.45% NaCl
    b. Sterile water
    c. NSS
    d. D5LR
A

d. D5LR

61
Q

Situation: ENTEROSTOMAL THERAPY is now considered a
specialty in nursing. You are participating in the OSTOMY
CARE CLASS.
61. You plan to teach Fermin how to irrigate the
colostomy when:
a. The perineal wound heals And Fermin
can sit comfortably on the commode
b. Fermin can lie on the side comfortably,
about the 3rd postoperative day
c. The abdominal incision is closed and contamination is no longer a danger
d. The stools starts to become formed,
around the 7th postoperative day

A

d. The stools starts to become formed,
around the 7th postoperative day

62
Q
  1. When preparing to teach Fermin how to irrigate
    colostomy, you should plan to do the procedure:
    a. When Fermin would have normal bowel
    movement
    b. At least 2 hours before visiting hours
    c. Prior to breakfast and morning care
    d. After Fermin accepts alteration in body
    image
A

a. When Fermin would have normal bowel
movement

63
Q

When observing a return demonstration of a
colostomy irrigation, you know that more
teaching is required if Fermin:
a. Lubricates the tip of the catheter prior to
inserting into the stoma
b. Hangs the irrigating bag on the
bathroom door cloth hook during fluid
insertion
c. Discontinues the insertion of fluid after
500 ml of fluid has been instilled
d. Clamps of the flow of fluid when felling
uncomfortable

A

b. Hangs the irrigating bag on the
bathroom door cloth hook during fluid
insertion

64
Q
  1. You are aware that teaching about colostomy
    care is understood when Fermin states, “I will
    contact my physician and report:
    a. If I have any difficulty inserting the
    irrigating tub into the stoma.”
    b. If I noticed a loss of sensation to touch in
    the stoma tissue.”
    c. The expulsion of flatus while the
    irrigating fluid is running out.”
    d. When mucus is passed from the stoma
    between the irrigations.”
A

a. If I have any difficulty inserting the
irrigating tub into the stoma.”

65
Q
  1. You would know after teaching Fermin that
    dietary instruction for him is effective when he
    states, “It is important that I eat:
    a. Soft food that is easily digested and
    absorbed by my large intestines.”
    b. Bland food so that my intestines do not
    become irritated.”
    c. Food low in fiber so that there are fewer
    stools.”
    d. Everything that I ate before the
    operation, while avoiding foods that
    cause gas”.
A

d. Everything that I ate before the
operation, while avoiding foods that
cause gas”

66
Q

Situation: Based on studies of nurses working in special
units like the intensive care unit and coronary care unit, it is important for nurses to gather as much information
to be able to address their needs for nursing care.
66. Critically ill patients frequently complain about
which of the following when hospitalized?
a. Hospital food
b. Lack of privacy
c. Lack of blankets
d. Inadequate nursing staff

A

b. Lack of privacy

67
Q
  1. Who of the following is at greatest risk of
    developing sensory problem?
    a. Female patient
    b. Transplant patient
    c. Adoloscent
    d. Unresponsive patient
A

d. Unresponsive patient

68
Q
  1. Which of the following factors may inhibit
    learning in critically ill patients?
    a. Gender
    b. Educational level
    c. Medication
    d. Previous knowledge of illness
A

c. Medication

69
Q
  1. Which of the following statements does not
    apply to critically ill patients?
    a. Majority need extensive rehabilitation
    b. All have been hospitalized previously
    c. Are physically unstable
    d. Most have chronic illness
A

b. All have been hospitalized previously

70
Q
  1. Families of critically ill patients desire which of
    the following needs to be met first by the nurse?
    a. Provision of comfortable space
    b. Emotional support
    c. Updated information on client’s status
    d. Spiritual counselling
A

b. Emotional support

71
Q

Situation: Johnny, sought consultation to the hospital
because of fatigability, irritability, jittery and he has been
experiencing this sign and symptoms for the past 5
months.
71. His diagnosis was hyperthyroidism, the following
are expected symptoms except:
a. Anorexia
b. Fine tremors of the hand
c. Palpitation
d. Hyper alertness

A

a. Anorexia

72
Q
  1. She has to take drugs to treat her
    hyperthyroidism. Which of the following will you
    NOT expect that the doctor will prescribe?
    a. Colace (Docusate)
    b. Tapazole (Methimazole)
    c. Cytomel (Liothyronine)
    d. Synthroid (Levothyroxin
A

a. Colace (Docusate)

73
Q
  1. The nurse knows that Tapazole has which of the
    following side effect that will warrant immediate
    withholding of the medication?
    a. Death
    b. Hyperthermia
    c. Sore throat
    d. Thrombocytosis
A

c. Sore throat

74
Q
  1. You asked questions as soon as she regained
    consciousness from thyroidectomy primarily to
    assess the evidence of:
    a. Thyroid storm
    b. Damage to the laryngeal nerve
    c. Mediastinal shift
    d. Hypocalcaemia tetany
A

b. Damage to the laryngeal nerve

75
Q
  1. Should you check for haemorrhage, you will:
    a. Slip your hand under the nape of her
    neck
    b. Check for hypotension
    c. Apply neck collar to prevent
    haemorrhage
    d. Observe the dressing if it is soaked with
    blood
A

a. Slip your hand under the nape of her
neck

76
Q
  1. Basal Metabolic rate is assessed on Johnny to
    determine his metabolic rate. In assessing the
    BMR using the standard procedure, you need to
    tell Johnny that:
    a. Obstructing his vision
    b. Restraining his upper and lower
    extremities
    c. Obstructing his hearing
    d. Obstructing his nostrils with a clamp
A

d. Obstructing his nostrils with a clamp

77
Q
  1. The BMR is based on the measurement that:
    a. Rate of respiration under different
    condition of activities and rest
    b. Amount of oxygen consumption under
    resting condition over a measured
    period of time
    c. Amount of oxygen consumption under
    stressed condition over a measured
    period of time
    d. Ratio of respiration to pulse rate over a
    measured period of time
A

b. Amount of oxygen consumption under
resting condition over a measured
period of time

78
Q
  1. Her physician ordered lugol’s solution in order to:
    a. Decrease the vascularity and size of the
    thyroid gland
    b. Decrease the size of the thyroid gland
    only
    c. Increase the vascularity and size of the
    thyroid gland
    d. Increase the size of the thyroid gland
    only
A

a. Decrease the vascularity and size of the
thyroid gland

79
Q
  1. Which of the following is a side effect of Lugol’s
    solution?
    a. Hypokalemia
    b. Enlargement of the Thryoid gland
    c. Nystagmus
    d. Excessive salivation
A

d. Excessive salivation

80
Q
  1. In administering Lugol’s solution, the
    precautionary measure should include:
    a. Administer with glass only
    b. Dilute with juice and administer with a
    straw
    c. Administer it with milk and drink it
    d. Follow it with milk of magnesia
A

b. Dilute with juice and administer with a
straw

81
Q

Situation: Pharmacological treatment was not effective
for Johnny’s hyperthyroidism and now, he is scheduled
for Thyroidectomy.
81. Instruments in the surgical suite for surgery is
classified as either CRITICAL, SEMI CRITICAL and
NON CRITICAL. If the instrument are introduced
directly into the blood stream or into any
normally sterile cavity or area of the body it is
classified as:
a. Critical
b. Non Critical
c. Semi Critical
d. Ultra Critical

A

a. Critical

82
Q
  1. Instruments that do not touch the patient or
    have contact only to intact skin is classified as:
    a. Critical
    b. Non Critical
    c. Semi Critical
    d. Ultra Critical
A

b. Non Critical

83
Q
  1. If an instrument is classified as Semi Critical, an
    acceptable method of making the instrument
    ready for surgery is through:
    a. Sterilization
    b. Disinfection
    c. Decontamination
    d. Cleaning
A

b. Disinfection

84
Q
  1. While critical items and should be:
    a. Clean
    b. Sterilized
    c. Decontaminated
    d. Disinfected
A

b. Sterilized

85
Q
  1. As a nurse, you know that intact skin acts as an
    effective barrier to most microorganisms.
    Therefore, items that come in contact with the
    intact skin or mucus membranes should be:
    a. Disinfected
    b. Clean
    c. Sterile
    d. Alcoholized
A

a. Disinfected

86
Q
  1. You are caring for Johnny who is scheduled to
    undergo total thyroidectomy because of a
    diagnosis of thyroid cancer. Prior to total
    thyroidectomy, you should instruct Johnny to:
    a. Perform range and motion exercise on
    the head and neck
    b. Apply gentle pressure against the
    incision when swallowing
    c. Cough and deep breathe every 2 hours
    d. Support head with the hands when
    changing position
A

d. Support head with the hands when
changing position

87
Q
  1. As Johnny’s nurse, you plan to set up emergency
    equipment at her bedside following
    thyroidectomy. You should include:
    a. An airway and rebreathing tube
    b. A tracheostomy set and oxygen
    c. A crush cart with bed board
    d. Two ampules of sodium bicarbonate
A

b. A tracheostomy set and oxygen

88
Q
  1. Which of the following nursing interventions is
    appropriate after a total thyroidectomy?
    a. Place pillows under your patient’s
    shoulders.
    b. Raise the knee-gatch to 30 degrees
    c. Keep you patient in a high-fowler’s
    position.
    d. Support the patient’s head and neck
    with pillows and sandbags
A

d. Support the patient’s head and neck
with pillows and sandbags

89
Q
  1. If there is an accidental injury to the parathyroid
    gland during a thyroidectomy which of the
    following might Leda develops postoperatively?
    a. Cardiac arrest
    b. Respiratory failure
    c. Dyspnea
    d. Tetany
A

d. Tetany

90
Q
  1. After surgery Johnny develops peripheral
    numbness, tingling and muscle twitching and
    spasm. What would you anticipate to
    administer?
    a. Magnesium sulfate
    b. Potassium iodide
    c. Calcium gluconate
    d. Potassium chloride
A

c. Calcium gluconate

91
Q

Situation: Budgeting is an important part of a nurse
managerial activity. The correct allocation and
distribution of resources is vital in the harmonious
operation of the financial balance of the agency.
91. Which of the following best defines Budget?
a. Plan for the allocation of resources for
future use
b. The process of allocating resources for
future use
c. Estimate cost of expenses
d. Continuous process in seeing that the
goals and objective of the agency is met

A

a. Plan for the allocation of resources for
future use

92
Q
  1. Which of the following best defines Capital
    Budget?
    a. Budget to estimate the cost of direct
    labour, number of staff to be hired and
    necessary number of workers to meet
    the general patient needs
    b. Includes the monthly and daily expenses
    and expected revenue and expenses
    c. These are related to long term planning
    and includes major replacement or
    expansion of the plant, major
    equipment and inventories.
    d. These are expenses that are not
    dependent on the level of production or
    sales. They tend to be time-related, such
    as salaries or rents being paid per month
A

c. These are related to long term planning
and includes major replacement or
expansion of the plant, major
equipment and inventories.

93
Q
  1. Which of the following best defines Capital
    Budget?
    a. Budget to estimate the cost of direct
    labour, number of staff to be hired and
    necessary number of workers to meet
    the general patient needs
    b. Includes the monthly and daily expenses
    and expected revenue and expenses
    c. These are related to long term planning
    and includes major replacement or
    expansion of the plant, major
    equipment and inventories.
    d. These are expenses that are not
    dependent on the level of production or
    sales. They tend to be time-related, such
    as salaries or rents being paid per month
A

c. These are related to long term planning
and includes major replacement or
expansion of the plant, major
equipment and inventories.

94
Q
  1. Which of the following accurately describes a
    Fixed Cost in budgeting?
    a. These are usually the raw materials and
    labour salaries that depend on the
    production or sales
    b. These are expenses that change in
    proportion to the activity of a business
    c. These are expenses that are not
    dependent on the level of production or
    sales. They tend to be time-related,
    such as rent
    d. This is the summation of the Variable
    Cost and the Fixed Cost
A

c. These are expenses that are not
dependent on the level of production or
sales. They tend to be time-related,
such as rent

95
Q
  1. Which of the following accurately describes
    Variable Cost in budgeting?
    a. These are related to long term planning
    and include major replacement or
    expansion of the plant, major
    equipments and inventories.
    b. These are expenses that change in
    proportion to the activity of a business
    c. These are expenses that are not
    dependent on the level of production or
    sales. They tend to be time-related, such
    as rent
    d. This is the summation of the Variable
    Cost and the Fixed Cost
A

b. These are expenses that change in
proportion to the activity of a business

96
Q

Situation – Andrea is admitted to the ER following an
assault where she was hit in the face and head. She was
brought to the ER by a police woman. Emergency
measures were started.
96. Andrea’s respiration is described as waxing and
waning. You know that this rhythm of respiration
is defined as:
a. Biot’s
b. Cheyne stokes
c. Kussmaul’s
d. Eupnea

A

b. Cheyne stokes

97
Q
  1. What do you call the triad of sign and symptoms
    seen in a client with increasing ICP?
    a. Virchow’s Triad
    b. Cushing’s Triad
    c. The Chinese Triad
    d. Charcot’s Triad
A

b. Cushing’s Triad

98
Q
  1. Which of the following is true with the Triad
    seen in head injuries?
    a. Narrowing of Pulse pressure, Cheyne
    stokes respiration, Tachycardia
    b. Widening Pulse pressure, Irregular
    respiration, Bradycardia
    c. Hypertension, Kussmaul’s respiration,
    Tachycardia
    d. Hypotension, Irregular respiration,
    Bradycardia
A

b. Widening Pulse pressure, Irregular
respiration, Bradycardia

99
Q
  1. In a client with a Cheyne stokes respiration,
    which of the following is the most appropriate
    nursing diagnosis?
    a. Ineffective airway clearance
    b. Impaired gas exchange
    c. Ineffective breathing pattern
    d. Activity intolerance
A

c. Ineffective breathing pattern

100
Q
  1. You know the apnea is seen in client’s with
    cheyne stokes respiration, APNEA is defined as:
    a. Inability to breathe in a supine position
    so the patient sits up in bed to breathe
    b. The patient is dead, the breathing stops
    c. There is an absence of breathing for a
    period of time, usually 15 seconds or
    more
    d. A period of hypercapnea and hypoxia
    due to the cessation of respiratory effort
    inspite of normal respiratory functioning
A

c. There is an absence of breathing for a
period of time, usually 15 seconds or
more

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