Guidelines for Managing Mental Health and Occupational Health Issues, Exams of Nursing

Download Guidelines for Managing Mental Health and Occupational Health Issues and more Exams Nursing in PDF only on Docsity! PHILIPPINE NLE BOARD EXAM: PSYCHIATRIC NURSING QUESTION & ANSWER W/ RATIONALE PSYCHIATRIC NURSING 1. Mental health is defined as: A. The ability to distinguish what is real from what is not. B. A state of well-being where a person can realize his own abilities can cope with normal stresses of life and work productively. C. Is the promotion of mental health, prevention of mental disorders, nursing care of patients during illness and rehabilitation D. Absence of mental illness Answer: (B) A state of well-being where a person can realize his own abilities can cope with normal stresses of life and work productively. Mental health is a state of emotional and psychosocial well being. A mentally healthy individual is self aware and self directive, has the ability to solve problems, can cope with crisis without assistance beyond the support of family and friends fulfill the capacity to love and work and sets goals and realistic limits. A. This describes the ego function reality testing. C. This is the definition of Mental Health and Psychiatric Nursing. D. Mental health is not just the absence of mental illness. 2. Which of the following describes the role of a technician? A. Administers medications to a schizophrenic patient. B. The nurse feeds and bathes a catatonic client C. Coordinates diverse aspects of care rendered to the patient D. Disseminates information about alcohol and its effects. Answer: (A) Administers medications to a schizophrenic patient. Administration of medications and treatments, assessment, documentation are the activities of the nurse as a technician. B. Activities as a parent surrogate. C. Refers to the ward manager role. D. Role as a teacher. 3. Liza says, “Give me 10 minutes to recall the name of our college professor who failed many students in our anatomy class.” She is operating on her: A. Subconscious B. Conscious C. Unconscious D. Ego Answer: (A) Subconscious Subconscious refers to the materials that are partly remembered partly forgotten but these can be recalled spontaneously and voluntarily. B. This functions when one is awake. One is aware of his thoughts, feelings actions and what is going on in the environment. C. The largest potion of the mind that contains the memories of one’s past particularly the unpleasant. It is difficult to recall the unconscious content. D. The conscious self that deals and tests reality. 4. The superego is that part of the psyche that: A. Uses defensive function for protection. B. Is impulsive and without morals. C. Determines the circumstances before making decisions. D. The censoring portion of the mind. Answer: (D) The censoring portion of the mind. The critical censoring portion of one’s personality; the conscience. A. This refers to the ego function that protects itself from anything that threatens it.. B. The Id is composed of the untamed, primitive drives and impulses. C. This refers to the ego that acts as the moderator of the struggle between the id and the superego. 5. Primary level of prevention is exemplified by: A. Helping the client resume self care. B. Ensuring the safety of a suicidal client in the institution. C. Teaching the client stress management techniques D. Case finding and surveillance in the community Answer: (C) Teaching the client stress management techniques Primary level of prevention refers to the promotion of mental health and prevention of mental illness. This can be achieved by rendering health teachings such as modifying ones responses to stress. A. This is tertiary level of prevention that deals with rehabilitation. B and D. Secondary level of prevention which involves reduction of actual illness through early detection and treatment of illness. 17. The child with conduct disorder will likely demonstrate: A. Easy distractibility to external stimuli. B. Ritualistic behaviors C. Preference for inanimate objects. D. Serious violations of age related norms. Answer: (D) Serious violations of age related norms. This is a disruptive disorder among children characterized by more serious violations of social standards such as aggression, vandalism, stealing, lying and truancy. A. This is characteristic of attention deficit disorder. B and C. These are noted among children with autistic disorder. 18. Ritalin is the drug of choice for chidren with ADHD. The side effects of the following may be noted: A. increased attention span and concentration B. increase in appetite C. sleepiness and lethargy D. bradycardia and diarrhea Answer: (A) increased attention span and concentration The medication has a paradoxic effect that decrease hyperactivity and impulsivity among children with ADHD. B, C, D. Side effects of Ritalin include anorexia, insomnia, diarrhea and irritability. 19. School phobia is usually treated by: A. Returning the child to the school immediately with family support. B. Calmly explaining why attendance in school is necessary C. Allowing the child to enter the school before the other children D. Allowing the parent to accompany the child in the classroom Answer: (A) Returning the child to the school immediately with family support. Exposure to the feared situation can help in overcoming anxiety. A. This will not help in relieving the anxiety due separation from a significant other. C. and C. Anxiety in school phobia is not due to being in school but due to separation from parents/caregivers so these interventions are not applicable. D. This will not help the child overcome the fear 20. A 10 year old child has very limited vocabulary and interaction skills. She has an I.Q. of 45. She is diagnosed to have Mental retardation of this classification: A. Profound B. Mild C. Moderate D. Severe Answer: (C) Moderate The child with moderate mental retardation has an I.Q. of 35-50 Profound Mental retardation has an I.Q. of below 20; Mild mental retardation 50-70 and Severe mental retardation has an I.Q. of 20-35. 21. The nurse teaches the parents of a mentally retarded child regarding her care. The following guidelines may be taught except: A. overprotection of the child B. patience, routine and repetition C. assisting the parents set realistic goals D. giving reasonable compliments Answer: (A) overprotection of the child The child with mental retardation should not be overprotected but need protection from injury and the teasing of other children. B,C, and D Children with mental retardation have learning difficulty. They should be taught with patience and repetition, start from simple to complex, use visuals and compliment them for motivation. Realistic expectations should be set and optimize their capability. 22. The parents express apprehensions on their ability to care for their maladaptive child. The nurse identifies what nursing diagnosis: A. hopelessness B. altered parenting role C. altered family process D. ineffective coping Answer: (B) altered parenting role Altered parenting role refers to the inability to create an environment that promotes optimum growth and development of the child. This is reflected in the parent’s inability to care for the child. A. This refers to lack of choices or inability to mobilize one’s resources. C. Refers to change in family relationship and function. D. Ineffective coping is the inability to form valid appraisal of the stressor or inability to use available resources 23. A 5 year old boy is diagnosed to have autistic disorder. Which of the following manifestations may be noted in a client with autistic disorder? A. argumentativeness, disobedience, angry outburst B. intolerance to change, disturbed relatedness, stereotypes C. distractibility, impulsiveness and overactivity D. aggression, truancy, stealing, lying Answer: (B) intolerance to change, disturbed relatedness, stereotypes These are manifestations of autistic disorder. A. These manifestations are noted in Oppositional Defiant Disorder, a disruptive disorder among children. C. These are manifestations of Attention Deficit Disorder D. These are the manifestations of Conduct Disorder 24. The therapeutic approach in the care of an autistic child include the following EXCEPT: A. Engage in diversionary activities when acting -out B. Provide an atmosphere of acceptance C. Provide safety measures D. Rearrange the environment to activate the child Answer: (D) Rearrange the environment to activate the child The child with autistic disorder does not want change. Maintaining a consistent environment is therapeutic. A. Angry outburst can be rechannelled through safe activities. B. Acceptance enhances a trusting relationship. C. Ensure safety from self-destructive behaviors like head banging and hair pulling. 25. According to Piaget a 5 year old is in what stage of development: A. Sensory motor stage B. Concrete operations C. Pre-operational D. Formal operation Answer: (C) Pre-operational Pre-operational stage (2-7 years) is the stage when the use of language, the use of symbols and the concept of time occur. A. Sensory-motor stage (0-2 years) is the stage when the child uses the senses in learning about the self and the environment through exploration. B. Concrete operations (7-12 years) when inductive reasoning develops. D. Formal operations (2 till adulthood) is when abstract thinking and deductive reasoning develop. 26. Situation : The nurse assigned in the detoxification unit attends to various patients with substance-related disorders. A 45 years old male revealed that he experienced a marked increase in his intake of alcohol to achieve the desired effect This indicates: A. withdrawal B. tolerance C. intoxication D. psychological dependence Answer: (B) tolerance tolerance refers to the increase in the amount of the substance to achieve the same effects. A. Withdrawal refers to the physical signs and symptoms that occur when the addictive substance is reduced or withheld. B. Intoxication refers to the behavioral changes that occur upon recent ingestion of a substance. D. Psychological dependence refers to the intake of the substance to prevent the onset of withdrawal symptoms. 27. The client admitted for alcohol detoxification develops increased tremors, irritability, hypertension and fever. The nurse should be alert for impending: A. delirium tremens B. Korsakoff’s syndrome C. esophageal varices D. Wernicke’s syndrome Answer: (A) delirium tremens Delirium Tremens is the most extreme central nervous system irritability due to withdrawal from alcohol B. This refers to an amnestic syndrome associated with chronic alcoholism due to a deficiency in Vit. B C. This is a complication of liver cirrhosis which may be secondary to alcoholism . D. This is a complication of alcoholism characterized by irregularities of eye movements and lack of coordination. 28. The care for the client places priority to which of the following: A. Monitoring his vital signs every hour B. Providing a quiet, dim room C. Encouraging adequate fluids and nutritious foods D. Administering Librium as ordered Answer: (A) Monitoring his vital signs every hour Pulse and blood pressure are usually elevated during withdrawal, Elevation may indicate impending delirium tremens B. Client needs quiet, well lighted, consistent and secure environment. Excessive stimulation can aggravate anxiety and cause illusions and hallucinations. C. Adequate nutrition with sulpplement of Vit. B should be ensured. D. Sedatives are used to relieve anxiety. 29. Another client is brought to the emergency room by friends who state that he took something an hour ago. He is actively hallucinating, agitated, with irritated nasal septum. A. Heroin B. cocaine C. LSD D. marijuana Answer: (B) cocaine The manifestations indicate intoxication with cocaine, a CNS stimulant. A. Intoxication with heroine is manifested by euphoria then impairment in judgment, attention and the presence of papillary constriction. C. Intoxication with hallucinogen like LSD is manifested by grandiosity, hallucinations, synesthesia and increase in vital signs D. Intoxication with Marijuana, a cannabinoid is manifested by sensation of slowed time, conjunctival redness, social withdrawal, impaired judgment and hallucinations. 30. A client is admitted with needle tracts on his arm, stuporous and with pin point pupil will likely be managed with: A. Naltrexone (Revia) B. Narcan (Naloxone) C. Disulfiram (Antabuse) D. Methadone (Dolophine) Answer: (B) Narcan (Naloxone) Narcan is a narcotic antagonist used to manage the CNS depression due to overdose with heroin. A. This is an opiate receptor blocker used to relieve the craving for heroine C. Disulfiram is used as a deterrent in the use of alcohol. D. Methadone is used as a substitute in the withdrawal from heroine 31. Situation: An old woman was brought for evaluation due to the hospital for evaluation due to increasing forgetfulness and limitations in daily function. The daughter revealed that the client used her toothbrush to comb her hair. She is manifesting: A. apraxia B. aphasia C. agnosia D. amnesia Answer: (C) agnosia This is the inability to recognize objects. A. Apraxia is the inability to execute motor activities despite intact comprehension. B. Aphasia is the loss of ability to use or understand words. D. Amnesia is loss of memory. 32. She tearfully tells the nurse “I can’t take it when she accuses me of stealing her things.” Which response by the nurse will be most therapeutic? A. ”Don’t take it personally. Your mother does not mean it.” 43. Initial intervention for the client should be to: A. Encourage to verbalize his fears as much as he wants. B. Assist him to find meaning to his feelings in relation to his past. C. Establish trust through a consistent approach. D. Accept her fears without criticizing. Answer: (D) Accept her fears without criticizing. The client cannot control her fears although the client knows its silly and can joke about it. A. Allow expression of the client’s fears but he should focus on other productive activities as well. B and C. These are not the initial interventions. 44. The nurse develops a countertransference reaction. This is evidenced by: A. Revealing personal information to the client B. Focusing on the feelings of the client. C. Confronting the client about discrepancies in verbal or non-verbal behavior D. The client feels angry towards the nurse who resembles his mother. Answer: (A) Revealing personal information to the client A. Countertransference is an emotional reaction of the nurse on the client based on her unconscious needs and conflicts. B and C. These are therapeutic approaches. D. This is transference reaction where a client has an emotional reaction towards the nurse based on her past. 45. Which is the desired outcome in conducting desensitization: A. The client verbalize his fears about the situation B. The client will voluntarily attend group therapy in the social hall. C. The client will socialize with others willingly D. The client will be able to overcome his disabling fear. Answer: (D) The client will be able to overcome his disabling fear. The client will overcome his disabling fear by gradual exposure to the feared object. A,B and C are not the desired outcome of desensitization. 46. Which of the following should be included in the health teachings among clients receiving Valium: A. Avoid taking CNS depressant like alcohol. B. There are no restrictions in activities. C. Limit fluid intake. D. Any beverage like coffee may be taken Answer: (A) Avoid taking CNS depressant like alcohol. Valium is a CNS depressant. Taking it with other CNS depressants like alcohol; potentiates its effect. B. The client should be taught to avoid activities that require alertness. C. Valium causes dry mouth so the client must increase her fluid intake. D. Stimulants must not be taken by the client because it can decrease the effect of Valium. 47. Situation: A 20 year old college student is admitted to the medical ward because of sudden onset of paralysis of both legs. Extensive examination revealed no physical basis for the complaint. The nurse plans intervention based on which correct statement about conversion disorder? A. The symptoms are conscious effort to control anxiety B. The client will experience high level of anxiety in response to the paralysis. C. The conversion symptom has symbolic meaning to the client D. A confrontational approach will be beneficial for the client. Answer: (C) The conversion symptom has symbolic meaning to the client the client uses body symptoms to relieve anxiety. A. The condition occurs unconsciously. B. The client is not distressed by the lost or altered body function. D. The client should not be confronted by the underlying cause of his condition because this can aggravate the client’s anxiety. 48. Nina reveals that the boyfriend has been pressuring her to engage in premarital sex. The most therapeutic response by the nurse is: A. “I can refer you to a spiritual counselor if you like.” B. “You shouldn’t allow anyone to pressure you into sex.” C. “It sounds like this problem is related to your paralysis.” D. “How do you feel about being pressured into sex by your boyfriend?” Answer: (D) “How do you feel about being pressured into sex by your boyfriend?” Focusing on expression of feelings is therapeutic. The central force of the client’s condition is anxiety. A. This is not therapeutic because the nurse passes the responsibility to the counselor. B. Giving advice is not therapeutic. C. This is not therapeutic because it confronts the underlying cause. 49. Malingering is different from somatoform disorder because the former: A. Has evidence of an organic basis. B. It is a deliberate effort to handle upsetting events C. Gratification from the environment are obtained. D. Stress is expressed through physical symptoms. Answer: (B) It is a deliberate effort to handle upsetting events Malingering is a conscious simulation of an illness while somatoform disorder occurs unconscious. A. Both disorders do not have an organic or structural basis. C. Both have primary gains. D. This is a characteristic of somatoform disorder. 50. Unlike psychophysiologic disorder Linda may be best managed with: A. medical regimen B. milieu therapy C. stress management techniques D. psychotherapy Answer: (C) stress management techniques Stree management techniques is the best management of somatoform disorder because the disorder is related to stress and it does not have a medical basis. A. This disorder is not supported by organic pathology so no medical regimen is required. B and D. Milieu therapy and psychotherapy may be used a therapeutic modalities but these are not the best. 51. Which is the best indicator of success in the long term management of the client? A. His symptoms are replaced by indifference to his feelings B. He participates in diversionary activities. C. He learns to verbalize his feelings and concerns D. He states that his behavior is irrational. Answer: (C) He learns to verbalize his feelings and concerns C. The client is encouraged to talk about his feelings and concerns instead of using body symptoms to manage his stressors. A. The client is encouraged to acknowledge feelings rather than being indifferent to her feelings. B. Participation in activities diverts the client’s attention away from his bodily concerns but this is not the best indicator of success. D. Help the client recognize that his physical symptoms occur because of or are exacerbated by specific stressor, not as irrational. 52. Situation: A young woman is brought to the emergency room appearing depressed. The nurse learned that her child died a year ago due to an accident. The initial nursing diagnosis is dysfunctional grieving. The statement of the woman that supports this diagnosis is: A. “I feel envious of mothers who have toddlers” B. “I haven’t been able to open the door and go into my baby’s room “ C. “I watch other toddlers and think about their play activities and I cry.” D. “I often find myself thinking of how I could have prevented the death. Answer: (B) “I haven’t been able to open the door and go into my baby’s room “ This indicates denial. This defense is adaptive as an initial reaction to loss but an extended, unsuccessful use of denial is dysfunctional. A. This indicates acknowledgement of the loss. Expressing feelings openly is acceptable. C. This indicates the stage of depression in the grieving process. D. Remembering both positive and negative aspects of the deceased love one signals successful mourning. 53. The client said “I can’t even take care of my baby. I’m good for nothing.” Which is the appropriate nursing diagnosis? A. Ineffective individual coping related to loss. B. Impaired verbal communication related to inadequate social skills. C. Low esteem related to failure in role performance D. Impaired social interaction related to repressed anger. Answer: (C) Low esteem related to failure in role performance This indicates the client’s negative self evaluation. A sense of worthlessness may accompany depression. A,B and D are not relevant. The cues do not indicate inability to use coping resources, decreased ability to transmit/process symbols, nor insufficient quality of social exchange 54. The following medications will likely be prescribed for the client EXCEPT: A. Prozac B. Tofranil C. Parnate D. Zyprexa Answer: (D) Zyprexa This is an antipsychotic. A. This is a SSRI antidepressant. B. This antidepressant belongs to the Tricyclic group. C. This is a MAOI antidepressant. 55. Which is the highest priority in the post ECT care? A. Observe for confusion B. Monitor respiratory status C. Reorient to time, place and person D. Document the client’s response to the treatment Answer: (B) Monitor respiratory status A side effect of ECT which is life threatening is respiratory arrest. A and C. Confusion and disorientation are side effects of ECT but these are not the highest priority. 56. Situation: A 27 year old writer is admitted for the second time accompanied by his wife. He is demanding, arrogant talked fast and hyperactive. Initially the nurse should plan this for a manic client: A. set realistic limits to the client’s behavior B. repeat verbal instructions as often as needed C. allow the client to get out feelings to relieve tension D. assign a staff to be with the client at all times to help maintain control Answer: (A) set realistic limits to the client’s behavior The manic client is hyperactive and may engage in injurious activities. A quiet environment and consistent and firm limits should be set to ensure safety. B. Clear, concise directions are given because of the distractibility of the client but this is not the priority. C. The manic client tend to externalize hostile feelings, however only non-destructive methods of expression should be allowed D. Nurses set limit as needed. Assigning a staff to be with the client at all times is not realistic. 57. An activity appropriate for the client is: A. table tennis B. painting C. chess D. cleaning Answer: (D) cleaning The client’s excess energy can be rechanelled through physical activities that are not competitive like cleaning. This is also a way to dissipate tension. A. Tennis is a competitive activity which can stimulate the client. 58. The client is arrogant and manipulative. In ensuring a therapeutic milieu, the nurse does one of the following: A. Agree on a consistent approach among the staff assigned to the client. B. Suggest that the client take a leading role in the social activities C. Provide the client with extra time for one on one sessions D. Allow the client to negotiate the plan of care Answer: (A) Agree on a consistent approach among the staff assigned to the client. A consistent firm approach is appropriate. This is a therapeutic way of to handle attempts of exploiting the weakness in others or create conflicts among the staff. Bargaining should not be Answer: (C) A living, learning or working environment. A therapeutic milieu refers to a broad conceptual approach in which all aspects of the environment are channeled to provide a therapeutic environment for the client. The six environmental elements include structure, safety, norms, limit setting, balance and unit modification. A. Behavioral approach in psychiatric care is based on the premise that behavior can be learned or unlearned through the use of reward and punishment. B. Cognitive approach to change behavior is done by correcting distorted perceptions and irrational beliefs to correct maladaptive behaviors. D. This is not congruent with therapeutic milieu. 69. Included as priority of care for the client will be: A. Encourage verbalization of concerns instead of demonstrating them through the body B. Divert attention to ward activities C. Place in semi-fowlers position and render O2 inhalation as ordered D. Help her recognize that her physical condition has an emotional component Answer: (C) Place in semi-fowlers position and render O2 inhalation as ordered Since psychopysiologic disorder has organic basis, priority intervention is directed towards disease- specific management. Failure to address the medical condition of the client may be a life threat. A and B. The client has physical symptom that is adversely affected by psychological factors. Verbalization of feelings in a non threatening environment and involvement in relaxing activities are adaptive way of dealing with stressors. However, these are not the priority. D. Helping the client connect the physical symptoms with the emotional problems can be done when the client is ready. 70. The client is concerned about his coming discharge, manifested by being unusually sad. Which is the most therapeutic approach by the nurse? A. “You are much better than when you were admitted so there’s no reason to worry.” B. “What would you like to do now that you’re about to go home?” C. “You seem to have concerns about going home.” D. “Aren’t you glad that you’re going home soon?” Answer: (C) “You seem to have concerns about going home.” . This statement reflects how the client feels. Showing empathy can encourage the client to talk which is important as an alternative more adaptive way of coping with stressors.. A. Giving false reassurance is not therapeutic. B. While this technique explores plans after discharge, it does not focus on expression of feelings. D. This close ended question does not encourage verbalization of feelings. 71. Situation: The nurse may encounter clients with concerns on sexuality. The most basic factor in the intervention with clients in the area of sexuality is: A. Knowledge about sexuality. B. Experience in dealing with clients with sexual problems C. Comfort with one’s sexuality D. Ability to communicate effectively Answer: (C) Comfort with one’s sexuality The nurse must be accepting, empathetic and non-judgmental to patients who disclose concerns regarding sexuality. This can happen only when the nurse has reconciled and accepted her feelings and beliefs related to sexuality. A,B and D are important considerations but these are not the priority. 72. Which of the following statements is true for gender identity disorder? A. It is the sexual pleasure derived from inanimate objects. B. It is the pleasure derived from being humiliated and made to suffer C. It is the pleasure of shocking the victim with exposure of the genitalia D. It is the desire to live or involve in reactions of the opposite sex Answer: (D) It is the desire to live or involve in reactions of the opposite sex Gender identity disorder is a strong and persistent desire to be the other sex. A. This is fetishism. B. This refers to masochism. C. This describes exhibitionism. 73. The sexual response cycle in which the sexual interest continues to build: A. Sexual Desire B. Sexual arousal C. Orgasm D. Resolution Answer: (B) Sexual arousal Sexual arousal or excitement refers to attaining and maintaining the physiologic requirements for sexual intercourse. A. Sexual Desire refers to the ability, interest or willingness for sexual stimulation. C. Orgasm refers to the peak of the sexual response where the female has vaginal contractions for the female and ejaculatory contractions for the male. D. Resolution is the final phase of the sexual response in which the organs and the body systems gradually return to the unaroused state. 74. The inability to maintain the physiologic requirements in sexual intercourse is: A. Sexual Desire Disorder B. Sexual Arousal Disorder C. Orgasm Disorder D. Sexual Pain disorder Answer: (B) Sexual Arousal Disorder This describes sexual arousal disorder. A. Sexual Desire Disorder refers to the persistent and recurrent lack of desire or willingness for sexual intercourse. C. Orgasm Disorder is the inability to complete the sexual response cycle because of the inability to achieve an orgasm. D. Sexual Pain Disorder is characterized by genital pain before, during or after sexual intercourse. 75. The nurse asks a client to roll up his sleeves so she can take his blood pressure. The client replies “If you want I can go naked for you.” The most therapeutic response by the nurse is: A. “You’re attractive but I’m not interested.” B. “You wouldn’t be the first that I will see naked.” C. “I will report you to the guard if you don’t control yourself.” D. “I only need access to your arm. Putting up your sleeve is fine.” Answer: (D) “I only need access to your arm. Putting up your sleeve is fine.” The nurse needs to deal with the client with sexually connotative behavior in a casual, matter of fact way. A and B. These responses are not therapeutic because they are challenging and rejecting. C. Threatening the client is not therapeutic. 76. Situation: Knowledge and skills in the care of violent clients is vital in the psychiatric unit. A nurse observes that a client with a potential for violence is agitated, pacing up and down the hallway and making aggressive remarks. Which of the following statements is most appropriate to make to this patient? A. What is causing you to become agitated? B. You need to stop that behavior now. C. You will need to be restrained if you do not change your behavior. D. You will need to be placed in seclusion. Answer: (A) What is causing you to become agitated? In a non-violent aggressive behavior, help the client identify the stressor or the true object of hostility. This helps reveal unresolved issues so that they may be confronted. B. Pacing is a tension relieving measure for an agitated client. C. This is a threatening statement that can heighten the client’s tension. D. Seclusion is used when less restrictive measures have failed. 77. The nurse closely observes the client who has been displaying aggressive behavior. The nurse observes that the client’s anger is escalating. Which approach is least helpful for the client at this time? A. Acknowledge the client’s behavior B. Maintain a safe distance from the client C. Assist the client to an area that is quiet D. Initiate confinement measures Answer: (D) Initiate confinement measures The proper procedure for dealing with harmful behavior is to first try to calm patient verbally. . When verbal and psychopharmacologic interventions are not adequate to handle the aggressiveness, seclusion or restraints may be applicable. A, B and C are appropriate approaches during the escalation phase of aggression. 78. The charge nurse of a psychiatric unit is planning the client assignment for the day. The most appropriate staff to be assigned to a client with a potential for violence is which of the following: A. A timid nurse B. A mature experienced nurse C. an inexperienced nurse D. a soft spoken nurse Answer: (B) A mature experienced nurse The unstable, aggressive client should be assigned to the most experienced nurse. A, C and D. A shy, inexperienced, soft spoken nurse may feel intimidated by the angry patient. 79. The nurse exemplifies awareness of the rights of a client whose anger is escalating by: A. Taking a directive role in verbalizing feelings B. Using an authoritarian, confrontational approach C. Putting the client in a seclusion room D. Applying mechanical restraints Answer: (A) Taking a directive role in verbalizing feelings Taking a directive role in the client’s verbalization of feelings can deescalate the client’s anger. B. A confrontational approach can be threatening and adds to the client’s tension. C and D. Use of restraints and isolation may be required if less restrictive interventions are unsuccessful. 80. The client jumps up and throws a chair out of the window. He was restrained after his behavior can no longer be controlled by the staff. Which of these documentations indicates the safeguarding of the patient’s rights? A. There was a doctor’s order for restraints/seclusion B. The patient’s rights were explained to him. C. The staff observed confidentiality D. The staff carried out less restrictive measures but were unsuccessful. Answer: (D) The staff carried out less restrictive measures but were unsuccessful. This documentation indicates that the client has been placed on restraints after the least restrictive measures failed in containing the client’s violent behavior. 81. Situation: Clients with personality disorders have difficulties in their social and occupational functions. Clients with personality disorder will most likely: A. recover with therapeutic intervention B. respond to antianxiety medication C. manifest enduring patterns of inflexible behaviors D. Seek treatment willingly from some personally distressing symptoms Answer: (C) manifest enduring patterns of inflexible behaviors Personality disorders are characterized by inflexible traits and characteristics that are lifelong. A and D. This disorder is manifested by life-long patterns of behavior. The client with this disorder will not likely present himself for treatment unless something has gone wrong in his life so he may not recover from therapeutic intervention. B. Medications are generally not recommended for personality disorders. 82. A client tends to be insensitive to others, engages in abusive behaviors and does not have a sense of remorse. Which personality disorder is he likely to have? A. Narcissistic B. Paranoid C. Histrionic D. Antisocial Answer: (D) Antisocial These are the characteristics of an individual with antisocial personality. A. Narcissistic personality disorder is characterized by grandiosity and a need for constant admiration from others. B. Individuals with paranoid personality demonstrate a pattern of distrust and suspiciousness and interprets others motives as threatening. C. Individuals with histrionic have excessive emotionality, and attention-seeking behaviors. 83. The client joins a support group and frequently preaches against abuse, is demonstrating the use of: C. She postpones the physical assessment until the client is calm D. Explains to the client that her reactions are normal Answer: (C) She postpones the physical assessment until the client is calm The nurse acts as a patient advocate as she protects the client from psychological harm A. The nurse acts a a counselor B. The nurse acts as a technician D. This exemplifies the role of a teacher 94. Crisis intervention carried out to the client has this primary goal: A. Assist the client to express her feelings B. Help her identify her resources C. Support her adaptive coping skills D. Help her return to her pre-rape level of function Answer: (D) Help her return to her pre-rape level of function The goal of crisis intervention to help the client return to her level of function prior to the crisis. A,B and C are interventions or strategies to attain the goal 95. Five months after the incident the client complains of difficulty to concentrate, poor appetite, inability to sleep and guilt. She is likely suffering from: A. Adjustment disorder B. Somatoform Disorder C. Generalized Anxiety Disorder D. Post traumatic disorder Answer: (D) Post traumatic disorder Post traumatic stress disorder is characterized by flashback, irritability, difficulty falling asleep and concentrating following an extremely traumatic event. This lasts for more that one month A. Adjustment disorder is the maladaptive reaction to stressful events characterized by anxiety, depression and work or social impairments. This occurs within 3 months after the event B. Somatoform disorders are anxiety related disorders characterized by presence of physical symptoms without demonstrable organic basis C. Generalized anxiety disorder is characterized by chronic, excessive anxiety for at least 6 months 96. Situation: A 29 year old client newly diagnosed with breast cancer is pacing, with rapid speech headache and inability to focus with what the doctor was saying. The nurse assesses the level of anxiety as: A. Mild B. Moderate C. Severe D. Panic Answer: (C) Severe The client’s manifestations indicate severe anxiety. A Mild anxiety is manifested by slight muscle tension, slight fidgeting, alertness, ability to concentrate and capable of problem solving. B. Moderate muscle tension, increased vital signs, periodic slow pacing, increased rate of speech and difficulty in concentrating are noted in moderate anxiety. D. Panic level of anxiety is characterized immobilization, incoherence, feeling of being overwhelmed and disorganization 97. Anxiety is caused by: A. an objective threat B. a subjectively perceived threat C. hostility turned to the self D. masked depression Answer: (B) a subjectively perceived threat Anxiety is caused by a subjectively perceived threat A. Fear is caused by an objective threat C. A depressed client internalizes hostility D. Mania is due to masked depression 98. It would be most helpful for the nurse to deal with a client with severe anxiety by: A. Give specific instructions using speak in concise statements. B. Ask the client to identify the cause of her anxiety. C. Explain i detail the plan of care developed D. Urge the client to focus on what the nurse is saying Answer: (A) Give specific instructions using speak in concise statements. The client has narrowed perceptual field. Lengthy explanations cannot be followed by the client. B. The client will not be able to identify the cause of anxiety C and D. The client has difficulty concentrating and will not be able to focus. 99. Which of the following medications will likely be ordered for the client?” A. Prozac B. Valium C. Risperdal D. Lithium Answer: (B) Valium Antianxiety A. Antidepressant C. Antipsychotic D. Antimanic 100. Which of the following is included in the health teachings among clients receiving Valium?: A. Avoid foods rich in tyramine. B. Take the medication after meals. C. It is safe to stop it anytime after long term use. D. Double up the dose if the client forgets her medication. Answer: (B) Take the medication after meals. Antianxiety medications cause G.I. upset so it should be taken after meals. A. This is specific for antidepressant MAOI. Taking tyramine rich food can cause hypertensive crisis. C. Valium causes dependency. In which case, the medication should be gradually withdrawn to prevent the occurrence of convulsion. D The dose of Valium should not be doubled if the previous dose was not taken. It can intensify the CNS depressant effects. Philippine NLE Board Exam: Community Health Nursing Question & Answer w/ rationale COMMUNITY HEALTH NURSING 1. Which is the primary goal of community health nursing? A. To support and supplement the efforts of the medical profession in the promotion of health and prevention of illness B. To enhance the capacity of individuals, families and communities to cope with their health needs C. To increase the productivity of the people by providing them with services that will increase their level of health D. To contribute to national development through promotion of family welfare, focusing particularly on mothers and children. Answer: (B) To enhance the capacity of individuals, families and communities to cope with their health needs To contribute to national development through promotion of family welfare, focusing particularly on mothers and children. 2. CHN is a community-based practice. Which best explains this statement? A. The service is provided in the natural environment of people. B. The nurse has to conduct community diagnosis to determine nursing needs and problems. C. The services are based on the available resources within the community. D. Priority setting is based on the magnitude of the health problems identified. Answer: (B) The nurse has to conduct community diagnosis to determine nursing needs and problems. Community-based practice means providing care to people in their own natural environments: the home, school and workplace, for example. 3. Population-focused nursing practice requires which of the following processes? A. Community organizing B. Nursing process C. Community diagnosis D. Epidemiologic process Answer: (C) Community diagnosis Population-focused nursing care means providing care based on the greater need of the majority of the population. The greater need is identified through community diagnosis. 4. R.A. 1054 is also known as the Occupational Health Act. Aside from number of employees, what other factor must be considered in determining the occupational health privileges to which the workers will be entitled? A. Type of occupation: agricultural, commercial, industrial B. Location of the workplace in relation to health facilities C. Classification of the business enterprise based on net profit D. Sex and age composition of employees Answer: (B) Location of the workplace in relation to health facilities Based on R.A. 1054, an occupational nurse must be employed when there are 30 to 100 employees and the workplace is more than 1 km. away from the nearest health center. 5. A business firm must employ an occupational health nurse when it has at least how many employees? A. 21 B. 101 C. 201 D. 301 Answer: (B) 101 Again, this is based on R.A. 1054. 6. When the occupational health nurse employs ergonomic principles, she is performing which of her roles? A. Health care provider B. Health educator C. Health care coordinator D. Environmental manager Answer: (D) Environmental manager Ergonomics is improving efficiency of workers by improving the worker’s environment through appropriately designed furniture, for example. 7. A garment factory does not have an occupational nurse. Who shall provide the occupational health needs of the factory workers? A. Occupational health nurse at the Provincial Health Office B. Physician employed by the factory C. Public health nurse of the RHU of their municipality D. Rural sanitary inspector of the RHU of their municipality Answer: (C) Public health nurse of the RHU of their municipality You’re right! This question is based on R.A.1054. 8. “Public health services are given free of charge.” Is this statement true or false? A. The statement is true; it is the responsibility of government to provide basic services. B. The statement is false; people pay indirectly for public health services. C. The statement may be true or false, depending on the specific service required. D. The statement may be true or false, depending on policies of the government concerned. Answer: (B) The statement is false; people pay indirectly for public health services. Community health services, including public health services, are pre-paid services, though taxation, for example. 9. According to C.E.Winslow, which of the following is the goal of Public Health? A. For people to attain their birthrights of health and longevity B. For promotion of health and prevention of disease C. For people to have access to basic health services D. For people to be organized in their health efforts Answer: (A) For people to attain their birthrights of health and longevity According to Winslow, all public health efforts are for people to realize their birthrights of health and longevity. 10. We say that a Filipino has attained longevity when he is able to reach the average lifespan of Filipinos. What other statistic may be used to determine attainment of longevity? A. Age-specific mortality rate B. Proportionate mortality rate C. Swaroop’s index D. Case fatality rate Answer: (C) Swaroop’s index C. 3 D. The RHU does not need any more midwife item. Answer: (A) 1 Each rural health midwife is given a population assignment of about 5,000. 25. If the RHU needs additional midwife items, you will submit the request for additional midwife items for approval to the A. Rural Health Unit B. District Health Office C. Provincial Health Office D. Municipal Health Board Answer: (D) Municipal Health Board As mandated by R.A. 7160, basic health services have been devolved from the national government to local government units. 26. As an epidemiologist, the nurse is responsible for reporting cases of notifiable diseases. What law mandates reporting of cases of notifiable diseases? A. Act 3573 B. R.A. 3753 C. R.A. 1054 D. R.A. 1082 Answer: (A) Act 3573 Act 3573, the Law on Reporting of Communicable Diseases, enacted in 1929, mandated the reporting of diseases listed in the law to the nearest health station. 27. According to Freeman and Heinrich, community health nursing is a developmental service. Which of the following best illustrates this statement? A. The community health nurse continuously develops himself personally and professionally. B. Health education and community organizing are necessary in providing community health services. C. Community health nursing is intended primarily for health promotion and prevention and treatment of disease. D. The goal of community health nursing is to provide nursing services to people in their own places of residence. Answer: (B) Health education and community organizing are necessary in providing community health services. The community health nurse develops the health capability of people through health education and community organizing activities. 28. Which disease was declared through Presidential Proclamation No. 4 as a target for eradication in the Philippines? A. Poliomyelitis B. Measles C. Rabies D. Neonatal tetanus Answer: (B) Measles Presidential Proclamation No. 4 is on the Ligtas Tigdas Program. 29. The public health nurse is responsible for presenting the municipal health statistics using graphs and tables. To compare the frequency of the leading causes of mortality in the municipality, which graph will you prepare? A. Line B. Bar C. Pie D. Scatter diagram Answer: (B) Bar A bar graph is used to present comparison of values, a line graph for trends over time or age, a pie graph for population composition or distribution, and a scatter diagram for correlation of two variables. 30. Which step in community organizing involves training of potential leaders in the community? A. Integration B. Community organization C. Community study D. Core group formation Answer: (D) Core group formation In core group formation, the nurse is able to transfer the technology of community organizing to the potential or informal community leaders through a training program. 31. In which step are plans formulated for solving community problems? A. Mobilization B. Community organization C. Follow-up/extension D. Core group formation Answer: (B) Community organization Community organization is the step when community assemblies take place. During the community assembly, the people may opt to formalize the community organization and make plans for community action to resolve a community health problem. 32. The public health nurse takes an active role in community participation. What is the primary goal of community organizing? A. To educate the people regarding community health problems B. To mobilize the people to resolve community health problems C. To maximize the community’s resources in dealing with health problems D. To maximize the community’s resources in dealing with health problems Answer: (D) To maximize the community’s resources in dealing with health problems Community organizing is a developmental service, with the goal of developing the people’s self- reliance in dealing with community health problems. A, B and C are objectives of contributory objectives to this goal. 33. An indicator of success in community organizing is when people are able to A. Participate in community activities for the solution of a community problem B. Implement activities for the solution of the community problem C. Plan activities for the solution of the community problem D. Identify the health problem as a common concern Answer: (A) Participate in community activities for the solution of a community problem Participation in community activities in resolving a community problem may be in any of the processes mentioned in the other choices. 34. Tertiary prevention is needed in which stage of the natural history of disease? A. Pre-pathogenesis B. Pathogenesis C. Prodromal D. Terminal Answer: (D) Terminal Tertiary prevention involves rehabilitation, prevention of permanent disability and disability limitation appropriate for convalescents, the disabled, complicated cases and the terminally ill (those in the terminal stage of a disease) 35. Isolation of a child with measles belongs to what level of prevention? A. Primary B. Secondary C. Intermediate D. Tertiary Answer: (A) Primary The purpose of isolating a client with a communicable disease is to protect those who are not sick (specific disease prevention). 36. On the other hand, Operation Timbang is prevention. A. Primary B. Secondary C. Intermediate D. Tertiary Answer: (B) Secondary Operation Timbang is done to identify members of the susceptible population who are malnourished. Its purpose is early diagnosis and, subsequently, prompt treatment. 37. Which type of family-nurse contact will provide you with the best opportunity to observe family dynamics? A. Clinic consultation B. Group conference C. Home visit D. Written communication Answer: (C) Home visit Dynamics of family relationships can best be observed in the family’s natural environment, which is the home. 38. The typology of family nursing problems is used in the statement of nursing diagnosis in the care of families. The youngest child of the de los Reyes family has been diagnosed as mentally retarded. This is classified as a A. Health threat B. Health deficit C. Foreseeable crisis D. Stress point Answer: (B) Health deficit Failure of a family member to develop according to what is expected, as in mental retardation, is a health deficit. 39. The de los Reyes couple have a 6-year old child entering school for the first time. The de los Reyes family has a A. Health threat B. Health deficit C. Foreseeable crisis D. Stress point Answer: (C) Foreseeable crisis Entry of the 6-year old into school is an anticipated period of unusual demand on the family. 40. Which of the following is an advantage of a home visit? A. It allows the nurse to provide nursing care to a greater number of people. B. It provides an opportunity to do first hand appraisal of the home situation. C. It allows sharing of experiences among people with similar health problems. D. It develops the family’s initiative in providing for health needs of its members. Answer: (B) It provides an opportunity to do first hand appraisal of the home situation. Choice A is not correct since a home visit requires that the nurse spend so much time with the family. Choice C is an advantage of a group conference, while choice D is true of a clinic consultation. 41. Which is CONTRARY to the principles in planning a home visit? A. A home visit should have a purpose or objective. B. The plan should revolve around family health needs. C. A home visit should be conducted in the manner prescribed by the RHU. D. Planning of continuing care should involve a responsible family member. Answer: (C) A home visit should be conducted in the manner prescribed by the RHU. The home visit plan should be flexible and practical, depending on factors, such as the family’s needs and the resources available to the nurse and the family. 42. The PHN bag is an important tool in providing nursing care during a home visit. The most important principle of bag technique states that it A. Should save time and effort. B. Should minimize if not totally prevent the spread of infection. C. Should not overshadow concern for the patient and his family. D. May be done in a variety of ways depending on the home situation, etc. Answer: (B) Should minimize if not totally prevent the spread of infection. Sensitivity is the capacity of a diagnostic examination to detect cases of the disease. If a test is 100% sensitive, all the cases tested will have a positive result, i.e., there will be no false negative results. 55. Use of appropriate technology requires knowledge of indigenous technology. Which medicinal herb is given for fever, headache and cough? A. Sambong B. Tsaang gubat C. Akapulko D. Lagundi Answer: (D) Lagundi Sambong is used as a diuretic. Tsaang gubat is used to relieve diarrhea. Akapulko is used for its antifungal property. 56. What law created the Philippine Institute of Traditional and Alternative Health Care? A. R.A. 8423 B. R.A. 4823 C. R.A. 2483 D. R.A. 3482 Answer: (A) R.A. 8423 (none) 57. In traditional Chinese medicine, the yielding, negative and feminine force is termed A. Yin B. Yang C. Qi D. Chai Answer: (A) Yin Yang is the male dominating, positive and masculine force. 58. What is the legal basis for Primary Health Care approach in the Philippines? A. Alma Ata Declaration on PHC B. Letter of Instruction No. 949 C. Presidential Decree No. 147 D. Presidential Decree 996 Answer: (B) Letter of Instruction No. 949 Letter of Instruction 949 was issued by then President Ferdinand Marcos, directing the formerly called Ministry of Health, now the Department of Health, to utilize Primary Health Care approach in planning and implementing health programs. 59. Which of the following demonstrates intersectoral linkages? A. Two-way referral system B. Team approach C. Endorsement done by a midwife to another midwife D. Cooperation between the PHN and public school teacher Answer: (D) Cooperation between the PHN and public school teacher Intersectoral linkages refer to working relationships between the health sector and other sectors involved in community development. 60. The municipality assigned to you has a population of about 20,000. Estimate the number of 14 year old children who will be given Retinol capsule 200,000 I.U. every 6 months. A. 1,500 B. 1,800 C. 2,000 D. 2,300 Answer: (D) 2,300 Based on the Philippine population composition, to estimate the number of 1-4 year old children, multiply total population by 11.5%. 61. Estimate the number of pregnant women who will be given tetanus toxoid during an immunization outreach activity in a barangay with a population of about 1,500. A. 265 B. 300 C. 375 D. 400 Answer: (A) 265 To estimate the number of pregnant women, multiply the total population by 3.5%. 62. To describe the sex composition of the population, which demographic tool may be used? A. Sex ratio B. Sex proportion C. Population pyramid D. Any of these may be used. Answer: (D) Any of these may be used. Sex ratio and sex proportion are used to determine the sex composition of a population. A population pyramid is used to present the composition of a population by age and sex. 63. Which of the following is a natality rate? A. Crude birth rate B. Neonatal mortality rate C. Infant mortality rate D. General fertility rate Answer: (A) Crude birth rate Natality means birth. A natality rate is a birth rate. 64. You are computing the crude death rate of your municipality, with a total population of about 18,000, for last year. There were 94 deaths. Among those who died, 20 died because of diseases of the heart and 32 were aged 50 years or older. What is the crude death rate? A. 4.2/1,000 B. 5.2/1,000 C. 6.3/1,000 D. 7.3/1,000 Answer: (B) 5.2/1,000 To compute crude death rate divide total number of deaths (94) by total population (18,000) and multiply by 1,000. 65. Knowing that malnutrition is a frequent community health problem, you decided to conduct nutritional assessment. What population is particularly susceptible to protein energy malnutrition (PEM)? A. Pregnant women and the elderly B. Under-5 year old children C. 1-4 year old children D. School age children Answer: (C) 1-4 year old children Preschoolers are the most susceptible to PEM because they have generally been weaned. Also, this is the population who, unable to feed themselves, are often the victims of poor intrafamilial food distribution. 66. Which statistic can give the most accurate reflection of the health status of a community? A. 1-4 year old age-specific mortality rate B. Infant mortality rate C. Swaroop’s index D. Crude death rate Answer: (C) Swaroop’s index Swaroop’s index is the proportion of deaths aged 50 years and above. The higher the Swaroop’s index of a population, the greater the proportion of the deaths who were able to reach the age of at least 50 years, i.e., more people grew old before they died. 67. In the past year, Barangay A had an average population of 1655. 46 babies were born in that year, 2 of whom died less than 4 weeks after they were born. There were 4 recorded stillbirths. What is the neonatal mortality rate? A. 27.8/1,000 B. 43.5/1,000 C. 86.9/1,000 D. 130.4/1,000 Answer: (B) 43.5/1,000 To compute for neonatal mortality rate, divide the number of babies who died before reaching the age of 28 days by the total number of live births, then multiply by 1,000. 68. Which statistic best reflects the nutritional status of a population? A. 1-4 year old age-specific mortality rate B. Proportionate mortality rate C. Infant mortality rate D. Swaroop’s index Answer: (A) 1-4 year old age-specific mortality rate Since preschoolers are the most susceptible to the effects of malnutrition, a population with poor nutritional status will most likely have a high 1-4 year old age-specific mortality rate, also known as child mortality rate. 69. What numerator is used in computing general fertility rate? A. Estimated midyear population B. Number of registered live births C. Number of pregnancies in the year D. Number of females of reproductive age Answer: (B) Number of registered live births To compute for general or total fertility rate, divide the number of registered live births by the number of females of reproductive age (15-45 years), then multiply by 1,000. 70. You will gather data for nutritional assessment of a purok. You will gather information only from families with members who belong to the target population for PEM. What method of data gathering is best for this purpose? A. Census B. Survey C. Record review D. Review of civil registry Answer: (B) Survey A survey, also called sample survey, is data gathering about a sample of the population. 71. In the conduct of a census, the method of population assignment based on the actual physical location of the people is termed A. De jure B. De locus C. De facto D. De novo Answer: (C) De facto The other method of population assignment, de jure, is based on the usual place of residence of the people. 72. The Field Health Services and Information System (FHSIS) is the recording and reporting system in public health care in the Philippines. The Monthly Field Health Service Activity Report is a form used in which of the components of the FHSIS? A. Tally report B. Output report C. Target/client list D. Individual health record Answer: (A) Tally report A tally report is prepared monthly or quarterly by the RHU personnel and transmitted to the Provincial Health Office. 73. To monitor clients registered in long-term regimens, such as the Multi-Drug Therapy, which component will be most useful? A. Tally report B. Output report C. Target/client list D. Individual health record Answer: (C) Target/client list When the baby has properly latched on to the breast, he takes deep, slow sucks; his mouth is wide open; and much of the areola is inside his mouth. And, you’re right! The mother does not feel nipple pain. 87. You explain to a breastfeeding mother that breast milk is sufficient for all of the baby’s nutrient needs only up to . A. 3 months B. 6 months C. 1 year D. 2 years Answer: (B) 6 months After 6 months, the baby’s nutrient needs, especially the baby’s iron requirement, can no longer be provided by mother’s milk alone. 88. What is given to a woman within a month after the delivery of a baby? A. Malunggay capsule B. Ferrous sulfate 100 mg. OD C. Retinol 200,000 I.U., 1 capsule D. Potassium iodate 200 mg, 1 capsule Answer: (C) Retinol 200,000 I.U., 1 capsule A capsule of Retinol 200,000 IU is given within 1 month after delivery. Potassium iodate is given during pregnancy; malunggay capsule is not routinely administered after delivery; and ferrous sulfate is taken for two months after delivery. 89. Which biological used in Expanded Program on Immunization (EPI) is stored in the freezer? A. DPT B. Tetanus toxoid C. Measles vaccine D. Hepatitis B vaccine Answer: (C) Measles vaccine Among the biologicals used in the Expanded Program on Immunization, measles vaccine and OPV are highly sensitive to heat, requiring storage in the freezer. 90. Unused BCG should be discarded how many hours after reconstitution? A. 2 B. 4 C. 6 D. At the end of the day Answer: (B) 4 While the unused portion of other biologicals in EPI may be given until the end of the day, only BCG is discarded 4 hours after reconstitution. This is why BCG immunization is scheduled only in the morning. 91. In immunizing school entrants with BCG, you are not obliged to secure parental consent. This is because of which legal document? A. P.D. 996 B. R.A. 7846 C. Presidential Proclamation No. 6 D. Presidential Proclamation No. 46 Answer: (A) P.D. 996 Presidential Decree 996, enacted in 1976, made immunization in the EPI compulsory for children under 8 years of age. Hepatitis B vaccination was made compulsory for the same age group by R.A. 7846. 92. Which immunization produces a permanent scar? A. DPT B. BCG C. Measles vaccination D. Hepatitis B vaccination Answer: (B) BCG BCG causes the formation of a superficial abscess, which begins 2 weeks after immunization. The abscess heals without treatment, with the formation of a permanent scar. 93. A 4-week old baby was brought to the health center for his first immunization. Which can be given to him? A. DPT1 B. OPV1 C. Infant BCG D. Hepatitis B vaccine 1 Answer: (C) Infant BCG Infant BCG may be given at birth. All the other immunizations mentioned can be given at 6 weeks of age. 94. You will not give DPT 2 if the mother says that the infant had A. Seizures a day after DPT 1. B. Fever for 3 days after DPT 1. C. Abscess formation after DPT 1. D. Local tenderness for 3 days after DPT 1. Answer: (A) Seizures a day after DPT 1. Seizures within 3 days after administration of DPT is an indication of hypersensitivity to pertussis vaccine, a component of DPT. This is considered a specific contraindication to subsequent doses of DPT. 95. A 2-month old infant was brought to the health center for immunization. During assessment, the infant’s temperature registered at 38.1°C. Which is the best course of action that you will take? A. Go on with the infant’s immunizations. B. Give Paracetamol and wait for his fever to subside. C. Refer the infant to the physician for further assessment. D. Advise the infant’s mother to bring him back for immunization when he is well. Answer: (A) Go on with the infant’s immunizations. In the EPI, fever up to 38.5°C is not a contraindication to immunization. Mild acute respiratory tract infection, simple diarrhea and malnutrition are not contraindications either. 96. A pregnant woman had just received her 4th dose of tetanus toxoid. Subsequently, her baby will have protection against tetanus for how long? A. 1 year B. 3 years C. 10 years D. Lifetime Answer: (A) 1 year The baby will have passive natural immunity by placental transfer of antibodies. The mother will have active artificial immunity lasting for about 10 years. 5 doses will give the mother lifetime protection. 97. A 4-month old infant was brought to the health center because of cough. Her respiratory rate is 42/minute. Using the Integrated Management of Child Illness (IMCI) guidelines of assessment, her breathing is considered A. Fast B. Slow C. Normal D. Insignificant Answer: (C) Normal In IMCI, a respiratory rate of 50/minute or more is fast breathing for an infant aged 2 to 12 months. 98. Which of the following signs will indicate that a young child is suffering from severe pneumonia? A. Dyspnea B. Wheezing C. Fast breathing D. Chest indrawing Answer: (D) Chest indrawing In IMCI, chest indrawing is used as the positive sign of dyspnea, indicating severe pneumonia. 99. Using IMCI guidelines, you classify a child as having severe pneumonia. What is the best management for the child? A. Prescribe an antibiotic. B. Refer him urgently to the hospital. C. Instruct the mother to increase fluid intake. D. Instruct the mother to continue breastfeeding. Answer: (B) Refer him urgently to the hospital. Severe pneumonia requires urgent referral to a hospital. Answers A, C and D are done for a client classified as having pneumonia. 100. A 5-month old infant was brought by his mother to the health center because of diarrhea occurring 4 to 5 times a day. His skin goes back slowly after a skin pinch and his eyes are sunken. Using the IMCI guidelines, you will classify this infant in which category? A. No signs of dehydration B. Some dehydration C. Severe dehydration D. The data is insufficient. Answer: (B) Some dehydration Using the assessment guidelines of IMCI, a child (2 months to 5 years old) with diarrhea is classified as having SOME DEHYDRATION if he shows 2 or more of the following signs: restless or irritable, sunken eyes, the skin goes back slow after a skin pinch. 101. Based on assessment, you classified a 3-month old infant with the chief complaint of diarrhea in the category of SOME DEHYDRATION. Based on IMCI management guidelines, which of the following will you do? A. Bring the infant to the nearest facility where IV fluids can be given. B. Supervise the mother in giving 200 to 400 ml. of Oresol in 4 hours. C. Give the infant’s mother instructions on home management. D. Keep the infant in your health center for close observation. Answer: (B) Supervise the mother in giving 200 to 400 ml. of Oresol in 4 hours. In the IMCI management guidelines, SOME DEHYDRATION is treated with the administration of Oresol within a period of 4 hours. The amount of Oresol is best computed on the basis of the child’s weight (75 ml/kg body weight). If the weight is unknown, the amount of Oresol is based on the child’s age. 102. A mother is using Oresol in the management of diarrhea of her 3-year old child. She asked you what to do if her child vomits. You will tell her to A. Bring the child to the nearest hospital for further assessment. B. Bring the child to the health center for intravenous fluid therapy. C. Bring the child to the health center for assessment by the physician. D. Let the child rest for 10 minutes then continue giving Oresol more slowly. Answer: (D) Let the child rest for 10 minutes then continue giving Oresol more slowly. If the child vomits persistently, that is, he vomits everything that he takes in, he has to be referred urgently to a hospital. Otherwise, vomiting is managed by letting the child rest for 10 minutes and then continuing with Oresol administration. Teach the mother to give Oresol more slowly. 103. A 1 ½ year old child was classified as having 3rd degree protein energy malnutrition, kwashiorkor. Which of the following signs will be most apparent in this child? A. Voracious appetite B. Wasting C. Apathy D. Edema Answer: (D) Edema Edema, a major sign of kwashiorkor, is caused by decreased colloidal osmotic pressure of the blood brought about by hypoalbuminemia. Decreased blood albumin level is due a protein- deficient diet. 104. Assessment of a 2-year old child revealed “baggy pants”. Using the IMCI guidelines, how will you manage this child? A. Refer the child urgently to a hospital for confinement. B. Coordinate with the social worker to enroll the child in a feeding program. attributed to other conditions; progressive, unexplained weight loss; night sweats; and hemoptysis. 117. Which clients are considered targets for DOTS Category I? A. Sputum negative cavitary cases B. Clients returning after a default C. Relapses and failures of previous PTB treatment regimens D. Clients diagnosed for the first time through a positive sputum exam Answer: (D) Clients diagnosed for the first time through a positive sputum exam Category I is for new clients diagnosed by sputum examination and clients diagnosed to have a serious form of extrapulmonary tuberculosis, such as TB osteomyelitis. 118. To improve compliance to treatment, what innovation is being implemented in DOTS? A. Having the health worker follow up the client at home B. Having the health worker or a responsible family member monitor drug intake C. Having the patient come to the health center every month to get his medications D. Having a target list to check on whether the patient has collected his monthly supply of drugs Answer: (B) Having the health worker or a responsible family member monitor drug intake Directly Observed Treatment Short Course is so-called because a treatment partner, preferably a health worker accessible to the client, monitors the client’s compliance to the treatment. 119. Diagnosis of leprosy is highly dependent on recognition of symptoms. Which of the following is an early sign of leprosy? A. Macular lesions B. Inability to close eyelids C. Thickened painful nerves D. Sinking of the nosebridge Answer: (C) Thickened painful nerves The lesion of leprosy is not macular. It is characterized by a change in skin color (either reddish or whitish) and loss of sensation, sweating and hair growth over the lesion. Inability to close the eyelids (lagophthalmos) and sinking of the nosebridge are late symptoms. 120. Which of the following clients should be classified as a case of multibacillary leprosy? A. 3 skin lesions, negative slit skin smear B. 3 skin lesions, positive slit skin smear C. 5 skin lesions, negative slit skin smear D. 5 skin lesions, positive slit skin smear Answer: (D) 5 skin lesions, positive slit skin smear A multibacillary leprosy case is one who has a positive slit skin smear and at least 5 skin lesions. 121. In the Philippines, which condition is the most frequent cause of death associated with schistosomiasis? A. Liver cancer B. Liver cirrhosis C. Bladder cancer D. Intestinal perforation Answer: (B) Liver cirrhosis The etiologic agent of schistosomiasis in the Philippines is Schistosoma japonicum, which affects the small intestine and the liver. Liver damage is a consequence of fibrotic reactions to schistosoma eggs in the liver. 122. What is the most effective way of controlling schistosomiasis in an endemic area? A. Use of molluscicides B. Building of foot bridges C. Proper use of sanitary toilets D. Use of protective footwear, such as rubber boots Answer: (C) Proper use of sanitary toilets The ova of the parasite get out of the human body together with feces. Cutting the cycle at this stage is the most effective way of preventing the spread of the disease to susceptible hosts. 123. When residents obtain water from an artesian well in the neighborhood, the level of this approved type of water facility is A. I B. II C. III D. IV Answer: (B) II A communal faucet or water standpost is classified as Level II. 124. For prevention of hepatitis A, you decided to conduct health education activities. Which of the following is IRRELEVANT? A. Use of sterile syringes and needles B. Safe food preparation and food handling by vendors C. Proper disposal of human excreta and personal hygiene D. Immediate reporting of water pipe leaks and illegal water connections Answer: (A) Use of sterile syringes and needles Hepatitis A is transmitted through the fecal oral route. Hepatitis B is transmitted through infected body secretions like blood and semen. 126. Which biological used in Expanded Program on Immunization (EPI) should NOT be stored in the freezer? A. DPT B. Oral polio vaccine C. Measles vaccine D. MMR Answer: (A) DPT DPT is sensitive to freezing. The appropriate storage temperature of DPT is 2 to 8° C only. OPV and measles vaccine are highly sensitive to heat and require freezing. MMR is not an immunization in the Expanded Program on Immunization. 127. You will conduct outreach immunization in a barangay with a population of about 1500. Estimate the number of infants in the barangay. A. 45 B. 50 C. 55 D. 60 Answer: (A) 45 To estimate the number of infants, multiply total population by 3%. 128. In Integrated Management of Childhood Illness, severe conditions generally require urgent referral to a hospital. Which of the following severe conditions DOES NOT always require urgent referral to a hospital? A. Mastoiditis B. Severe dehydration C. Severe pneumonia D. Severe febrile disease Answer: (B) Severe dehydration The order of priority in the management of severe dehydration is as follows: intravenous fluid therapy, referral to a facility where IV fluids can be initiated within 30 minutes, Oresol/nasogastric tube, Oresol/orem. When the foregoing measures are not possible or effective, tehn urgent referral to the hospital is done. 129. A client was diagnosed as having Dengue fever. You will say that there is slow capillary refill when the color of the nailbed that you pressed does not return within how many seconds? A. 3 B. 5 C. 8 D. 10 Answer: (A) 3 Adequate blood supply to the area allows the return of the color of the nailbed within 3 seconds. 130. A 3-year old child was brought by his mother to the health center because of fever of 4-day duration. The child had a positive tourniquet test result. In the absence of other signs, which is the most appropriate measure that the PHN may carry out to prevent Dengue shock syndrome? A. Insert an NGT and give fluids per NGT. B. Instruct the mother to give the child Oresol. C. Start the patient on intravenous fluids STAT. D. Refer the client to the physician for appropriate management. Answer: (B) Instruct the mother to give the child Oresol. Since the child does not manifest any other danger sign, maintenance of fluid balance and replacement of fluid loss may be done by giving the client Oresol. 131. The pathognomonic sign of measles is Koplik’s spot. You may see Koplik’s spot by inspecting the . A. Nasal mucosa B. Buccal mucosa C. Skin on the abdomen D. Skin on the antecubital surface Answer: (B) Buccal mucosa Koplik’s spot may be seen on the mucosa of the mouth or the throat. 132. Among the following diseases, which is airborne? A. Viral conjunctivitis B. Acute poliomyelitis C. Diphtheria D. Measles Answer: (D) Measles Viral conjunctivitis is transmitted by direct or indirect contact with discharges from infected eyes. Acute poliomyelitis is spread through the fecal-oral route and contact with throat secretions, whereas diphtheria is through direct and indirect contact with respiratory secretions. 133. Among children aged 2 months to 3 years, the most prevalent form of meningitis is caused by which microorganism? A. Hemophilus influenzae B. Morbillivirus C. Steptococcus pneumoniae D. Neisseria meningitidis Answer: (A) Hemophilus influenzae Hemophilus meningitis is unusual over the age of 5 years. In developing countries, the peak incidence is in children less than 6 months of age. Morbillivirus is the etiology of measles. Streptococcus pneumoniae and Neisseria meningitidis may cause meningitis, but age distribution is not specific in young children. 134. Human beings are the major reservoir of malaria. Which of the following strategies in malaria control is based on this fact? A. Stream seeding B. Stream clearing C. Destruction of breeding places D. Zooprophylaxis Answer: (D) Zooprophylaxis Zooprophylaxis is done by putting animals like cattle or dogs close to windows or doorways just before nightfall. The Anopheles mosquito takes his blood meal from the animal and goes back to its breeding place, thereby preventing infection of humans. 135. The use of larvivorous fish in malaria control is the basis for which strategy of malaria control? A. Stream seeding B. Stream clearing C. Destruction of breeding places D. Zooprophylaxis Answer: (A) Stream seeding Stream seeding is done by putting tilapia fry in streams or other bodies of water identified as breeding places of the Anopheles mosquito 136. Mosquito-borne diseases are prevented mostly with the use of mosquito control measures. Which of the following is NOT appropriate for malaria control? A. Use of chemically treated mosquito nets B. Seeding of breeding places with larva-eating fish A. The older one gets, the more susceptible he becomes to the complications of chicken pox. B. A single attack of chicken pox will prevent future episodes, including conditions such as shingles. C. To prevent an outbreak in the community, quarantine may be imposed by health authorities. D. Chicken pox vaccine is best given when there is an impending outbreak in the community. Answer: (A) The older one gets, the more susceptible he becomes to the complications of chicken pox. Chicken pox is usually more severe in adults than in children. Complications, such as pneumonia, are higher in incidence in adults. 149. Complications to infectious parotitis (mumps) may be serious in which type of clients? A. Pregnant women B. Elderly clients C. Young adult males D. Young infants Answer: (C) Young adult males Epididymitis and orchitis are possible complications of mumps. In post-adolescent males, bilateral inflammation of the testes and epididymis may cause sterility. Philippine NLE Board Exam: Leadership Nursing Question & Answer w/ rationale LEADERSHIP, MANAGEMENT, BIOETHICS AND RESEARCH 1. Ms. Castro is newly-promoted to a patient care manager position. She updates her knowledge on the theories in management and leadership in order to become effective in her new role. She learns that some managers have low concern for services and high concern for staff. Which style of management refers to this? A. Organization Man B. Impoverished Management C. Country Club Management D. Team Management Answer: (C) Country Club Management Country club management style puts concern for the staff as number one priority at the expense of the delivery of services. He/she runs the department just like a country club where every one is happy including the manager. 2. Her former manager demonstrated passion for serving her staff rather than being served. She takes time to listen, prefers to be a teacher first before being a leader, which is characteristic of Transformational leader A. Transactional leader B. Servant leader C. Charismatic leader Answer: (C) Servant leader Servant leaders are open-minded, listen deeply, try to fully understand others and not being judgmental 3. On the other hand, Ms. Castro notices that the Chief Nurse Executive has charismatic leadership style. Which of the following behaviors best describes this style? A. Possesses inspirational quality that makes followers gets attracted of him and regards him with reverence B. Acts as he does because he expects that his behavior will yield positive results C. Uses visioning as the core of his leadership D. Matches his leadership style to the situation at hand. Answer: (A) Possesses inspirational quality that makes followers gets attracted of him and regards him with reverence Charismatic leaders make the followers feel at ease in their presence. They feel that they are in good hands whenever the leader is around. 4. Which of the following conclusions of Ms. Castro about leadership characteristics is TRUE? A. There is a high correlation between the communication skills of a leader and the ability to get the job done. B. A manager is effective when he has the ability to plan well. C. Assessment of personal traits is a reliable tool for predicting a manager’s potential. D. There is good evidence that certain personal qualities favor success in managerial role. Answer: (C) Assessment of personal traits is a reliable tool for predicting a manager’s potential. It is not conclusive that certain qualities of a person would make him become a good manager. It can only predict a manager’s potential of becoming a good one. 5. She reads about Path Goal theory. Which of the following behaviors is manifested by the leader who uses this theory? A. Recognizes staff for going beyond expectations by giving them citations B. Challenges the staff to take individual accountability for their own practice C. Admonishes staff for being laggards. D. Reminds staff about the sanctions for non performance. Answer: (A) Recognizes staff for going beyond expectations by giving them citations Path Goal theory according to House and associates rewards good performance so that others would do the same 6. One leadership theory states that “leaders are born and not made,” which refers to which of the following theories? A. Trait B. Charismatic C. Great Man D. Situational Answer: (C) Great Man Leaders become leaders because of their birth right. This is also called Genetic theory or the Aristotelian theory 7. She came across a theory which states that the leadership style is effective dependent on the situation. Which of the following styles best fits a situation when the followers are selfdirected, experts and arematured individuals? A. Democratic B. Authoritarian C. Laissez faire D. Bureaucratic Answer: (C) Laissez faire Laissez faire leadership is preferred when the followers know what to do and are experts in the field. This leadership style is relationship-oriented rather than task-centered. 8. She surfs the internet for more information about leadership styles. She reads about shared leadership as a practice in some magnet hospitals. Which of the following describes this style of leadership? A. Leadership behavior is generally determined by the relationship between the leader’s personality and the specific situation B. Leaders believe that people are basically good and need not be closely controlled C. Leaders rely heavily on visioning and inspire members to achieve results D. Leadership is shared at the point of care. Answer: (D) Leadership is shared at the point of care. Shared governance allows the staff nurses to have the authority, responsibility and accountability for their own practice. 9. Ms. Castro learns that some leaders are transactional leaders. Which of the following does NOT characterize a transactional leader? A. Focuses on management tasks B. Is a caretaker C. Uses trade-offs to meet goals D. Inspires others with vision Answer: (D) Inspires others with vision Inspires others with a vision is characteristic of a transformational leader. He is focused more on the day-to-day operations of the department/unit. 10. She finds out that some managers have benevolent-authoritative style of management. Which of the following behaviors will she exhibit most likely? A. Have condescending trust and confidence in their subordinates B. Gives economic or ego awards C. Communicates downward to the staff D. Allows decision making among subordinates Answer: (A) Have condescending trust and confidence in their subordinates Benevolent-authoritative managers pretentiously show their trust and confidence to their followers 11. Harry is a Unit Manager I the Medical Unit. He is not satisfied with the way things are going in his unit. Patient satisfaction rate is 60% for two consecutive months and staff morale is at its lowest. He decides to plan and initiate changes that will push for a turnaround in the condition of the unit. Which of the following actions is a priority for Harry? A. Call for a staff meeting and take this up in the agenda. B. Seek help from her manager. C. Develop a strategic action on how to deal with these concerns. D. Ignore the issues since these will be resolved naturally. Answer: (A) Call for a staff meeting and take this up in the agenda. This will allow for the participation of every staff in the unit. If they contribute to the solutions of the problem, they will own the solutions; hence the chance for compliance would be greater. 12. She knows that there are external forces that influence changes in his unit. Which of the following is NOT an external force? A. Memo from the CEO to cut down on electrical consumption B. Demands of the labor sector to increase wages C. Low morale of staff in her unit D. Exacting regulatory and accreditation standards Answer: (C) Low morale of staff in her unit Low morale of staff is an internal factor that affects only the unit. All the rest of the options emanate from the top executive or from outside the institution. 13. After discussing the possible effects of the low patient satisfaction rate, the staff started to list down possible strategies to solve the problems head-on. Should they decide to vote on the best change strategy, which of the following strategies is referred to this? A. Collaboration B. Majority rule C. Dominance D. Compromise Answer: (B) Majority rule Majority rule involves dividing the house and the highest vote wins.1/2 + 1 is a majority. 14. One staff suggests that they review the pattern of nursing care that they are using, which is described as a A. job description B. system used to deliver care C. manual of procedure D. rules to be followed Answer: (B) system used to deliver care A system used to deliver care. In the 70’s it was termed as methods of patient assignment; in the early 80’s it was called modalities of patient care then patterns of nursing care in the 90’s until recently authors called it nursing care systems. 15. Which of the following is TRUE about functional nursing? A. Concentrates on tasks and activities B. Emphasizes use of group collaboration C. One-to-one nurse-patient ratio D. Provides continuous, coordinated and comprehensive nursing services Answer: (A) Concentrates on tasks and activities Functional nursing is focused on tasks and activities and not on the holistic care of the patients 16. Functional nursing has some advantages, which one is an EXCEPTION? A. Psychological and sociological needs are emphasized. Unity of direction means having one goal or one objective for the team to pursue; hence all members of the organization should put their efforts together towards the attainment of their common goal or objective. 28. Julius stresses the importance of promoting ‘esprit d corps’ among the members of the unit. Which of the following remarks of the staff indicates that they understand what he pointed out? A. “Let’s work together in harmony; we need to be supportive of one another” B. “In order that we achieve the same results; we must all follow the directives of Julius and not from other managers.” C. “We will ensure that all the resources we need are available when needed.” D. “We need to put our efforts together in order to raise the bar of excellence in the care we provide to all our patients.” Answer: (A) “Let’s work together in harmony; we need to be supportive of one another” The principle of ‘esprit d’ corps’ refers to promoting harmony in the workplace, which is essential in maintaining a climate conducive to work. 29. He discusses the goal of the department. Which of the following statements is a goal? A. Increase the patient satisfaction rate B. Eliminate the incidence of delayed administration of medications C. Establish rapport with patients. D. Reduce response time to two minutes. Answer: (A) Increase the patient satisfaction rate Goal is a desired result towards which efforts are directed. Options AB, C and D are all objectives which are aimed at specific end. 30. He wants to influence the customary way of thinking and behaving that is shared by the members of the department. Which of the following terms refer to this? A. Organizational chart B. Cultural network C. Organizational structure D. Organizational culture Answer: (D) Organizational culture An organizational culture refers to the way the members of the organization think together and do things around them together. It’s their way of life in that organization 31. He asserts the importance of promoting a positive organizational culture in their unit. Which of the following behaviors indicate that this is attained by the group? A. Proactive and caring with one another B. Competitive and perfectionist C. Powerful and oppositional D. Obedient and uncomplaining Answer: (A) Proactive and caring with one another Positive culture is based on humanism and affiliative norms 32. Stephanie is a new Staff Educator of a private tertiary hospital. She conducts orientation among new staff nurses in her department. Joseph, one of the new staff nurses, wants to understand the channel of communication, span of control and lines of communication. Which of the following will provide this information? A. Organizational structure B. Policy C. Job description D. Manual of procedures Answer: (A) Organizational structure Organizational structure provides information on the channel of authority, i.e., who reports to whom and with what authority; the number of people who directly reports to the various levels of hierarchy and the lines of communication whether line or staff. 33. Stephanie is often seen interacting with the medical intern during coffee breaks and after duty hours. What type of organizational structure is this? A. Formal B. Informal C. Staff D. Line Answer: (B) Informal This is usually not published and oftentimes concealed. 34. She takes pride in saying that the hospital has a decentralized structure. Which of the following is NOT compatible with this type of model? A. Flat organization B. Participatory approach C. Shared governance D. Tall organization Answer: (D) Tall organization Tall organizations are highly centralized organizations where decision making is centered on one authority level. 35. Centralized organizations have some advantages. Which of the following statements are TRUE? 1. Highly cost-effective 2. Makes management easier 3. Reflects the interest of the worker 4. Allows quick decisions or actions. A. 1 & 2 B. 2 & 4 C. 2, 3& 4 D. 1, 2, & 4 Answer: (A) 1 & 2 Centralized organizations are needs only a few managers hence they are less expensive and easier to manage 36. Stephanie delegates effectively if she has authority to act, which is BEST defined as: A. having responsibility to direct others B. being accountable to the organization C. having legitimate right to act D. telling others what to do Answer: (C) having legitimate right to act Authority is a legitimate or official right to give command. This is an officially sanctioned responsibility 37. Regardless of the size of a work group, enough staff must be available at all times to accomplish certain purposes. Which of these purposes in NOT included? A. Meet the needs of patients B. Provide a pair of hands to other units as needed C. Cover all time periods adequately. D. Allow for growth and development of nursing staff. Answer: (B) Provide a pair of hands to other units as needed Providing a pair of hands for other units is not a purpose in doing an effective staffing process. This is a function of a staffing coordinator at a centralized model. 38. Which of the following guidelines should be least considered in formulating objectives for nursing care? A. Written nursing care plan B. Holistic approach C. Prescribed standards D. Staff preferences Answer: (D) Staff preferences Staff preferences should be the least priority in formulating objectives of nursing care. Individual preferences should be subordinate to the interest of the patients. 41. Stephanie considers shifting to transformational leadership. Which of the following statements best describes this type of leadership? A. Uses visioning as the essence of leadership. B. Serves the followers rather than being served. C. Maintains full trust and confidence in the subordinates D. Possesses innate charisma that makes others feel good in his presence. Answer: (A) Uses visioning as the essence of leadership. Transformational leadership relies heavily on visioning as the core of leadership. 42. As a manager, she focuses her energy on both the quality of services rendered to the patients as well as the welfare of the staff of her unit. Which of the following management styles does she adopt? A. Country club management B. Organization man management C. Team management D. Authority-obedience management Answer: (C) Team management Team management has a high concern for services and high concern for staff. 43. Katherine is a young Unit Manager of the Pediatric Ward. Most of her staff nurses are senior to her, very articulate, confident and sometimes aggressive. Katherine feels uncomfortable believing that she is the scapegoat of everything that goes wrong in her department. Which of the following is the best action that she must take? A. Identify the source of the conflict and understand the points of friction B. Disregard what she feels and continue to work independently C. Seek help from the Director of Nursing D. Quit her job and look for another employment. Answer: (A) Identify the source of the conflict and understand the points of friction This involves a problem solving approach, which addresses the root cause of the problem. 44. As a young manager, she knows that conflict occurs in any organization. Which of the following statements regarding conflict is NOT true? A. Can be destructive if the level is too high B. Is not beneficial; hence it should be prevented at all times C. May result in poor performance D. May create leaders Answer: (B) Is not beneficial; hence it should be prevented at all times Conflicts are beneficial because it surfaces out issues in the open and can be solved right away. Likewise, members of the team become more conscientious with their work when they are aware that other members of the team are watching them. 45. Katherine tells one of the staff, “I don’t have time to discuss the matter with you now. See me in my office later” when the latter asks if they can talk about an issue. Which of the following conflict resolution strategies did she use? A. Smoothing B. Compromise C. Avoidance D. Restriction Answer: (C) Avoidance This strategy shuns discussing the issue head-on and prefers to postpone it to a later time. In effect the problem remains unsolved and both parties are in a lose-lose situation. 46. Kathleen knows that one of her staff is experiencing burnout. Which of the following is the best thing for her to do? A. Advise her staff to go on vacation. B. Ignore her observations; it will be resolved even without intervention C. Remind her to show loyalty to the institution. D. Let the staff ventilate her feelings and ask how she can be of help. Answer: (D) Let the staff ventilate her feelings and ask how she can be of help. Reaching out and helping the staff is the most effective strategy in dealing with burn out. Knowing that someone is ready to help makes the staff feel important; hence her self-worth is enhanced. 47. She knows that performance appraisal consists of all the following activities EXCEPT: A. Setting specific standards and activities for individual performance. B. Using agency standards as a guide. C. Determine areas of strength and weaknesses D. Performs comprehensive initial assessment Answer: (B) Provides care to a group of patients together with a group of nurses This function is done in team nursing where the nurse is a member of a team that provides care for a group of patients. 60. Which pattern of nursing care involves the care given by a group of paraprofessional workers led by a professional nurse who take care of patients with the same disease conditions and are located geographically near each other? A. Case method B. Modular nursing C. Nursing case management D. Team nursing Answer: (B) Modular nursing Modular nursing is a variant of team nursing. The difference lies in the fact that the members in modular nursing are paraprofessional workers. 61. St. Raphael Medical Center just opened its new Performance Improvement Department. Ms. Valencia is appointed as the Quality Control Officer. She commits herself to her new role and plans her strategies to realize the goals and objectives of the department. Which of the following is a primary task that they should perform to have an effective control system? A. Make an interpretation about strengths and weaknesses B. Identify the values of the department C. Identify structure, process, outcome standards & criteria D. Measure actual performances Answer: (B) Identify the values of the department Identify the values of the department will set the guiding principles within which the department will operate its activities 62. Ms. Valencia develops the standards to be followed. Among the following standards, which is considered as a structure standard? A. The patients verbalized satisfaction of the nursing care received B. Rotation of duty will be done every four weeks for all patient care personnel. C. All patients shall have their weights taken recorded D. Patients shall answer the evaluation form before discharge Answer: (B) Rotation of duty will be done every four weeks for all patient care personnel. Structure standards include management system, facilities, equipment, materials needed to deliver care to patients. Rotation of duty is a management system. 63. When she presents the nursing procedures to be followed, she refers to what type of standards? A. Process B. Outcome C. Structure D. Criteria Answer: (A) Process Process standards include care plans, nursing procedure to be done to address the needs of the patients. 64. The following are basic steps in the controlling process of the department. Which of the following is NOT included? A. Measure actual performance B. Set nursing standards and criteria C. Compare results of performance to standards and objectives D. Identify possible courses of action Answer: (D) Identify possible courses of action This is a step in a quality control process and not a basic step in the control process. 65. Which of the following statements refers to criteria? A. Agreed on level of nursing care B. Characteristics used to measure the level of nursing care C. Step-by-step guidelines D. Statement which guide the group in decision making and problem solving Answer: (B) Characteristics used to measure the level of nursing care Criteria are specific characteristics used to measure the standard of care. 66. She wants to ensure that every task is carried out as planned. Which of the following tasks is NOT included in the controlling process? A. Instructing the members of the standards committee to prepare policies B. Reviewing the existing policies of the hospital C. Evaluating the credentials of all nursing staff D. Checking if activities conform to schedule Answer: (A) Instructing the members of the standards committee to prepare policies Instructing the members involves a directing function. 67. Ms. Valencia prepares the process standards. Which of the following is NOT a process standard? A. Initial assessment shall be done to all patients within twenty four hours upon admission. B. Informed consent shall be secured prior to any invasive procedure C. Patients’ reports 95% satisfaction rate prior to discharge from the hospital. D. Patient education about their illness and treatment shall be provided for all patients and their families. Answer: (C) Patients’ reports 95% satisfaction rate prior to discharge from the hospital. This refers to an outcome standard, which is a result of the care that is rendered to the patient. 68. Which of the following is evidence that the controlling process is effective? A. The things that were planned are done B. Physicians do not complain. C. Employees are contended D. There is an increase in customer satisfaction rate. Answer: (A) The things that were planned are done Controlling is defined as seeing to it that what is planned is done. 69. Ms. Valencia is responsible to the number of personnel reporting to her. This principle refers to: A. Span of control B. Unity of command C. Carrot and stick principle D. Esprit d’ corps Answer: (A) Span of control Span of control refers to the number of workers who report directly to a manager. 70. She notes that there is an increasing unrest of the staff due to fatigue brought about by shortage of staff. Which action is a priority? A. Evaluate the overall result of the unrest B. Initiate a group interaction C. Develop a plan and implement it D. Identify external and internal forces. Answer: (B) Initiate a group interaction Initiate a group interaction will be an opportunity to discuss the problem in the open. 71. Kevin is a member of the Nursing Research Council of the hospital. His first assignment is to determine the level of patient satisfaction on the care they received from the hospital. He plans to include all adult patients admitted from April to May, with average length of stay of 3-4 days, first admission, and with no complications. Which of the following is an extraneous variable of the study? A. Date of admission B. Length of stay C. Age of patients D. Absence of complications Answer: (C) Age of patients An extraneous variable is not the primary concern of the researcher but has an effect on the results of the study. Adult patients may be young, middle or late adult. 72. He thinks of an appropriate theoretical framework. Whose theory addresses the four modes of adaptation? A. Martha Rogers B. Sr. Callista Roy C. Florence Nightingale D. Jean Watson Answer: (B) Sr. Callista Roy Sr. Callista Roy developed the Adaptation Model which involves the physiologic mode, self- concept mode, role function mode and dependence mode 73. He opts to use a self-report method. Which of the following is NOT TRUE about this method? A. Most direct means of gathering information B. Versatile in terms of content coverage C. Most accurate and valid method of data gathering D. Yields information that would be difficult to gather by another method Answer: (C) Most accurate and valid method of data gathering The most serious disadvantage of this method is accuracy and validity of information gathered 74. Which of the following articles would Kevin least consider for his review of literature? A. “Story-Telling and Anxiety Reduction Among Pediatric Patients” B. “Turnaround Time in Emergency Rooms” C. “Outcome Standards in Tertiary Health Care Institutions” D. “Environmental Manipulation and Client Outcomes” Answer: (B) “Turnaround Time in Emergency Rooms” The article is for pediatric patients and may not be relevant for adult patients. 75. Which of the following variables will he likely EXCLUDE in his study? A. Competence of nurses B. Caring attitude of nurses C. Salary of nurses D. Responsiveness of staff Answer: (C) Salary of nurses Salary of staff nurses is not an indicator of patient satisfaction, hence need not be included as a variable in the study. 76. He plans to use a Likert Scale to determine A. degree of agreement and disagreement B. compliance to expected standards C. level of satisfaction D. degree of acceptance Answer: (A) degree of agreement and disagreement Likert scale is a 5-point summated scale used to determine the degree of agreement or disagreement of the respondents to a statement in a study. 77. He checks if his instruments meet the criteria for evaluation. Which of the following criteria refers to the consistency or the ability to yield the same response upon its repeated administration? A. Validity B. Reliability C. Sensitivity D. Objectivity Answer: (B) Reliability Reliability is repeatability of the instrument; it can elicit the same responses even with varied administration of the instrument 78. Which criteria refer to the ability of the instrument to detect fine differences among the subjects being studied? A. Sensitivity B. Reliability C. Validity D. Objectivity Answer: (A) Sensitivity Sensitivity is an attribute of the instrument that allow the respondents to distinguish differences of the options where to choose from 79. Which of the following terms refer to the degree to which an instrument measures what it is supposed to be measure? D. Design the theoretical and conceptual framework Answer: (B) Review related literature After formulating and delimiting the research problem, the researcher conducts a review of related literature to determine the extent of what has been done on the study by previous researchers. 92. Which of the following codes of research ethics requires informed consent in all cases governing human subjects? A. Helsinki Declaration B. Nuremberg Code C. Belmont Report D. ICN Code of Ethics Answer: (A) Helsinki Declaration Helsinki Declaration is the first international attempt to set up ethical standards in research involving human research subjects. 93. Which of the following ethical principles was NOT articulated in the Belmont Report? A. Beneficence B. Respect for human dignity C. Justice D. Non-maleficence Answer: (D) Non-maleficence Non-maleficence is not articulated in the Belmont Report. It only includes beneficence, respect for human dignity and justice. 39. Which one of the following criteria should be considered as a top priority in nursing care? A. Avoidance of destructive changes B. Preservation of life C. Assurance of safety D. Preservation of integrity Answer: (B) Preservation of life The preservation of life at all cost is a primary responsibility of the nurse. This is embodied in the Code of Ethics for registered nurses ( BON Resolution 220 s. 2004). 40. Which of the following procedures ensures that the investigator has fully described to prospective subjects the nature of the study and the subject's rights? A. Debriefing B. Full disclosure C. Informed consent D. Cover data collection Answer: (B) Full disclosure Full disclosure is giving the subjects of the research information that they deserve to know prior to the conduct of the study. 94. After the review session has been completed, Karen and the staff signed the document. Which of the following is the purpose of this? A. Agree about the content of the evaluation. B. Signify disagreement of the content of the evaluation. C. Document that Karen and the staff reviewed the evaluation. D. Serve as basis for future evaluation. Answer: (C) Document that Karen and the staff reviewed the evaluation. Signing the document is done to serve as a proof that performance review was conducted during that date and time. 95. A nurse who would like to practice nursing in the Philippines can obtain a license to practice by: A. Paying the professional tax after taking the board exams B. Passing the board exams and taking the oath of professionals C. Paying the examination fee before taking the board exams D. Undergoing the interview conducted by the Board of Nursing and taking the board exams Answer: (B) Passing the board exams and taking the oath of professionals For a nurse to obtain a license to practice nursing in the Philippines, s/he must pass the board examinations and then take the oath of professionals before the Board of Nursing. 96. Reciprocity of license to practice requires that the country of origin of the interested foreign nurse complies with the following conditions: A. The country of origin has similar preparation for a nurse and has laws allowing Filipino nurses to practice in their country. B. The Philippines is recognized by the country of origin as one that has high quality of nursing education C. The country of origin requires Filipinos to take their own board examination D. The country of origin exempts Filipinos from passing their licensure examination Answer: (A) The country of origin has similar preparation for a nurse and has laws allowing Filipino nurses to practice in their country. According to the Philippine Nurses Act of 2002, foreign nurses wanting to practice in the Philippines must show proof that his/her country of origin meets the two essential conditions: a) the requirements for registration between the two countries are substantially the same; and b) the country of origin of the foreign nurse has laws allowing the Filipino nurse to practice in his/her country just like its own citizens. 97. Nurses practicing the profession in the Philippines and are employed in government hospitals are required to pay taxes such as: A. Both income tax and professional tax B. Income tax only since they are exempt from paying professional tax C. Professional tax which is paid by all nurses employed in both government and private hospitals D. Income tax which paid every March 15 and professional tax which is paid every January 31. Answer: (B) Income tax only since they are exempt from paying professional tax According to the Magna Carta for Public Health Workers, government nurses are exempted from paying professional tax. Hence, as an employee in the government, s/he will pay only the income tax. 98. According to RA 9173 Philippine Nursing Act of 2002, a graduate nurse who wants to take must licensure examination must comply with the following qualifications: A. At least 21 years old, graduate of BSN from a recognized school, and of good moral character B. At least 18 years old, graduate of BSN from a recognized school and of good moral character C. At least 18 years old, provided that when s/he passes the board exams, s/he must be at least 21 years old; BSN graduate of a recognized school, and of good moral character D. Filipino citizen or a citizen of a country where we have reciprocity; graduate of BSN from a recognized school and of good moral character Answer: (D) Filipino citizen or a citizen of a country where we have reciprocity; graduate of BSN from a recognized school and of good moral character RA 9173 section 13 states that the qualifications to take the board exams are: Filipino citizen or citizen of a country where the Philippines has reciprocity; of good moral character and graduate of BSN from a recognized school of nursing. There is no explicit provision about the age requirement in RA 9173 unlike in RA7164 (old law). 99. Which of the following is TRUE about membership to the Philippine Nurses Association (PNA)? A. Membership to PNA is mandatory and is stipulated in the Philippine Nursing Act of 2002 B. Membership to PNA is compulsory for newly registered nurses wanting to enter the practice of nursing in the country C. Membership to PNA is voluntary and is encouraged by the PRC Code of Ethics for Nurses D. Membership to PNA is required by government hospitals prior to employment Answer: (C) Membership to PNA is voluntary and is encouraged by the PRC Code of Ethics for Nurses Membership to any organization, including the PNA, is only voluntary and this right to join any organization is guaranteed in the 1987 constitution of the Philippines. However, the PRC Code of Ethics states that one of the ethical obligations of the professional nurse towards the profession is to be an active member of the accredited professional organization. 100. When the license of the nurse is revoked, it means that the nurse: A. Is no longer allowed to practice the profession for the rest of her life B. Will never have her/his license re-issued since it has been revoked C. May apply for re-issuance of his/her license based on certain conditions stipulated in RA 9173 D. Will remain unable to practice professional nursing Answer: (C) May apply for re-issuance of his/her license based on certain conditions stipulated in RA 9173 RA 9173 sec. 24 states that for equity and justice, a revoked license maybe re-issued provided that the following conditions are met: a) the cause for revocation of license has already been corrected or removed; and, b) at least four years has elapsed since the license has been revoked. 101. According to the current nursing law, the minimum educational qualification for a faculty member of a college of nursing is: A. Only a Master of Arts in Nursing is acceptable B. Masters degree in Nursing or in the related fields C. At least a doctorate in nursing D. At least 18 units in the Master of Arts in Nursing Program Answer: (B) Masters degree in Nursing or in the related fields According to RA 9173 sec. 27, the educational qualification of a faculty member teaching in a college of nursing must be masters degree which maybe in nursing or related fields like education, allied health professions, psychology. 102. The educational qualification of a nurse to become a supervisor in a hospital is: A. BSN with at least 9 units of post graduate studies in nursing administration B. Master of Arts in Nursing major in administration C. At least 2 years experience as a headnurse D. At least 18 units of post graduate studies in nursing administration Answer: (A) BSN with at least 9 units of post graduate studies in nursing administration According to RA 9173 sec. 29, the educational qualification to be a supervisor in a hospital is at least 9 units of postgraduate studies in nursing administration. A masters degree in nursing is required for the chief nurse of a secondary or tertiary hospital. 103. The Board of Nursing has quasi-judicial power. An example of this power is: A. The Board can issue rules and regulations that will govern the practice of nursing B. The Board can investigate violations of the nursing law and code of ethics C. The Board can visit a school applying for a permit in collaboration with CHED D. The Board prepares the board examinations Answer: (B) The Board can investigate violations of the nursing law and code of ethics Quasi-judicial power means that the Board of Nursing has the authority to investigate violations of the nursing law and can issue summons, subpoena or subpoena duces tecum as needed. 104. When a nurse causes an injury to the patient and the injury caused becomes the proof of the negligent act, the presence of the injury is said to exemplify the principle of: A. Force majeure B. Respondeat superior C. Res ipsa loquitur D. Holdover doctrine Answer: (C) Res ipsa loquitur Res ipsa loquitur literally means the thing speaks for itself. This means in operational terms that the injury caused is the proof that there was a negligent act. 105. Ensuring that there is an informed consent on the part of the patient before a surgery is done, illustrates the bioethical principle of: A. Beneficence B. Autonomy C. Truth telling/veracity D. Non-maleficence Answer: (B) Autonomy 117. She knows that the most important categories of information in literature review is the: A. research findings B. theoretical framework C. methodology D. opinions Answer: (A) research findings The research findings is the most important category of information that the researcher should copy because this will give her valuable information as to what has been discovered in past studies about the same topic. 118. She also considers accessing electronic data bases for her literature review. Which of the following is the most useful electronic database for nurses? A. CINAHL B. MEDLINE C. HealthSTAR D. EMBASE Answer: (A) CINAHL This refers to Cumulative Index to Nursing and Allied Health Literature which is a rich source for literature review for nurses. The rest of the sites are for medicine, pharmacy and other healthrelated sites. 119. While reviewing journal articles, Stephanie got interested in reading the brief summary of the article placed at the beginning of the journal report. Which of the following refers to this? A. Introduction B. Preface C. Abstract D. Background Answer: (C) Abstract Abstract contains concise description of the background of the study, research questions, research objectives, methods, findings, implications to nursing practice as well as keywords used in the study. 120. She notes down ideas that were derived from the description of an investigation written by the person who conducted it. Which type of reference source refers to this? A. Footnote B. Bibliography C. Primary source D. Endnotes Answer: (C) Primary source . This refers to a primary source which is a direct account of the investigation done by the investigator. In contrast to this is a secondary source, which is written by someone other than the original researcher. 121. She came across a study which is referred to as meta-analysis. Which of the following statements best defines this type of study? A. Treats the findings from one study as a single piece of data B. Findings from multiple studies are combined to yield a data set which is analyzed as individual data C. Represents an application of statistical procedures to findings from each report D. Technique for quantitatively combining and thus integrating the results of multiple studies on a given topic. Answer: (D) Technique for quantitatively combining and thus integrating the results of multiple studies on a given topic. Though all the options are correct, the best definition is option D because it combines quantitatively the results and at the same time it integrates the results of the different studies as one finding. 122. This kind of research gathers data in detail about a individual or groups and presented in narrative form, which is A. Case study B. Historical C. Analytical D. Experimental Answer: (A) Case study Case study focuses on in-depth investigations of single entity or small number of entities. It attempts to analyze and understand issues of importance to history, development or circumstances of the person or entity under study. 123. Stephanie is finished with the steps in the conceptual phase when she has conducted the LAST step, which is A. formulating and delimiting the problem. B. review of related literature C. develop a theoretical framework D. formulate a hypothesis Answer: (D) formulate a hypothesis The last step in the conceptualizing phase of the research process is formulating a hypothesis. The rest are the first three steps in this phase. 124. She states the hypothesis of the study. Which of the following is a null hypothesis? A. Infants who are breastfed have the same weight as those who are bottle fed. B. Bottle-fed infants have lower weight than breast-fed infants C. Cuddled infants sleep longer than those who are left by themselves to sleep. D. Children of absentee parents are more prone to experience depression than those who live with both parents. Answer: (A) Infants who are breastfed have the same weight as those who are bottle fed. Null hypothesis predicts that there is no change, no difference or no relationship between the variables in the study 125. She notes that the dependent variable in the hypothesis “Duration of sleep of cuddled infants is longer than those infants who are not cuddled by mothers” is A. Cuddled infants B. Duration of sleep C. Infants D. Absence of cuddling Answer: (B) Duration of sleep Duration of sleep is the ‘effect’ (dependent variable) of cuddling ‘cause’ (independent variable). 126. Situation: Aretha is a nurse researcher in a tertiary hospital. She is tasked to conduct a research on the effects of structured discharge plan for post-open heart surgery patients. She states the significance of the research problem. Which of the following statements is the MOST significant for this study? A. Improvement in patient care B. Development of a theoretical basis for nursing C. Increase the accountability of nurses. D. Improves the image of nursing Answer: (A) Improvement in patient care The ultimate goal of conducting research is to improve patient care which is achieved by enhancing the practice of nurses when they utilize research results in their practice. 127. Regardless of the significance of the study, the feasibility of the study needs to be considered. Which of the following is considered a priority? A. Availability of research subjects B. Budgetary allocation C. Time frame D. Experience of the researcher Answer: (A) Availability of research subjects Availability is the most important criteria to be considered by the researcher in determining whether the study is feasible or not. No matter how significant the study may be if there are no available subjects/respondents, the study can not push through. 128. Aretha knows that a good research problem exhibits the following characteristics; which one is NOT included? A. Clearly identified the variables/phenomenon under consideration. B. Specifies the population being studied. C. Implies the feasibility of empirical testing D. Indicates the hypothesis to be tested. Answer: (D) Indicates the hypothesis to be tested. Not all studies require a hypothesis such as qualitative studies, which does not deal with variables but with phenomenon or concepts. 129. She states the purposes of the study. Which of the following describe the purpose of a study? 1. Establishes the general direction of a study 2. Captures the essence of the study 3. Formally articulates the goals of the study 4. Sometimes worded as an intent A. 1, 2, 3 B. 2, 3, 4 C. 1, 3, 4 D. 1, 2, 3, 4 Answer: (D) 1, 2, 3, 4 The purposes of a research study covers all the options indicated. 130. She opts to use interviews in data collection. In addition to validity, what is the other MOST serious weakness of this method? A. Accuracy B. Sensitivity C. Objectivity D. Reliability Answer: (A) Accuracy Accuracy and validity are the most serious weaknesses of the self-report data. This is due to the fact that the respondents sometimes do not want to tell the truth for fear of being rejected or in order to please the interviewer. 131. She plans to subject her instrument to pretesting. Which of the following is NOT achieved in doing pretesting? A. Determines how much time it takes to administer the instrument package B. Identify parts that are difficult to read or understand C. Determine the budgetary allocation for the study D. Determine if the measures yield data with sufficient variability Answer: (C) Determine the budgetary allocation for the study Determining budgetary allocation for the study is not a purpose of doing a pretesting of the instruments. This is done at an earlier stage of the design and planning phase. 132. She tests the instrument whether it looks as though it is measuring appropriate constructs. Which of the following refers to this? A. Face validity B. Content validity C. Construct Validity D. Criterion-related validity Answer: (A) Face validity Face validity measures whether the instrument appears to be measuring the appropriate construct. It is the easiest type of validity testing. 133. Which of the following questions would determine the construct validity of the instrument? A. “What is this instrument really measuring?” B. “How representative are the questions on this test of the universe of questions on this topic?” C. “Does the question asked looks as though it is measuring the appropriate construct?” D. “Does the instrument correlate highly with an external criterion? Answer: (A) “What is this instrument really measuring?” 145. Other studies are categorized according to the time frame. Which of the following refers to a study of variables in the present which is linked to a variable that occurred in the past? A. Prospective design B. Retrospective design C. Cross sectional study D. Longitudinal study Answer: (B) Retrospective design Retrospective studies are done in order to establish a correlation between present variables and the antecedent factors that have caused it. 146. Situation : Harry a new research staff of the Research and Development Department of a tertiary hospital is tasked to conduct a research study about the increased incidence of nosocomial infection in the hospital. Which of the following ethical issues should he consider in the conduct of his study? 1. Confidentiality of information given to him by the subjects 2. Self-determination which includes the right to withdraw from the study group 3. Privacy or the right not to be exposed publicly 4. Full disclosure about the study to be conducted A. 1, 2, 3 B. 1, 3, 4 C. 2, 3, 4 D. 1, 2, 3, 4 Answer: (D) 1, 2, 3, 4 This includes all the options as these are the four basic rights of subjects for research. 147. Which of the following is the best tool for data gathering? A. Interview schedule B. Questionnaire C. Use of laboratory data. D. Observation Answer: (C) Use of laboratory data. Incidence of nosocomial infection is best collected through the use of biophysiologic measures, particularly in vitro measurements, hence laboratory data is essential. 148. During data collection, Harry encounters a patient who refuses to talk to him. Which of the following is a limitation of the study? A. Patient’s refusal to fully divulge information. B. Patients with history of fever and cough C. Patients admitted or who seeks consultation at the ER and doctors offices D. Contacts of patients with history of fever and cough Answer: (A) Patient’s refusal to fully divulge information. Patient’s refusal to divulge information is a limitation because it is beyond the control of Harry. 149. What type of research is appropriate for this study? A. Descriptive- correlational B. Experiment C. Quasi-experiment D. Historical Answer: (A) Descriptive- correlational Descriptive- correlational study is the most appropriate for this study because it studies the variables that could be the antecedents of the increased incidence of nosocomial infection. 150. In the statement, “Frequent hand washing of health workers decreases the incidence of nosocomial infections among post-surgery patients”, the dependent variable is A. incidence of nosocomial infections B. decreases C. frequent hand washing D. post-surgery patients Answer: (A) incidence of nosocomial infections The dependent variable is the incidence of nosocomial infection, which is the outcome or effect of the independent variable, frequent hand washing. 151. Harry knows that he has to protect the rights of human research subjects. Which of the following actions of Harry ensures anonymity? A. Keep the identities of the subject secret B. Obtain informed consent C. Provide equal treatment to all the subjects of the study. D. Release findings only to the participants of the study Answer: (A) Keep the identities of the subject secret Keeping the identities of the research subject secret will ensure anonymity because this will hinder providing link between the information given to whoever is its source. 152. He is oriented to the use of electronic databases for nursing research. Which of the following will she likely access? A. MEDLINE B. National Institute of Nursing Research C. American Journal of Nursing D. International Council of Nurses Answer: (B) National Institute of Nursing Research National Institute for Nursing Research is a useful source of information for nursing research. The rest of the options may be helpful but NINR is the most useful site for nurses. 153. He develops methods for data gathering. Which of the following criteria of a good instrument refers to the ability of the instrument to yield the same results upon its repeated administration? A. Validity B. Specificity C. Sensitivity D. Reliability Answer: (D) Reliability Reliability is consistency of the research instrument. It refers to the repeatability of the instrument in extracting the same responses upon its repeated administration. 154. Harry is aware of the importance of controlling threats to internal validity for experimental research, which include the following examples EXCEPT: A. History B. Maturation C. Attrition D. Design Answer: (D) Design Design is not a threat to internal validity of the instrument just like the other options. 155. His colleague asks about the external validity of the research findings. Which of the responses of Harry is appropriate? The research findings can be A. generalized to other settings or samples B. shown to result only from the effect of the independent variable C. reflected as results of extraneous variables D. free of selection biases Answer: (A) generalized to other settings or samples External validity refers to the generalizability of research findings to other settings or samples. This is an issue of importance to evidence-based nursing practice. Philippine NLE Board Exam: Medical Surgical Nursing Question & Answer w/ rationale MEDICAL SURGICAL NURSING 1. Following surgery, Mario complains of mild incisional pain while performing deep- breathing and coughing exercises. The nurse’s best response would be: A. “Pain will become less each day.” B. “This is a normal reaction after surgery.” C. “With a pillow, apply pressure against the incision.” D. “I will give you the pain medication the physician ordered.” Answer: (C) “With a pillow, apply pressure against the incision.” Applying pressure against the incision with a pillow will help lessen the intra-abdominal pressure created by coughing which causes tension on the incision that leads to pain. 2. The nurse needs to carefully assess the complaint of pain of the elderly because older people A. are expected to experience chronic pain B. have a decreased pain threshold C. experience reduced sensory perception D. have altered mental function Answer: (C) experience reduced sensory perception Degenerative changes occur in the elderly. The response to pain in the elderly maybe lessened because of reduced acuity of touch, alterations in neural pathways and diminished processing of sensory data. 3. Mary received AtropineSO4 as a pre-medication 30 minutes ago and is now complaining of dry mouth and her PR is higher, than before the medication was administered. The nurse’s best A. The patient is having an allergic reaction to the drug. B. The patient needs a higher dose of this drug C. This is normal side-effect of AtSO4 D. The patient is anxious about upcoming surgery Answer: (C) This is normal side-effect of AtSO4 Atropine sulfate is a vagolytic drug that decreases oropharyngeal secretions and increases the heart rate. 4. Ana’s postoperative vital signs are a blood pressure of 80/50 mm Hg, a pulse of 140, and respirations of 32. Suspecting shock, which of the following orders would the nurse question? A. Put the client in modified Trendelenberg's position. B. Administer oxygen at 100%. C. Monitor urine output every hour. D. Administer Demerol 50mg IM q4h Answer: (D) Administer Demerol 50mg IM q4h Administering Demerol, which is a narcotic analgesic, can depress respiratory and cardiac function and thus not given to a patient in shock. What is needed is promotion for adequate oxygenation and perfusion. All the other interventions can be expected to be done by the nurse. 5. Mr. Pablo, diagnosed with Bladder Cancer, is scheduled for a cystectomy with the creation of an ileal conduit in the morning. He is wringing his hands and pacing the floor when the nurse enters his room. What is the best approach? A. "Good evening, Mr. Pablo. Wasn't it a pleasant day, today?" B. "Mr, Pablo, you must be so worried, I'll leave you alone with your thoughts. C. “Mr. Pablo, you'll wear out the hospital floors and yourself at this rate." D. "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?" Answer: (D) "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?" The client is showing signs of anxiety reaction to a stressful event. Recognizing the client’s anxiety conveys acceptance of his behavior and will allow for verbalization of feelings and concerns. 6. After surgery, Gina returns from the Post-anesthesia Care Unit (Recovery Room) with a nasogastric tube in place following a gall bladder surgery. She continues to complain of nausea. Which action would the nurse take? A. Call the physician immediately. B. Administer the prescribed antiemetic. C. Check the patency of the nasogastric tube for any obstruction. D. Change the patient’s position. Answer: (C) Check the patency of the nasogastric tube for any obstruction. Nausea is one of the common complaints of a patient after receiving general anesthesia. But this complaint could be aggravated by gastric distention especially in a patient who has undergone abdominal surgery. Insertion of the NGT helps relieve the problem. Checking on the patency of the NGT for any obstruction will help the nurse determine the cause of the problem and institute the necessary intervention. 7. Mr. Perez is in continuous pain from cancer that has metastasized to the bone. Pain medication provides little relief and he refuses to move. The nurse should plan to: A. Reassure him that the nurses will not hurt him A. Dyspnea on exertion B. Foamy, blood-tinged sputum C. Wheezing sound on inspiration D. Cough or change in a chronic cough Answer: (D) Cough or change in a chronic cough Cigarette smoke is a carcinogen that irritates and damages the respiratory epithelium. The irritation causes the cough which initially maybe dry, persistent and unproductive. As the tumor enlarges, obstruction of the airways occurs and the cough may become productive due to infection. 19. Which is the most relevant knowledge about oxygen administration to a client with COPD? A. Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing. B. Hypoxia stimulates the central chemoreceptors in the medulla that makes the client breath. C. Oxygen is administered best using a non-rebreathing mask D. Blood gases are monitored using a pulse oximeter. Answer: (A) Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing. COPD causes a chronic CO2 retention that renders the medulla insensitive to the CO2 stimulation for breathing. The hypoxic state of the client then becomes the stimulus for breathing. Giving the clientoxygen in low concentrations will maintain the client’s hypoxic drive. 20. When suctioning mucus from a client's lungs, which nursing action would be least appropriate? A. Lubricate the catheter tip with sterile saline before insertion. B. Use sterile technique with a two-gloved approach C. Suction until the client indicates to stop or no longer than 20 second D. Hyperoxygenate the client before and after suctioning Answer: (C) Suction until the client indicates to stop or no longer than 20 second One hazard encountered when suctioning a client is the development of hypoxia. Suctioning sucks not only the secretions but also the gases found in the airways. This can be prevented by suctioning the client for an average time of 5-10 seconds and not more than 15 seconds and hyperoxygenating the client before and after suctioning. 21. Dr. Santos prescribes oral rifampin (Rimactane) and isoniazid (INH) for a client with a positive Tuberculin skin test. When informing the client of this decision, the nurse knows that the purpose of this choice of treatment is to A. Cause less irritation to the gastrointestinal tract B. Destroy resistant organisms and promote proper blood levels of the drugs C. Gain a more rapid systemic effect D. Delay resistance and increase the tuberculostatic effect Answer: (D) Delay resistance and increase the tuberculostatic effect Pulmonary TB is treated primarily with chemotherapeutic agents for 6-12 mons. A prolonged treatment duration is necessary to ensure eradication of the organisms and to prevent relapse. The increasing prevalence of drug resistance points to the need to begin the treatment with drugs in combination. Using drugs in combination can delay the drug resistance. 22. Mario undergoes a left thoracotomy and a partial pneumonectomy. Chest tubes are inserted, and one-bottle water-seal drainage is instituted in the operating room. In the postanesthesia care unit Mario is placed in Fowler's position on either his right side or on his back to A. Reduce incisional pain. B. Facilitate ventilation of the left lung. C. Equalize pressure in the pleural space. D. Increase venous return Answer: (B) Facilitate ventilation of the left lung. Since only a partial pneumonectomy is done, there is a need to promote expansion of this remaining Left lung by positioning the client on the opposite unoperated side. 23. A client with COPD is being prepared for discharge. The following are relevant instructions to the client regarding the use of an oral inhaler EXCEPT A. Breath in and out as fully as possible before placing the mouthpiece inside the mouth. B. Inhale slowly through the mouth as the canister is pressed down C. Hold his breath for about 10 seconds before exhaling D. Slowly breath out through the mouth with pursed lips after inhaling the drug. Answer: (D) Slowly breath out through the mouth with pursed lips after inhaling the drug. If the client breathes out through the mouth with pursed lips, this can easily force the just inhaled drug out of the respiratory tract that will lessen its effectiveness. 24. A client is scheduled for a bronchoscopy. When teaching the client what to expect afterward, the nurse's highest priority of information would be A. Food and fluids will be withheld for at least 2 hours. B. Warm saline gargles will be done q 2h. C. Coughing and deep-breathing exercises will be done q2h. D. Only ice chips and cold liquids will be allowed initially. Answer: (A) Food and fluids will be withheld for at least 2 hours. Prior to bronchoscopy, the doctors sprays the back of the throat with anesthetic to minimize the gag reflex and thus facilitate the insertion of the bronchoscope. Giving the client food and drink after the procedure without checking on the return of the gag reflex can cause the client to aspirate. The gag reflex usually returns after two hours. 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. B. Call the physician. C. Lower the oxygen rate. D. Position the client in a Fowler's position. Answer: (C) Lower the oxygen rate. The client with COPD is suffering from chronic CO2 retention. The hypoxic drive is his chief stimulus for breathing. Giving O2 inhalation at a rate that is more than 2-3L/min can make the client lose his hypoxic drive which can be assessed as decreasing RR. 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 B. Decreased tissue perfusion. C. Impaired gas exchange. D. Risk for infection Answer: (C) Impaired gas exchange. Pneumonia, which is an infection, causes lobar consolidation thus impairing gas exchange between the alveoli and the blood. Because the patient would require adequate hydration, this makes him prone to fluid volume excess. 27. A nurse at the weight loss clinic assesses a client who has a large abdomen and a rounded face. Which additional assessment finding would lead the nurse to suspect that the client has Cushing’s syndrome rather than obesity? A. large thighs and upper arms B. pendulous abdomen and large hips C. abdominal striae and ankle enlargement D. posterior neck fat pad and thin extremities Answer: (D) posterior neck fat pad and thin extremities “Buffalo hump” is the accumulation of fat pads over the upper back and neck. Fat may also accumulate on the face. There is truncal obesity but the extremities are thin. All these are noted in a client with Cushing’s syndrome. 28. Which statement by the client indicates understanding of the possible side effects of Prednisone therapy? A. “I should limit my potassium intake because hyperkalemia is a side-effect of this drug.” B. “I must take this medicine exactly as my doctor ordered it. I shouldn’t skip doses.” C. “This medicine will protect me from getting any colds or infection.” D. “My incision will heal much faster because of this drug.” Answer: (B) “I must take this medicine exactly as my doctor ordered it. I shouldn’t skip doses.” The possible side effects of steroid administration are hypokalemia, increase tendency to infection and poor wound healing. Clients on the drug must follow strictly the doctor’s order since skipping the drug can lower the drug level in the blood that can trigger acute adrenal insufficiency or Addisonian Crisis 29. A client, who is suspected of having Pheochromocytoma, complains of sweating, palpitation and headache. Which assessment is essential for the nurse to make first? A. Pupil reaction B. Hand grips C. Blood pressure D. Blood glucose Answer: (C) Blood pressure Pheochromocytoma is a tumor of the adrenal medulla that causes an increase secretion of catecholamines that can elevate the blood pressure. 30. 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 Answer: (D) Give the guest a glass of orange juice In diabetic patients, the nurse should watch out for signs of hypoglycemia manifested by dizziness, tremors, weakness, pallor diaphoresis and tachycardia. When this occurs in a conscious client, he should be given immediately carbohydrates in the form of fruit juice, hard candy, honey or, if unconscious, glucagons or dextrose per IV. 31. An adult, who is newly diagnosed with Graves disease, asks the nurse, “Why do I need to take Propanolol (Inderal)?” Based on the nurse’s understanding of the medication and Grave’s disease, the best response would be: A. “The medication will limit thyroid hormone secretion.” B. “The medication limit synthesis of the thyroid hormones.” C. “The medication will block the cardiovascular symptoms of Grave’s disease.” D. “The medication will increase the synthesis of thyroid hormones.” Answer: (C) “The medication will block the cardiovascular symptoms of Grave’s disease.” Propranolol (Inderal) is a beta-adrenergic blocker that controls the cardiovascular manifestations brought about by increased secretion of the thyroid hormone in Grave’s disease. 32. During the first 24 hours after thyroid surgery, the nurse should include in her care: A. Checking the back and sides of the operative dressing B. Supporting the head during mild range of motion exercise C. Encouraging the client to ventilate her feelings about the surgery D. Advising the client that she can resume her normal activities immediately Answer: (A) Checking the back and sides of the operative dressing Following surgery of the thyroid gland, bleeding is a potential complication. This can best be assessed by checking the back and the sides of the operative dressing as the blood may flow towards the side and back leaving the front dry and clear of drainage. 33. On discharge, the nurse teaches the patient to observe for signs of surgically induced hypothyroidism. The nurse would know that the patient understands the teaching when she states she should notify the MD if she develops: A. Intolerance to heat B. Dry skin and fatigue C. Progressive weight gain D. Insomnia and excitability Answer: (C) Progressive weight gain Hypothyroidism, a decrease in thyroid hormone production, is characterized by hypometabolism that manifests itself with weight gain. 34. What is the best reason for the nurse in instructing the client to rotate injection sites for insulin? A. encouraging the client to take adequate deep breaths by mouth B. encouraging the client to cough and deep breathe C. changing the dressing at least BID D. irrigate the T-tube frequently Answer: (B) encouraging the client to cough and deep breathe Cholecystectomy requires a subcostal incision. To minimize pain, clients have a tendency to take shallow breaths which can lead to respiratory complications like pneumonia and atelectasis. Deep breathing and coughing exercises can help prevent such complications. 45. 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 B. Monitor VS C. Encourage him to take deep breaths D. Notify the MD Answer: (A) Deflate the esophageal balloon When a client with a Sengstaken-Blakemore tube develops difficulty of breathing, it means the tube is displaced and the inflated balloon is in the oropharynx causing airway obstruction 46. The client presents with severe rectal bleeding, 16 diarrheal stools a day, severe abdominal pain, tenesmus and dehydration. Because of these symptoms the nurse should be alert for other problems associated with what disease? A. Chrons disease B. Ulcerative colitis C. Diverticulitis D. Peritonitis Answer: (B) Ulcerative colitis Ulcerative colitis is a chronic inflammatory condition producing edema and ulceration affecting the entire colon. Ulcerations lead to sloughing that causes stools as many as 10-20 times a day that is filled with blood, pus and mucus. The other symptoms mentioned accompany the problem. 47. A client is being evaluated for cancer of the colon. In preparing the client for barium enema, the nurse should: A. Give laxative the night before and a cleansing enema in the morning before the test B. Render an oil retention enema and give laxative the night before C. Instruct the client to swallow 6 radiopaque tablets the evening before the study D. Place the client on CBR a day before the study Answer: (A) Give laxative the night before and a cleansing enema in the morning before the test Barium enema is the radiologic visualization of the colon using a die. To obtain accurate results in this procedure, the bowels must be emptied of fecal material thus the need for laxative and enema. 48. The client has a good understanding of the means to reduce the chances of colon cancer when he states: A. “I will exercise daily.” B. “I will include more red meat in my diet.” C. “I will have an annual chest x-ray.” D. “I will include more fresh fruits and vegetables in my diet.” Answer: (D) “I will include more fresh fruits and vegetables in my diet.” Numerous aspects of diet and nutrition may contribute to the development of cancer. A low-fiber diet, such as when fresh fruits and vegetables are minimal or lacking in the diet, slows transport of materials through the gut which has been linked to colorectal cancer. 49. Days after abdominal surgery, the client’s wound dehisces. The safest nursing intervention when this occurs is to A. Cover the wound with sterile, moist saline dressing B. Approximate the wound edges with tapes C. Irrigate the wound with sterile saline D. Hold the abdominal contents in place with a sterile gloved hand Answer: (A) Cover the wound with sterile, moist saline dressing Dehiscence is the partial or complete separation of the surgical wound edges. When this occurs, the client is placed in low Fowler’s position and instructed to lie quietly. The wound should be covered to protect it from exposure and the dressing must be sterile to protect it from infection and moist to prevent the dressing from sticking to the wound which can disturb the healing process. 50. An intravenous pyelogram reveals that Paulo, age 35, has a renal calculus. He is believed to have a small stone that will pass spontaneously. To increase the chance of the stone passing, the nurse would instruct the client to force fluids and to A. Strain all urine. B. Ambulate. C. Remain on bed rest. D. Ask for medications to relax him. Answer: (B) Ambulate. Free unattached stones in the urinary tract can be passed out with the urine by ambulation which can mobilize the stone and by increased fluid intake which will flush out the stone during urination. 51. A female client is admitted with a diagnosis of acute renal failure. She is awake, alert, oriented, and complaining of severe back pain, nausea and vomiting and abdominal cramps. Her vital signs are blood pressure 100/70 mm Hg, pulse 110, respirations 30, and oral temperature 100.4°F (38°C). Her electrolytes are sodium 120 mEq/L, potassium 5.2 mEq/L; her urinary output for the first 8 hours is 50 ml. The client is displaying signs of which electrolyte imbalance? A. Hyponatremia B. Hyperkalemia C. Hyperphosphatemia D. Hypercalcemia Answer: (A) Hyponatremia The normal serum sodium level is 135 – 145 mEq/L. The client’s serum sodium is below normal. Hyponatremia also manifests itself with abdominal cramps and nausea and vomiting 52. Assessing the laboratory findings, which result would the nurse most likely expect to find in a client with chronic renal failure? A. BUN 10 to 30 mg/dl, potassium 4.0 mEq/L, creatinine 0.5 to 1.5 mg/dl B. Decreased serum calcium, blood pH 7.2, potassium 6.5 mEq/L C. BUN 15 mg/dl, increased serum calcium, creatinine l.0 mg/dl D. BUN 35 to 40 mg/dl, potassium 3.5 mEq/L, pH 7.35, decreased serum calcium Answer: (B) Decreased serum calcium, blood pH 7.2, potassium 6.5 mEq/L Chronic renal failure is usually the end result of gradual tissue destruction and loss of renal function. With the loss of renal function, the kidneys ability to regulate fluid and electrolyte and acid base balance results. The serum Ca decreases as the kidneys fail to excrete phosphate, potassium and hydrogen ions are retained. 53. Treatment with hemodialysis is ordered for a client and an external shunt is created. Which nursing action would be of highest priority with regard to the external shunt? A. Heparinize it daily. B. Avoid taking blood pressure measurements or blood samples from the affected arm. C. Change the Silastic tube daily. D. Instruct the client not to use the affected arm. Answer: (B) Avoid taking blood pressure measurements or blood samples from the affected arm. In the client with an external shunt, don’t use the arm with the vascular access site to take blood pressure readings, draw blood, insert IV lines, or give injections because these procedures may rupture the shunt or occlude blood flow causing damage and obstructions in the shunt. 54. Romeo Diaz, age 78, is admitted to the hospital with the diagnosis of benign prostatic hyperplasia (BPH). He is scheduled for a transurethral resection of the prostate (TURP). It would be inappropriate to include which of the following points in the preoperative teaching? A. TURP is the most common operation for BPH. B. Explain the purpose and function of a two-way irrigation system. C. Expect bloody urine, which will clear as healing takes place. D. He will be pain free. Answer: (D) He will be pain free. Surgical interventions involve an experience of pain for the client which can come in varying degrees. Telling the pain that he will be pain free is giving him false reassurance. 55. Roxy is admitted to the hospital with a possible diagnosis of appendicitis. On physical examination, the nurse should be looking for tenderness on palpation at McBurney’s point, which is located in the A. left lower quadrant B. left upper quadrant C. right lower quadrant D. right upper quadrant Answer: (C) right lower quadrant To be exact, the appendix is anatomically located at the Mc Burney’s point at the right iliac area of the right lower quadrant. 56. Mr. Valdez has undergone surgical repair of his inguinal hernia. Discharge teaching should include A. telling him to avoid heavy lifting for 4 to 6 weeks B. instructing him to have a soft bland diet for two weeks C. telling him to resume his previous daily activities without limitations D. recommending him to drink eight glasses of water daily Answer: (A) telling him to avoid heavy lifting for 4 to 6 weeks The client should avoid lifting heavy objects and any strenuous activity for 4-6 weeks after surgery to prevent stress on the inguinal area. There is no special diet required. The fluid intake of eight glasses a day is good advice but is not a priority in this case. 57. A 30-year-old homemaker fell asleep while smoking a cigarette. She sustained severe burns of the face,neck, anterior chest, and both arms and hands. Using the rule of nines, which is the best estimate of total body-surface area burned? A. 18% B. 22% C. 31% D. 40% Answer: (C) 31% Using the Rule of Nine in the estimation of total body surface burned, we allot the following: 9% head; 9% - each upper extremity; 18%- front chest and abdomen; 18% - entire back; 18% - each lower extremity and 1% - perineum. 58. Nursing care planning is based on the knowledge that the first 24-48 hours post-burn are characterized by: A. An increase in the total volume of intracranial plasma B. Excessive renal perfusion with diuresis C. Fluid shift from interstitial space D. Fluid shift from intravascular space to the interstitial space Answer: (D) Fluid shift from intravascular space to the interstitial space This period is the burn shock stage or the hypovolemic phase. Tissue injury causes vasodilation that results in increase capillary permeability making fluids shift from the intravascular to the interstitial space. This can lead to a decrease in circulating blood volume or hypovolemia which decreases renal perfusion and urine output. 59. If a client has severe bums on the upper torso, which item would be a primary concern? A. Debriding and covering the wounds B. Administering antibiotics C. Frequently observing for hoarseness, stridor, and dyspnea D. Establishing a patent IV line for fluid replacement Answer: (C) Frequently observing for hoarseness, stridor, and dyspnea Burns located in the upper torso, especially resulting from thermal injury related to fires can lead to inhalation burns. This causes swelling of the respiratory mucosa and blistering which can lead to airway obstruction manifested by hoarseness, noisy and difficult breathing. Maintaining a patent airway is a primary concern. D. “I know that my primary nurse has to wear one of those badges like the people in the x-ray department, but they are not necessary for anyone else who comes in here.” Answer: (B) “My 7 year old twins should not come to visit me while I’m receiving treatment.” Children have cells that are normally actively dividing in the process of growth. Radiation acts not only against the abnormally actively dividing cells of cancer but also on the normally dividing cells thus affecting the growth and development of the child and even causing cancer itself. 71. High uric acid levels may develop in clients who are receiving chemotherapy. This is caused by: A. The inability of the kidneys to excrete the drug metabolites B. Rapid cell catabolism C. Toxic effect of the antibiotic that are given concurrently D. The altered blood ph from the acid medium of the drugs Answer: (B) Rapid cell catabolism One of the oncologic emergencies, the tumor lysis syndrome, is caused by the rapid destruction of large number of tumor cells. . Intracellular contents are released, including potassium and purines, into the bloodstream faster than the body can eliminate them. The purines are converted in the liver to uric acid and released into the blood causing hyperuricemia. They can precipitate in the kidneys and block the tubules causing acute renal failure. 72. Which of the following interventions would be included in the care of plan in a client with cervical implant? A. Frequent ambulation B. Unlimited visitors C. Low residue diet D. Vaginal irrigation every shift Answer: (C) Low residue diet It is important for the nurse to remember that the implant be kept intact in the cervix during therapy. Mobility and vaginal irrigations are not done. A low residue diet will prevent bowel movement that could lead to dislodgement of the implant. Patient is also strictly isolated to protect other people from the radiation emissions 73. Which nursing measure would avoid constriction on the affected arm immediately after mastectomy? A. Avoid BP measurement and constricting clothing on the affected arm B. Active range of motion exercises of the arms once a day. C. Discourage feeding, washing or combing with the affected arm D. Place the affected arm in a dependent position, below the level of the heart Answer: (A) Avoid BP measurement and constricting clothing on the affected arm A BP cuff constricts the blood vessels where it is applied. BP measurements should be done on the unaffected arm to ensure adequate circulation and venous and lymph drainage in the affected arm 74. A client suffering from acute renal failure has an unexpected increase in urinary output to 150ml/hr. The nurse assesses that the client has entered the second phase of acute renal failure. Nursing actions throughout this phase include observation for signs and symptoms of A. Hypervolemia, hypokalemia, and hypernatremia. B. Hypervolemia, hyperkalemia, and hypernatremia. C. Hypovolemia, wide fluctuations in serum sodium and potassium levels. D. Hypovolemia, no fluctuation in serum sodium and potassium levels. Answer: (C) Hypovolemia, wide fluctuations in serum sodium and potassium levels. The second phase of ARF is the diuretic phase or high output phase. The diuresis can result in an output of up to 10L/day of dilute urine. Loss of fluids and electrolytes occur. 75. An adult has just been brought in by ambulance after a motor vehicle accident. When assessing the client, the nurse would expect which of the following manifestations could have resulted from sympathetic nervous system stimulation? A. A rapid pulse and increased RR B. Decreased physiologic functioning C. Rigid posture and altered perceptual focus D. Increased awareness and attention Answer: (A) A rapid pulse and increased RR The fight or flight reaction of the sympathetic nervous system occurs during stress like in a motor vehicular accident. This is manifested by increased in cardiovascular function and RR to provide the immediate needs of the body for survival. 76. Ms. Sy undergoes surgery and the abdominal aortic aneurysm is resected and replaced with a graft. When she arrives in the RR she is still in shock. The nurse's priority should be A. placing her in a trendeleburg position B. putting several warm blankets on her C. monitoring her hourly urine output D. assessing her VS especially her RR Answer: (D) assessing her VS especially her RR Shock is characterized by reduced tissue and organ perfusion and eventual organ dysfunction and failure. Checking on the VS especially the RR, which detects need for oxygenation, is a priority to help detect its progress and provide for prompt management before the occurrence of complications. 77. A major goal for the client during the first 48 hours after a severe bum is to prevent hypovolemic shock. The best indicator of adequate fluid balance during this period is A. Elevated hematocrit levels. B. Urine output of 30 to 50 ml/hr. C. Change in level of consciousness. D. Estimate of fluid loss through the burn eschar. Answer: (B) Urine output of 30 to 50 ml/hr. Hypovolemia is a decreased in circulatory volume. This causes a decrease in tissue perfusion to the different organs of the body. Measuring the hourly urine output is the most quantifiable way of measuring tissue perfusion to the organs. Normal renal perfusion should produce 1ml/kg of BW/min. An output of 30-50 ml/hr is considered adequate and indicates good fluid balance. 78. A thoracentesis is performed on a chest-injured client, and no fluid or air is found. Blood and fluids is administered intravenously (IV), but the client's vital signs do not improve. A central venous pressure line is inserted, and the initial reading is 20 cm H^O. The most likely cause of these findings is which of the following? A. Spontaneous pneumothorax B. Ruptured diaphragm C. Hemothorax D. Pericardial tamponade Answer: (D) Pericardial tamponade Pericardial tamponade occurs when there is presence of fluid accumulation in the pericardial space that compresses on the ventricles causing a decrease in ventricular filling and stretching during diastole with a decrease in cardiac output. . This leads to right atrial and venous congestion manifested by a CVP reading above normal. 79. Intervention for a pt. who has swallowed a Muriatic Acid includes all of the following except A. administering an irritant that will stimulate vomiting B. aspirating secretions from the pharynx if respirations are affected C. neutralizing the chemical D. washing the esophagus with large volumes of water via gastric lavage Answer: (A) administering an irritant that will stimulate vomiting Swallowing of corrosive substances causes severe irritation and tissue destruction of the mucous membrane of the GI tract. Measures are taken to immediately remove the toxin or reduce its absorption. For corrosive poison ingestion, such as in muriatic acid where burn or perforation of the mucosa may occur, gastric emptying procedure is immediately instituted, This includes gastric lavage and the administration of activated charcoal to absorb the poison. Administering an irritant with the concomitant vomiting to remove the swallowed poison will further cause irritation and damage to the mucosal lining of the digestive tract. Vomiting is only indicated when non-corrosive poison is swallowed. 80. Which initial nursing assessment finding would best indicate that a client has been successfully resuscitated after a cardio-respiratory arrest? A. Skin warm and dry B. Pupils equal and react to light C. Palpable carotid pulse D. Positive Babinski's reflex Answer: (C) Palpable carotid pulse Presence of a palpable carotid pulse indicates the return of cardiac function which, together with the return of breathing, is the primary goal of CPR. Pulsations in arteries indicates blood flowing in the blood vessels with each cardiac contraction. Signs of effective tissue perfusion will be noted after. 81. Chemical burn of the eye are treated with A. local anesthetics and antibacterial drops for 24 – 36 hrs. B. hot compresses applied at 15-minute intervals C. Flushing of the lids, conjunctiva and cornea with tap or preferably sterile water D. cleansing the conjunctiva with a small cotton-tipped applicator Answer: (C) Flushing of the lids, conjunctiva and cornea with tap or preferably sterile water Prompt treatment of ocular chemical burns is important to prevent further damage. Immediate tap- water eye irrigation should be started on site even before transporting the patient to the nearest hospital facility. In the hospital, copious irrigation with normal saline, instillation of local anesthetic and antibiotic is done. 82. The Heimlich maneuver (abdominal thrust), for acute airway obstruction, attempts to: A. Force air out of the lungs B. Increase systemic circulation C. Induce emptying of the stomach D. Put pressure on the apex of the heart Answer: (A) Force air out of the lungs The Heimlich maneuver is used to assist a person choking on a foreign object. The pressure from the thrusts lifts the diaphragm, forces air out of the lungs and creates an artificial cough that expels the aspirated material. 83. John, 16 years old, is brought to the ER after a vehicular accident. He is pronounced dead on arrival. When his parents arrive at the hospital, the nurse should: A. ask them to stay in the waiting area until she can spend time alone with them B. speak to both parents together and encourage them to support each other and express their emotions freely C. Speak to one parent at a time so that each can ventilate feelings of loss without upsetting the other D. ask the MD to medicate the parents so they can stay calm to deal with their son’s death. Answer: (B) speak to both parents together and encourage them to support each other and express their emotions freely Sudden death of a family member creates a state of shock on the family. They go into a stage of denial and anger in their grieving. Assisting them with information they need to know, answering their questions and listening to them will provide the needed support for them to move on and be of support to one another. 84. An emergency treatment for an acute asthmatic attack is Adrenaline 1:1000 given hypodermically. This is given to: A. increase BP B. decrease mucosal swelling C. relax the bronchial smooth muscle D. decrease bronchial secretions Answer: (C) relax the bronchial smooth muscle Acute asthmatic attack is characterized by severe bronchospasm which can be relieved by the immediate administration of bronchodilators. Adrenaline or Epinephrine is an adrenergic agent that causes bronchial dilation by relaxing the bronchial smooth muscles. 85. A nurse is performing CPR on an adult patient. When performing chest compressions, the nurse understands the correct hand placement is located over the A. upper half of the sternum B. upper third of the sternum A. Measure the ph of the fluid B. Measure the specific gravity of the fluid C. Test for glucose D. Test for chlorides Answer: (C) Test for glucose The CSF contains a large amount of glucose which can be detected by using glucostix. A positive result with the drainage indicate CSF leakage. 97. The nurse includes the important measures for stump care in the teaching plan for a client with an amputation. Which measure would be excluded from the teaching plan? A. Wash, dry, and inspect the stump daily. B. Treat superficial abrasions and blisters promptly. C. Apply a "shrinker" bandage with tighter arms around the proximal end of the affected limb. D. Toughen the stump by pushing it against a progressively harder substance (e.g., pillow on a foot- stool). Answer: (C) Apply a "shrinker" bandage with tighter arms around the proximal end of the affected limb. The “shrinker” bandage is applied to prevent swelling of the stump. It should be applied with the distal end with the tighter arms. Applying the tighter arms at the proximal end will impair circulation and cause swelling by reducing venous flow. 98. A 70-year-old female comes to the clinic for a routine checkup. She is 5 feet 4 inches tall and weighs 180 pounds. Her major complaint is pain in her joints. She is retired and has had to give up her volunteer work because of her discomfort. She was told her diagnosis was osteoarthritis about 5 years ago. Which would be excluded from the clinical pathway for this client? A. Decrease the calorie count of her daily diet. B. Take warm baths when arising. C. Slide items across the floor rather than lift them. D. Place items so that it is necessary to bend or stretch to reach them. Answer: (D) Place items so that it is necessary to bend or stretch to reach them. Patients with osteoarthritis have decreased mobility caused by joint pain. Over-reaching and stretching to get an object are to be avoided as this can cause more pain and can even lead to falls. The nurse should see to it therefore that objects are within easy reach of the patient. 99. A client is admitted from the emergency department with severe-pain and edema in the right foot. His diagnosis is gouty arthritis. When developing a plan of care, which action would have the highest priority? A. Apply hot compresses to the affected joints. B. Stress the importance of maintaining good posture to prevent deformities. C. Administer salicylates to minimize the inflammatory reaction. D. Ensure an intake of at least 3000 ml of fluid per day. Answer: (D) Ensure an intake of at least 3000 ml of fluid per day. Gouty arthritis is a metabolic disease marked by urate deposits that cause painful arthritic joints. The patient should be urged to increase his fluid intake to prevent the development of urinary uric acid stones. 100. A client had a laminectomy and spinal fusion yesterday. Which statement is to be excluded from your plan of care? A. Before log rolling, place a pillow under the client's head and a pillow between the client's legs. B. Before log rolling, remove the pillow from under the client's head and use no pillows between the client's legs. C. Keep the knees slightly flexed while the client is lying in a semi-Fowler's position in bed. D. Keep a pillow under the client's head as needed for comfort. Answer: (B) Before log rolling, remove the pillow from under the client's head and use no pillows between the client's legs. Following a laminectomy and spinal fusion, it is important that the back of the patient be maintained in straight alignment and to support the entire vertebral column to promote complete healing. 101. The nurse is assisting in planning care for a client with a diagnosis of immune deficiency. The nurse would incorporate which of the ff. as a priority in the plan of care? A. providing emotional support to decrease fear B. protecting the client from infection C. encouraging discussion about lifestyle changes D. identifying factors that decreased the immune function Answer: (B) protecting the client from infection Immunodeficiency is an absent or depressed immune response that increases susceptibility to infection. So it is the nurse’s primary responsibility to protect the patient from infection. 102. Joy, an obese 32 year old, is admitted to the hospital after an automobile accident. She has a fractured hip and is brought to the OR for surgery. After surgery Joy is to receive a piggy-back of Clindamycin phosphate (Cleocin) 300 mg in 50 ml of D5W. The piggyback is to infuse in 20 minutes. The drop factor of the IV set is 10 gtt/ml. The nurse should set the piggyback to flow at: A. 25 gtt/min B. 30 gtt/min C. 35 gtt/min D. 45 gtt/min Answer: (A) 25 gtt/min To get the correct flow rate: multiply the amount to be infused (50 ml) by the drop factor (10) and divide the result by the amount of time in minutes (20) 103. The day after her surgery Joy asks the nurse how she might lose weight. Before answering her question, the nurse should bear in mind that long-term weight loss best occurs when: A. Fats are controlled in the diet B. Eating habits are altered C. Carbohydrates are regulated D. Exercise is part of the program Answer: (B) Eating habits are altered For weight reduction to occur and be maintained, a new dietary program, with a balance of foods from the basic four food groups, must be established and continued 104. The nurse teaches Joy, an obese client, the value of aerobic exercises in her weight reduction program. The nurse would know that this teaching was effective when Joy says that exercise will: A. Increase her lean body mass B. Lower her metabolic rate C. Decrease her appetite D. Raise her heart rate Answer: (A) Increase her lean body mass Increased exercise builds skeletal muscle mass and reduces excess fatty tissue. 105. The physician orders non-weight bearing with crutches for Joy, who had surgery for a fractured hip. The most important activity to facilitate walking with crutches before ambulation begun is: A. Exercising the triceps, finger flexors, and elbow extensors B. Sitting up at the edge of the bed to help strengthen back muscles C. Doing isometric exercises on the unaffected leg D. Using the trapeze frequently for pull-ups to strengthen the biceps muscles Answer: (A) Exercising the triceps, finger flexors, and elbow extensors These sets of muscles are used when walking with crutches and therefore need strengthening prior to ambulation. 106. The nurse recognizes that a client understood the demonstration of crutch walking when she places her weight on: A. The palms and axillary regions B. Both feet placed wide apart C. The palms of her hands D. Her axillary regions Answer: (C) The palms of her hands The palms should bear the client’s weight to avoid damage to the nerves in the axilla (brachial plexus) 107. Joey is a 46 year-old radio technician who is admitted because of mild chest pain. He is 5 feet, 8 inches tall and weighs 190 pounds. He is diagnosed with a myocardial infarct. Morphine sulfate, Diazepam (Valium) and Lidocaine are prescribed. The physician orders 8 mg of Morphine Sulfate to be given IV. The vial on hand is labeled 1 ml/ 10 mg. The nurse should administer: A. 8 minims B. 10 minims C. 12 minims D. 15 minims Answer: (C) 12 minims Using ratio and proportion 8 mg/10 mg = X minims/15 minims 10 X= 120 X = 12 minims The nurse will administer 12 minims intravenously equivalent to 8mg Morphine Sulfate 108. Joey asks the nurse why he is receiving the injection of Morphine after he was hospitalized for severe anginal pain. The nurse replies that it: A. Will help prevent erratic heart beats B. Relieves pain and decreases level of anxiety C. Decreases anxiety D. Dilates coronary blood vessels Answer: (B) Relieves pain and decreases level of anxiety Morphine is a specific central nervous system depressant used to relieve the pain associated with myocardial infarction. It also decreases anxiety and apprehension and prevents cardiogenic shock by decreasing myocardial oxygen demand. 109. Oxygen 3L/min by nasal cannula is prescribed for Joey who is admitted to the hospital for chest pain. The nurse institutes safety precautions in the room because oxygen: A. Converts to an alternate form of matter B. Has unstable properties C. Supports combustion D. Is flammable Answer: (C) Supports combustion The nurse should know that Oxygen is necessary to produce fire, thus precautionary measures are important regarding its use. 110. Myra is ordered laboratory tests after she is admitted to the hospital for angina. The isoenzyme test that is the most reliable early indicator of myocardial insult is: A. SGPT B. LDH C. CK-MB D. AST Answer: (C) CK-MB The cardiac marker, Creatinine phosphokinase (CPK) isoenzyme levels, especially the MB sub-unit which is cardio-specific, begin to rise in 3-6 hours, peak in 12-18 hours and are elevated 48 hours after the occurrence of the infarct. They are therefore most reliable in assisting with early diagnosis. The cardiac markers elevate as a result of myocardial tissue damage. 111. An early finding in the EKG of a client with an infarcted mycardium would be: A. Disappearance of Q waves B. Elevated ST segments C. Absence of P wave D. Flattened T waves Answer: (B) Elevated ST segments C. Passage of flatus during expulsion of feces D. Inability to complete the procedure in half an hour Answer: (B) Difficulty in inserting the irrigating tube Difficulty of inserting the irrigating tube indicates stenosis of the stoma and should be reported to the physician. Abdominal cramps and passage of flatus can be expected during colostomy irrigations. The procedure may take longer than half an hour. 123. A client with colostomy refuses to allow his wife to see the incision or stoma and ignores most of his dietary instructions. The nurse on assessing this data, can assume that the client is experiencing: A. A reaction formation to his recent altered body image. B. A difficult time accepting reality and is in a state of denial. C. Impotency due to the surgery and needs sexual counseling D. Suicide thoughts and should be seen by psychiatrist Answer: (B) A difficult time accepting reality and is in a state of denial. As long as no one else confirms the presence of the stoma and the client does not need to adhere to a prescribed regimen, the client’s denial is supported 124. The nurse would know that dietary teaching had been effective for a client with colostomy when he states that he will eat: A. Food low in fiber so that there is less stool B. Everything he ate before the operation but will avoid those foods that cause gas C. Bland foods so that his intestines do not become irritated D. Soft foods that are more easily digested and absorbed by the large intestines Answer: (B) Everything he ate before the operation but will avoid those foods that cause gas There is no special diets for clients with colostomy. These clients can eat a regular diet. Only gasforming foods that cause distention and discomfort should be avoided. 125. Eddie, 40 years old, is brought to the emergency room after the crash of his private plane. He has suffered multiple crushing wounds of the chest, abdomen and legs. It is feared his leg may have to be amputated. When Eddie arrives in the emergency room, the assessment that assume the greatest priority are: A. Level of consciousness and pupil size B. Abdominal contusions and other wounds C. Pain, Respiratory rate and blood pressure D. Quality of respirations and presence of pulsesQuality of respirations and presence of pulses Answer: (D) Quality of respirations and presence of pulsesQuality of respirations and presence of pulses Respiratory and cardiovascular functions are essential for oxygenation. These are top priorities to trauma management. Basic life functions must be maintained or reestablished 126. Eddie, a plane crash victim, undergoes endotracheal intubation and positive pressure ventilation. The most immediate nursing intervention for him at this time would be to: A. Facilitate his verbal communication B. Maintain sterility of the ventilation system C. Assess his response to the equipment D. Prepare him for emergency surgery Answer: (C) Assess his response to the equipment It is a primary nursing responsibility to evaluate effect of interventions done to the client. Nothing is achieved if the equipment is working and the client is not responding 127. A chest tube with water seal drainage is inserted to a client following a multiple chest injury. A few hours later, the client’s chest tube seems to be obstructed. The most appropriate nursing action would be to A. Prepare for chest tube removal B. Milk the tube toward the collection container as ordered C. Arrange for a stat Chest x-ray film. D. Clam the tube immediately Answer: (B) Milk the tube toward the collection container as ordered This assists in moving blood, fluid or air, which may be obstructing drainage, toward the collection chamber 128. The observation that indicates a desired response to thoracostomy drainage of a client with chest injury is: A. Increased breath sounds B. Constant bubbling in the drainage chamber C. Crepitus detected on palpation of chest D. Increased respiratory rate Answer: (A) Increased breath sounds The chest tube normalizes intrathoracic pressure and restores negative intra-pleural pressure, drains fluid and air from the pleural space, and improves pulmonary function 129. In the evaluation of a client’s response to fluid replacement therapy, the observation that indicates adequate tissue perfusion to vital organs is: A. Urinary output is 30 ml in an hour B. Central venous pressure reading of 2 cm H2O C. Pulse rates of 120 and 110 in a 15 minute period D. Blood pressure readings of 50/30 and 70/40 within 30 minutes Answer: (A) Urinary output is 30 ml in an hour A rate of 30 ml/hr is considered adequate for perfusion of kidney, heart and brain. 130. A client with multiple injury following a vehicular accident is transferred to the critical care unit. He begins to complain of increased abdominal pain in the left upper quadrant. A ruptured spleen is diagnosed and he is scheduled for emergency splenectomy. In preparing the client for surgery, the nurse should emphasize in his teaching plan the: A. Complete safety of the procedure B. Expectation of postoperative bleeding C. Risk of the procedure with his other injuries D. Presence of abdominal drains for several days after surgery Answer: (D) Presence of abdominal drains for several days after surgery Drains are usually inserted into the splenic bed to facilitate removal of fluid in the area that could lead to abscess formation. 131. To promote continued improvement in the respiratory status of a client following chest tube removal after a chest surgery for multiple rib fracture, the nurse should: A. Encourage bed rest with active and passive range of motion exercises B. Encourage frequent coughing and deep breathing C. Turn him from side to side at least every 2 hours D. Continue observing for dyspnea and crepitus Answer: (B) Encourage frequent coughing and deep breathing This nursing action prevents atelectasis and collection of respiratory secretions and promotes adequate ventilation and gas exchange. 132. A client undergoes below the knee amputation following a vehicular accident. Three days postoperatively, the client is refusing to eat, talk or perform any rehabilitative activities. The best initial nursing approach would be to: A. Give him explanations of why there is a need to quickly increase his activity B. Emphasize repeatedly that with as prosthesis, he will be able to return to his normal lifestyle C. Appear cheerful and non-critical regardless of his response to attempts at intervention D. Accept and acknowledge that his withdrawal is an initially normal and necessary part of grieving Answer: (D) Accept and acknowledge that his withdrawal is an initially normal and necessary part of grieving The withdrawal provides time for the client to assimilate what has occurred and integrate the change in the body image. Acceptance of the client’s behavior is an important factor in the nurse’s intervention. 133. The key factor in accurately assessing how body image changes will be dealt with by the client is the: A. Extent of body change present B. Suddenness of the change C. Obviousness of the change D. Client’s perception of the change Answer: (D) Client’s perception of the change It is not reality, but the client’s feeling about the change that is the most important determinant of the ability to cope. The client should be encouraged to his feelings. 134. Larry is diagnosed as having myelocytic leukemia and is admitted to the hospital for chemotherapy. Larry discusses his recent diagnosis of leukemia by referring to statistical facts and figures. The nurse recognizes that Larry is using the defense mechanism known as: A. Reaction formation B. Sublimation C. Intellectualization D. Projection Answer: (C) Intellectualization People use defense mechanisms to cope with stressful events. Intellectualization is the use of reasoning and thought processes to avoid the emotional upsets. 135. The laboratory results of the client with leukemia indicate bone marrow depression. The nurse should encourage the client to: A. Increase his activity level and ambulate frequently B. Sleep with the head of his bed slightly elevated C. Drink citrus juices frequently for nourishment D. Use a soft toothbrush and electric razor Answer: (D) Use a soft toothbrush and electric razor Suppression of red bone marrow increases bleeding susceptibility associated with thrombocytopenia, decreased platelets. Anemia and leucopenia are the two other problems noted with bone marrow depression. 136. Dennis receives a blood transfusion and develops flank pain, chills, fever and hematuria. The nurse recognizes that Dennis is probably experiencing: A. An anaphylactic transfusion reaction B. An allergic transfusion reaction C. A hemolytic transfusion reaction D. A pyrogenic transfusion reaction Answer: (C) A hemolytic transfusion reaction This results from a recipient’s antibodies that are incompatible with transfused RBC’s; also called type II hypersensitivity; these signs result from RBC hemolysis, agglutination, and capillary plugging that can damage renal function, thus the flank pain and hematuria and the other manifestations. 137. A client jokes about his leukemia even though he is becoming sicker and weaker. The nurse’s most therapeutic response would be: A. “Your laugher is a cover for your fear.” B. “He who laughs on the outside, cries on the inside.” C. “Why are you always laughing?” D. “Does it help you to joke about your illness?” Answer: (D) “Does it help you to joke about your illness?” This non-judgmentally on the part of the nurse points out the client’s behavior. 138. In dealing with a dying client who is in the denial stage of grief, the best nursing approach is to: A. Agree with and encourage the client’s denial B. Reassure the client that everything will be okay C. Allow the denial but be available to discuss death D. Leave the client alone to discuss the loss Answer: (C) Allow the denial but be available to discuss death This does not take away the client’s only way of coping, and it permits future movement through the grieving process when the client is ready. Dying clients move through the different stages of grieving and the nurse must be ready to intervene in all these stages.