SITUATION 1: ABG measurement is a must need for any student nurses to

know in order to equip them wih valuable knowledge and skills. It

also is very important to determine Nursing Actions to help stabilize
life learning skills.

1. an elementary student, was rushed to the hospital due to vomiting

and a decreased level of consciousness. The patient displays slow and
deep (Kussmaul breathing), and he is lethargic and irritable in
response to stimulation. He appears to be dehydrated—his eyes are
sunken and mucous membranes are dry—and he has a two week history of
polydipsia, polyuria, and weight loss. Measurement of arterial blood
gas shows pH 7.0, PaÓ 90 mm Hg, PaCÓ 23 mm Hg, and HCǑ 12 mmol/L;
other results are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95 mmol/L.
What is your assessment?

A. Respiratory Acidosis, Uncompensated

B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Acidosis, Partially, Compensated

2.A cigarette vendor was brought to the emergency department of a

hospital after she fell into the ground and hurt her left leg. She is
noted to be tachycardic and tachypneic. Painkillers were carried out
to lessen her pain. Suddenly, she started complaining that she is
still in pain and now experiencing muscle cramps, tingling, and
paraesthesia. Measurement of arterial blood gas reveals pH 7.6, PaÓ
120 mm Hg, PaCÓ 31 mm Hg, and HCǑ 25 mmol/L. What does this mean?

A. Respiratory Alkalosis, Uncompensated

B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Alkalosis, Partially Compensated

3. A patient receives atropine, an anticholinergic drug, in

preparation for surgery. The nurse expects this drug to affect the GI
tract by doing what?
a. Increasing gastric emptying
b.Decreasing secretions and peristaltic action
c. Relaxing pyloric and ileocecal sphincters
d. Stimulating the nervous system of the GI tract
4.When caring for a patient who has had most of the stomach
surgically removed, what is important for the nurse to teach the
patient?
a. Extra iron will need to be taken to prevent anemia.
b. Avoid foods with lactose to prevent bloating and diarrhea.
c. Lifelong supplementation of cobalamin (vitamin B12) will be
needed.
d. Because of the absence of digestive enzymes, protein malnutrition
is likely

5.A 68-year-old patient is in the office for a physical. She notes

that she no longer has regular bowel movements. Which suggestion by
the nurse would be most helpful to the patient?
a. Take an additional laxative to stimulate defecation.
b. Eat less acidic foods to enable the gastrointestinal system to
increase peristalsis.
c. Eat less food at each meal to prevent feces from backing up
related to slowed peristalsis.
d. Attempt defecation after breakfast because gastrocolic reflexes
increase colon peristalsis at that time.

SITUATION 2: There are 4 quadrants and 9 regions on digestive system.

Physical assessment is important to note different deterioration on
diseases in gastrointestinal.

6. A patient is admitted to the hospital with left upper quadrant

(LUQ) pain. What may be a possible source of the pain?
a. Liver
b. Appendix
c. Pancreas
d. Gallbladder

7. What characterizes auscultation of the abdomen?

a. The presence of borborygmi indicates hyperperistalsis.
b. The bell of the stethoscope is used to auscultate high-pitched
sounds.
c. High-pitched, rushing, and tinkling bowel sounds are heard after
eating.
d. Absence of bowel sounds for 1 minute in each quadrant is reported
as abnormal

8. Following auscultation of the abdomen, what should the nurse’s

next action be?
a. Lightly percuss over all four quadrants
b. Have the patient empty his or her bladder
c. Inspect perianal and anal areas for color, masses, rashes, and
scars
d. Perform deep palpation to delineate abdominal organs and masses

9. A patient’s serum liver enzyme tests reveal an elevated aspartate

aminotransferase (AST). The nurse recognizes what about the elevated
AST?
a. It eliminates infection as a cause of liver damage.
b. It is diagnostic for liver inflammation and damage.
c. Tissue damage in organs other than the liver may be identified.
d. Nervous system symptoms related to hepatic encephalopathy may be
the cause

10. Checking for the return of the gag reflex and monitoring for LUQ
pain, nausea and vomiting are necessary nursing actions after which
diagnostic procedure?
a. ERCP
b. Barium swallow
c. Colonoscopy
d. Esophagogastroduodenoscopy (EGD)

SITUATION 3: Diet is an important aspect to help nursing students to

help evaluate efforts from creating a healthy lifestyle.

11. To evaluate the effect of nutritional interventions for a patient

with protein-calorie malnutrition, what is the best indicator for the
nurse to use?
a. Height and weight
b. Weight in relation to ideal body weight
c. Body mass index (BMI)
d. Mid-upper arm circumference and triceps skinfold

12. The nurse evaluates that patient teaching about a high-calorie,

high-protein diet has been effective when the patient selects which
breakfast option from the hospital menu?
a. Two poached eggs, hash brown potatoes, and whole milk
b. Two slices of toast with butter and jelly, orange juice, and skim
milk
c. Three pancakes with butter and syrup, two slices of bacon, and
apple juice
d. Cream of wheat with 2 tbsp of skim milk powder, one half
grapefruit, and a high-protein milkshake
13. When teaching the older adult about nutritional needs during
aging, what does the nurse emphasize?
a. Need for all nutrients decreases as one ages.
b. Fewer calories, but the same or slightly increased amount of
protein, are required as one ages.
c. Fats, carbohydrates, and protein should be decreased, but vitamin
and mineral intake should be increased.
d. High-calorie oral supplements should be taken between meals to
ensure that recommended nutrient needs are met.

14. When considering tube feedings for a patient with severe

protein-calorie malnutrition, what is an advantage of a gastrostomy
tube versus a nasogastric (NG) tube?
a. There is less irritation to the nasal and esophageal mucosa.
b. The patient experiences the sights and smells associated with
eating.
c. Aspiration resulting from reflux of formulas into the esophagus is
less common.
d. Routine checking for placement is not required because gastrostomy
tubes do not become displaced.

15. What is an indication for parenteral nutrition that is not an

appropriate indication for enteral tube feedings?
a. Head and neck cancer
b. Malabsorption syndrome
c. Hypermetabolic states
d. Protein-calorie malnutrition

SITUATION 4: Vomiting has been a somewhat shoo-in problem when it

comes to digestion. It has been a rampant issue to people on how to
cater the needs to the existing common problems.

16. The nurse is caring for a patient receiving 1000 mL of parenteral

nutrition solution over 24 hours. When it is time to change the
solution, 150 mL remain in the bottle. What is the most appropriate
action by the nurse?
a. Hang the new solution and discard the unused solution.
b. Open the IV line and rapidly infuse the remaining solution.
c. Notify the health care provider for instructions regarding the
infusion rate.
d. Wait to change the solution until the remaining solution infuses
at the prescribed rate

17. What physiologically occurs with vomiting?

a. The acid-base imbalance most commonly associated with persistent
vomiting is metabolic acidosis caused by loss of bicarbonate.
b. Stimulation of the vomiting center by the chemoreceptor trigger
zone (CTZ) is commonly caused by stretch and distention of hollow
organs.
c. Vomiting requires the coordination of activities of structures
including the glottis, respiratory expiration, relaxation of the
pylorus, and closure of the lower esophageal sphincter.
d. Immediately before the act of vomiting, activation of the
parasympathetic nervous system causes increased salivation, increased
gastric motility, and relaxation of the lower esophageal sphincter.

18. Which laboratory findings should the nurse expect in the patient
with persistent vomiting?
a. ↓ pH, ↑ sodium, ↓ hematocrit
b. ↑ pH, ↓ potassium, ↑ hematocrit
c. ↑ pH, ↓ chloride, ↓ hematocrit
d. ↓ pH, ↓ potassium, ↑ hematocrit

19. A patient who has been vomiting for several days from an unknown
cause is admitted to the hospital. What should the nurse anticipate
will be included in collaborative care?
a. Oral administration of broth and tea
b. Administration of parenteral antiemetics
c. IV replacement of fluid and electrolytes
d. Insertion of a nasogastric (NG) tube for suction

20. A patient treated for vomiting is to begin oral intake when the
symptoms have subsided. To promote rehydration, the nurse plans to
administer which fluid first?
a. Water
b. Gatorade
c. Hot tea
d. Warm broth

SITUATION 5: Medications are needed in order to treat diseases to

improve lifestyle and return back patient to their Optimum Quality of
Life. Chemotherapy has been a traditional treatment when it comes to
many types of cancer.

21. Ondansetron (Zofran) is prescribed for a patient with cancer

chemotherapy–induced vomiting. What should the nurse understand about
this drug?
a. It is a derivative of cannabis and has a potential for abuse.
b. It has a strong antihistamine effect that provides sedation and
induces sleep.
c. It is used only when other therapies are ineffective because of
side effects of anxiety and hallucinations.
d. It relieves vomiting centrally by action in the vomiting center
and peripherally by promoting gastric emptying

22. What are characteristics of gingivitis?

a. Formation of abscesses with loosening of teeth
b. Caused by upper respiratory tract viral infection
c. Shallow, painful vesicular ulcerations of lips and mouth
d. Infectious ulcers of mouth and lips as a result of systemic
disease

23. Which infection or inflammation is found related to systemic

disease and cancer chemotherapy?
a. Parotitis
b. Oral candidiasis
c. Stomatitis
d. Vincent’s infection

24.A patient is scheduled for biopsy of a painful tongue ulcer. Based

on knowledge of risk factors for oral cancer, what should the nurse
specifically ask the patient about during a history?
a. Excessive exposure to sunlight
b. Use of any type of tobacco products
c. Recurrent herpes simplex infections
d. Difficulty swallowing and pain in the ear

25. Priority Decision: When caring for a patient following a

glossectomy with dissection of the floor of the mouth and a radical
neck dissection for cancer of the tongue, what is the nurse’s primary
concern?
a. Relief of pain
b. Positive body image
c. Patent airway
d. Tube feedings to provide nutrition

SITUATION 6: GERD, in which stomach acid moves into the esophagus,

causes discomfort and may lead to precancerous changes in the lining
of the esophagus.

26. A patient with oral cancer has a history of heavy smoking,

excessive alcohol intake, and personal neglect. During the patient’s
early postoperative course, what does the nurse anticipate that the
patient may need?
a. Oral nutritional supplements
b. Drug therapy to prevent substance withdrawal symptoms
c. Counseling about lifestyle changes to prevent recurrence of the
tumor
d. Less pain medication because of cross-tolerance with central
nervous system (CNS) depressant

27.How should the nurse teach the patient with a hiatal hernia or
GERD to control symptoms?
a. Drink 10 to 12 oz of water with each meal.
b. Space six small meals a day between breakfast and bedtime.
c. Sleep with the head of the bed elevated on 4- to 6-inch blocks
d. Perform daily exercises of toe-touching, sit-ups, and weight
lifting.

28. Following a patient’s esophagogastrostomy for cancer of the

esophagus, what is most important for the nurse to do?
a. Report any bloody drainage from the NG tube.
b. Maintain the patient in semi-Fowler’s or Fowler’s position.
c. Monitor for abdominal distention that may disrupt the surgical
site.
d. Expect to find decreased breath sounds bilaterally because of the
surgical approach.

29. Which esophageal disorder is described as a precancerous lesion

associated with GERD?
a. Achalasia
b. Esophageal strictures
c. Barrett’s esophagus
d. Esophageal diverticula

30. The nurse plans teaching for the patient with a colostomy but
the patient refuses to look at the nurse or the stoma, stating, “I
just can’t see myself with this thing.” What is the best nursing
intervention for this patient?
a. Encourage the patient to share concerns and ask questions.
b. Refer the patient to a chaplain to help cope with this situation.
c. Explain that there is nothing the patient can do about it and must
take care of it.
d. Tell the patient that learning about it will prevent stool leaking
and the sounds of flatus.
SITUATION 7: Mark, a student nurse is frequently questioned about
immune system disease and was

31. What should the nurse teach the patient with diverticulosis to
do?
a. Use anticholinergic drugs routinely to prevent bowel spasm.
b. Have an annual colonoscopy to detect malignant changes in the
lesions.
c. Maintain a high-fiber diet to increase fecal volume.
d. Exclude whole grain breads and cereals from the diet to prevent
irritating the bowel.

32.Following a hemorrhoidectomy, what should the nurse advise the

patient to do?
a. Use daily laxatives to facilitate bowel emptying.
b. Use ice packs to the perineum to prevent swelling.
c. Avoid having a bowel movement for several days until healing
occurs.
d. Take warm sitz baths several times a day to promote comfort and
cleaning

33.The patient experienced a blood transfusion reaction. How should

the nurse explain to the patient the cause of the hemolytic jaundice
that occurred?
a. Results from hepatocellular disease
b. Due to a malaria parasite breaking apart red blood cells (RBCs)
c. Results from decreased flow of bile through the liver or biliary
system
d. Due to increased breakdown of RBCs that caused elevated serum
unconjugated bilirubin

34. The patient returned from a 6-week mission trip to Somalia with
complaints of nausea, malaise, fatigue, and achy muscles. Which type
of hepatitis is this patient most likely to have contracted?
a. Hepatitis B (HBV)
b. Hepatitis D (HDV)
c. Hepatitis C (HCV)
d. Hepatitis E (HEV)

35. Which type of hepatitis is a DNA virus, can be transmitted via

exposure to infectious blood or body fluids, is required for HDV to
replicate, and increases the risk of the chronic carrier for
hepatocellular cancer?
a. Hepatitis A (HAV) b. Hepatitis C (HCV) c. Hepatitis B (HBV) d.
Hepatitis E (HEV)
SITUATION 8: Your liver plays a major role in your everyday health.
It’s responsible for filtering toxins and other harmful substances
from your blood. It also assists with digestion, makes hormones and
proteins, and regulates your cholesterol and blood sugar.

36. The family members of a patient with hepatitis A ask if there is

anything that will prevent them from developing the disease. What is
the best response by the nurse?
a. “No immunization is available for hepatitis A, nor are you likely
to get the disease.”
b. “All family members should receive the hepatitis A vaccine to
prevent or modify the infection.” c. “Those who have had household or
close contact with the patient should receive immune globulin.”
d. “Only those individuals who have had sexual contact with the
patient should receive immunization.”

37. The nurse identifies a need for further teaching when the patient
with hepatitis B makes which statement?
a. “I should avoid alcohol completely for as long as a year.”
b. “I must avoid all physical contact with my family until the
jaundice is gone.”
c. “I should use a condom to prevent spread of the disease to my
sexual partner.”
d. “I will need to rest several times a day, gradually increasing my
activity as I tolerate it.

38. Priority Decision: The patient has hepatic encephalopathy. What

is a priority nursing intervention to keep the patient safe?
a. Turn the patient every 3 hours.
b. Assist the patient to the bathroom.
c. Encourage increasing ambulation.
d. Prevent constipation to reduce ammonia production.

39. What laboratory test results should the nurse expect to find in a
patient with cirrhosis?
a. Serum albumin: 7.0 g/dL (70 g/L)
b. Total bilirubin: 3.2 mg/dL (54.7 mmol/L)
c. Serum cholesterol: 260 mg/dL (6.7 mmol/L)
d. Aspartate aminotransferase (AST): 6.0 U/L (0.1 mkat/L)

40.What manifestation in the patient does the nurse recognize as an

early sign of hepatic encephalopathy?
a. Manifests asterixis
b. Has increasing oliguria
c. Becomes unconscious
d. Is irritable and lethargic

SITUATION 9:Different cardiac terminologies have been established to

create a better understanding on how the Cardiovascular system works.

41.Which of the following is not one of the three main factors

influencing blood pressure?
A) cardiac output
B) peripheral resistance
C) emotional state
D) blood volume

42. Which statement best describes arteries?

A)All carry oxygenated blood to the heart.
B) All carry blood away from the heart.
C) All contain valves to prevent the backflow of blood.
D) All arteries are lined with endothelium.

43. The pulse pressure is ______.

A) systolic pressure plus diastolic pressure
B) systolic pressure minus diastolic pressure
C) systolic pressure divided by diastolic pressure
D) diastolic pressure plus 1/3 (systolic pressure plus diastolic
pressure

44. Which of the following is likely during vigorous exercise?

A) Blood will be diverted to the digestive organs.
B) The skin will be cold and clammy.
C) Capillaries of the active muscles will be engorged with blood.
D) Blood flow to the kidneys increases.

45. Select the correct statement about factors that influence blood
pressure.
A) An increase in cardiac output corresponds to a decrease in blood
pressure, due to the increased delivery.
B) Systemic vasodilation would increase blood pressure, due to
diversion of blood to essential areas.
C) Excess protein production would decrease blood pressure.
D) Excess red cell production would cause a blood pressure increase

SITUATION 10: As a supervisor, you face a variety of issues brought

on by a variety of factors. Conflict ensued as a result of its rank
from clinical personnel to administration. You attempted to find a
solution.

46. As a result, you should think about using the following methods
to settle disputes, except:
a. Making a compromise b. Majority rule c. Reporting d. Smoothing

47. A nurse manager's desired objectives include all but the

following: a. Practice only the leadership style that works best for
you
b. Use a leadership style that encourages high-level work performance
c. Use a leadership style that causes the fewest disruptions possible
d. Use a leadership style that is best suited to the task at hand.

48.The nurse writes to the head nurse and asks for a special
privilege. The request is approved by receiving a response. This
movement portrays:
a. Corruptive communication
b. Positional communication
c. Organizational communication
d. Inappropriate communication channels

49.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.

50.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

SITUATION 11: Cardiovascular diseases are the still the leading cause
of diseases that’s why it is still very important to know the
biomarkers and medication given to the said diseases.

51.A client complains of crushing chest pain that radiates to his

left arm. He should be presented with the following treatment:
a. Aspirin, oxygen, nitroglycerin, and morphine
b. Aspirin, oxygen, nitroglycerin, and codeine
c. Oxygen, nitroglycerin, meperidine, and thrombolytics
d. Aspirin, oxygen, nitroprusside, and morphine

52. patient who has undergone a valve replacement with a mechanical

valve prosthesis is due to be discharged home. During discharge
teaching, the nurse should discuss the importance of antibiotic
prophylaxis prior to which of the following?
a. Exposure to immunocompromised individuals
b. Future hospital admissions
c.Dental procedures
d. Live vaccinations

53.The nurse teaches the client with angina about the common expected
side effects of nitroglycerin, including
a.Headache
b. High blood pressure
c. Shortness of breath
d. Stomach cramps

54.A client is taking VARDENAFIL [Levitra]. Which of the following is

a major side effect when this drug is taken with NITRATES?
a. Penile dysfunction
b. Severe pallor
c. Continued alertness
d.Fatal Hypotension

55.Which of the following blood tests is most indicative of cardiac

damage?
a. Lactate dehydrogenase
b. Complete blood count
c. Troponin I
d.Creatine KInase
SITUATION 12: Myocardial infarction is the most common diseases when
discussing about Heart problems. This happens when oxygen is not
enough administered to the cells of the heart.

56. The nurse is assigned to care for a client who had a myocardial
infarction (MI) 2 days ago. The client has many questions about this
condition. What area is a priority for the nurse to discuss at this
time?
a. Daily needs and concerns
b. The overview cardiac rehabilitation
c. Medication and diet guideline
d.Activity and Rest Guidelines

57.Which of the following classes of medications maximizes cardiac

performance in clients with heat failure by increasing ventricular
contractility?
a. Beta-adrenergic blockers
b. Calcium channel blockers
c. Diuretics
d.Inotropic Agents

58. The nurse checks the laboratory result for a serum digoxin level
that was determined for a client earlier in the day and notes that
the result is 2.4 ng/Ml. Which of the following is the most
important action on the part of the nurse?
a.Notify the Physician
b. Check the client’s last pulse
c. Record the normal value on the client’s flow sheet
d. Administer the next dose of the medication as scheduled.

59. A client with congestive heart failure (CHF) is being discharged

with a new prescription for captopril (Capoten), an
angiotensin-converting enzyme (ACE) inhibitor. The nurse's discharge
instruction should include reporting which problem to the health care
provider?
a. Weight loss.
b.Dry,Persistent Cough
c. Muscle cramps.
d. Dry mucus membranes

60.The client comes to the emergency department saying, "I am having

a heart attack." Which question is most pertinent when assessing the
client?
a. "Can you describe your chest pain?"
b."What were you doing when the pain started?"
c. "Did you have a high-fat meal today?"
d. "Does the pain get worse when you lie down?"

SITUATION 13: It is assumed that a professional nurse keeps herself

up to date on the field in order to remain competent in her work.
Staff nurses and head nurses alike discuss the process of nursing
management.

61.This major function of the management process establishes formal

authority. It defines qualifications and also includes staffing:
a. Planning b. Directing C. Organizing D. Controlling

62. On the other hand, this major function of the management process
actuates efforts towards the accomplishment of goals. It includes
updating policies and procedures:
a.Planning b. Organizing c.Directing d. Controlling

63. She noticed that policies and standard operating procedures

(SOP’s) are strictly implemented in the hospital. What management
function is this?
a. Planning b. Organizing C. Directing D. Controlling

64. When giving responsibilities to the staff members she should

consider the following:
a.Job description
b. Abilities of the staff
c.Preference of the staff
d. Her own decision

65. Which task can be delegated to the nursing aid when the patient
is stable?
a. Administering tap water enema
b.Incorporating potassium chloride intravenously
c. Teaching patient to administer insulin
d. Taking CVP

SITUATION 14: Peripheral arterial disease (PAD) in the legs or lower

extremities is the narrowing or blockage of the vessels that carry
blood from the heart to the legs. It is primarily caused by the
buildup of fatty plaque in the arteries, which is called
atherosclerosis.

66.The other patient of Ms. Lydia is suffering from BUerger’s

disease. He has been complaining of intermittent claudication of the
lower extremities which has been giving him so much discomfort. What
is the BEST nursing action she should perform to address the
patient’s complaint?
a. Allow the patient to lie flat on bed.
b. Teach him foot care and leg exercises
c. Place affected extremities on dependent position
d. Apply warm water bag to the affected extremities.

67.Which of the following information is NOT tru of Buerger’s

disease?
a. Small and medium arteries and veins are mostly affected.
b. Smoking is a major cause of Buerger’s disease.
c. Incidence of Buerger’s disease is high in men than women
d.A strong relationship exists between diabetes and Buerger disease.

68.Which of the following controllable risk factors for coronary

artery disease [CAD] appears most closely linked to the development
of the disease?
A. Age
B. Medication usage
C. High cholesterol levels
D. Gender

69.Which of the following is an uncontrollable risk factor that has

been linked to the development of CAD?
A. Exercise
B. Obesity
C. Stress
D. Hereditary

70.Exceeding which of the following serum cholesterol levels

significantly increases the risk of coronary artery disease?
A. 100 mg/dl
B. 150 mg/dl
C. 175 mg/dl
D. 200 mg/dl

SITUATION 15: Hospital situations has been a very important

development in managerial functions of a prudent nurse. Different
approaches have been used in order to improve different aspects of
healthcare.

71. The nurse in the medication unit passes the medications for all
the clients on the nursing unit. The head nurse is making rounds with
the physician and coordinates clients’ activities with other
departments. The nurse assistant changes the bed lines and answers
call lights. A second nurse is assigned for changing wound dressings;
a licensed practitioner nurse takes vital signs and bathes the
clients. This illustrates what method of nursing care?
a.Case management method
b. Primary Nursing Method
c.Team method
d. Functional method

72. As the supervisor, you plan to implement change in the nursing

unit from team nursing to primary nursing. You anticipate that there
will be resistance to change. In order to avoid such, which of the
following should be done?
a. Determine the need for change
b. Confront the staff individually
c. Develop the change one step at a time
d. Use coercion to implement change

73. The supervisor has implemented changes. A nurse aide seems to be

resistant to the change. Which of the following should be done?
a.Ignore the resistance
b. Utilize coercion
c. Give reward to the nursing assistant
d. Talk to the nurse assistant and encourage verbalization of
feelings

74. As a medication nurse, you are tasked to give digoxin to a

patient with arrhythmia. You noticed that the heart rate is
40 beats per minute and the potassium level is below normal. The
physician orders digoxin STAT. An assertive response of the nurse
should be:
a.“I think we have to monitor the patient’s cardiac rate before
giving the drug.”
b.“I don’t want to carry out your order”
c.“Don’t you know the precautions for giving this drug?”
d.“Yes doctor. I will give it right now.”

75. Determining the standard of the institution is one of the

concerns in controlling. When the institution has reached the
minimum level of excellence, it should:
a.Be contented on the result of the evaluation
b. Do something to improve the standard
c. Help maintain the standard of the institution
d.Publish the result to the publication
SITUATION 16: As many have mentioned, Medical-Surgical Nursing has
always been a difficult subject to deal with as its concepts need
interrelatedness between different aspects of care. However, as a
competent nurse one should fully equip his knowledge and
understanding about medical-surgical nursing.

76.A patient who has terminal cancer has an order for morphine
sulfate (MS Contin) tablets every 8 to 12 hrs p.r.n. for moderate
pain or morphine sulfate injections of 10 to 12 mg every four hours
p.r.n. intramuscularly for severe pain. The patient has been
receiving MS Contain p.o. every 12 hours but is experiencing
breakthrough pain after about 10 hours. Which of the following
nursing action is most appropriate.
a. Administer injectable morphine sulfate, 12 mg, IM, p.r.n.
b. Administer the MS Contain, po, every 12 hours
c. Administer the MS Contain, po, every 10 hours
d. Withhold the pain medications and notify the physician

77.Which of the following outcomes observed by the nurse during the

drain cycle of peritoneal dialysis should be reported immediately to
the physician?
a. Clear yellow output
b. Cloudy output
c. Patient complaint of slight cramping
d. A drain output of 50 cc less than instilled

78. Which of the following foods should be removed from the dietary
tray of a patient who has hepatic encephalopathy?
a. Pasta
b. Spinach
c. Fresh fruit
d. Eggs

79. Which of the following questions is most important for a nurse to

ask when taking a history from a patient who presents with symptoms
of peripheral arterial occlusive disease?
a. “Do your legs hurt while walking?”
b. “Do you notice swelling in your legs at night?”
c. “Do you have calf pain when you flex your foot?”
d. “Do you feet feel warm after exercise?”
80. Which of the following instructions should a nurse give to a
patient who has history of venous leg ulcers in order to prevent
recurrence?
a. “Sit with your legs dependent whenever possible”
b. “Use warm compresses on your legs in the evening”
c. “Examine your legs for areas of redness every day”
d. “Keep your legs flexed when standing for long periods”

SITUATION 17:Acute kidney failure occurs when your kidneys suddenly

become unable to filter waste products from your blood. When your
kidneys lose their filtering ability, dangerous levels of wastes may
accumulate, and your blood's chemical makeup may get out of balance.

81. Which of the following laboratory result, if identified in a

patient who is experiencing vomiting and diarrhea, is most suggestive
of hypovolemic shock?
a. Potassium, 5.6 mEq/ L
b. Hematocrit, 58%
c. Hemoglobin, 11g/dL
d. Calcium, 6 mEq/ L

82. Nurse Sarah interviews a client named Alben. He claimed that he

developed acute renal failure (ARF) after sustaining multiple
physical injuries from a vehicular accident eight weeks ago. Nurse
Sarah interprets that this type of renal failure is due to:
a. Prerenal cause
b. Postrenal cause
c. Intrarenal cause
d. Extrarenal cause

83. Nurse Sarah noticed that Alben’s doctor wrote in his progress
notes that Alben is on the oliguric phase of acute renal failure.
Nurse Sarah monitors him for which of the following?
a. Hypernatremia, Hypokalemia and CNS depression
b. Pulmonary edema and ECG changes
c. Kussmaul’s respiration, acidosis and hypotension
d. Urine with high specific gravity and low sodium concentration

84. The doctor ordered for close monitoring of Alben’s serum

electrolyte levels. The result revealed that he has a serum potassium
level of 6.8 mEq/L. Nurse Sarah would plan which of the following as
a priority action?
a. Allow an extra 500 mL fluid intake to dilute the electrolyte
concentration.
b. Encourage increased intake of fruits and vegetables in the
diet.
c. Place the client on a cardiac monitor.
d. Check the sodium and magnesium level

85. Nurse develops a care plan for a patient named Vinci, who has
chronic renal failure. He is receiving hemodialysis via an
arteriovenous (AV) fistula in the right arm. Nurse Sarah includes
which interventions in the plan, to ensure protecting the AV fistula
apart from?
a. Palpate for bruit and auscultate for thrills every 4 hours.
b. Check for bleeding and infection at hemodialysis needle
insertion sites.
c. Instruct the client not to carry heavy objects or anything that
compresses the extremity.
d. Instruct the client not to sleep in a position that places his
or her body weight on top of the extremity.

SITUATION 18: Dialysis nurses have become in-demand as many Filipinos

are now suffering from Kidney failure related to predisposing
problems that increases the risk for the disease.

86. During the dialysis, Vinci suddenly develops restlessness,

nausea and vomiting, and fluctuating level of consciousness. Nurse
Sarah is abreast with the disease process if she assumes that her
patient’s signs and symptoms subsisted as a result of:
a. High levels of serum sodium, potassium, magnesium and
phosphorus
b. Fluid accumulation and increased intracranial pressure
c. Rapid cerebral fluid shifts
d. Multiple organ failure

87. Four days after, Vinci is again scheduled for hemodialysis this
morning, and is due to receive a daily dose of enalapril (Vasotec).
Nurse Sarah plans to administer this medication:
a. During dialysis
b. Just before dialysis
c. The day after dialysis
d. Upon return from dialysis

88. Patient Vinci is prescribed to be on a fluid restriction atmost

1500 mL per day. Nurse Sarah best plans to assist him with
maintaining the restriction by:
a. Removing the water pitcher from the bedside
b. Using mouthwash with alcohol for mouth care
c. Prohibiting beverages with sugar to minimize thirst
d. Asking the client to calculate the IV fluids into the total
daily allotment

89. A nurse is caring for a client who has just returned to the
nursing unit after an intravenous pyelogram (IVP). The nurse
determines that which of the following is important in the
postprocedure care of this client?
a. encouraging increased intake of oral fluids
b. ambulating the client in the hallway
c. encouraging the client to try to avoid frequently
d. maintaining the client on bedrest

90. A nurse has collected nutritional data from a client with a

diagnosis of cystitis. The nurse determines that which beverage needs
to be eliminated from the client's diet to minimize the recurrence of
cystitis?
a. fruit juice
b. tea
c. water
d. lemonade

SITUATION 19: Mr. Martirez is an Operating Room head nurse for five
years. He strongly felt that his unit needs some changes in order to
be competitive with other hospitals.

91. Which of the following is incompatible with the planning process

in the organization?
a. Establishes goals and objectives
b. Places goals of nursing personnel above organizational goals
c. Evaluates goal implementation
d. Revises and updates plan

92. Which of the following is not included in the capital expense

budget?
a. Renovation of the OR suites
b. Purchase of heart-lung machine
c. Purchase of anesthetic machine
d. Repair of air conditioning

93. An old ventilator often malfunctions and has inefficiencies

resulting from the speed of the equipment or downtime
(amount of time it is out of service for repairs). The organization
decided to purchase new technology because the old one is too
expensive to maintain. What type of budget is allotted for the
equipment?
a. Operational budget
b. Capital Budget
c.Construction budget
d. Any of the above

94. An operational budget is a financial tool that outlines

anticipated revenue and expenses over a specified period. Which
of the following are incorrect regarding budget?
a. The budget translates operational plans into financial and
statistical terms so that income can be projected with
associated costs
b.Budget serve as standards to plan, monitor, and evaluate the
performance of a health care system
c.Budget account for the relationship of income to the expenses
needed to deliver the services
d.All of the above

95. Which among the following is the purpose of monitoring a budget?

a.Keep expenses above budget
b. Maintain revenue above the previous year’s budget
c.Ensure revenue is generated monthly
d. Generate revenue and control expenses within a projected framework

SITUATION 20: The urinary tract infection has always been more common
in females than males because of its shorter urethra. The most common
bacterial cause of UTI is E. Coli which is a natural bacteria in the
intestinal flora.

96.The nurse has provided instructions to a female client with

cystitis about measures to prevent recurrence. The nurse determines
that the client needs further instruction if the client verbalizes
to:
a) take bubble baths for more effective hygiene
b) wear underwater made of cotton or with cotton panels
c) drink a glass of water and void after intercourse
d) avoid wearing pantyhose while wearing socks

97. An adult male is hospitalized for Urolithiasis. A stone he passed

in his urine was sent to the laboratory this morning. The laboratory
identifies the stone as an oxalate stone. Which of the following
modifications should the nurse teach him to make in his diet?
A. Limit milk and dairy product
B. Limit his intake of tea, chocolate, and spinach
C. Eat an acid ash diet to keep his urine acidic
D. Limit food high in purine

98. Mr. de Vera, 46, is admitted to the hospital with a diagnosis of

renal calculi. He developed renal calculi several years ago. He is
experiencing severe flank pain and is nauseated, and his temperature
is 38 Celsius. Given an understanding of renal calculi and Mr. de
Vera’s assessment data, the nurse’s IMMEDIATE goal should be to:
A. Prevent urinary complication
B. Alleviate nausea
C. Alleviate the pain
D. Maintain fluid and electrolyte balance

99. All of the following findings appear in Mr. de Vera’s nursing

priority. Which finding is LEAST likely to have predisposed him for
renal calculi?
A. Having had several UTI in the past two years
B. Having taken large doses of Vitamin C in the past several years
C. Drinking less than the recommended amount of milk
D. Having been on prolonged bed rest following an accident the
previous year

100. In addition to being nauseated and experiencing severe flank

pain, Mr. de Vera is experiencing pain in his groin and bladder. The
nurse should judge that these symptoms are MOST likely the result of:
A. Nephritis
B. Referred pain
C. Urinary retention
D. Additional stone formation