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NURSING SEMINAR II

Nursing Prac4ce II:

Care of Healthy/At Risk Mother and Child

FINAL EXAMINATION

Situa&on: Nurse Jessica works as an OB-Gyne Nurse and a9ends to several HIGH-RISK PREGNANCIES: Par&cular women with
pre-exis&ng or Newly Acquired illness. The following condi&ons apply

1. Suze9e is a 22-year old woman. Which condi&on would make her more prone than others to developing a Candida infec&on
during pregnancy?

a. Her husband plays golf 6 days a week

b. She was over 35 when she became pregnant

c. She usually drinks tomato juice for breakfast

d. She has developed gesta&onal diabetes

2. Suze9e develops a deep vein thrombosis following an auto accident and is prescribed heparin sub-Q. What should Joanna
educate her about in regard to this?

a. Some infants will be born with allergic symptoms to heparin

b. Her infant will be born with sca9ered petechial on his trunk

c. Heparin can cause darkened skin in newborns

d. Heparin does not cross placenta and so does not aXect a fetus

3. The cousin of Suze9e with sickle-cell anemia alerted Joanna that she may need further instruc&on on prenatal care. What
statement signiYes this fact?

a. I've stopped jogging so I don't risk becoming dehydrated.

b. I take an iron pill every day to help grow new red blood cells

c. I an careful to drink at least eight glasses of [uid every day

d. I understand why folic acid is important for red cell forma&on

4. Suze9e rou&nely takes acetylsalicylic acid (aspirin) for arthri&s. Why should she limit or discon&nue this toward the end of
pregnancy?

a. Aspirin can lead to deep vein thrombosis following birth

b. Newborns develop a red rash from salicylate toxicity

c. Newborns develop withdrawal headaches from salicylates

d. Salicylates can lead to increased maternal bleeding ling at childbirth

MERGED BY @JAMES_O10

5. Suze9e received a lacera&on on her leg from her automobile accident. Why are lacera&ons of lower extremi&es poten&ally
more serious in pregnant women than others?

a. Lacera&ons can provoke allergic responses because of gonadotropic hormone

b. Increased bleeding can occur from uterine pressure on leg veins

c. A woman is less able to keep the lacera&on clean because of her fa&gue

d. Healing is limited during pregnancy, so these will not heal un&l aaer birth.

Situa4on: The goals of perinatal educa4on are to help parents become knowledgeable consumers take ac4vi4es role in
maintaining health during pregnancy. Anna a 25-year-old Gravida 3 Para 2 seeks prenatal consulta4on.

6. Nurse Yolly discusses Teratogens with a client during pre-conceptual counseling. The client demonstrates understanding by
sta&ng:

A. "I should stop taking all my medica&ons while I am pregnant."

B. "The fetus is at greatest risk for developing anomalies during the Yrst 16 weeks of pregnancy."

C. "Aaer 12 weeks, the placenta protects the fetus from teratogens."

D. "Exposure to teratogens poses the greatest risk during the Yrst eight weeks."

7. Anna had her menstrua&on last April 12, 2018. She has a 27-day cycle. Given the scenario, the expected date of next
ovula&on is:

A. April 25, 2018

B. April 26, 2018

C. May 25, 2018

D. May 26, 2018

8. Following an ultrasound at 6 weeks gesta&on, the client comments, "The embryo doesn't look human." She asks, "When will
it begin to look like a baby?" The nurse's best response is:

A. "In one more week the embryo will take on a human appearance."

B. "The embryo looks like a baby already. Let me show you again."

C. "The embryo becomes a fetus and looks human aaer 8 weeks gesta&on."

D. "You are right! The embryo doesn't look human. Is this important to you?"

9. Carla another pa&ent in the clinic just found out that she is pregnant. She asks when would be her delivery date. What is the
expected date of conYnement (EDC) of a pregnant woman whose menstrua&on was from April 10 to April 137

A. January 17

B. January 20

C. July 17
MERGED BY @JAMES_O10

D. July 20

10. The nurse noted the fundic height of Anna is at the level of the umbilicus. In documen&ng the data using Bartholomew's
rule, the most probable age of gesta&on (AOG) in week is:

A. 12 weeks

B. 16 weeks

C. 20 weeks

D. 32 weeks

11.A nurse is collec&ng data during an admission assessment of a client who is pregnant with twins. The client has healthy 5-
year-old child that was delivered at 38 weeks and tells the nurse that she does not have a history of any typ of abor&on or fetal
demise. The nurse would document the GTPAL for this client as

A. G = 3 T = 2 P = 0 A = 0 L = 1

B. G = 1 T = 1 P1, A = 0 L = 1

C. G = 2 T = 1 P = 0 A = 0 L = 1

D. G = 2 T = 0 , P = 0 , A = 0 L = 1

12. Which assessment relates most directly to ruptured membranes and release of amnio&c [uid?

A. Bloody show

B. Fluid with a pH of 5.0 with Nitrazine test

C. Fluid with a pH of 7.0 to 7.5 with Nitrazine test.

D. Woman complains of urge to push.

13. Which assessment most closely relates to a diagnosis of ectopic pregnancy?

A. Brownish red, tapioca-like vesicles

B. Elevated temperature

C. Spomng or bleeding 2 to 3 weeks aaer a missed menstrual period

D. Sudden absence of fetal movement

14. Jessica has been experiencing regular, coordinated contrac&ons with cervical dila&on moving from 4 cm to 6 cm in th last
half hour, and her membranes are s&ll intact, Jessica is in which of the following stages of labor?

A. Latent phase of the second stage of labor.

B. Placental stage or the third stage of labor.

C. Ac&ve phase of the Yrst stage of labor.

D. Predelivery stage or the prelabor stage of labor.

MERGED BY @JAMES_O10

15. Lhia is admi9ed in ac&ve labor. The nurse locates fetal heart sounds in the upper lea quadrant of her abdomen. T nurse
recognizes which of the following?

A. Lhia will probably deliver very quickly and without problems.

B. This indicates Lhia will probably have a breech delivery.

C. The fetus is in the most favorable birthing posi&on.

D. This posi&on is referred to as being lea anteropelvic.

16. As soon as the baby is delivered, what is the Yrst thing the skilled birth a9endant should do?

A. Place the baby on the mother's chest.

B. Suc&on the baby's mouth and nose.

C. Call out the &me of birth and sex.

D. Administer oxytocin intramuscularly.

17. Ac&ve management of the third stage of labor (AMTSL), in order, are:

A . controlled cord trac&on, oxytocin IM, uterine massage.

B. oxytocin IM, controlled cord trac&on, uterine massage.

C. oxytocin IV, methergine IM, controlled cord trac&on, ice compress.

D. methergin IM, oxytocin IM, controlled cord trac&on, uterine massage.

18. Which of the following client's responses aaer giving health teachings regarding preven&on of nipple cracking, re[ects a
need for further instruc&on?

A. "I will rub the excess milk into my nipples aaer feeding my baby."

B. "I need to wear well-Y9ed support bra."

C. "I should not allow my breast to air dry aaer each feeding."

D. "I should break the infant's suc&on in my breast before removing him completely oX my breast."

19. If a Rh-nega&ve woman experiences a miscarriage during her Yrst pregnancy, she should be instructed to do which of the
following?

A. Adopt children, since future pregnancies will result in future miscarriages.

B. Avoid pregnancy for the next year to permit a decrease in Rh an&gens

C. Consume high doses of vitamin D and vitamin K to prevent anemia.

D. Receive Rh immune globulin (Rhig) to prevent isoimmuniza&on.

20. Aaer birth, when inspec&ng her newborn baby girl, the mother no&ces a discharge from the nipples of both breasts of the
baby. The nurse should explain that this is evidence of
MERGED BY @JAMES_O10

A. Monilia contracted disease during birth

B. Congenital hormonal imbalance

C. An infec&on contracted in utero

D. The in[uence of the mother's hormones

A. 10 week of pregnancy

B. 12 week of pregnancy

C. 8th week of pregnancy

D. 18 week of pregnancy

22. Aaer doing Leopold's maneuvers on a laboring client, the nurse determines that the fetus is in the ROP posi&on. To best
auscultate the fetal heart tones, the Doppler is placed:

A. Above the umbilicus in the midline.

B. Below the umbilicus on the right side.

C. Above the umbilicus on the lea side.

D. Below the umbilicus near the lea groin.

23. A diabe&c mul&gravida is scheduled for an amniocentesis at 32 weeks gesta&on to determine the L/S ra&o and phospha&dyl
glycerol level. The L / S ra&o is 1:1 and the presence of phospha&dylglycerol is noted. The nurse's assessment of this data is:

A. The infant is at low risk for congenital anomalies.

B. The infant is at high risk for birth trauma.

C. The infant is at high risk for respiratory distress syndrome.

D. The infant is at high risk for intrauterine growth retarda&on.

24. During the ini&al interview, the client reports that she has a lesion on the perineum. Further inves&ga&on reveals a small
blister on the vulva that is painful to touch. The nurse is aware that the most likely source of the lesion is:

A. Gonorrhea

B. Herpes

C. Syphilis

D. Condylomata

25. A client is admi9ed to the labor and delivery unit in ac&ve labor. During examina&on, the nurse notes a papular lesion on
the perineum. Which ini&al ac&on is most appropriate?

A. Con&nue primary care as prescribed

B. Document the Ynding

MERGED BY @JAMES_O10

C. Report the Ynding to the doctor

D. Prepare the client for a C-sec&on

26. The nurse-midwife, monitoring a client who is experiencing a miscarriage episode must consider which of the following
facts?

A. Miscarriages occurring before the 6th week of pregnancy oaen result in severe bleeding and hypovolemia.

B. A D&C can be performed to prevent a threatened miscarriage from advancing to an imminent miscarriage

C. A missed miscarriage will result in no expulsion of blood or fetal material un&l the fetus actually dies.

D. Incomplete miscarriages present a greater poten&al for hemorrhage than do complete miscarriages.

27. A postpartum mother expresses anger and the desire to harm her baby. She's quite tearful, irritable, and furious. The nurse-
midwife should appropriately implement interven&ons to protect the client and her infant, because her behavior is indica&ve
of.

A. nervous breakdown.

B. psycho&c tendencies.

C. postpartum exhaus&on.

D. postpartum depression.

28. Nurse-midwife Michelle is assessing a 24-year-old client with a diagnosis of hyda&diform mole. She is aware that one of the
following is unassociated with this condi&on?

A. Vaginal bleeding.

B. Excessive fetal ac&vity.

C. Larger than normal uterus for gesta&onal age.

D. Elevated levels of human chorionic gonadotropin.

29. Which of the following assessment Yndings of the midwife would lead to a concrete conclusion that her pa&ent has an
incompetent cervix?

A. Habitual abor&on.

B. Vaginal bleeding every 3 trimester.

C . Giving a full-term delivery, but leads to fetal death.

D. Diqculty conceiving.

30. Which of the following symptoms indicates increasing severity of PIH?

A. 2+ edema in hands and feet

B. Fa&gue and headache

C. Epigastric pain and oliguria

MERGED BY @JAMES_O10

D. Three-pound weight gain over 2 months and shortness of breath

31. A 35-year-old client is scheduled for a conisa&on of the cervix to remove dysplasic cervical cells and etermine the extent of
involvement. The nurse would determine that the client understands the postopera&ve course if the client.

A. States she will resume sexual intercourse within 48 hours

B. Demonstrates the ability to change sterile surgical dressings

C. Makes a posi&ve adjustment to the loss of reproduc&ve func&on

D. Verbalizes expecta&ons of a vaginal discharge for 3 to 5 days and altered menstrual periods

32. The symptoms observed in a client following radium inser&on for a cancer of the cervix that are indica&ve of a radium
reac&on are:

A. Nausea and vomi&ng

B. Restlessness and irritability

C. Vaginal discharge and excoria&on

D. Pain and eleva&on of temperature

33. Safety precau&ons the nurse should explain when radium that had been inserted in the vagina of a client is being removed
include:

A. Cleaning radium carefully in ether or alcohol

B. Ensuring that long forceps are available for use

C. Handling the radium carefully wearing the lined rubber gloves

D. Char&ng the date and hour of removal and the total &me of treatment

34. The nurse checking the perineum of a client with a radium implant for cervical cancer Ynds the packing protruding from the
vagina. The immediate ac&on to take is to report this situa&on to the physician at once because the packing:

A. Must be removed

B. Has become radioac&ve

C. Prevents excessive loss of blood

D. Decreases rectal and bladder trauma

35. When caring for a client who has a radium implant for cancer of the cervix, the nurse should:

A. Restrict visitors to a 10-minute stay

B. Store urine in a lead-lined container

C. Wear a lead apron when giving care

D. Avoid giving IM injec&ons into the gluteal muscle

MERGED BY @JAMES_O10

36. A client has a radium implant for a cancer of the cervix. Before discharge, the nurse should explain the importance of

A. Limi&ng daily [uid intake

B. Con&nuing a low-residue diet

C. Returning for medical follow-up care

D. Taking daily mul&vitamin supplements

37. A client who is scheduled to have an abdominal panhysterectomy asks how the surgery will aXect her periods. The nurse
should respond:

A. "You will no longer menstruate."

B. "Ini&ally your periods will increase."

C. "Your monthly periods will be lighter."

D. "Your monthly periods will be more regular."

38. A client expresses concern about having a hysterectomy at age 45 because she has heard from friends that she will undergo
severe symptoms of menopause aaer surgery. The most appropriate response for the nurse would be

A. "This is something that does occur in older women on occasion, but you don't have to worry about it."

B. "It's too bad you did not discuss this with your doctor. I really can't give you any kind of informa&on about this."

C. "You are correct. This happens following this type of surgery. Your friend probably had a similar diagnosis."

D. "Some women occasionally experience exaggerated symptoms of menopause if in addi&on to their uterus their ovaries are
removed."

39. Aaer a hysterosalpingo-oophorectomy a client wants to know if it would be wise for her to take hormones right away to
prevent symptoms of menopause. The most appropriate response would be:

A. "It is best to wait, you may not have any symptoms at all."

B "You have to wait un&l symptoms are severe; otherwise, hormones will have no eXect."

C. "Isn't it comfor&ng to know that hormones are available if you should really need them?"

D. "This is something you should discuss with your physician, because it is important for the physician to know how you feel and
what your concerns are."

40. Following an abdominal hysterectomy, the nurse notes that the urine in the client's Foley bag has become increasingly
sanguinous. The nurse suspects that the client may have:

A. An incisional nick in the bladder

B. A urinary infec&on from the catheter

C. Uterine relaxa&on with increased lochia

D. Disseminated intravascular coagulopathy

MERGED BY @JAMES_O10

41. A few days following a hysterectomy, the client asks for sanitary pads because she feels she is going to menstruate. The
nurse should base a response on the fact that

A. The client will not menstruate because the uterus has been removed

B. It will take several weeks before normal menstrua&on is re-established

C. The client is probably showing signs of developing an anxiety response

D. The appearance of frank vaginal bleeding is expected following this type of surgery

42. A client's pathology report shows metasta&c adenocarcinoma of the breast. The client is to receive doxorubicin
(Adriamycin), which modiYes the growth of cancer cells by:

A. Preven&ng folic acid synthesis

B. Changing the osmo&c gradient in the cell

C. Inhibi&ng RNA synthesis by binding DNA

D. Increasing the permeability of the cell wall

43. When reinforcing the surgeon's discussion with a client before a mastectomy, the nurse should explain the
contraindica&ons for breast reconstruc&on following a mastectomy which include:

A. A wide margin of &ssue that would remain under the skin [aps

B. The need to postpone reconstruc&ve surgery for at least one year

C. The removal of the nipple-areolar complex that is required for the reconstructed breast

D. A tumor and surrounding &ssue excision that is very close to the overlying skin and nipple

44. A client who has a mastectomy asks about the term ERP-posi&ve. The nurse explains that tumor cells are evaluate for
estrogen receptor protein to determine:

A. If breast reconstruc&on is possible

B. The need for supplemental estrogen

C. Poten&al response to hormone therapy

D. The degree of metastasis that has occurred

45. Following a mastectomy, the nurse should posi&on the client's arm on the aXected side:

A. In abduc&on supported by sandbags

B. In abduc&on surrounded by sandbags

C. With the hand higher than the arm on pillows

D. Lower than the level of the right atrium on pillows

46. When encouraging a client to cough and deep breathe the following a bilateral mastectomy, the client says, "Leave me
alone, don't you know I'm in pain!" The nurse's most therapeu&c response would be:
MERGED BY @JAMES_O10

A. "I'm sure you are in pain, rest now and I'll come back later."

B. "Your pain is to be expected, but you must exercise your lungs.

C. "I'll give you something for your pain; we'll start exercising tomorrow.

D "If you are unable to cough, I understand, but try to take Yve or six deep breaths."

47. When wri&ng a teaching plan about osteoporosis, the nurse should recall that osteoporosis is best described as:

A Avascular necrosis

B Pathologic fractures

C. Hyperplasia of osteoblasts

D. A decrease in bone substance

48. The plan care for a client with osteoporosis includes ac&ve and passive exercises, calcium supplements, and daily vitamins
The desired eXect of therapy would be noted by the nurse if the client

A Increased mobility

B. Experienced fewer muscular spasms

C. Had fewer bruises than on admission

D. Developed fewer cardiac irregulari&es

49. The opera&ve procedure which would result in surgical menopause would be a:

A. Tubal liga&on

B. Simple hysterectomy

C. Bilateral oophorectomy

D. Bilateral salpingectomy

50. A nurse teaches a women's group that hot [ashes are caused by the:

A. Accumula&on of acetylcholine

B. Cessa&on of pituitary gonadotropins

C. Overs&mula&on of the adrenal medulla

D. Hormonal s&mula&on of the sympathe&c system

51. Chris&an, a 16-year old pa&ent, is admi9ed following Yberglass cast applica&on for a fractured ulna. Which Ynding should
be reported to the doctor?

a Pain at the site

b. Warm Yngers

c. Pulses rapid
MERGED BY @JAMES_O10

d Paresthesia of the Yngers

52. Chris&an then asks the nurse if it will be okay to allow his friends to autograph his cast. Which response would be best?

A. "It will be alright for your friends to autograph the cast.

B. "Because the cast is made of plaster, autographing can weaken the cast."

C. "If they don't use chalk to autograph, it is okay."

D. "Autographing or wri&ng on the cast in any form will harm the cast."

53. A two-year-old is admi9ed for repair of a fractured femur and is placed in Bryant's trac&on. Which Ynding by the nurse
indicates that the trac&on is working properly?

A. The infant no longer complains of pain.

B. The bu9ocks are 15° oX the bed.

C. The legs are suspended in the trac&on.

D. The pins are secured within the pulley.

54. To maintain Bryant's trac&on, the nurse must make certain that the child's:

A. Hips are res&ng on the bed, with the legs suspended at a right angle to the bed

B. Hips are slightly elevated above the bed and the legs are suspended at a right angle to the bed

C. Hips are elevated above the level of the body on a pillow and the legs are suspended parallel to the bed

D. Hips and legs are [at on the bed, with the trac&on posi&oned at the foot of the bed

55. A child with scoliosis has a spica cast applied. Which ac&on speciYc to the spica cast should be taken?

A. Check the bowel sounds.

B. Assess the blood pressure.

C. OXer pain medica&on.

D. Check for swelling.

56. Which observa&on in the newborn of a diabe&c mother would require immediate nursing interven&on?

a. Crying

b. Wakefulness

c. Ji9eriness

d. Yawning

57. A 15-year-old teenager is admi9ed to the ER. She accidentally slipped and fell from their 3-human-storey stunts. She was
diagnosed with a SCI at the C7 level. During assessment the nurse iden&Yes the presence of spinal shock on Ynding:

a. Paraplegia with [accid paralysis

MERGED BY @JAMES_O10

b. Tetraplegia with total sensory loss

c. Total hemiplegia with sensory and motor loss

d. Spas&c tetraplegia with loss of pressure sensa&on

58. Bullia Prag, 12 years old, sought medical care due to progressive lateral curvature of the spine. Which of the following tests
should be used to determine the asymmetry of the ribs and [anks?

a. Ortolani's maneuver

b. Borlow's test

c. Adam's test

d. Allis' test

59. Bullia has to undergo surgery for spinal fusion. The child complains of abdominal discomfort and begins vomi&ng. Based on
these Yndings, the nurse should:

a. No&fy the physician

b. Administer an&-eme&c

c. Increase the IV [uid [ow rate

d. Logroll the client

60. Post-opera&vely, ac&vi&es with bending, liaing and twis&ng are prohibited up to:

a. 1 month

b. 2 months

c. 3 months

d. 4 months

61. The home health nurse is visi&ng a 15-year-old with osteogenesis imperfecta. Which informa&on obtained on the visit
would cause the most concern? The client

a. Likes to play football

b. Drinks carbonated drinks

c. Has two sisters

d. Is taking acetaminophen for pain

62. A kid with cys&c Ybrosis is taking pancrea&c enzymes. The nurse should administer this medica&on:

a. Once per day in the morning

b. Three &mes per day with meals

c. Once per day at bed&me

MERGED BY @JAMES_O10

d. Four &mes per day

63. Which nurse's instruc&on should be avoided by the client with hiatal hernia?

a. Lying recumbent following a meal

b. Taking in small, bland meals

c. Raising the head of bed on 6-inch blocks

d. Taking H2-receptor antagonist medica&on

64. Jaimeeeh, a 5-year-old girl, with a 3-day history of nausea and vomi&ng presents to the ER department. The client is
hypoven&la&ng and has RR of 6 breaths/min. The ECG monitor displays tachycardia, with HR of 120beats / m * in ABGS are
drawn and the nurse reviews the results, expec&ng to note which of the following?

a. Decreased pH and increased CO2

b. Increased pH and decreased CO2

c. Decreased pH and decreased HCO3-

d. Increased pH and increased HCO3-

65. Nurse Agatha has another client aged 10 year-old who was admi9ed due to constant fever. Upon assessment, she noted:
child's skin feels warm, sensi&vity to light, malaise and loss of appe&te. Nurse Agatha determines that the child in what phase of
fever?

a Onset

b. Course

c. Fever Abatement

d. Flush

66. Aaer cleansing the wound with NSS, the nurse on duty saw that the child a9ained an abrasion from his fall. There was the
presence of redness and edema in the aXected area. The nurse concluded that the client's wound is going through normal
wound healing stage of

a. Regrowth Phase

b. Remodeling Phase

c. Restora&on Phase

d. Reac&on Phase

67. Basha, a mother of 3 year-old child, expressed her concern regarding her child's behaviour of holding and expelling feces
during defeca&on. The nurse explains that

a. This is a behaviour that needs to be reported to the physician immediately.

b. This behaviour is acceptable because the most important thing is the child is able to defecate.

c. This behaviour provides pleasure and a sense of control to the child.

MERGED BY @JAMES_O10

d. This is a behaviour that should be halted for it increases the risk for diqcult toilet training.

68. A 16 year-old Dianne was accompanied by her mother to see a dermatologist for acne problems. Aaer receiving the
prescrip&ons, the nurse instructed the client to do the following except:

a. Encourage dally bath

b. Instruct to avoid foods rich in carbohydrate and protein content.

c. Keep the skin dry and clean.

d. Avoid picking and squeezing the pimples.

69. Which of the following vic&ms should be considered by the nurse as the priority?

a. Child with fracture of the arm complaining of abdominal pain

b. Sobbing child with mul&ple lacera&ons on the face, arms, and legs

c. Crying child with closed head wound and mul&ple compound fractures of the arms and legs

d. Confused child with bright red blood coming out from a leg wound

70. The nurse approaches the child lying near the stairs of the hotel and determines the need to establish airway. The nurse
opens the airway in this child by ?

a. Til&ng the head slightly backwards and applying pressure to the forehead and the chin

b. Til&ng the head sideward and applying support in the nape

c. Moving the child to knee chest posi&on for lung expansion

d. Placing the index and middle Yngers to physically push the posterior aspects of the mandible upwards while the thumbs push
down on the chin to open the mouth

71. How many breaths/minute should be given to a 7 year-old client in rescue breathing?

a 10 - 12 bpm

b. 12-20 bpm

c 8 - 10bpn

d. 18-25 bpm

72. When performing CPR on children and infants, the nurse should depress the sternum:

a. ½ to 1

b. 2 ½ to 3

c. 1/3 to ½ the depth of the chest

d. Deep enough to make a Ynger impression

MERGED BY @JAMES_O10

73. A teenager arrives at the hospital. He is alert and ambulatory, but this shirt and pants are covered with blood. He and his
hysterical friends are yelling and trying to explain that they were gooYng around and he got poked in the abdomen with a s&ck.
Which of the following comments should be given Yrst considera&on?

a. "There was a lot of blood and we used three bandages."

b. "He pulled the s&ck out, just now, because it was hur&ng him."

c. "The s&ck was really dirty and covered with mud."

d. "He's a diabe&c, so he needs a9en&on right away."

74. Following the bombing incident, the nurse is preparing a child for IV conscious seda&on prior to repair of a facial lacera&on,
what informa&on should you immediately report to the physician?

a. The parent is unsure about the child's tetanus immuniza&on status.

b. The child is upset and pulls out the IV.

c. The parent declines the IV conscious seda&on.

d. The parent wants informa&on about the IV conscious seda&on

75. A pediatric client with VSD repair is placed on a maintenance dosage of digoxin (Lanoxin) elixir. The dosage is 0.07
mg/kg/mL and the client's weight is 7.2 kg. The physician orders the digoxin to be given twice daily. A nurse prepares how much
digoxin to administer to the client at each dose?

a: 0.25 mg

b. 0.37 mg

c. 0.5 mg

d.2.5 mg

76. Tre&noin (Re&n-A) gel is prescribed for an adolescent client with acne. The client calls the clinic nurse and tells the nurse
that her skin has become very red and is beginning to peel. The nurse should make which statement to the client?

A. "No&fy the physician."

B. "Discon&nue the medica&on."

C. "Come to the clinic immediately."

D. "This is a normal occurrence.

77. A child is hospitalized with a diagnosis of lead poisoning, and chela&on therapy is prescribed. The nurse caring for the child
would prepare to administer which of the following medica&ons?

A. Ipecac syrup

B. Calcium disodium edetate (EDTA)

C. Ac&vated charcoal

D. Sodium bicarbonate
MERGED BY @JAMES_O10

78. A nurse is caring for a child who has been placed in Buck's extension trac&on. The nurse provides for counter trac&on to
reduce shear and fric&on by:

A. Using a footboard

B. Providing an overhead trapeze

C. Slightly eleva&ng the foot of the bed

D. Slightly eleva&ng the head of the bed

79. The nurse evaluates a pediatric client following treatment for carbon monoxide poisoning. The nurse would do that the
treatment was eXec&ve if which of the following were present?

A. The client is sleeping soundly.

B. The client is awake and talking.

C. The heart monitor shows sinus tachycardia,

D. Carboxyhemoglobin levels are less than 5%.

80. A nurse is checking postopera&ve prescrip&ons and planning care for a 110-pound child aaer spinal fusion. Morphine
sulfate, 8 mg subcutaneously every 4 hours PRN for pain, is prescribed. The pediatric drug reference states that the safe dose is
0.1 to 0.2 mg/kg/dose every 2 to 4 hours. From this informa&on, the nurse determines that

A. The dose is too low

B. The dose is too high.

C. The dose is within the safe dosage range.

D.. There is not enough informa&on to determine the safe dose

81. Which among the following interven&ons is the priority of the emergency department nurse for a female client who is
complaining of having the worst headache of her life?

A. Administering pain medica&on

B. Star&ng oxygen

C. Performing neuro check

D. Inser&ng a Foley catheter

82. Four hours aaer the client has been transferred to the recovery room immediately aaer undergoing lea caro&d
endarterectomy, which among the following assessment Yndings would require immediate referral to the physician?

A. Temperature 99.4°F, heart rate 110, respiratory rate 24

B. Drowsiness, urinary output of 50mL in the past hour

C. BP 120/60, lethargic, right-sided weakness

D. Alert and oriented, BP 168/96, heart rate 70

MERGED BY @JAMES_O10

83. A client with cancer is experiencing a common side eXect of chemotherapy administra&on. Which laboratory assessment
Ynding would cause the most concern?

A. A sodium level of 50mg/dL

B. A blood glucose of 110mg/dL.

C. A platelet count of 100,000/mm3

D. A white cell count of 5,000/mm3

84. A nurse is caring for a client with acute conges&ve heart failure who is receiving high doses of a diure&c. On assessment the
nurse notes that the client has [at neck veins, generalized muscle weakness, and diminished deep tendon re[exes. The nurse
suspects hyponatremia: What addi&onal signs would the nurse expect to note in this client if hyponatremia were present?

A. Dry skin

B. Decreased urinary output

C. Increased speciYc gravity of the urine

D. Hyperac&ve bowel sounds

85. When Nurse Nathaniel evaluates the eXec&veness of a nutri&onal program, which is the best short term indicator of an
improved nutri&onal status?

A. Weight gain of 2 lbs daily

B. Decreasing serum albumin

C. Increasing transferrin level

D. Appropriate skin turgor

86. Yoona, a 24-year-old client arrived at the trauma unit of the emergency department bleeding profusely aaer sustaining an
injury from a vehicular accident. The physician ordered for a blood transfusion, the nurse would an&cipate administering which
blood product that does not require blood typing and cross matching?

A. AB posi&ve

B. AB nega&ve

C. O posi&ve

D. O nega&ve

87. A client with a stroke and malnutri&on has been placed on Total Parenteral Nutri&on (TPN). The nurse notes air entering the
client via the central line. Which ini&al ac&on is most appropriate?

A. No&fy the physician.

B. Elevate the head of the bed.

C. Place the client in the lea lateral decubitus posi&on.

D. Stop the TPN and hang D5 1/2 NS.

MERGED BY @JAMES_O10

88. Nurse Allie is to administer a medica&on intramuscularly to her client u&lizing the Z-track method. Which of the following
measures will be helpful in preven&ng tracking of the medica&on?

A. Inject the medica&on in the deltoid muscle,

B. Use a 22-gauge needle when preparing the syringe.

C. Omit aspira&ng for blood before injec&ng.

D. Draw up 0.2mL of air aaer the proper medica&on dose.

89. Which among the following indicates that the client requires a tracheal suc&oning?

A. Arterial oxygen level of 90 mm Hg

B. Congested breath sounds in the lung Yelds

C. Two hours have elapsed since last suc&oning

D. Respiratory rate of 18 breaths per minute, up from 16

90. A client who has been diagnosed with gallstones and obstruc&ve jaundice is complaining of severe itching. The physician
ordered for the client to take cholestyramine (Questran). Prior to administra&on of the medica&on, the nurse explained to the
client that this medica&on is prescribed because.

A. "It blocks histamine, reducing the allergic response."

B. "It inhibits the enzyme responsible for bile excre&on."

C. "It decreases the amount of bile in the gallbladder."

D. "It binds with bile acids and is excreted in bowel movements with stool."

91. Chany, a nurse researcher, is conduc&ng study on the diXerence between the academic knowledge competences of Fourth
Year Nursing Students from rural (Pangasinan) to urban-based universi&es (Manila). Which arnong the following purposes of
research is most applica&on to the study of Chany?

a. Descrip&on

b. Predic&on and Control

c. Explana&on

d. Explora&on

92. Since she would be using a random selec&on, the most appropriate sampling technique that Chany may use for her study to
achieve the required samples is:

a. Purposive Sampling Technique

b. Incidental Sampling Technique

c. Cluster Sampling Technique

d. Simple Random Sampling Technique

MERGED BY @JAMES_O10

93. Which among the following design is the most appropriate for Chany's study?

a. Compara&ve Research

b. Experimental Research

c. Ethnographic Research

d. Phenomenological Research

94. From the problem of Chany's research study, this can be classiYed as:

a. Basic Research

b. Applied Research

c. Experimental Research

d. Historical Research

95. In research, the group that is subjected to the treatment used by the researcher to acquire results is known as:

a. Control Group

b. Experimental Group

c. Cluster Group

d. None of the above

96. Pepper is the head of a research study on the common cases of nosocomial infec&on in the government-based hospitals in
the country. The most appropriate sampling technique that she may use for her study to achieve the required sample is:

a. Purposive Sampling Technique

b. Incidental Sampling Technique

c. Cluster Sampling Technique

d. Simple Random Sampling Technique.

97. Pepper and the other researchers decided to use this type of sampling method, which means:

a. Selec&on of respondents speciYcally according to the objec&ve of the study

b. Iden&Yca&on of respondents using interval as a basis for selec&on

c. Inclusion of the en&re popula&on as respondents of the study

d. Use of techniques such as table of random numbers

98. The researchers aim to iden&fy the most common nosocomial infec&ons including the average incidences per month and
per year. Which among the following sta&s&cal treatment is most appropriate?

a. Frequency Distribu&on

b. Measurement of Variability
MERGED BY @JAMES_O10

c. Measurement of Central Tendency

d. ANOVA

99. One of the concerns of Pepper is that she must look into some records of pa&ents who were already discharged. He knows
that ethical to do:

a. Jus&ce

b. ConYden&ality

c. Informed Consent

d. NonmaleYcence

100. The best instrument that she may use for her study is:

a. Interview

b. Review of Records

c. Observa&on

d. Ques&onnaire

TOP THE BOARD EXAM

MERGED BY @JAMES_O10

NURSING SEMINAR II

Nursing Practice III:

Care of the Clients with Physiologic and Psychological Alterations

(A)

FINAL EXAMINATION

1. Bravo, a student nurse, was explaining about the heart's activity. Cardiac
electrical activity is the result of the movement of ions across the cell
membrane. He mentioned repolarization. He would be correct if he said.

a. Repolarization is the electrical activation of the cell.

b. Repolarization is the return of the cell to its resting state.

C. Repolarization transmit impulses to the largest chamber of the heart, the

left bundle branch bifurcates into the left anterior and left posterior bundle
branches.

d Repolarization interaction between changes in membrane voltage and

muscle contraction.

2. Charlie, a student nurse, stated that the heart, during its latter part of
repolarization, if a stimulation is stronger than usual, the myocardium can be
stimulated to contract. This is what you would call:

a. Depolarization

b. Repolarization

C. Resting Stage

d. Refractory Period
MERGED BY @JAMES_O10

3. The blood How to the diIerent parts of the body is generated by the
pumping actions of the heart. Among the statements below, which would
support the true mechanism of the muscle organ?

a At the end of diastole, pressure within the right and left ventricles rapidly
increases.

b. During systole, when the ventricles are relaxed and the AV valves are
open, blood returning from the veins Hows into the atria and then into the
ventricles.

c.Toward the end of the diastolic period, the atrial muscles contract in
response to an electrical impulse initiated by the SA node.

d. Atrial diastole augments ventricular blood volume by 15% to 25% and is

sometimes referred to as the "atrial kick".

4. Nurse Hotel was also able to recall about the S4 heart sound. This is
usually heard on clients with:

a Myocardial Infarction

b. Hypertension

c. Angina Pectoris

d Ventricular Failure

5. Nurse India tried to recall his background on cardiovascular diseases. He

took the lab works of his client. Which of the following should alert him?

a. BUN of 10 mg/dL

B. PTT of 98 seconds
MERGED BY @JAMES_O10

C ESR of 19 mm/hr

d. CK-MB of 156 mu/mL

6. A chest x-ray has been done to a client with MI. Nurse Juliet was asked by
his client if the diagnostic test contribute to the diagnosis of his condition. He
should respond:

a. Yes, it helps diagnose MI and its complications

B. . No, it does not help diagnose acute MI but can help diagnose some
complications.

c. No, it is only recommended to clients with pacemakers

d. Yes, it contributed to the diagnoses of MI by determining the location of

the infarct

7. In exercise stress test, the client complained dizziness and sudden mild
chest pain. What should the nurse do?

A. Inform the client to stay on the treadmill. He is experiencing expected

outcome of the test.

b. Instruct the client to slow down.

c. Instruct the client to stop running in the treadmill.

d. Tell the client to run faster to further increase myocardial activity.

8. After an exercise stress test, the client is monitored for:

a. 5 to 10 minutes
MERGED BY @JAMES_O10

b. 10 to 15 minutes

c. 15 to 20 minutes

d. 20 to 25 minutes

9. In myocardial disorders, a Positron Emission Tomography (PET), which is

primarily used to detect neurologic dysfunction, can now contribute to the
diagnosis of cardiac problems. This includes all, except:

A. PET provides more specifc information about myocardial perfusion and

variability than does Transesophageal Echocardiogram or Thallium Scanning.

b. PET helps in planning treatment for cardiac clients, including those without
symptoms.

c. PET helps evaluate the patency of native and previously grafted vessels
and the collateral circulation.

d. PET helps evaluate coronary artery perfusion, to detect myocardial

ischemia and infarction, and to asses ventricular function.

10.A newborn with sickle cell anemia will be symptom-free because the

a High level of hemoglobin of fetal blood helps prevent sickling of the red
blood cells

b. High level of oxygen in the blood helps prevent sickling of the red blood
cells

c. Low number of red blood cells in the fetal blood help prevent sickling of
red blood cells

d. Low number of platelets prevents the sickling of red blood cells

MERGED BY @JAMES_O10

11. Nurse Tom has been assigned to provide health assistance to the dark-
skinned Aeta people in the isolated mountainous area of Philippines. He
knows that the body part that would most likely display jaundice is the?

a. Conjunctiva of the eye

b. Soles of the feet

c. Roof of the mouth

d. Shins area where the yellowing is noticeable.

12. The nurse correctly pinpoints which form of congenital heart defects as
directly related to increased pulmonary blood a How, except?

A. Atrioventricular Canal Defect

B. Patent Ductus Arteriosus

c. Tetralogy of Fallot

d. Ventricular Septal Defect

13. A pre-term infant was born presenting a degree of cyanosis sand the
Attending Physician suspects Patent Ductus Arteriosus. Which medication
should the nurse prepare to administer to close the PDA?

a. Pancuronium bromide

b. Ritodrine

c. Terbutaline Sulfate

d. Ibuprofen
MERGED BY @JAMES_O10

14. Nurse TayTay disease. Which is teaching the client with polycythemia
vera with regards of the following statements by the client indicates to the
prevention of complications of the sa need for further teaching?

a. "I will drink 500mL of Huid or less each day.

b"I will wear support hose."

C. "I will check my blood pressure regularly."

d. "I will report ankle edema."

15. Hospital stall that often assist with coronary bypass graft surgery include
the operating room (OR) nurse. The OR nurse knows that the vessel most
commonly used as source for a CABG is what?

a. Brachial Artery

b. Internal Mammary Artery

c. Femoral artery

d. Saphenous Artery

16. JooJoo, a 15-year old student who has been diagnosed with hemophilia, is
in the school clinic. His nose is bleeding. Which nursing action of the school
nurse is most appropriate for this situation?

A. Place the client in a sitting position.

b. Apply ice packs to the forehead.

c. Administer acetaminophen (Tylenol).

d. Pinch the soft lower part of the nose.

MERGED BY @JAMES_O10

17. Pepper has been admitted to the hospital due to malnutrition. She has
also been diagnosed with Vitamin B9 defciency. Nurse Uno would instruct
the Pepper to eat which of the following foods to obtain the best supply of
the said vitamin?

a. Oyster and milk

b. Root crops

c. Dried beans and oranges

d. Baked salmon

18. Client November then asked his nurse Oscar how his CVP can be
measured; the nurse requires no further instruction when he says:

a. The zero mark on the manometer must be placed on a reference point.

b. The water level must always be maintained at zero level.

c. A monitor that reads central venous pressure is used.

d. Electrodes are attached to the client as the CVP is read.

19. Client Papa, 47 years old, is admitted with a diagnosis if MI suddenly

develops cardiogenic shock. Which characteristics should be observed?

a. Hyperthermia

b. Slowing pulse

c. Scanty urination

d Hypertension
MERGED BY @JAMES_O10

20. A newborn that was diagnosed of having an absent tricuspid valve was
scheduled for a series of surgical interventions to create a redirection of
blood How so that shunting would occur from the Inferior and Superior Vena
Cava to the Pulmonary Artery. The nurse then prepares the child to undergo
which procedure?

a. Blalock Taussig Procedure

b. Mustard and Senning's Procedure

c. Jatene's Procedure

d. Fontan Procedure.

21. Which health teaching should the nurse impart to the mother of a 6-year
old child with a Cyanotic Congenital Heart Defect upon discharge?

a. "Let him lean on a high chair during an episode of blue spell".

B. Allow your son to inhale a warm steam during acute episodes of hypoxia
to dilate his airways."

C. "Enlarge the nipple-hole of your son's bottle."

d. "Make sure that you prepare foods rich in protein, vitamins and minerals."

22. The nurse is caring for a patient who has experienced an ML. The nurse
notes that there are changes in the ECG C the patient. What change on an
ECG may indicate that necrosis is occurring?

a. P-wave inversion

b. T-wave inversion
MERGED BY @JAMES_O10

c. Q-wave changes with no change in ST or T Wave

d. P-wave enlargement

23. Which of the following would the nurse note on the ECG of clients with
potassium level of 3.2 mEq/L?

a U waves

b. Absent P waves

c. Elevated T waves

d. Elevated ST segment

24. Which of the following description shows a second-degree AV block type

17

a. This is also called Mobitz block.

B. The PR intervals are prolonged but remain constant.

c. The PR interval is not more than 0.20 seconds.

d. The PR interval increases with each beat.

25. Which of the following ECG recordings will make the nurse suspect that
the patient is experiencing Myocardial Infarction?

a. ST segment elevated with loss of R wave.

b. Deep Q waves as a result of absence of depolarization current from dead

tissue.
MERGED BY @JAMES_O10

C. ST segment depression with T wave inversion.

d. Pathologic Q waves as a result of absence of repolarization current from

dead tissue.

Situation: Problems in Oxygenation involves patients with

disturbances in lower and upper airways. Nurse Benjie a Pulmonary
Nurse is attending to clients with respiratory diseases.

26. Nurse Benjie observes an anxious client hyperventilating after learning

that his wife met an accident and intervenes to prevent

A. cardiac arrest

B. carbonic acid defcit

C. reduction in serum pH

D. excess oxygen saturation

27. Nurse Benjie admitted another client with an arterial blood gas report
indicates the client's pH is 7.25, Pco₂ is 35 mm Hg, and HCO3 is 20 mEq/L.
Which disturbance does the nurse identify based on these results?

A. metabolic acidosis

B. metabolic alkalosis

C. respiratory acidosis

D. respiratory alkalosis

28. A client arterial blood gas report indicates the pH is 7.52, Pco₂ is 32 mm
Hg, and HCO3 is 24 mEq/L. What imbalance does Nurse Benjie identify as a
possible cause of these results?
MERGED BY @JAMES_O10

A. airway obstruction

B. inadequate nutrition

C. prolonged gastric suction

D. excessive mechanical ventilation

29. Nurse Benjie understands that in the absence of pathology, a client's

respiratory center is stimulated by:

A. oxygen

B. lactic acid

C. calcium ions

D. carbon dioxide

30. The client stated that the Physician said the tidal volume is slightly
diminished and asks the nurse what this means. What explanation should the
nurse give the client? Tidal volume is the amount of air.

A. exhaled forcibly after a normal expiration

B. exhaled after there is a normal inspiration

C. inspired forcibly above a normal inspiration

D. trapped in the alveoli that cannot be exhaled

Situation: Edwin 36 years old seeks consultation in an Out-Patient

Clinic with complaints of productive cough for 2 weeks and with
diSculty of breathing.
MERGED BY @JAMES_O10

31. The nurse is teaching Edwin deep-breathing exercises. The nurse

understands that air rushes into the alveoli as a result of which change in
pressure?

A. increasing alveolar pressure>

B. elevated diaphragmatic pressure

C. rising pressure in the pleural space

D. lowered pressure within the chest activity

32. Edwin is scheduled for a pulmonary function test. The nurse explains that
during the test one of the instructions the respiratory therapist will give the
client is to breathe normally. What is being measuring when the client
follows these directions?

A. tidal volume

B. vital capacity

C. expiratory reserve

D. inspiratory reserve

33. Edwin is admitted for further management and treatment. The nurse
notes that Edwin's Hemoglobin level is decreasing and is concerned about
tissue hypoxia. An increase in what diagnostic test result indicates
acceleration in O₂ dissociation from haemoglobin?

A. pH

B. po2

C. pco2
MERGED BY @JAMES_O10

D. HCO3

34. What nursing action will limit hypoxia when suctioning a client's airway?

A. lubricate the catheter with saline

B. use a sterile suction catheter each time

C. apply suction only after catheter is inserted

D. limit suctioning with catheter to 30 seconds

35. Another client is admitted to the unit with acute Pulmonary Edema.
Which rapidly acting' diuretic that can be administered intravenously should
the nurse anticipate that the physician will order?

A. Furosemide (Lasix)

B. Chlorothiazide (Diuril)

C. Chlorthalidone (Hygroton)

D. Spironolactone (Aldactone)

Situation: A male 72 year-old client is admitted with severe diSculty

of breathing and with a history of smoking for 15 years. The
Physician diagnosed Emphysema and prescribed an oxygen
inhalation at 2-3 liters per minute.

36. Nurse Kim repositions a client to which of the following position who is
diagnosed with emphysema to facilitate maximum air exchange?

A. supine
MERGED BY @JAMES_O10

B. orthopneic

C. Low-Fowler's

D. Semi-Fowler's

37. Nurse Kim must be alert for signs of respiratory acidosis in the client with
Emphysema. In addition to a long-term problem with O₂ maintenance, what
problem does this client have?

A. CO₂ retention

B. localized tissue necrosis

C. increased respiratory rate

D. saturated haemoglobin molecules

38. Nurse Romeo a recovery room, nurse is attending the client on his frst
24 hours after insertion of chest tubes, and assessing the function of a three
chamber, closed-chest drainage system. He notes that the water in the
underwater seal tube is not Huctuating. What initial action should the Nurse
Romeo take?

A. inform the physician

B. take the client's vital signs

C check whether the tube is kinked

D. turn the client to the unaIected side

MERGED BY @JAMES_O10

39. Romeo is a Recovery room nurse preparing to endorse his clients to the
next incoming shift. A client diagnosed with a spontaneous Pneumothorax.
Which physiologic eIect of a spontaneous Pneumothorax should the nurse
include in a teaching plan for the client?

A. the heart and great vessels shift to the aIected side

B. There is greater negative pressure within the chest cavity

C. inspired air will move from the lung into the pleural space

D. the other lung will collapse if not treated immediately

Answer C. Positive pressure - prevent air entry

40. Another client in the recovery room is suspected with Atelectasis. Which
clinical indicator does the nurse expect to identify when assessing the client?

A. slow, deep respirations

B. diminished breath sounds

C. a dry, unproductive cough

D. a normal oral temperature

41. The patient with Addison's disease asks why she must take aldosterone.
The nurse clarifes that the drug will

A. increase cardiac output.

B. regulate the excretion of potassium and sodium.

C. decrease the level of cortisol.

D. lower the blood sugar level,

MERGED BY @JAMES_O10

Answer B. Hydrocortisone helps regulate the excretion of potassium and

sodium, the two electrolytes that control Huid distribution.

42. The nurse assesses a disturbance in body image when a woman with
Addison's disease says:

A. "Will I look like a zebra for the rest of my life?"

B. "I have found makeup to cover my rash."

C "With this red face, I sure can't wear pink anymore."

E. "At last! I look like I have a suntan."

43. The nurse explains to a 14-year-old that because he has Addison's, he

will:

A. not develop pubic hair.

B. grow a heavy beard.

C. grow bald at an early age.

D. have enlarged joints.

44. The care of a postoperative hypophysectomy patient, in whom the entire

pituitary was removed, would include:

A. strict intake and output.

B. keeping patient Hat in bed for the frst 24 hours.

C. withholding analgesics to assess level of consciousness better.

MERGED BY @JAMES_O10

D. mouth care with thorough cleansing of the oral cavity.

45. The nurse explains that the laboratory report indicating a low ACTH level
in a patient with Addison's disease means that:

A. surgery on the adrenals is the best remedy.

B. the disease is caused by a pituitary problem.

C. the disorder's cause is a problem of the adrenal cortex,

D. the symptoms will resolve without medication.

46. Which statement made by the family member caring for the client with a
percutaneous gastrostomy tube indicates understanding of the nurse's
teaching?

a. "I must Hush the tube with water after feedings and clamp the tube."

b. "I must check placement four times per day."

C. I will report to the doctor any signs of indigestion."

D. If my father is unable to swallow, I will discontinue the feeding and call the
clinic."

47. A client with acute pancreatitis is experiencing severe abdominal pain.

Which of the following orders should be questioned by the nurse?

a. Meperidine 100mg IM m 4 hours PRN pain

b. Mylanta 30 ccs m 4 hours via NG

C. Cimetadine 300mg PO m.i.d.

MERGED BY @JAMES_O10

d. Morphine 8mg IM m 4 hours PRN pain

48. A client with cystic fbrosis is taking pancreatic enzymes. The nurse
should administer this medication:

a. Once per day in the morning

b. Three times per day with meals

c. Once per day at bedtime

d. Four times per day

49. The physician has prescribed ranitidine (Zantac) for a client with erosive
gastritis. The nurse should administer the medication:

a. 30 minutes before meals

b. With each meal

c. In a single dose at bedtime

d. 60 minutes after meals

50. A temporary colostomy is performed on the client with colon cancer. The
nurse is aware that the proximal end of a double barrel colostomy:

a. Is the opening on the client's left side

B. Is the opening on the distal end on the client's left side

c. Is the opening on the client's right side

d. Is the opening on the distal right side

MERGED BY @JAMES_O10

51. A client with an abdominal cholecystectomy returns from surgery with a

Jackson-Pratt drain. The chief purpose of the Jackson-Pratt drain is to:

a. Prevent the need for dressing changes

b. Reduce edema at the incision

c. Provide for wound drainage

D. Keep the common bile duct open

52. A day after cholecystectomy, the nurse notes that the T-tube has drained
750 mL of green-brown drainage. Which nursing intervention is appropriate?

a. Clamp the tube

b. Irrigate the tube

c. Notify the physician

d. Document the fndings

53. Which post operative order should the nurse question and verify
following a Billroth II procedure?

a. Leg exercises

b. Early ambulation

C. Irrigating the NGT

d. Coughing and deep breathing exercises

MERGED BY @JAMES_O10

54. In preventing dumping syndrome, which discharge instruction should be

provided to the client?

a. Ambulate following a meal

b. Eat high carbohydrate foods

C. Limit the Huids taken with meals

d. Sit in a high Fowler's positions during meals

55. Which of the following early signs and symptoms indicate the occurrence
of dumping syndrome?

a. Sweating and pallor

b. Bradycardia and indigestion

c. Double vision and chest pain

d. Abdominal cramping and pain

56. Which assessment fnding should be reported to the physician in a client

with diagnosis of ulcerative colitis?

a. Hypotension

b. Bloody diarrhea

C. Rebound tenderness

d. Hemoglobin level of 12mg / dL

MERGED BY @JAMES_O10

57. Which would be the assessment of the nurse to the client who has
developed Hepatitis A after eating contaminated oysters?

a. Malaise

b. Dark stools

c. Jaundice

d. Left upper quadrant discomfort

58. Prior to colonoscopy, Glucagon must be administered in order to?

a. Prevent possible hypoglycemia during the diagnostic procedure

b. Provide moderate sedation and reduce anxiety

c. Decrease the gastrointestinal tract secretions

d. Reduce spasms during procedure

59. All but one if the diagnostic procedure indicated for client with epiphrenic
diverticulum?

a. Barium Swallow

b. Manometric Studies

c. Esophagoscopy

d None of the above.

60. During an assessment with an 18-year old college student, the nurse
noted white patches with rough-like projections along the lateral border of
MERGED BY @JAMES_O10

the tongue. History taking reveals chronic use of tobacco and an active
sexual lifestyle. These fndings suggest the occurrence of?

a Nicotine stomatitis

b. Hairy leukoplakia

c. Candidiasis

d. Lichen planus

61. During the consultation, a client with morbid obesity was advised to
undergo bariatric surgery. Few months prior to undergoing the surgery, the
patient is required to:

a. Perform extensive counselling programs

b. Intake high fber diet

c. Undergo counselling

d. Have routine laxatives or enema

62. Health teaching should include which of the following in client receiving
Ornistat due to morbid obesity?

A. It is contraindicated to clients with dysrhythmias

b. One of the side eIects is dry mouth

c. This medication increases the heart rate

d. A multivitamin is usually recommended

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63. A client with stage 4 colon cancer had undergone abdominoperineal

resection with creation of permanent colostomy. The nurse is instructing a
client regarding ostomy care. What should be included in this teaching?

a. Change the drainage pouch daily.

b. Clothing of a special style will be needed now that a pouch is worn.

c. Stick a pin into the drainage pouch to relieve any gas buildup.

d. Secure the faceplate to the drainage pouch so no skin around the stoma is
exposed.

64. A client recovering from abdominal surgery is demonstrating abdominal

distention from trapped Hatus. What can the nurse do to help this client?

a. Assist the client to move in bed.

b. Restrict Huids.

c. Obtain an order for a rectal tube.

d Provide a diet high in roughage.

65. A client has received an oil retention enema. The nurse should instruct
the client that the enema will take eIect within

a. 1 to 3 hours.

b. 10 to 20 minutes.

C. 5 to 10 minutes.

d. 10 to 15 minutes.
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66. The client is 1 hour post-endoscopic retrograde cholangiopancreatogram

(ERCP). Which intervention should the nurse include in the plan of care?

a. Instruct the client to cough forcefully

b. encourage early ambulation

c. assess for return of gag reHex

d. administer held medications

67. The client diagnosed with liver cancer asks the nurse, "Why are my
stools clay colored?" On which medical rationale should the nurse base this
response?

a. There is an increase in serum ammonia level.

b. The liver is unable to excrete bilirubin.

c. The liver is unable to metabolize fatty foods.

d. A damaged liver cannot detoxify vitamins.

68. The nurse is aware that the symptoms of portal hypertension in clients
with liver cancer are chieHy the result of:

a. infection of the liver parenchyma

b. fatty degeneration of the KupIer cells

c. obstruction of the portal circulation by the growing tumor

D. obstruction of the cystic and hepatic ducts

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69. The client has insulinoma type of pancreatic tumor, the nurse must
watch out for which of the following:

a. Anorexia

b. Malnutrition

C. Hypoglycemia

d. Abdominal pain

70. Which among the following has the least risk for liver cancer:

A. Woman using contraceptives

b. Male who loves alcoholic drinks

c. Male with history of hepatitis B

d. None of the above

e. All of the above

71. Develop a teaching care plan for Angie who is about to undergo a liver
biopsy. Which of the following points do you include?

A. "You'll need to lie on your stomach during the test."

B. "You'll need to lie on your right side after the test."

c. "During the biopsy you'll be asked to exhale deeply and hold it."

d. "The biopsy is performed under general anesthesia.

72. The following are manifestations which can be seen in a client with
pancreatic cancer, except:
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a. Pain

b. Jaundice

c. Weight loss

d. Rectal bleeding

73. While preparing for surgery, the nurse must be alert of for symptoms of:

a. Hyperglycemia

b. Hypoglycemia

c. Hypertension

d. Hypotension

74. The nurse performs a home care visit on a client with a diagnosis of
right-sided cerebrovascular accident. The client's wife states that she is
having frequent loose stools, and the physician diagnosed viral
gastroenteritis. The nurse would be MOST concemed if which of the following
was observed?

A. The wife is washing her hands frequently.

b. The wife is drinking Gatorade.

C. The wife is using a separate tube of toothpaste

d. The wife is preparing lunch for herself and her husband.

75. The nurse should recognize that ascites develops from liver cirrhosis
because of portal hypertension and:
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a. an excess serum sodium level

b. an increased metabolism of aldosterone

c. a decreased How of hepatic lymph

d. a decreased serum albumin level

76. Which of the following positions would be most appropriate for a client
with severe ascites?

a. Fowler's

b. Side-lying

c. Reverse trendelenburg

D. Semi-Fowler's

77. A patient with Laennec's cirrhosis developed rashes over his skin due to
accumulation of bilirubin. What would be the CORRECT teaching by the
nurse?

a. "Cold water decreases pruritus."

b. "Use antihistamine regularly."

c. "Apply calamine lotion for itch."

d "Avoid detergent soaps in bathing."

78. A nurse receives a patient during endorsement in medical-surgical

department diagnosed with liver cirrhosis. Which of the following tubes is
expected by the nurse to be inserted when the patient is at risk for
esophageal varices rupture?
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a. Levine tube

B. Sengstaken-blakemore tube

c. Pneumatic dilator tube

d. Gastrostomy tube

Situation: Wendy is scheduled for a paracentesis because of ascites

formation subsequent to cirrhosis of the liver.

79. Which of the following instructions should be made by the nurse to the
patient prior to paracentesis?

a. Should be on NPO for 2 hours prior to the procedure.

b. To empty his bladder.

c. Should take antidiuretic frst.

d. Eat small meal.

80. The nurse helps Wendy to assume the proper position for a paracentesis,
which is:

a. recumbent so that the Huid will pool to the lower abdomen.

b. lying on her left side so that Huid will not exert pressure on the liver.

C. semi-Fowler's to avoid shock and provide the most comfort.

D. upright with her feet resting on a support so that the puncture site will be
readily visible.
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81. Nurse Jejomar should monitor the urine chloride level for a client
diagnosed with a serum chloride level of less than 100 mEq/L because
urinary excretion of chloride:

A. Decreases to retain more of the serum chloride.

B. Increases with a level of 100 mEq/L or less.

C. Is not inHuenced by serum chloride level.

D. Increases with levels greater than 100 mEq/L.

82. An alert client is admitted with a diagnosis of hyperchloremia. The nurse

should place highest priority on doing which of the following interventions
frst?

A. Place the client on isolation precautions.

B. Document the client's history.

C. Allow the client to ambulate ad lib unassisted to maintain independence.

D. Start an IV of 3% saline infusion stat.

83. Nurse Jejomar anticipates that which of the following clients is at risk for
hypermagnesemia?

A. An anorexic teen

B. An alcoholic

C. A client with a history of partial gastrectomy

D. A client with renal failure

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84. Miss Mahinay with hypercalcemia is receiving digoxin (Lanoxin). Nurse

Jessica plans to incorporate which of the following in client assessments?

A. Checking for Trousseau's sign

B-Frequent pulse checks to determine any change in heart rhythm

C. Auscultation of bowel sounds

D. Inspection of skin for signs of bleeding

85. Mr. Domagas becomes hypocalcemic as a result of prolonged nasogastric

(NG) tube suctioning. Nurse Jessica concludes that the primary cause for
hypocalcemia at this time is

A. Metabolic alkalosis.

B-Plaid shifts from hyperalbuminemia.

C. Hypermagnesemia.

D. Metabolic acidosis.

86. Which of the following is a correct statement by the nurse performing a

discharge teaching for a client going home with a prescription for
spironolactone (Aldactone)?

A. "Make sure you eat foods such as bananas and oranges."

B "Take this pill just before you go to bed."

C. "Cut back on your intake on those foods on your list that are high in
potassium."
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D. "You don't have to watch your intake of Huid while you are taking this
medicine."

87. Which of the following statements indicates that JB has an understanding

of the side eIects of furosemide (Lasix) and its relationship to potassium
levels?

A. "I don't need to take my pulse anymore when I take my Digoxin.

B. "I should call the doctor if I develop diarrhea."

C. I should call my doctor if I feel myself becoming dizzy when I stand up."

D. "I don't need to eat bananas for breakfast anymore since I am taking this
medication.

88. An 85-year-old client with a feeding tube has been experiencing severe
watery diarrhea. The client is lethargic with decreased skin turgor, pulse rate
of 110, and hyperactive reHexes. Nursing interventions would include:

A. Monitoring and recording intake, output and daily weights.

B. Administering salt tablets and monitoring hypertonic parenteral solutions.

C. Administering sedatives and analgesics.

D. Restricting Huid intake.

89. When an adult is receiving an intravenous (IV) infusion of 3% * saline

what are the monitoring priorities for the early detection of complications of
therapy?

A. Neurologic status, lung sounds and serum sodium levels

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B. Heart rate, blood pressure, and daily weights

C. Serum glucose levels and urine specifc gravity

D. Pulse oximetry and peripheral edema in legs

90. Nurse Jessica while instructing an adolescent client, states that in

addition to building bones and teeth, calcium is also important for:

A. bile production

B. blood production

C. blood clotting

D. digestion of fats

91. A nurse manager works for a nonproft health care corporation in which
there has been signifcant revenue over expenses for the year. The nurse
manager has been told to anticipate in which action?

A. Receipt a portion of the revenue to improve client services on the unit.

B. Revenue will be identifed as proft.

C. Revenue will be divided among stockholders as dividends.

D. Reduction operating expenses to help the organization pay taxes on the

revenue.

92. During the unit conference, the nurse manager reported that there is an
increased incidence of nosocomial infection among the clients admitted to
the unit. The nurse manager together with the group decided on measures
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they should Implement in order to minimize the number of cases of

nosocomial infection. The nurse manager achieves consensus In making
decisions within the group to:

A. Explore alternative solutions

B. Facilitate cooperative eIort towards goal

C. Dernonstrate that staIs are Hexible

D. Ensure use of eIective autocratic decision making

93. Performance improvement is an important component of continuous

quality improvement. Which action should an eIective nurse-manager take
when conducting performance evaluation

A. Conduct performance evaluations in a group setting so input from peers

and subordinates is considered when evaluating staI members
eIectiveness.

B. Provide feedback on strengths as well as areas for improvement and

clarify what the staI member is expected to accomplish before the next
performance evaluation.

C. accument areas for improvement in writing. Areas of strength don't need

to be documented because these areas are complementary and don't
describe actions the staI member must take to improve.

D. Delegate responsibility for conducting performance evaluations to primary

nursing whenever possible to help them grow professionally.

94 Which among the following situations shows that the nurse manager is
utilizing autocractic type of leadership?

A. Planning vacation time for staI.

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B. Directing staI activities if a client has a cardiac arrest.

C. Evaluating a new medication administration process.

D. Identifying the strengths and weaknesses of a client education video.

95. You are the nurse manager of the medical unit. Which is the following is
the priority for you to consider when planning for the care of the group
client's utilizing evidence-based practice?

A. A client's care is planned based on the Nurses clinical expertise and latest
research fndings

B. Standardized care plans are used on all of the client's

C. Standards of care are developed by the hospital nursing service and

should be followed

D. Client's needs are assessed and individualize care plan are developed for
each client.

96. As per the latest research conducted by The British Medical Journal last
January 23, 2019, regular eating of fried foods is linked with a heightened
risk of death from any cause, especially heart-related causes. From the
gathered data, one or more servings of fried chicken a day was linked to how
many percent of heart-related deaths?

a-13%

b. 12%

c. 11%

d. 10%
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97.Scientists at the University of Virginia School of Medicine have discovered

a defect in immune cells knownackd make that explains their inability to
destroy cancer icine have disresearchers believe that repairing this defect
could a make the cells much better cancer killers. This approach is known to
be as:

A. Chimeric Antigen Receptor T-Cell Therapy

B. Immunochemotactice Receptor T-Cell Therapy

c. CD4+ Modifcation Therapy

d. T-Cell Receptor Immunotherapy

98. Around one in 10 people in the US and 2 which is associated with 2018
serious in this type of di death. An observational study Canada have type 2
diabetes rush Medical Journal last 2018 to reverse this diabetes. This is
mainly on:

a. Planned Ketogenic Diet

b. Planned Remittent Exercise

C. Planned Intermittent Fasting

d. Planned High-Glucose Intake

99. Linoleic acid is found in plant-based olls, nuts and seeds, and it is the
most common polyunsaturated omega-6 fatty acid to the research done by
Univer and festemd it and which of the following is true with regards to this
type facid ?
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a. The eIects of linoleic acid on the human body are largely dependent on
genes.

b. The metabolites of linoleic acid can mediate buIer system.

c. A high intake and high levels of linoleic acid in the blood have been
associated with a reduced risk of type 2 diabetes and genitourinary diseases.

d. All of the aforementioned statements.

100. A research study, led by Dr. Atsushi "Austin" Nakano, a University of

California associate professor of molecular, cell and developmental biology
and member of the Eli and Edythe Broad Center of Regenerative Medicine
and Stem Cell Research at UCLA, has identifed for the frst time the origin of
an immune cell that plays a critical role in the formation of healthy heart.
This is specifcally a breakthrough to what anatomical part of the heart?

a. SA node

b. Valves

c. Myocardium

d. Atrioventricular Septum

TOP THE BOARD EXAM