SET 4

Situation 1 : Cancer of the prostate is the leading cancer in Men other than skin cancer. The following questions will assess your knowledge and theoretical foundation in dealing with clients with prostate cancer. 1. Among the following population group, who has a higher risk in the development of prostate cancer? A. African-American B. Caucasian C. Asian D. Hispanics

2. Which among the following is NOT a risk factor for prostate cancer? A. A family member with prostate cancer B. Advancing age C. High fat and diet high in red meats D. Smoking

3. Mr. Juan Jose Rodrigo has been diagnosed with prostate cancer just a few hours ago. Which of the following sign would alert the nurse that the cancer is already advanced? A. I have difficulty starting my urination B. My backs and hips are painful and my right leg is slightly larger than the other C. My urine is bloody D. My urine is bouncing 4. At the initial sign and symptoms of prostate cancer, before diagnosis, the physician can perform a screening test to detect a characteristic STONY HARD prostate and nodules at the prostate area using: A. Cytoscopy B. PSA C. DRE D. MRI

5. To diagnose the presence of prostate cancer, the physician will perform: A. Transrectal needle biopsy of the prostate B. Test to identify the PSA levels C. Transrectal ultrasound D. Radiolabeled monoclonal antibody capromab penetide with indium-111

6. After the removal of the prostate tissue, The physician soaked the solution in formaldehyde in a sterile specimen container and asked you to send the specimen immediately. Which of the following is a correct nursing action? A. Dr. Ruiz, I dont think this specimen is acceptable. Please redo the procedure and do not soak the specimen in any medium. B. Dr. Ruiz, I just want you to know that you soaked the specimen in formaldehyde wherein, it should not be soaked in any medium at all. C. Accept the specimen because there is nothing wrong with the physicians action D. Dr. Ruiz, it should be soaked in NSS not formaldehyde. I am going to report you to the board of medicine for this could lead to a false result. 7. In any biopsy, the specimen is sent to the: A. Radiologist Medical Technologist 8. PSA is used not for the detection but to know if the cancer is responding to treatment or advancing. The nurse knows that the abbreviation PSA stands for: A. Prostate specific antibody B. Prostate specific antigen 9. In testing for the PSA, the nurse will collect which specimen? A. Blood B. Urine C. Feces D. Prostatic fluid C. Prostate specified antibody D. Prostate specified antigen B. Nearest of Kin C. Pathologist D.

10. Mr. Rodrigo said that he has difficulty voiding. Which of the following is the best nursing action to encourage voiding in any clients with voiding difficulties? A. Encourage the client to drink plenty of fluids to promote urination B. Bring the client to the bathroom and stay with him when the sensation to void is felt by the client C. Catheterize the client D. Encourage the use of bathroom or commode rather than bedpans Situation : Care of clients with tracheotosmy is often a challenge to a beginning nurse. The following questions will test your knowledge on Tracheostomy and its related care.

11. You know that when rendering tracheotosmy care, the priority consideration is always to keep the airway patent and also to prevent infection at the site. The nurse knows the technique used in rendering Tracheostomy care is: A. Clean B. Disinfected C. Sterile D. Medical

12. Prior to the suctioning or removal of the inner cannula, the nurse knows that the client is prepared and positioned in: A. High fowlers B. Semi fowlers position C. Left side lying D. Sims

13. In cleaning the inner cannula or other parts of the tracheotosmy tube, The best cleansing mediums are: A. Hydrogen peroxide and Sterile NSS B. Providone Iodine and Sterile NSS C. Alcohol and Sterile NSS D. Alcohol and Hydrogen Peroxide 14. In contrary with Tracheostomy tubes, sizes of chest tubes are expressed in terms of: A. French B. Gauge C. M2 D. Diameter

15. Which of the following is NOT true with regards to securing the Tracheostomy? A. The cuff provides sufficient securing B. The Tracheostomy can be sutured in place C. The Tracheostomy can be stapled in place D. Tie or Velcro tie are used to generally secure the Tracheostomy around the client 16. The nurse knows that in Tracheostomy creation, 1% Lidocaine and 1:100,000 Epinephrine is injected at the incision site. The purpose of Lidocaine is mainly to provide anesthetic effect while the Epinephrine is needed to: A. Relax the bronchus and dilate the airway for easier insertion B. To promote faster healing C. To prevent the Vasovagal reflex that might cause bradycardia D. For Hemostasis

17. Which of the following is not considered as a regular part of a Tracheostomy tube? A. The outer cannula B. The inner cannula C. The obturator D. The cuff

18. Which of the following is the reason why will a surgeon select a cuffed tube over a non cuffed Tracheostomy tube? A. Cuffed tube offers efficient securing attachment B. Cuffed tube is mainly used to prevent coughing D. For mechanical ventilation C. Cuff tube offers excellent

19. The size of the Tracheostomy tube is denoted in terms of: A. French B. Gauge 20. The function of the obturator is: A. To direct the outer cannula to traverse the curvature of the trachea for easier insertion B. In cases of emergency, when outer cannula accidentally dislodges C. To facilitate dilation of the stoma for the insertion of the outer cannula D. To prevent too much pressure on the jugular vein after the tie has been placed Situation : Organ donation is a new form of treatment that provides multiple complication such as rejection. 21. Organ donation to save life was initially with the first transplant done by: A. Dr. Christian Barnard of the Union of South Africa B. Dr. Christian of the U.S.A. C. Dr. Christian Barnard of Soviet Union D. Dr. Christian Barnard of U.K. 22. In 1983, The FDA approved the first anti-rejection drug by the name of: A. Cyclosporine B. Prednisone C. Imuran D. Azathioprine C. Units D. Size / mmID

23. You would expect that in cases of organ donation, you would expect that the immunosuppressant medications such as Cyclosporine, Prednisone and Imuran are taken: A. For 2 years B. When the suture heals C. When rejection is not anymore viable D. For the rest of the clients life

24. Which of the following is a sign that the transplanted kidney is being rejected? A. Fever and Weight Gain B. Fever and Weight Loss C. Chills, Fever, Polyuria D. Anuria, Fever, Weight Gain and Hematuria

25. Among children candidates for organ transplant, when all selected children have appropriate tissue matches for the same donated organ, the basis for the decision as to which child gets the organ is given to the child who: 1. will receive the most benefit from the new organ 2. is most likely to die without the transplant 3. is selected by the lottery system for available organs 4. is at the top of the list and has waited the longest time

Situation: In a client with widespread colon cancer, A colectomy is the surgical procedure of choice instead of an Abdominal perineal resection. 26. Ileostomy is performed after a colectomy. The nurse will expect that the stool of the client will be: A. Mushy B. Spicy C. Liquid D. Soft

27. When should the teaching about ileostomy care commence? A. Immediately after the operation, when the anesthesia is wearing off B. 72 hours after operation C. When readiness and interest is observed D. As soon as the patient is admitted 28. Which of the following indicates a need for further teaching in clients with ileostomy? A. I am expecting a change in my diet. B. I can remove the appliance during sleep.

C. I can still swim D. I am prone to dehydration because of the ileostomy 29. For the clients stool to be more formed which of the following food are added to the clients diet? A. Boiled rice B. Spaghetti and macaroni C. Cheese D. Bran 30. An expert nurse in the field of colostomy and ileostomy is called as a/an: A. Enterostomal Therapy Nurse B. Ostomy nurse C. Nurse oncologist D. Nurse Enterostomist

Situation: During surgical operation, it is inevitable to utilize sutures. The nurse should know the basic principles in suturing as well as knowledge in selecting sutures and caring for clients with sutures. 31. Steel has the highest tensile strength among sutures in the non absorbable category. When you say tensile strength, it refers to: A. The amount of weight or force necessary to break the suture B. The cross sectional size of the suture C. The ability of the suture to absorb fluid D. The force necessary to cause the knot to slip 32. In suturing the internal organs such as kidneys, liver, spleen, pancreas and stomach, the nurse knows that the type of suture material that the physician will most likely use is: A. Steel B. Vicryl C. Cotton D. Silk

33. If the suture is removed to soon, the nurse knows that it could lead to failed healing of the wound as well as infection. If the suture is removed too late, which of the following can occur? A. Itching B. Swelling C. Scarring D. Pain

34. The nurse noticed that there are yellow and brown crustings around the area of the suture. Which of the following is the best cleansing medium to remove such crusting? A. Hydrogen Peroxide C. NSS B. Providone Iodine D. Alcohol

35. If the suture is performed on the clients face. The nurse will reinforce the teaching t hat the client should return when for suture removal? A. After 7 days B. After 3 to 4 Days C. After 10 days D. The next day

36. Sizes of sutures denotes the diameter. The physician will perform a corneal transplant and will suture the eye. The nurse will prepare which of the following suture size? A.7 B. 5 C.3 D. 9-0

37. Who holds the packet flaps of sutures to open it and place it in the sterile table for use? A. Scrub nurse B. Circulating nurse C. Assistant surgeon D. Surgeon

38. Non absorbable suture material such as cotton, nylon and silk are best used in suturing which of the following abdominal layer? A. Skin B. Peritoneum C. Fascia D. Muscle

39. When least amount of trauma is desired, or when the client is prone to keloid formation, the nurse should prepare which type of the needle? A. Swaged B. Round C. Blunt D. Taper

40. Another alternative suture for skin closure is the use of ____________ A. Staple B. Therapeutic glue C. Absorbent dressing D. Invisible suture Situation: The following are questions with regards to the OPERATING ROOM.

41. The operating room is divided into three areas, The unrestricted, the semi restricted and the restricted areas. Where is the operating room? A. Restricted B. Unrestricted C. Semi restricted D. PACU

42. What OR attires are worn in the restricted area? 1. Scrub suit, OR shoes, head cap 2. Head cap, scrub suit, mask, OR shoes 3. Mask, OR shoes, scrub suit 4. Cap, mask, gloves, shoes

43. What OR attires are worn in the semi-restricted area? A. scrub suit only B. scrub suit, shoe cover, mask C. scrub suit and head cap, with or without the shoe cover D. head cap, mask, shoe cover only 44. One of the hidden dangers in the OR is missing instruments. What is the appropriate approach to this happening? A. correct labeling B. a place for everything and everything in its place C. install a flush sterilizer in the OR D. increase instrument inventory 45. PACU Vital signs monitoring is performed every: A. 5 minutes B. 10 minutes C. 15 minutes D. 30 minutes

46. Mr. T.O. has undergone surgery for lyses of adhesions. He is transferred from Post Anesthesia Care Unit (PACU) to the Surgical floor, the nurse should obtain blood pressure, pulse and respiration every: A. 3 minutes B. 30 minutes C. 15 minutes D. 20 minutes

47. Another worthy study is the compliance to the principles of aseptic technique among the sterile OR team. Who does NOT belong to the sterile OR team?

A. scrub nurse B. assistant surgeon

C. x-ray technician D. surgeon

48. The patient demonstrates knowledge of the psychological response to the operation and other invasive procedure when she asks about: A. Who will be with me in the OR? B. How is the post operative pain over the site like? C. Will I be naked during the operation? D. Is it cold inside the? 49. Endoscopic minimally invasive surgery has evolved from diagnostic modality to a widespread surgical technique. What department should the nurse collaborate which is unusual in conventional surgery? A. engineering department services B. x-ray department D. linen section C. blood bank

50. When the client is discharged from the hospital and is not capable of doing the needed care services, the following can assume the role, EXCEPT: A. family members B. chaplain C. significant others D. responsible caregiver

Situation: Anesthesia is used even during the Ancient times. In its evolution, modern marvels in the use of anesthesia enables the nurses to develop a more competitive approach in patient care. 51. An anesthesia delivered directly to the spinal canal is known as: A. Epidural B. Intrathecal C. General D. Local

52. After spinal anesthesia, 30% of the patient develops spinal headache. This is due to: A. Severe hypotension associated with Vasodilation due to the anaesthetics. B. Increase volume of the cerebrospinal fluid due to anesthesia induction. C. Cerebral edema due to rapid absorption of the anaesthetics.

D. CSF leakage due to the puncture created by the spinal needle in the membrane that surrounds the spinal cord. 53. Before the induction of spinal anesthesia, the client is placed in which of the following preferred position to widen the vertebral space: A. Quasi fetal position position B. Prone position affected side 54. After spinal anesthesia, to prevent spinal headache, the client is placed on which of the following position? A. Sitting position B. Sidelying position affected side C. Flat on bed, supine D. Flat on bed, prone D. Sidelying position C. Flat on bed supine

55. Another way to prevent spinal headache is by the use of the correct needle gauge. If the client is an adult client, the anaesthesiologist might order a pink spinal set. The nurse knows that the pink spinal set has a gauge of: A. 12 B. 16 C. 22 D. 26

Situation: The nurse utilizes the theoretical foundation basic to perioperative nursing in the various nursing scenarios: 56. In medical and nursing practice, code means a call for: A. DNR state B. call to order C. clinical case D. cardiopulmonary resuscitation

57. The OR team collaborates from the first to the last surgical procedure. Who monitors the activities of each OR suite? A. scrub nurse B. anesthesiologist C. circulating nurse D. surgeon

58. In patients with acute pancreatitis, the administration of the analgesic morphine may cause:

A. addiction B. urinary retention

C. paralytic ileus D. spasms of the sphincter of Oddi

59. Who is responsible in daily monitoring the standards of safe, nursing practice in the operating suite? A. surgeon B. perioperative nurse 60. During surgery, movement of personnel should be: A. kept to a minimum B. restricted C. monitored D. eliminated when possible C. OR nurse supervisor D. chief nurse

61. The patient has a right to information regarding the operation or other invasive procedure and potential effects. This right is achieved through: A. Enlightened Consent B. preoperative visit C. charting D. doctors rounds

62. Which statement about a persons character is evident in the OR team? A. it assists in the control of feelings, thoughts and emotions in the face of difficulty B. it reflects the moral values and beliefs that are used as guides to personal behavior and actions C. it encourages the constructive use of the pleasure of the senses D. it refers to the quality of being righteous, correct, fair and impartial 63. You continuously evaluate the clients adaptation to pain. Which of the following behaviors indicate appropriate adaptation? 1. The client reports pain reduction and decreased activity 2. The client denies existence of pain 3. The client can distract himself during pain episodes 4. The client reports independence from watchers

64. Pain in ortho cases may not be mainly due to the surgery. There might be other factors such as cultural or psychological that influence pain. How can you alter these factors as the nurse? 1. Explain all the possible interventions that may cause the client to worry 2. Establish trusting relationship by giving his medication on time

3. Stay with the client during pain episodes 4. Promote clients sense of control and participation in control by listening to his concerns 65. In some hip surgeries, Fentanyl analgesia is given. What is your nursing priority care in such a case? 1. Instruct client to observe strict bed rest 2. Check for epidural catheter drainage 3. Administer analgesia through epidural catheter as prescribed 4. Assess respiratory rate carefully Situation: Mrs. Diaz is assigned in the female surgical ward. While on duty, an 15 year old client, married, was admitted for CS. The informed consent for the operation has to be obtained. 66. The person legally responsible for taking the informed consent is: A. The OR nurse who is going to assist with the operation B. Any doctor assigned with the team C. The doctor who is going to perform the procedure D. The ward nurse where the patient stayed before the operation 67. Mr. Diaz has to remember the following with regard to the IC: A. Because the patient is a minor, the parents should be asked to sign the consent. B. The informed consent should be signed either by the patient or her 20 year old husband if patient is unconscious C. Nurses has the responsibility to obtain the informed consent prior to surgery D. Legal guardian should sign the consent since the client is 15 year old 68. The medical intern who assisted in the operation gave post operative orders. In this case, Mrs.Diaz should: A. Validate the order from the surgeon and request him to counter sign B. Follow the order as long as they are within the scope of nursing practice C. Clarify from the medical intern those that are ambiguous D. Refuse to follow the order because it is not legal

69. After one year, Mrs. Diaz was rotated to the delivery room. As a DR Nurse, the Obstetrician ordered her to administer spinal anesthesia because the anaesthesiologist did not arrive at the scene. The nurse would: A. Give the anesthesia if the supervising nurse approves it B. Give the anesthesia if the OB supervises her C. Give the anesthesia if the doctor writes the order D. Do not follow 70. Which of the following should the nurse remember when a doctor requests them to administer anesthesia? A. The nurse has the right to refuse it, if the doctors order is unlawful B. Doctors order should always be written C. The nurse may render medical procedure if the doctor supervises him D. The staff nurse can be accused of insubordination if she does not follow the doctors order Situation: Miss Matias, found out that Mang Carding, newly admitted patient, has terminal cancer and that his nurse has not yet informed him of the diagnosis. 71. Initially, Miss Matias should: A. Tell the doctor the Mang Carding hinted that he feels he has Cancer B. Be available to listen when the patient decides to discuss his illness C. Call in the family and the team to prepare Mang Carding about his impending death D. Inform Mang Carding about his Diagnosis 72. On the second day, the wife of Mang Carding shows signs of grieving, The stages of Grieving identified by Elizabeth Kubler-Ross Are: A. Numbness, Anger, Resolution and Reorganization B. Denial, Anger, Bargaining, Disorganization, Acceptance C. Denial, Anger, Bargaining, Depression, Resolution D. Denial, Anger, Bargaining, Depression, Detachment 73. Which of the following will be the most helpful therapy for the Grieving family? A. Watching the video of the dying client over and over to encourage moving on B. A course on death and dying

C. Psychotherapy D. Group meeting with other grieving families 74. the nurse, when dealing with the relatives of a dying patients must be sensitive to their emotional reactions. A family member who blames herself for the condition of the dying patient indicates that she: A. Has major issues B. is oversensitive C. Has neurotic tendencies D. Is potentially risk for suicide 75. In caring of a dying client during post mortem, the most important thing that the nurse should remember is: A. Treat the body with outmost dignity B. Close the eyes immediately before the onset of rigor mortis C. Verify that the client is really dead by checking the ABC and double checking the death notice D. Close the mouth, straighten the body, elbows and knees before the onset of rigor mortis

Situation : The patients chart is a legal documentation the is admissible in the court. In working with the client, The protection of the information on the chart and patients privacy is one of the priority. You are caring for Ana, a 12 year old grade 6 pupil from manila and is one of the daughters of Maria, A 38 year old mother of 12. 76. Who cannot access the clients chart? A. Maria B. The patient 77. Who owns the patient chart? A. The patient B. The doctor in charge C. The hospital D. The government C. Member of the health care team D. The nurse from the nearby hospital

78. If the court issues an investigation necessitating the utilization of Anas chart, you know that the chart will not be admissible IF:

A. Maria refuses B. Ana refuses

C. The chart is not legible D. The chart is missing

79. The research teams from other countries are interested in investigating Anas case. They want to read and gather information about Ana and the manifestation of her condition. For the sake of improving knowledge and the development of a cure, the nurse knows that research is very important. Permission in this case will be taken from: A. Ana B. Maria C. The hospital management D. The doctor in charge

80. If Ana reaches the age of majority, 18 years of age, and Maria asks for her chart, which of the following is the best nursing action? A. Ignore Marias request B. Decline Marias request C. Give the chart to the Mother of Ana D. Tell Maria to ask permission from Ana

Situation 6 Infection can cause debilitating consequences when host resistance is compromised and virulence of microorganisms and environmental factors are favorable. Infection control is one important responsibility of the nurse to ensure quality of care. 81. Honrad, who has been complaining of anorexia and feeling tired, develops jaundice, after a workup he is diagnosed of having Hepatitis A. his wife asks you about gamma globulin for herself and her household help. Your most appropriate response would be: A. Dont worry your husbands type of hepatitis is no longer communicable B. Gamma globulin provides passive immunity for hepatitis B C. You should contact your physician immediately about getting gammaglobulin. D. A vaccine has been developed for this type of hepatitis 82. Voltaire develops a nosocomial respiratory tract infection. He ask you what that means? Your best response would be: A. You acquired the infection after you have been admitted to the hospital. B. This is a highly contagious infection requiring complete isolation.

C. The infection you had prior to hospitalization flared up. D. As a result of medical treatment, you have acquired a secondary infection. 83. As a nurse you know that one of the complications that you have to watch out for when caring for Omar who is receiving total parenteral nutrition is: A. stomatitis B. hepatitis C. dysrhythmia D. infection 84. A solution used to treat Pseudomonas wound infection is: A. Dakins solution B. Half-strength hydrogen peroxide C. Acetic acid D. Betadine 85. Which of the following is the most reliable in diagnosing a wound infection? A. Culture and sensitivity B. Purulent drainage from a wound C. WBC count of 20,000/L D. Gram stain testing Situation : Respiration is one of the most important vital sign. This is usually the first Vital sign to be assessed more than anything for it is easily altered by the patients consciousness. The nurse should be aware of the different changes and alteration in respiration. 86. Another name for an abnormal breath sound is: A. Adventurous breath sound B. Excursion C. Adventitious breath sound D. Dyspnea 87. In a client with diabetic ketoacidosis, Kussmauls respiration is exhibited. This is evidence that there is the presence of:

A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis 88. If the nurse will auscultate the base of the lungs, it is expected that she will hear: A. Bronchovesicular C. Vesicular B. Tubular D. Crackles

89. The respiratory center is found in the: A. Pons C. Medulla B. Hypothalamus D. Lungs

90. Initially in asthma, you are expecting that the clients acid base disturbance is: A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis Situation: Carbon Monoxide poisoning is said to be the 2nd leading cause of poison death. It is said to be the leading cause of inhalation poisoning. Mang edgardo was rushed to the hospital after being unconscious inside an enclosed parking lot. Carbon monoxide poisoning is suspected. 91. The pulse oximetry reading of Mang edgardo is 100%. This suggests that: A. There is no danger of hypoxia B. There is no carbon monoxide poisoning, it should be ruled out C. This is not a reliable sign to rule out carbon monoxide poisoning, further assessment is required D. That the client has an improved chance of surviving, since the client is well oxygenated 92. Which of the following is a sign the nurse will expect to see on Mang edgardo? A. Cherry-red skin B. Pale skin

C. Cyanotic D. Restlessness 93. Initially, in patient with suspected inhalation poisoning, the most important intervention at the scene of poisoning is: A. Assess the patients airway breathing and circulation B. Conduct a head to toe physical assessment C. Administer oxygen and loosen the clients clothing D. Carry the client on the fresh air immediately opening all windows and doors if this is enclosed 94. Which of the following laboratory result is constantly checked in clients undergoing treatment for carbon monoxide poisoning? A. Oxygen saturation B. RBC count C. Skin color D. Carboxyhemoglobin level

95. If a client demonstrates psychoses, visual disturbance, ataxia, amnesia and confusion even after completion of resuscitation and the return of normal oxygenation, this will indicate that: A. The client suffered from an irreversible brain damage B. That the client still needs to be evaluated for this is evidence that resuscitation is not yet complete C. That the client will need a longer rehabilitation to go back to the previous functioning D. That the client is exhibiting secondary gains Situation: The physician has ordered 3 units of whole blood to be transfused to WQ following a repair of a dissecting aneurysm of the aorta. 96. You are preparing the first unit of whole blood for transfusion. From the time you obtain it from the blood bank, how long should you infuse it? A. 6 hours B. 1 hour C. 4 hours D. 2 hours

97. What should you do FIRST before you administer blood transfusion? A. verify client identity and blood product, serial number, blood type, cross matching results, expiration date

B. verify client identity and blood product serial number, blood type, cross matching results, expiration date with another nurse C. check IV site and use appropriate BT set and needle D. verify physicians order 98. As WQs nurse, what will you do AFTER the transfusion has started? A. add the total amount of blood to be transfused to the intake and output B. discontinue the primary IV of Dextrose 5% Water C. check the vital signs every 15 minutes D. stay with WQ for 15 minutes to note for any possible BT reactions 99. WQ is undergoing blood transfusions of the first unit. The EARLIEST signs of transfusion reactions are: A. oliguria and jaundice B. urticaria and wheezing C. hypertension and flushing D. headache, chills, fever

100. In case WQ will experience an acute hemolytic reaction, what will be your PRIORITY intervention? A. immediately stop the blood transfusion, infuse Dextrose 5% in Water and call the physician B. stop the blood transfusion and monitor the patient closely C. immediately stop the BT, infuse NSS, call the physician, notify the blood bank D. immediately stop the BT, notify the blood bank and administer antihistamines