SITUATION 1: While waiting for delivery cases, the clinical instructor discusses with her students the physiological

changes expected during pregnancy. The following

questions apply.
1. The internal generative organs of the female reproductive – uterus and vagina are being distributed by blood supply by different arteries found within it. Because of the
proximity in its arrangement, an example is the uterine artery lies underneath the ureter, hence once the artery will be ligated, the ureter might as well be ligated. Which
of the following artery or arteries is/are responsible for giving blood supply to the uterus for proper implantation?
I. Internal Pudendal Artery
II. Middle Rectal Artery
III. Ovarian Artery
IV. Uterine Artery
V. Vaginal Artery
A. I, II
B. III, IV
C. All except III
D. All of the above
RATIO: The uterine blood supply has a dual blood supply: ovarian and uterine arteries. Vaginal blood supply from the proximal portion is being supplied by the vaginal and
uterine arteries, on posterior vaginal wall the middle rectal artery and on the distal portion, internal pudendal artery.
2. In the cases of pelvic organ prolapse, ligament fixation is usually being performed. Understanding the normal anatomy of the uterus, which of the following ligaments
provide the main support for this organ?
I. Broad Ligament
II. Cardinal Ligament
III. Round Ligament
IV. Uterosacral Ligament
A. I and II
B. I and III
C. II and III
D. II and IV
RATIO: The main support of the uterus is provided by the cardinal ligament and the uterosacral ligament. In the cases of pelvic organ prolapse, uterosacral ligament fixation is
usually being performed. Cardinal ligament or Transverse Cervical or Mackenrodt ligament is a thick base of the broad ligament.
3. The clinical instructor is discussing now on the different diagnosis of pregnancy. He is talking about presumptive evidences of pregnancy. Which of the following are
symptomatic presumptive evidences?
I. Amenorrhea
II. Breast engorgement
III. Frequency in urination
IV. Morning sickness
V. Skin changes such chloasma and linea nigra
VI. Striae Gravidarum
A. I and II
B. III and IV
C. V and VI
D. All of the above
RATIO: While all are indeed presumptive signs of pregnancy the question is asking for SYMPTOMATIC evidences. All others are SIGNS.
4. The clinical instructor talks about Goodell’s and Hegar’s signs in pregnancy. Which of the following is an inappropriate description for these signs of pregnancy?
A. Both signs are probable signs of pregnancy.
B. Both signs happen at 6-8 weeks of pregnancy.
C. Both signs pertain to softening of internal female reproductive organs.
D. None of the above
RATIO: Goodell’s – softening of the uterine isthmus – Hegar’s- softening of the cervix. Both signs are probable evidences of pregnancy and happen at 6-8 weeks of
pregnancy.
5. Which of the following signs are considered to be positive evidences of pregnancy?
I. Detection of beta-HCG
II. Ballottement
III. Fetal Heart Tone
IV. Perception of fetal movement by examiner
V. Positive Pregnancy Test
VI. Sonographic recognition
A. All except I and II
B. All except II
C. All except IV
D. III, IV, VI
RATIO: All others are considered probable signs of pregnancy.
SITUATION 2: Nurse Rica is teaching a 17-year old pregnant on her first trimester of pregnancy about important points to bear in mind in sustaining the pregnancy experience.
The following questions apply.
6. Nurse Rica specifically warned this patient to watch out for danger signs of pregnancy that may signal preeclampsia, infection or threatened pregnancy. Which of the
following danger signs are suggestive of infection that may cause premature rupture of membrane (PROM)?
A. Fever, Dysuria, Bloody Vaginal discharge
B. Fever, Dysuria, Watery Vaginal discharge
C. Fever, Epigastric pain, Bloody Vaginal discharge
D. Fever, Epigastric pain, Watery Vaginal discharge
RATIO: Signs of infection like UTI in pregnancy causes PROM and include fever, dysuria, and watery vaginal discharge. The presence of epigastric pain may signal
preeclampsia, along with headache, blurring of vision and prolonged vomiting. Bloody vaginal discharge and decreased fetal movement indicates threatened pregnancy.
7. In getting the obstetrical history of this patient, she was able to gather that her first pregnancy resulted to miscarriage at 2 nd month of her pregnancy. 2 years after that
incident, she gave birth via cesarean section at 37th week of gestation to twins Barry and Berry, who are now 2 years old. What is the correct score for this patient?
A. G2,P1
 B. G2,P2
C. G3,P1
D. G3,P2
RATIO: This is the third time for the patient to be pregnant (abortion, twins, current pregnancy). Parity talks about number of pregnancies reaching 20 weeks or age of viability.
Parity is not increased if multiple pregnancy (twins) are delivered in a giver pregnancy, counting multiple pregnancy as 1 parity.
8. The patient reports to Nurse Rica that her last menstrual period ended on February 15, 2019. What will be her expected date of confinement using the Naegele’s rule if
the first day of her last menstruation happened five days prior to her last day of last menstrual period?
A. November 17 2019
B. November 17 2020
C. November 22 2019
D. November 22 2020
9. The patient expresses to Nurse Rica her fear about having a preterm delivery considering her lifestyle practices. Considering the following, which of the following are
factors extracted from the patient that predisposes a pregnant to have a preterm delivery?
I. Alcoholism
II. Illicit Drug Use
III. Partner Violence
IV. Smoking
A. I and II
B. III and IV
C. All except I
D. All except III
RATIO: Smoking and partner violence increase the chance of leading to preterm delivery. Alcoholism may lead to growth retardation, facial abnormalities, CNS dysfunction.
Illicit drug use increases risk for IUGR and SGA neonate.
10. Nurse Rica performs Leopold’s maneuver on the patient and obtains the following findings: LM1- irregular nodular upon palpation; LM2 – linear, convex, bony ridge on
the maternal left, numerous nodulation on the maternal right; LM3- round, ballotable mass on palpation; LM4- cephalic prominence opposite side as the back. Which of
the following interpretation is correct?
A. Breech presentation, fetal back on the maternal left with the head extended
B. Breech presentation, fetal back on the maternal left with the head flexed.
C. Cephalic presentation, fetal back on the maternal left with head not engaged and extended
D. Cephalic presentation, fetal back on the maternal left with head not engaged and flexed
RATIO: LM1 – Fundal grip (What fetal pole occupies the fundus?): Irregular nodular: Cephalic; Hard, round, ballotable, mobile: Breech
LM2- Umbilical grip (On which side is the back?): Linear, convex, bony ridge: back; numerous nodulation: extremities
LM3-Pawlicks grip (What fetal part lies above the pelvic inlet?): Head engaged: feel shoulder, fixed knob-like; Head not engaged – round ballotable
LM4-Pelvic grip (on which side is the cephalic prominence): Opposite side as the back: head flexed; same side as the back – head extended
SITUATION 3: Cancer imposes a major threat to be the leading cause of morbidity and mortality across all regions in our country. The mission of the Department of Health’s
Philippine Cancer Control Program is to provide quality, effective and accessible services for the prevention and control of cancer.
11. Breast cancer is the most common cancer diagnosed among Filipino wome n as provided in the statistics given by the Department of Health. Specifically, which of the
following types of breast cancer is the most commonly occurring?
A. Ductal Carcinoma in Situ
B. Inflammatory Breast Cancer
C. Invasive Ductal Carcinoma
D. Invasive Lobular Carcinoma
RATIO: There are numerous types of breast cancer, but cancer that begins in the milk ducts (ductal carcinoma) is the most common type. - (DOH).
Invasive ductal carcinoma (IDC), sometimes called infiltrating ductal carcinoma, is the most common type of breast cancer. About 80% of all breast cancers are invasive ductal
carcinomas. Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer. Invasive lobular carcinoma (ILC), sometimes called infiltrating lobular
carcinoma, is the second most common type of breast cancer after invasive ductal carcinoma. Inflammatory breast cancer (IBC) is a rare and aggressive form of breast
cancer. (breastcancer.org)
12. Inflammatory Breast Cancer (IBC) differs from other types of breast cancer since most breast cancers start as lumps or tumors, while the former usually starts with breast
thickness or heaviness. In providing health teaching in this aggressive form of breast cancer, the nurse should inform the patient that the hallmark characteristic of IBC is
which of the following?
A. Peau D’ Orange
B. Redness of the Breast
C. Swelling of the Breast
D. Breast feeling warm
RATIO: Redness involving part or the entire breast is a hallmark of inflammatory breast cancer. Sometimes the redness comes and goes. All of the manifestations above may
be observed though. Swelling must come first before peau d’ orange.
13. A 28-year old patient being treated for liver cirrhosis is clarifying with the male nurse why his doctor told him he should also watch for signs of developing breast cancer.
The nurse may provide which sound information?
A. “Alcoholism that caused your liver disease increases the risk of breast cancer by increasing your fat cells, making you obese. These fat cells will increase the
estrogen level in your body. They say, estrogen is the food of cancer. So the increased estrogen level means increased risk of cancer.”
B. “Damage on the liver decreases your androgen level and increases your female hormone level. These hormonal changes put you at higher risk of having the breast
cancer.”
C. “Earlier research linked having liver disease to increased risk of breast cancer. But, that is already a debunked study. Age exposes our risk to cancers. In your
case, you’re still young to have cancer.”
D. “The doctor might just be fooling around with you and you have it the other way. Unless you have big breasts like females do, that’s a key concern. We won’t catch
breast cancer, don’t worry because we’re men.”
RATIO: A liver damaged by cirrhosis causes high estrogen levels and low androgen levels in the body, which are associated with a greater risk of developing breast cancer.
There is no clear causal relationship between alcohol consumption and obesity. However, there are associations between alcohol and obesity and these are heavily influenced
by lifestyle, genetic and social factors. In addition, take note, alcoholism was not stated in the question as the culprit of the patient’s medical condition.
14. A post-menopausal woman is being treated for early breast cancer with the use of hormone therapy. As a nurse, you know hormone therapy acts by either lowering the
estrogen level or stopping the estrogen from acting on breast cancer cells. Which of the following drugs should be expected by the nurse to be administered to the patient
as the preferred treatment?
A. exemestane (Aromasin)
 B. fulvestrant (Faslodex)
C. tamoxifen (Nolvadex)
D. toremifene (Fareston)
RATIO:   Aromatase inhibitors (discussed below) are the preferred treatment for women who have gone through menopause. Three drugs that stop estrogen production in
post-menopausal women have been approved to treat both early and advanced breast cancer: letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin). They
work by blocking an enzyme (aromatase) in fat tissue that is responsible for making small amounts of estrogen in post-menopausal women. They cannot stop the ovaries from
making estrogen, so they are only effective in women whose ovaries aren’t working, either due to menopause or due to treatment with luteinizing hormone-releasing hormone
analogs. Other options act by blocking the estrogen.
15. Early detection and prompt treatment increases the survivability chances of patients diagnosed with breast cancer. Which of the following chromosomal conditions
increases the risk of breast cancer?
A. Down Syndrome
B. Edwards Syndrome
C. Klinefelter Syndrome
D. Patau Syndrome
RATIO: Klinefelter’s syndrome is a rare genetic condition in which men are born with an extra X chromosome. Men with this syndrome may have an increased risk of breast
cancer because they have higher levels of estrogen and lower levels of male hormones called androgens.
SITUATION 2: Nurse Nebula is counselling couple, the woman age 40 and the man age 50. With this type of age distribution, development of fetal genetic abnormality is
highest, especially that of Down syndrome. Nurse Nebula must be able to impart her knowledge about this chromosomal aberration to the couple.
16. When chromosomes are photographed and displayed, the resulting arrangement is termed a karyotype. Which of the following is the associated karyotype for a female
with Down syndrome?
A. 47, XX 18 +
B. 47, XX 21+
C. 47, XY 18 +
D. 47, XY 21 +
RATIO: Down syndrome (trisomy 21) (47XX21 + or47XY21 +) is an example of a disease in which the individual has 47 chromosomes. There are three rather than two copies
of chromosome 21. Trisomy 18 is known as the Edwards Syndrome. XX is a female, XY is a male.
17. Which of the following are associated physical characteristics of a child born with Down syndrome?
I. Large Tongue
II. Late closure of fontanelles
III. Low-set Ears
IV. Microcephaly
V. Simian Crease on palm
VI. Slant Eyes
A. All except I and II
B. All except III and IV
C. All except V and VI
D. All of the above
RATIO: Microcephaly and Low-set ears are associated with Trisomy 18 (Edwards syndrome) and Trisomy 13 (Patau Syndrome). The eyelids have an extra fold of tissue at the
inner canthus (an epicanthal fold), and the palpebral fissure (opening between the eyelids) tends to slant laterally upward. The tongue may protrude from the mouth because
the oral cavity is smaller than usual. The ears may be low-set. The palm of the hand shows a peculiar crease (a simian line), which is a single horizontal palm crease rather
than the usual three creases in the palm
18. Chorionic Villi Sampling may be used to detect common genetic disorders. As with any other health alterations, early detection plays a crucial role in the acceptance of
possible conditions. If the couple expresses interest to perform this test as early as possible during pregnancy, Nurse Nebula should advise them to go to the clinic
when?
A. 5th week of pregnancy
B. 10th week of pregnancy
C. 15th week of pregnancy
D. 20th week of pregnancy
RATIO: Although this procedure may be done as early as week 5 of pregnancy, it is more commonly done at 8 to 10 weeks.
19. It was found out that the mother has an absent Rh factor in her blood. In addition to typical CVS preparation, for this situation the administration of immune globulin is
necessary to prevent isoimmunisation against the fetus. Nurse Nebula knows that through this administration, the mother will receive what type of immunity?
A. Artificial Active Immunity
B. Artificial Passive Immunity
C. Natural Active Immunity
D. Natural Passive Immunity
RATIO: Artificial Active – vaccination; Natural Active – disease exposure; Natural Passive – transfer of antibody
20. Although less sensitive compared to CVS, amniocentesis can also be performed to detect genetic disorders. Nurse Nebula should advise the couple that this can
possibly be performed at which month of pregnancy?
A. 1st trimester of pregnancy
B. 2nd trimester of pregnancy
C. 3rd trimester of pregnancy
D. 4th trimester of pregnancy
RATIO: Amniocentesis has the advantage over CVS of carrying only a 0.5% risk of spontaneous miscarriage. Unfortunately, it usually is not done until the 14th to 16th week of
pregnancy. This may prove to be a difficult time because, by this date, a woman is beginning to accept her pregnancy and bond with the fetus. In addition, termination of
pregnancy during the second trimester is more difficult than during a first trimester.
SITUATION 3: Because of the slow trend in the decline of maternal and newborn mortality, the Department of Health issued Administrative Order 2008-0029 “Implementing
Health Reforms for Rapid Reduction of Maternal and Neonatal Mortality” which includes the provision of maternal, newborn, child health and nutrition (MNCHN) services to
reverse this unrewarding trend.
21. Which of the following is not included in the key strategies of MNCHN?
A. Establishment of service delivery network at all levels of care to provide the package services and interventions.
B. Ensuring universal access to and utilization of MNCHN core package of services and interventions directed not only to individual women of reproductive age and
newborns at different stages of the life cycle but also to the community.
C. Every delivery is facility-based and managed by skilled birth attendants or skilled health professionals
 D. Rapid build-up of institutional capacities of DOH and PhilHealth.
Option C is not a strategy. It is the intermediate results of MNCHN strategy.
22. The implementation of MNCHN entails which of the following concepts apart from:
A. All pregnant women are at risk of complications.
B. Every pregnancy is wanted, planned and supported.
C. The MNCHN core package of services consists of interventions from pre-pregnancy to childhood periods.
D. This is mainly in response to the findings that reveal the ability of antenatal protocols to accurately predict onset of complications during childbirth.
This is in response to the INABILITY of protocols to predict complications. 
23. Which of the following is considered to be the most immediate action for all newborns, regardless of gestational age or birth weight?
A. Breathing stimulation through suctioning of oral and nasal passages.
B. Early skin-to-skin contact between mother and newborn
C. Early skin-to-skin contact between nurse and newborn
D. Stimulation of breathing and prevention of cold stress and hypothermia
Immediate thorough and drying which does not only protect from cold stress and hypothermia, but also stimulates breathing is recommended as the immediate first action for
all newborns.
24. Delayed cord clamping may be beneficial to term infants by:
A. Lowering the incidence of brain hemorrhage.
B. Reducing the likelihood of developing iron deficiency anemia
C. Reducing the need for blood transfusion
D. All of the above
Delayed cord clamping increases newborn’s blood volume and iron reserves. It is significant to preterm infants by reducing need for BT and lowering brain hemorrhages
incidence.
25. Which of the following is a maternal advantage in the initiation of early breastfeeding?
A. Diminution of lower respiratory tract infections.
B. Promotion of maternal-infant bonding.
C. Reduction of infant death due to diarrhea and dehydration.
D. Resultant uterine contraction
Benefits of early breastfeeding to the mother include the stimulation of oxytocin secretion resulting in uterine contraction.
SITUATION 4: Considering vulnerability, respiratory tract disorders impose greater danger to the children in comparison to other systems. Without proper plans and
interventions, the child may easily progress to more perilous complications which may be reversible or irreversible. Nurse Kevin is assign to render clinical services on the
respiratory ward of the pediatric department.
26. Nurse Kevin is assessing a pediatric patient admitted with an asthma attack. Hours later, the child again went into attack and became unresponsive to inhaled
bronchodilator. Status asthmaticus is suspected. Which of the following assessment cues will not be beneficial in confirming the present condition of the child?
A. Decreased plasma pH
B. Loud, high-pitched musical sound
C. Partial pressure of carbon dioxide in arterial blood of 60 mm Hg
D. Partial pressure of oxygen in arterial blood of 60 mm Hg.
In status asthmaticus, SaO2 and PaO2 are low; PCO2 is elevated because the bronchi are so constricted the child cannot exhale, resulting in CO2 accumulation. The rising
PCO2 rapidly leads to acidosis. In contrast to loud wheezing initially heard in an asthma attack, children with status asthmaticus may have so little air able to pass in or out of
their lungs that breathe sounds are limited.
27. Dehydration is a priority problem associated with status asthmaticus. As such, which of the following interventions will be appropriate for Nurse Kevin to institute?
A. Encourage the significant others to force fluid. C. Offer cold oral fluids as tolerated.
B. Introduce fluid via intravenous access. D. All of the above
During acute stage of status asthmaticus, children need increased fluid to combat dehydration and keep airway secretion moist. Drinking tends to aggravate coughing, so an
intravenous infusion is usually prescribed to supply fluid. If a child can drink, do not offer cold fluids because these tend to aggravate bronchospasm.
28. After teaching the parents of a preschooler who has undergone a tonsillectomy and adenoidectomy about appropriate foods to give the child after discharge, which of the
following, if stated by the parents as appropriate foods, indicates successful teaching?
A. Cream of chicken soup and orange sherbet C. Meat loaf and uncooked carrots
B. Hot dog and potato chips D. Pork and noodle casserole
For the first few days after a tonsillectomy and adenoidectomy, liquids and soft foods are best tolerated by the child while the throat is sore. Children typically do not chew their
food thoroughly, and solid foods are to be avoided because they are difficult to swallow. Although meat loaf would be considered a soft food, uncooked carrots would not be.
Pork is frequently difficult to chew. Foods that have sharp edges, such as potato chips, are contraindicated because they are hard to chew and may cause more throat
discomfort.
29. After teaching the parents of a toddler about commonly aspirated foods, which of the following foods, if identified by the parents as easily aspirated, would indicate the
need for additional teaching?
A. Crackers C. Raw Vegetables
B. Popcorn D. Round Candy
Crackers, because they crumble and easily dissolve, are not commonly aspirated. Because children commonly eat popcorn hulls or pieces that have not popped, popcorn can
be easily aspirated. Toddlers frequently do not chew their food well, making raw vegetables a commonly aspirated food. Round candy is often difficult to chew and comes in
large pieces, making it easily aspirated
30. A three-year-old is brought into the emergency department in her mother’s arms. The child’s mouth is open and she is drooling and lethargic. Her mother states that she
became ill suddenly within the past 2 hours. What should the nurse do first?
A. Draw blood cultures for complete blood count.
B. Inspect the child’s throat with a tongue blade.
C. Maintain the child in an undisturbed, upright position.
D. Start an intravenous line
This child is in severe respiratory distress with the potential for complete airway obstruction. The nurse should refrain from disturbing the child at this time to avoid irritating the
epiglottis and causing it to completely obstruct the child’s airway. The child may be intubated or undergo a tracheotomy. However, initially, the child should be kept as calm as
possible with as little disruption as possible. Any attempt to restrain the child, draw blood, insert an I.V., or examine her throat could result in total airway obstruction.
SITUATION 5: Newborn screening (NBS) is a public health program aimed at the early identification of infants who are affected by certain genetic/metabolic/infectious
conditions. Early identification and timely intervention can lead to significant reduction of morbidity, mortality, and associated disabilities in affected infants. It was integrated
into the public health delivery system with the enactment of the Newborn Screening Act of 2004 (Republic Act 9288). 
31. Primrose, a child with Congenital Hypothyroidism is receiving sodium levothyroxine to treat the condition. In preventing poor bone formation while on this medication,
what vitamin may be given as supplementary?
A. Vitamin A C. Vitamin C
B. Vitamin B D. Vitamin D
Supplemental Vitamin D may also be given to prevent the development of rickets when with the administration of thyroid hormone rapid bone growth begins.
32. Congenital Adrenal Hyperplasia may be detected earliest with the use of which diagnostic testing for genetic disorders?
A. Amniocentesis C. Fetal Imaging
B. Chorionic Villi Sampling D. Percutaneous Umbilical Blood Sampling
It is possible to identify the fetus with CAH as early as 6-8 weeks of pregnancy by means of CVS and at 15 weeks by amniocentesis
33. A father is asking the physician why his child with phenylketonuria appears to be excessively fair skinned and blue eyed. The nurse knows that the physician’s response
will be based on which change associated with PKU?
A. Absence of liver enzyme phenylalanine hydroxylase C. Excessive phenylalanine
B. Decreased tyrosine D. Increased phenylpyruvic acid
Absence of the liver enzyme phenylalanine hydroxylase prevents conversion of phenylalanine into tyrosine. As a result, excessive phenylalanine builds up in the bloodstream
and tissues, causing permanent damage to the brain tissue and leaving children severely cognitively challenged. The metabolite phenylpyruvic acid spills into the urine,
causing to have a typical musty odor. Tyrosine is necessary for building up body pigment. Without it, body pigment fades and child becomes very fair skinned, light blonde
haired, and blue eyed.
34. Early detection is the key to prevent brain damage caused by galactosemia since toxic level of galactose destroys body cells. Diagnosis is made by measuring the
deficiency level of galactose 1-phosphate uridyltransferase of which blood cell?
A. Red Blood Cells C. White Blood Cells
B. Thrombocytes D. All of the Above
Diagnosis is made by measuring the level of the affected enzyme in the RBC.
35. Which of the following is not true about Glucose-6-Phosphate Dehydrogenase Deficiency?
A. Blood transfusion is rarely necessary for drug-induced form.
B. Excessive glucose-6-phosphate dehydrogenase enzyme is necessary in prevention of hemolysis.
C. With this abnormality in metabolism, aspirin should not be avoided as it may prevent hemolysis.
D. All of the above
The enzyme glucose-6-phosphate dehydrogenase is necessary for RBC life maintenance. Lack of this enzyme results in premature destruction of RBCs. G6PD occurs in two
identifiable forms: a) Congenital nonspherocytic hemolytic anemia and b) Drug-induced form in which the blood patterns are normal until the child is exposed to fava beans or
drugs such as antipyretics, sulfonamides, antimalarials and napthaquinolones (the most common drug in these group is aspirin). Drug-induced hemolysis usually is self-limiting
and blood transfusions are rarely necessary.
SITUATION 6: Nurse Katniss is designated by the nurse-manager to care for Primrose, her daughter diagnosed with Acute Lymphoid Leukemia.
36. The physician informed the nurse that he is going to check for flow cytometry of the white blood cells of Primrose. With which of the following procedures can the
physician possibly attain this type of study?
A. Bone Marrow Aspiration C. Lumbar Puncture
B. Complete Blood Count D. Peripheral Blood Smear
Definitive diagnosis of leukemia is based on the flow cytometry of cells obtained in the bone marrow aspiration or biopsy. Flow cytometry identifies the specific type of blast
cell. After diagnosis is confirmed, a lumbar puncture is performed to determine if there is any CNS involvement.
37. A patient with leukemia may have bilateral optical disc swelling that may eventually lead to vision loss. Which of the following pathological changes associated with
leukemia may explain this manifestation?
A. CNS leukemic infiltration C. Hypermetabolism
B. Fibrosis of lymph glands D. Neutropenia
The CNS may be affected by leukemic infiltration, which may cause increased ICP. The ICP will definitely cause the papilledema.
38. Treatment of a child with acute lymphoid leukemia involves the use of chemotherapeutic agents in different phases. Almost immediately after confirmation of diagnosis,
the induction therapy is begun to achieve a complete remission or stabilize at less than 5% the leukemic cells in the bone marrow. Which of the following sets of
chemotherapeutic agents is used for this phase of therapy?
A. Dexamethasone and Vincristine
B. Hematopoietic Stem Cell Transplantation
C. Hydrocortisone and Methotrexate
D. Prednisone and Vincristine
HSCT is not recommended for children with ALL during the first remission because of the excellent results possible with chemotherapy. Option C is used for patients with CNS
disease. Principal drugs used for induction in ALL are corticosteroids and vincristine. Recent clinical trials have substituted dexamethasone for prednisone because of its
effectiveness in crossing blood-brain barrier and reducing CSF relapse.
39. Which of the following actions of a nurse should be questioned if carried out to a pediatric patient with leukemia?
A. Allowing the mother to feed the child with well-prepared fresh vegetable salad.
B. Encouraging the child to read child-friendly books.
C. Providing emotional support to the mother during episodes of bleeding.
D. Taking the core temperature of the patient with rectal thermometer to monitor for possible infection.
Using rectal thermometer is avoided to prevent trauma.
40. One of the side effects of cyclophosphamide (Cytoxan) is the hemorrhagic cystitis. This side effect will not be prevented or decreased by the nurse with which of the
following interventions?
A. Administering the drug preferably on bed time.
B. Giving an agent that protects the bladder such as Mesna as prescribed.
C. Liberal fluid intake at least 1 ½ times greater than the regular fluid intake.
D. Voiding before going to bed and after arising.
Administer the drug early in the day to allow for sufficient oral intake and voiding.
SITUATION 7: Gastrointestinal tract disturbance is also a common problem among children. The following questions apply.
41. An infant with cleft lip is to be fed by Nurse A. After positioning the infant to sit upright, which of the following should also be considered while feeding?
A. Avoid repeated removal of nipple.
B. Feed slowly over approximately 45 minutes.
C. Nipple is angled on the side of the mouth toward the cleft so infant’s tongue can press the nipple against the upper gum or dental arch.
D. Only feed the infant when agitated.
Nipple angle should be away from the cleft. Feeding longer than 45 minutes may expend too many calories and tire infant. Agitation becomes a problem when feeding. Feed
the infant before she becomes hungry. Option A is correct because repeated removal will frustrate the infant, causing crying and increased chances of aspiration.
42. An experienced nurse is given the task to discuss Esophageal Atresia with Tracheoesophageal Fistula to the newly-hired staff nurses of the pediatric ward. Which of the
following types of this condition is the most common?
A. Esophageal atresia with fistula between proximal and distal ends of trachea and esophagus.
B. Proximal and distal segments of esophagus are blind; there is no connection to trachea
C. Proximal segment of esophagus has blind end; distal segment of esophagus connects into trachea by fistula.
D. Proximal segment of esophagus opens into trachea by fistula; distal segment is blind.
RATIO: The most common is Type III/C. Please refer to Chapter 48, page 1534 of Lippincott Manual of Nsg Practice 8th edition for full description.
43. Which of the following is not a clinical manifestation associated with Gastroesophageal Reflux?
A. Blue Spell C. Food Refusal
B. Failure to Thrive D. Projectile Regurgitation
RATIO: There is forceful regurgitation, not projectile.
44. A malnourished patient with organic failure to thrive is assigned to Nurse Kristian. Since nutrition is a primary concern, he must prepare to do which of the following
interventions?
A. Ask for a homogenized plan of care to instruct parents of child regarding dietary needs.
B. Continuously monitor the patient for refeeding syndrome until laboratory studies are stable.
C. Make sure environment is stimulating for eating.
D. Monitor for signs of dehydration when gradually reducing protein intake.
45. A nurse must assess a child with celiac disease for aphthous ulcers particularly in which anatomic area?
A. Abdomen
B. Fingers
C. Mouth
D. Skin
SITUATION 8: Steve Rogers, a fresh Nursing graduate is taking the NLE on June. Steve Rogers should be equipped with all these basic knowledge about nursing.
46. Nursing has a code of ethics that professional registered nurses follow and:
A. Defines the principles by which nurse’s provide care to their clients.
B. Ensures identical care to all clients.
C. Improves self-health care.
D. Protects the client from harm.
The Code of Ethics for Nurses With Interpretative Statements provides a guide for carrying out nursing responsibilities that provide quality nursing care and provides for the
ethical obligations of the profession.
SOURCE: Fundamentals of Nursing 6th ed. by Potter and Perry p. 24.
47. Contemporary nursing requires that the nurse possess knowledge and skills for a variety of professional roles and responsibilities. Examples include:
A. Autonomy and accountability.
B. Following physician’s orders.
C. Increased emphasis on health promotion and illness prevention.
D. Providing bedside care.
Contemporary nursing requires that the nurse possess knowledge and skills for a variety of professional roles and responsibilities. In the past, the principal role of nurses was
to provide care and comfort as they carried out specific nursing functions. However, changes in nursing have expanded the role to include increased emphasis on health
promotion and illness prevention, as well as concern for the client as a whole.
SOURCE: Fundamentals of Nursing 6th ed. by Potter and Perry p. 24.
48. Which of the following correctly describes ACCOUNTABILITY as a professional responsibility?
A. A process that mandates that individuals are not answerable for their actions.
B. Assuming the responsibilities that are either within or beyond the scope of practice
C. It requires individual to exclude admitting mistakes and to avoid evaluation of one’s own actions
D. Not assuming responsibility for activities in which competence has not been achieved
ACCOUNTABILITY is a process that mandates that individuals are answerable for their actions and have an obligation or duty to act. One should assume only the
responsibilities within the scope of practice. One should NOT assume responsibility for activities in which competence has not been achieved. It involves admitting mistakes
rather than blaming others, and evaluating the outcomes of one’s own action.
49. It refers to the measurable activities specific to the development of designated services and programs of an organization:
A. Goals and Objectives
B. Mission Statement
C. Organizational Chart
D. Policy and Procedures
Rationale: Goals and Objectives are measurable activities specific to the development of designated services and programs of an organization. Mission Statement
communicates in broad terms an organization’s reason for existence, the geographical area the organization serves, and attitudes and beliefs within which the organization
functions. Procedures protocols guide in defining courses of action.
50. Which of the following communicates in broad terms an organization’s reason for existence, the geographical area the organization serves, and attitudes and beliefs
within which the organization functions?
A. Goals and Objectives
B. Mission Statement
C. Organizational Chart
D. Policy and Procedures
Rationale: Mission Statement communicates in broad terms an organization’s reason for existence, the geographical area the organization serves, and attitudes and beliefs
within which the organization functions. Goals and Objectives are measurable activities specific to the development of designated services and programs of an organization.
Organizational Chart depicts and communicates how activities are arranged, how authority relationships are defined, and how communication channels are established.
SITUATION 9: Tony Stark is also a fresh nursing graduate. Fundamental skills and knowledge is an important factor in being a competent nurse practitioner. Tony Stark will be
facing this test of fundamental SKA in taking the NLE this June.
51. When taking a health history, Tony Stark should focus on which of the following?
A. Attempting to have no interruption from family members present
B. Completing the process in a timely manner.
C. Documenting objective data using the client’s own words
 D. Using good communication skills to identify the client’s healthcare status
A nurse must focus on using good communication skills, which will enhance the interview. In addition, the ability to interpret nonverbal communication is paramount in
achieving the goals of history taking. The history should be done at a comfortable pace and should not be rushed. The nurse must document carefully, but it is subjective
data, not objective, that is recorded using the client’s own words. The client can have family in the room if they do not distract the client or nurse in the interview; in many
instances family members are helpful in the process.
52. Tony Stark would attempt to gather which of the following information while obtaining a health history from a client?
A. Personal goals related to healthcare
B. Physical, psychosocial, and spiritual well-being
C. Reaction to past hospitalizations
D. Type of insurance and financial concerns
The nurse seeks to obtain data from the client using a holistic approach. The nurse focuses on physical, psychosocial, and spiritual concerns. Information regarding a client’s
personal finances should not be alluded to in the interview. Reactions to past hospitalizations and goals for future healthcare are encompassed in the psychosocial aspect of
the history.
53. Which of the following would Tony Stark not consider as description of values?
A. affirmed to self
B. consistently incorporated to one’s self
C. freely chosen
D. prized
Values are freely chosen, prized, and cherished, affirmed to others, and consistently incorporated into one’s behavior.
54. By maintaining a closed record, Tony Stark assures the client of which of the following?
A. Anonymity
B. Beneficence
C. Disclosure
D. Privacy
Clients must be assured the right of privacy because they disclose sensitive and personal information. Beneficence promotes the health professional to do good for the client.
Disclosure of information is restricted to authorized personnel only. Anonymity is not possible for permanent, legal healthcare records because the client’s name, social
security number and the other identifying data must be included.
55. Tony Stark knows that this term refers to the concern for the welfare and well-being of others.
A. Altruism
B. Autonomy
C. Integrity
D. Social Justice
ALTRUISM is reflected by the nurse’s concern for the welfare of patients, other nurses and other health care providers. Altruism is the principle of unselfish regard for others,
denying oneself for the sake of others. Social justice is upholding moral, legal, and humanistic principles, ensuring equal treatment under the law and access to quality health
care without bias. Integrity is acting accordance within appropriate ethics and accepted standards of practice. Autonomy is the right to self-determination, respecting the right to
make one’s own decision.
SITUATION 10: Quality gives people with different functions in the organization a common language for improvement. Quality exists to the degree that service is efficient, well-
executed, effective and appropriate
56. This refers to the process of evaluation that is applied to the health care system and the provision of health care services by health workers. It promotes collegial and
sharing relationships among workers instead of a feeling of threat when observed and evaluated. What is this?
A. Quality Assurance
B. Quality Improvement Program
C. Sentinel Events
D. Total Quality Management
57. Quality assurance methods in nursing include the following except:
A. concurrent and retrospective patient care audits
B. patient care profile analysis
C. peer review
D. total quality management (TQM)
58. The standards of nursing practice use indicators to measure volumes of occurrence of negligent practices in the workplace. Which of the following indicators measure a
low-volume but serious, undesirable and often avoidable process or outcome such as falls and medication errors?
A. Health status indicator
B. Malpractice indicator
C. Patient care audits
D. Sentinel events indicator
59. This is defined as a group of workers doing similar work who meet regularly, voluntarily, on normal working time, under the leadership of their supervisor, to identify,
analyze and solve work related problems and to recommend solutions to management. What is this?
A. Benchmarking
B. Patient Care Audits
C. Peer Review
D. Quality Circles
60. An approach to evaluation which includes the steps in the nursing process in compliance with established standards of nursing practice is called?
A. Outcome approach
B. Process approach
C. Quality Assurance criteria
D. Structure approach
SITUATION 11: Natasha Romanoff, a 35 laundry woman seeks consultation at Family Planning Clinic. She has 5 children and her youngest is 8 months old. She wants to
undergo bilateral tubal ligation (BTL).
61. In counselling Natasha Romanoff on BTL, which of the following pre-operative instructions is paramount?
A. Bring a companion
B. NPO after midnight until after the procedure
C. She and her husband must be certain that this procedure is permanent
D. Take a bath before the procedure
Surgical sterilization usually is a permanent measure and should be undertaken only after a great deal of consideration. It is most desirable if both partners sign the informed
consent.
62. She asks about the possibility of getting pregnant after BTL. Which of the following is the appropriate response of the nurse?
A. “The probability is rare.”
B. “Why don’t you ask your obstetrician?”
C. “Yes, you can get pregnant, so you can choose another method.”
D. “Your doctor is an expert on BTL so you don’t need to worry.”
Although pregnancy is uncommon after sterilization (BTL), it may occur and may be ectopic.
63. Which of the following should the nurse include in her discussion of the advantages of BTL to Natasha Romanoff?
I. Does not interrupt sexual activities
II. Immediate sterility
III. No long term side effects
IV. Very effective and safe
A. I, II, III
B. I, II, IV
C. I, II, III, IV
D. II, III, IV
All of the above are advantages of BTL.
64. After the procedure, the nurse knows that Natasha Romanoff understands the post-operative care when she says that she will:
A. Have full bath anytime
B. Not lift her youngest child
C. Rest for one week
D. Resume sexual relations with her husband immediately
The woman may be sent home within a few hours after the procedure if she is stable. She may require a mild analgesic for a few days and avoid heavy lifting for a week. Side
effects are minimal, and uterine function is not altered. Ovulation still occurs, but the ovum is absorbed into the peritoneal cavity.
65. The nurse instructs Natasha Romanoff to return after one week. Which of the following procedures is likely to be done during this visit?
A. Change of dressing of the surgical wound
B. Ensure absence of pain
C. Evaluate surgical site
D. Removal of suture
The mother is instructed to return to the clinic after 1 week for removal of sutures
SITUATION 12: You are working as Pediatric Nuse in your own Child Health Nursing Clinic. The following cases pertain to care of the newborn at risk conditions.
66. The nurse teaches a mother of a child diagnosed with bacterial conjunctivitis regarding measures to prevent the transmission of the infection. Which statement by the
mother indicates a need for further teaching?
A. "A clean washcloth can be used to wipe my child's eyes."
B. "Hands need to be washed frequently."
C. "It is all right to share towels and washcloths as long as they are bleached after use."
D. "The eye drops must be given as prescribed, and hands need to be washed before and after instillation."
Bacterial conjunctivitis is highly contagious, and the nurse should teach infection control measures. These measures include frequent hand washing and not sharing towels
and washcloths regardless of the bleaching process. Options B and C are correct treatment measures.
67. A10-year-old child complains of ear pain that is aggravated by palpation of the auricle. Afoul-smelling yellow, tenacious discharge is noted in the ear canal, and the child
is diagnosed with acute otitis externa. The nurse provides information to the child and the child's mother and tells them that:
A. Annual ear testing must be done by a special physician.
B. Anything smaller than the child's elbow should not be placed in the ear.
C. Cotton-tipped applicators should be used to clean the ears.
D. Dizziness is common with this disorder.
The nurse should provide information about ear care to a child because it is not uncommon for children to put sharp or small objects, such as cotton swabs, into their ears, and
these behaviors can cause injury. A facecloth is safe to use for ear cleaning. Acute otitis externa may cause a low-pitched tinnitus but usually does not cause dizziness unless
the condition has progressed to an otitis media. Audiography is performed during a screening done at school usually every year and does not necessarily need to be
performed by a special physician.
68. The nurse is developing a plan of care for an infant following surgical intervention for imperforate anus. The nurse includes in the plan that the most appropriate position
for the infant in the postoperative period is which of the following?
A. Prone position
B. Side-lying with the legs extended
C. Supine with no head elevation
D. Supine with the head elevated 45 degrees
The most appropriate position following surgical intervention for an imperforate anus is a side-lying position with the legs flexed or a prone position to keep the hips elevated.
These positions will reduce edema and pressure on the surgical site. Options B, C, and D will promote pressure at the surgical site.
69. The nurse is caring for an 8-month-old infant. A urinalysis has been ordered, and the nurse plans lo collect the specimen. The nurse collects the specimen by which most
appropriate method?
A. Attaching a urinary collection device to the infant's perineum
B. Catheterizing the infant using a No. 5 French Foley catheter
C. Monitoring the urinary patterns and preparing to collect the specimen into a cup when the infant voids
D. Obtaining the specimen from the diaper, using a syringe, after the infant voids
Although many methods have been used to collect urine from an infant, the most reliable and appropriate method is the urine collection device. This device is a plastic bag that
has an opening that is lined with adhesive so that it may be attached to the perineum. Urine for certain tests, such as specific gravity, may be obtained from a diaper. Urinary
catheterization is not to be done unless specifically prescribed because of the risk of infection. Monitoring urinary patterns and attempting to collect the specimen in a cup when
the infant voids are not reasonable.
70. The pediatric nurse is caring for a 3-year-old child with a diagnosis of acute lymphocytic leukemia. The child is crying and complaining that his knees hurt. Which of the
following nursing interventions would be most appropriate?
A. Administer acetaminophen (Tylenol) to the child.
B. Apply heat to the knees and elevate the knees on a pillow.
C. Ask the child if he would like a baby aspirin.
 D. Involve the child in a diversion activity
Aspirin is not administered to the child with acute lymphocytic leukemia because of its anticoagulant properties and because administering aspirin could lead to bleeding in the
joints. Heat also would increase the pain by increasing circulation to the area. Diversional activities would not relieve the pain.
SITUATION 13: In rendering nursing care one should be knowledgeable about Growth and Development.
71. A mother is frustrated because her 2½-year-old is not toilet trained and will not use the potty when placed on it. What suggestion by the nurse is most appropriate?
A. Do not let the child off the potty until stool or urine is evacuated.
B. Do not try to toilet-train the child, as it is too early.
C. Give the child a laxative and place on the potty in 30 minutes.
D. Make up a game to encourage the child to want to use the potty.
Rationale: The child is at Freud's anal stage of development (1½ to 3 years). The major conflict of this stage is toilet training. The child needs to be able to maintain a sense of
control, and training should be a pleasurable experience. That can be accomplished by making toilet training a game. Punishment and forcing a child to sit on the potty do not
support the child's sense of control. Laxatives are not appropriate unless recommended by the physician for constipation.
72. An 82-year-old client complains that he is "sick, old, and useless," and that people are "no good and don't care." The nurse recognizes that these statements at this age
indicate negative resolution of which task, according to Erikson?
A. Generativity versus stagnation
B. Identity versus role confusion
C. Integrity versus despair
D. Intimacy versus isolation
Rationale: The central task of maturity (65 years to death), according to Erikson, is integrity versus despair. Unsuccessful resolution results in a sense of loss and contempt for
others. Identity versus role confusion is a task of adolescence. Generativity versus stagnation is a task of adulthood, and intimacy versus isolation is a task of young adulthood.
73. The nurse is developing a teaching plan for a 9-year-old female client who is diabetic. Which actions would be appropriate, according to Piaget?
A. Discussing future hazards of pregnancy for diabetic mothers
B. Teaching size of food portions and importance of timing snacks and meals
C. Using hand puppets to teach proper nutrition
D. Using hypothetical problem situations to teach potential problem solving
Rationale: This child is at the concrete operations phase (ages 7-11), characterized by the ability to understand size relationships, solve concrete problems, understand left
and right, and recognize viewpoints. Developmentally, the child should be able to understand portion size and timing of meals and snacks. The child is still focused on the here
and now, so discussing future pregnancy hazards is not appropriate. Use of hypothetical problem situations is more appropriate to the formal operations phase (ages 11-18
years), and use of hand puppets is more appropriate for younger children.
74. A client is hesitant to have needed surgery because of multiple family, social, and church obligations, saying, "I hate to let everybody down." The nurse recognizes that
this client's moral dilemma is a result of the client operating at which level of Kohlberg's stages of moral development?
A. Conventional
B. Pre conventional
C. Post conventional
D. Universal
Rationale: The client is operating at the conventional level of moral development, which is characterized by valuing of conformity and loyalty, and maintaining expectations of
family, groups, and society. The characteristics of the preconventional level are fear of punishment and expectation of reward. At the post conventional level, the person has
autonomously defined moral values that are distinct from personal identification with group values. Universal focus describes the internalized rules governing decisions and
behavior of a person who is operating at the post conventional level.
75. The nursing student classified the sample into young, middle-aged and old. This is an example of what scale in research according to level of measurement?
A. Interval Scale
B. Nominal Scale
C. Ordinal Scale
D. Ratio Scale
SITUATION 14: Adequate knowledge on leadership and management is also essential especially in areas where conflict and confusion is common.
76. A nurse is regularly assigned to the newborn nursery. On a particular shift, two of the regularly assigned staff members are on sick time and no new staff is available for
assistance. The nurse should:
A. Prioritize care so that all clients receive reasonably safe care.
B. Provide nursing care only to those clients regularly assigned.
C. Refuse the nursing assignment because the increased number of clients makes it unsafe.
D. Take all of the infants out to their mothers to take care of them.
In the case of unusual circumstances, a test of reasonableness is applied. The nurse is expected to be flexible enough to prioritize care, and the minimal level of acceptable
care is client safety. Providing customary or ideal care to some clients and leaving others without care would not meet the test of reasonableness. Refusing the assignment
would expose the clients to harm from abandonment. Care by family members does not obviate the need for nursing care or attendance by the nurse.
77. It is the nursing applicant's turn to ask questions during a job interview at a local hospital. "What is the most strategic step the applicant could take to increase the
chances of securing a job offer?
A. Ask as many questions about the facility as possible.
B. Begin with questions about client care assignments, advancement opportunities, and continuing education.
C. Clarify information regarding salary, benefits, and working hours first, because this information will help in deciding whether or not to take the job.
D. Decline to ask questions, because mat is the responsibility of the interviewer.
This choice implies concern for client care and self-improvement. Even though the interviewer will direct the interview process, it is always a good idea to have one or two
questions ready. Implies that the applicant did not do some homework and is not knowledgeable about the facility. Salary, benefits are the last questions to be asked.
78. A physician calls the unit, wishing to leave an important order. A new nurse answers the phone, so that the senior nurses may continue a conversation they are having.
The new nurse does not know the physician or the client to whom the order pertains. The nurse should:
A. Ask the charge nurse or one of the other senior staff nurses to take the telephone order.
B. Ask the physician to call back after the nurse has read the hospital policy manual.
C. Refuse to take the telephone order.
D. Take the telephone order.
Get a senior nurse who knows the policies, the client, and the doctor. Generally speaking, a nurse should not accept telephone orders. However, if it is necessary to take one,
follow the hospital's policy regarding telephone orders. Failure to follow hospital policy could be considered negligence. In mis case, the nurse was new and did not know the
hospital's policy concerning telephone orders. The nurse was also unfamiliar with the doctor and the client. Therefore, the nurse should not take the order unless (a) no one
else is available, and (b) it is an emergency situation.
79. "Which of the following is the best example of a management function?
 A. Directing and evaluating nursing staff members.
B. Explaining medication side effects to a client.
C. Negotiating labor contracts.
D. Writing a letter to the editor of a nursing journal.
80. When developing a care plan for an older adult the nurse should consider which challenges faced by clients in this age group?
A. Adjusting to retirement, deaths of family members, and decreased physical strength
B. Developing leisure activities, preparing for retirement, and resolving empty nest crisis
C. Managing a home, developing leisure activities, and preparing for retirement
D. Selecting a vocation, becoming financially independent, and managing a home
Challenges faced in older adulthood include adjusting to retirement, deaths of family members, and decreased physical strength. Challenges faced in young adulthood include
selecting a vocation, becoming financially independent, and managing a home. Challenges in middle adulthood include developing leisure activities, preparing for retirement,
and resolving empty nest crisis.
SITUATION 15: Among the persistent disparity in health outcomes is the mortality related to pregnancy-induced complications. As a nurse one must be able to address
postpartal complications.
81. The greatest danger of postpartal hemorrhage happens in the first 24 hours after delivery related to unprotected uterine area following placental detachment. Although all
can lead to postpartal hemorrh age, which of the following is the most frequent cause for this occurrence?
A. Disseminated Intravascular Coagulation C. Uterine Atony
B. Retained Placental Fragments D. Uterine Inversion
RATIO: There are five main causes for postpartal hemorrhage: uterine atony, lacerations, retained placental fragments, uterine inversion, and disseminated intravascular
coagulation Uterine atony, or relaxation of the uterus, is the most frequent cause of postpartal hemorrhage.
82. Which of the following maternal factors can most likely influence to result to poor uterine tone?
A. Deep anesthesia or analgesia use and endometritis
B. High parity and labor initiated with an oxytocin agent
C. Maternal age more than 35 years and possible chorioamnionitis
D. Prolonged difficult labor and prolonged use of tocolytic therapy
RATIO: All the factors above can contribute to poor uterine tone but take note of the question, it indicates MATERNAL FACTORS. Deep anesthesia or analgesia, labor initiated
with an oxytocin agent and prolonged difficult labor and prolonged use of tocolytic therapy are all MEDICAL MANAGEMENT.
83. When seepage of blood occurs over the first postpartum hour, which of the following should be appropriately instructed by the nurse?
A. Stimulate uterine contraction through fundal message, ensuring the patient is with empty bladder and placing one hand above the fundus.
B. Stimulate uterine contraction through fundal message, ensuring the patient is with empty bladder and placing one hand below the fundus.
C. Stimulate uterine contraction through fundal message, ensuring the patient is with full bladder and placing one hand above the fundus.
D. Stimulate uterine contraction through fundal message, ensuring the patient is with full bladder and placing one hand below the fundus.
RATIO: In the event of uterine atony, the first step in controlling hemorrhage is to attempt uterine massage to encourage contraction. Purposes of fundal message: to stimulate
uterine contraction, promote uterine tone and consistency, and minimize the risk of hemorrhage. In performing the procedure, ask the client to void (unless bleeding is
extensive and more rapid action seems necessary). An empty bladder prevents displacement of
the uterus and ensures accurate assessment of uterine tone. Put on gloves. Place one hand on the abdomen just above the symphysis pubis. Place the other hand around the
top of the fundus. This location helps to assess and locate the fundus and determine height.
84. Pharmacological interventions can also be instituted if a uterus cannot remain to be contracted. The nurse should assess for diarrhea if which of the following are
administered to relieve this postpartal complication?
A. Carboprost tromethamine (Hemabate)
B. Carboprost tromethamine (Hemabate) and Methylergonovine maleate (Methergine)
C. Carboprost tromethamine (Hemabate), Methylergonovine maleate (Methergine), and oxytocin (Pitocin).
D. Carboprost tromethamine (Hemabate), Methylergonovine maleate (Methergine), oxytocin (Pitocin) and rectal misoprostol.
RATIO: If a uterus cannot remain contracted, her physician or nurse-midwife probably will order a dilute intravenous infusion of oxytocin (Pitocin) to help the uterus maintain
tone. Carboprost tromethamine (Hemabate), a prostaglandin F2a derivative, or methyler-gonovine maleate (Methergine), an ergot compound, given intramuscularly, are
second possibilities. Rectal misoprostol, a prostaglandin E1 analogue, may be administered rectally. Because prostaglandins tend to cause diarrhea as a side effect, assess
for this frequently. Oxytocin causes nausea, emesis and water intoxication. Methergine causes nausea, emesis and blood pressure alteration.
85. Which of the following serves as the first line of therapy for ineffective uterine contraction following delivery?
A. Continuous oxytocin (Pitocin) therapy via intrauterine route
B. Continuous oxytocin (Pitocin) therapy via intravenous route
C. Single-dose oxytocin (Pitocin) therapy via intrauterine route
D. Single-dose oxytocin (Pitocin) therapy via intravenous route
RATIO: If a uterus cannot remain contracted, her physician or nurse-midwife probably will order a dilute intravenous infusion of oxytocin (Pitocin) to help the uterus maintain
tone. When oxytocin is given intravenously, its action is immediate. However, be aware that oxytocin has a short duration of action, approximately 1 hour, so symptoms of
uterine atony can recur quickly after administration of only a single dose.
SITUATION 16: A group of intensive care unit nurses decided to conduct a research study to describe the relationship between the frequency of endotracheal suctioning and
the incidence of infection among ventilator assisted patients. The team selected the non-experimental design particularly the prospective approach.
86. If you are a member of the research team, which of the following will you consider as the research study’s independent variables when you formulate the research
problem?
A. Incidence of infection
B. Relationship of endotracheal suctioning with incidence of infection.
C. Dependence of clients on mechanical ventilation.
D. Frequency of endotracheal suctioning.
Independent variables are variables that influence another variable. In this case, the independent variable is the frequency of suctioning and the dependent is the incidence of
infection.
87. Data regarding the study’s dependent variable will be collected by the research team through which of the following:
A. Self-report techniques. C. Projective techniques
B. In Vitro Measures D. Available data in the patient’s chart.
Since this is a hospital setting, nurses have more data about infection in the chart than the clients doing self-report techniques. Also, remember that the clients are having
endotracheal suctioning which means there’s an endotracheal tube that would not allow the client to talk.
88. The research team is fully aware that measurement of variable is very important consideration in obtaining quality data in the study. Which of the following statements
will you accept as TRUE?
A. Reliability quality of an instrument is independent of its validity
 B. An instrument can be valid without being reliable
C. A measuring device which is unreliable can be valid.
D. High reliability of an instrument provides no evidence of validity.
This is called constant error, wherein the measurement of the variable is consistently being affected the same way each time the measure is done. For example, a weighing
scale that consistently weighs two grams over the actual weight. The measurement will appear to be reliable, as repeated measures of the same item results in the same
weight. The measurement, however, will not be a valid weight as it is constantly two grams over the actual weight of any item. (Basic Steps in Planning Nursing Research, 5 th
ed., 174-175)
89. Taking into consideration the content of the written informed consent, which of the following reflects the research team’s recognition of the participant’s right to privacy?
A. Right to withdraw and withhold information C. Voluntary consent
B. Confidentiality pledge D. Potential benefits and risk
Confidentiality pledge, wherein the reseachers inform their prospective subjects the extent to which their responses and records will be kept confidential. Subjects are
promised that their identity will remain anonymous in reports and publications of the study.
Right to withdraw, voluntary consent, and potential benefits and risks when given to clients would respect his right to self-determination or autonomy. (Grove’s Understanding
Nursing Research, 4th Ed., Page 216-217)
90. The research team decided to conduct the study for 3 months. Utilizing the prospective approach, which of the following will the researcher appropriately do?
A. Participants will be assigned to the experimental and control group and incidence of infection in the two groups will be compared.
B. During the period of 3 months, those ventilator assisted patients who developed infection will be included in the study.
C. On the last day of the 3rd month, charts of participants will be reviewed and data collected regarding frequency of endotracheal suction and incidence of infection.
D. From day 1 to the last day of the 3rd month, data regarding frequency of endotracheal suctioning and incidence of infection will be collected.
Prospective approach or studies are used to describe studies that are designed to follow the subjects over a period of time, obtaining repeated measurements and establishing
changes in the variables over time. In this type of study, the sample is chosen on the basis of the presence of a presumed causative variable. The sample is followed to find
out if the dependent variable occurs or changes over time. (Basic Steps in Planning Nursing Research, 5 th Ed., Page 103)
Other types are:
Retrospective studies are used to describe cause-and-effect studies wherein the effect is known and the cause is sought. In other words, a phenomenon that occurs in the
present is thought to have a cause that can be found in the past. (Basic Steps in Planning Nursing Research, 5 th Ed., Page 102)
Cross-sectional studies collect data at one time only and are meant to obtain a “cross-section” of the population at a given moment in time. The result is a measurement of
what exists today, with no attempt to document changes over time either in the past or in the future. (Basic Steps in Planning Nursing Research, 5 th Ed., Page 103)
SITUATION 19: Nurse Harry P. is caring for Draco M., a client with HIV infection.
91. Draco M. is experiencing anorexia and diarrhea. Which nursing actions does Nurse Harry P. delegate to a nursing assistant?
A.  Collaborate with the client to select foods that are high in calories.
B.  Provide oral care to the client before meals to enhance appetite. 
C.  Assess the perianal area every 8 hours for signs of skin breakdown.
D.  Discuss the need to avoid foods that are spicy or irritating.
Providing oral care is within the scope of practice of unlicensed personnel such as nursing assistants. Diet planning, assessment, and client teaching are higher-level actions
that require more broad education and scope of practice; these actions should be done by licensed staff.
92. Nurse Harry P. is conducting a health assessment interview with Draco M. Which statement by the client does the nurse immediately address?
A.  “When I injected heroin, I was exposed to HIV.”
B.  “I don’t understand how the antiretroviral drugs work.”
C.  “I remember to take my antiretroviral drugs almost every day.” 
D.  “My sex drive is weaker than it used to be since I started taking my antiretroviral medications.”
Because inconsistent use of antiretroviral medications can lead to unsuccessful therapy and the development of drug-resistant HIV strains, it is important that clients take these
drugs consistently. The nurse should immediately assess the reasons why the client does not take the medications daily and then should implement a plan to improve
adherence. The nurse should assess whether the client is still injecting drugs and should make certain the client understands the risks for infection with another strain of HIV or
other bloodborne pathogens and the risk for spreading HIV, but this does not need to be addressed immediately. The nurse must provide further education about how the
medications work and assess how the lack of knowledge or decreased libido influences compliance, but this does not need to be addressed immediately.
93. Draco M. is concerned about getting opportunistic infections and asks Nurse Harry P. how to prevent them. Which interventions does she recommend to Draco M.?
A.  Clean toothbrushes once a week. C.  Eat salad at least once a day.
B.  Bathe daily using an antimicrobial soap.  D.  Wash dishes in cool water.
Bathing daily and using an antimicrobial soap will help decrease the risk for opportunistic infections by reducing the number of bacteria found on the skin. Toothbrushes should
be cleaned daily through the dishwasher or by rinsing in liquid laundry bleach. Salads and raw fruits and vegetables could be contaminated and should be avoided. Dishes
should be washed in hot, soapy water or in a dishwasher.
94. Draco M. is prescribed zidovudine (Retrovir), efavirenz (Sustiva), lamivudine (Epivir), and enfuvirtide (Fuzeon). She asks Nurse Harry P. what will happen if the
prescriptions are not refilled on time, or if a few doses of one of the medications are missed. What is Nurse Harry P.’s best response?
A.  “This will not make any difference in the viral load.”
B.  “Blood concentrations will be decreased, which will lead to increased viral replication.” 
C.  “If only one dose of medication is missed, this will not make a difference.”
D.  “This will cause an increase in opportunistic infections.”
When doses are missed, blood concentrations become lower than what is needed for inhibition of viral replication (often called the  inhibitory concentration). When this
concentration is too low, the organism can replicate and produce new organisms that are resistant to the drugs being used. Therefore, it is critical to ensure that highly active
antiretroviral therapy (HAART) doses are not missed, delayed, or administered in lower-than-prescribed dosages in the inpatient setting. Teach clients the importance of taking
their drugs exactly as prescribed to maintain the effectiveness of HAART.
95. Draco M. is receiving highly active antiretroviral therapy (HAART). Which statement by Draco M. indicates a need for further teaching by Nurse Harry P.?
A.  “With this treatment, I probably cannot spread this virus to others.” 
B.  “This treatment does not kill the virus.”
C.  “This medication prevents the virus from replicating in my body.”
D.  “Research has shown the effectiveness of this therapy if I do not forget to take any doses.”
HAART reduces viral load and improves CD4+ T-cell counts, but the client must still protect others from contact with his or her body fluids. HAART inhibits viral replication; it
does not kill the virus. Remembering to take all doses of HAART is very important for preventing drug resistance.
SITUATION 20: Nurse Barry A. is assigned to the medical ward of One Ward Medical Center. Due to a shortage of staff, he is tasked to care for more clients than the usual
ratio of 1 is to 5. As such, he needs to prioritize activities.
96. Which client does the charge nurse on a medical-surgical unit assign to the LPN/LVN?
A.  Cardiac client who has a diltiazem (Cardizem) IV infusion being titrated to maintain a heart rate between 60 and 80 beats/min 
B.  Diabetic client admitted for hyperglycemia who is on an IV insulin drip and needs frequent glucose checks
 C.  Older client admitted for confusion who has a heparin lock that needs to be flushed every 8 hours 
D.  Postoperative client receiving blood products after excessive blood loss during surgery
The older client admitted for confusion with a heparin lock is the most stable and requires basic monitoring of the IV site for common complications such as phlebitis and local
infection, which would be familiar to an LPN/LVN. The cardiac client with a diltiazem (Cardizem) IV infusion, the diabetic client on an IV insulin drip, and the postoperative client
receiving blood products all are not stable and will require ongoing assessments and adjustments in IV therapy that should be performed by an RN.
97. When flushing a client’s central line with normal saline, the nurse feels resistance. Which action does the nurse take first?
A.  Decrease the pressure being used to flush the line.
B.  Obtain a 10-mL syringe and reattempt flushing the line.
C.  Stop flushing and try to aspirate blood from the line. 
D.  Use “push-pull” pressure applied to the syringe while flushing the line.
If resistance is felt when flushing any IV line, the nurse should stop and further assess the line. Aspiration of blood would indicate that the central line is intact and is not
obstructed by thrombus. Continuing or reattempting to flush the line, or using a push-pull action on the syringe, might result in thrombus or injection of particulate matter into
the client’s circulation.
98. The nurse is assigned to care for four clients. Which client does the nurse assess first?
A. Client with human immune deficiency virus (HIV) and Kaposi’s sarcoma who has increased swelling of a sarcoma lesion on the right arm
B. Client with a history of liver transplantation who is currently taking cyclosporine (Sandimmune) and has an elevated temperature 
C. Client who has been admitted to receive a monthly dose of serum immune globulin to treat Bruton’s agammaglobulinemia
D. Client who has been receiving radiation to the abdomen and has a decreased total lymphocyte count
The temperature elevation of the client with a history of liver transplantation indicates that infection may be occurring; the client is at risk for overwhelming infection because of
cyclosporine-induced immune suppression. Immediate assessment by the nurse is indicated. Information regarding the HIV-positive client with Kaposi’s sarcoma and the client
with Bruton’s agammaglobulinemia indicates that these clients’ physiologic statuses are relatively stable. It is not unusual for a client who is undergoing radiation to have a
decreased total lymphocyte count.
99. The RN working on an oncology unit has just received report on these clients. Which client should be assessed first?
A.  Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature 
B.  Client with lymphoma who will need administration of an antiemetic before receiving chemotherapy
C.  Client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour
D.  Client with xerostomia associated with laryngeal cancer who needs oral care before breakfast
Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune-suppressed people; the nurse should see the client
with chemotherapy-induced neutropenia first. The client with lymphoma and the client with metastatic breast cancer are not in distress and can be assessed later. The client
with dry mouth (xerostomia) can be assessed later, or the nurse can delegate mouth care to unlicensed assistive personnel.
100. Which nursing intervention is the priority in preparing a client for pulmonary function testing (PFT)?
A.  Administer bronchodilator medication on call.
B.  Encourage clear fluid intake 12 hours before the procedure.
C.  Ensure no smoking 6 hours before the test. 
D.  Provide supplemental oxygen as testing begins.
If the client has been smoking, this may alter parts of the PFT (diffusing capacity [DLCO]), yielding inaccurate results. Administering bronchodilators is not indicated for PFT,
but they may be withheld for 4 to 6 hours before the test. Fluid intake does not have an effect on PFT testing. Unless the client develops distress during testing, supplemental
oxygen is not required and will alter the results of PFT.
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