PRACTICE PAPER #1, 2018

NURSING PRACTICE

SPECIALIZED NURSING
(Questions requires Prioritization, Judgement & Decision making)
Question types – analysis

SHOCK
1. A client is admitted into the Emergency Room with diaphoresis, pale clammy skin, and
BP of 90/70. Which of the following intervention should the nurse implement FIRST?

a) Start an IV with an 18-gauge catheter.

b) Administer dopamine intravenous infusion.
c) Obtain arterial blood gases (ABGs).
d) Insert an indwelling urinary catheter.

2. Which of the following assessment data needs IMMEDIATE intervention by the nurse
when caring for a patient diagnosed with shock?

a) Vital signs T 100.4˚F, P 104, R 26, and BP 102/60.

b) A white blood cell count of 18,000/mm3.
c) A urinary output of 90 mL in the last four (4) hours.
d) The client complains of being thirsty.

3. Which of the following doctors order for a patient diagnosed with Septicemia has the
HIGHEST PRIORITY?

a) Provide clear liquid diet.

b) Initiate IV antibiotic therapy.
c) Obtain a STAT chest x-ray.
d) Perform hourly glucometer checks.

4. Which of the following signs/symptoms should the nurse assess for in a client diagnosed
with Neurogenic shock?

a) Cool moist skin.

b) Bradycardia.
c) Wheezing.
d) Decreased bowel sounds.

5. Which of the following intervention should the nurse implement for a discharged client
diagnosed with Pneumonia who received an antibiotic injection IM for the FIRST time?

a) Ask the client about drug allergies.

b) Obtain a sterile sputum specimen.
c) Have the client wait for 30 minutes.
 d) Place a warm washcloth on the client’s left hip.

SYNERGISTIC (blood transfusion)

6. After cardiac surgery, a patient who is a Jehovah’s Witness had an Hct of 18% and
accumulated chest tube drainage of 1800m in the first 3 hours. The MOST
APPROPRIATE action would be to begin/administer_______.

a) continuous-circuit auto-transfusion
b) donated directed PRBCs
c) donated autologous whole blood
d) 500ml of albumin

CARDIAC (heart failure)

7. The heart sound MOST OFTEN associated with heart failure is________.

a) An S3
b) A pericardial friction rub
c) An S4
d) A systolic ejection murmur

NEURO (Epilepsy & CVA)

8. What should be the nurse FIRST action for a patient is experiencing a new-onset grand
mal seizure in the ICU?

a) Hit the Code Blue Button

b) Hold the patient down to prevent injury
c) Insert an oral airway and call for help
d) Roll to the right side and protect the airway

9. Which of following deficits would the critical care nurse MOST likely expect a client
who has had a left temporal Cerebral Vascular Accident due to uncontrolled
Hypertension to experience?

a) Receptive Aphasia
b) Motor Deficits
c) Balance deficits
d) Expressive Aphasia

CODES
10. Which of the following actions should the nurse implement FIRST when a client is found
lying on the floor unresponsive?

a) Check the client for breathing.

b) Assess the carotid artery for a pulse.
c) Shake the client and shout.
 d) Notify the Rapid Response Team.

11. Which of the following behavior warrants IMMEDIATE intervention by the nurse when
a PCA is found performing cardiac compressions during a code? The
PCA____________.

a) has hand placement on the lower half of the sternum

b) performs cardiac compressions and allows for rescue breathing
c) depresses the sternum 0.5 to one (1) inch during compressions
d) asks to be relieved from performing compressions because of exhaustion

12. Which of the following interventions is MOST IMPORTANT for the nurse to implement
when participating in a code?

a) Elevate the arm after administering medication.

b) Maintain sterile technique throughout the code.
c) Treat the client’s signs/symptoms; do not treat the monitor.
d) Provide accurate documentation of what happened during the code.

13. The CPR instructor is discussing an automated external defibrillator (AED) during class.
Which of the following statements BEST describes an AED?

a) It analyzes the rhythm and shocks the client in ventricular fibrillation.

b) The client will be able to have synchronized cardioversion with the AED.
c) It will keep the health-care provider informed of the client’s oxygen level.
d) The AED will perform cardiac compressions on the client.

14. Which of the following clients is MOST LIKELY to experience sudden cardiac death?
The ________.

a) 84-year-old client exhibiting uncontrolled atrial fibrillation.

b) 60-year-old client exhibiting asymptomatic sinus bradycardia.
c) 53-year-old client exhibiting ventricular fibrillation.
d) 65-year-old client exhibiting supraventricular tachycardia.

15. Which of the following intervention is the MOST IMPORTANT for the nurse to
implement when performing mouth-to-mouth resuscitation on a client who has pulseless
ventricular fibrillation?

a) Perform the jaw thrust maneuver to open the airway.

b) Use the mouth to cover the client’s mouth and nose.
c) Insert an oral airway prior to performing mouth-to-mouth.
d) Use a pocket mouth shield to cover client’s mouth.
HEALTH HISTORY & PHYSICAL ASSESSMENT (KINDLE)

16. SCENARIO: During the day, while being admitted to the nursing unit from the
emergency department, a patient tells the nurse that she is short of breath and has pain in
her chest when she breathes. Her respiratory rate is 28, and she is coughing up yellow
sputum. Her skin is hot and moist, and her temperature is 102.2 ° F (39 ° C). The
laboratory results show white blood cell count elevation and the sputum result is pending.
The patient says that coughing makes her head hurt, and she aches all over. Identify the
subjective and objective assessment findings for this patient.

17. Prioritization & Decision Making: For the patient described in Question 26, the data
will lead the night shift nurse to complete a focused nursing assessment on which of the
following body part(s)?

a) Abdomen
b) Arms and legs
c) Head and neck
d) Anterior and posterior chest

18. Prioritization & Decision Making: The nurse prepares to interview a patient for a
nursing history but finds the patient in obvious pain. Which action by the nurse is the
BEST at this time?

a) Delay the interview until the patient is free of pain.

b) Administer pain medication before initiating the interview.
c) Gather as much information as quickly as possible by using closed-ended questions
that require brief answers.
d) Ask only those questions pertinent to the specific problem and complete the interview
when the patient is more comfortable.

19. Prioritization & Decision Making: While the nurse is obtaining a health history, the
patient tells the nurse, “I am so tired, I can hardly function.” What is the nurse's BEST
action at this time?

a) Stop the interview and leave the patient alone to be able to rest.
b) Arrange another time with the patient to complete the interview.
c) Question the patient further about the characteristics of the symptoms.
d) Reassure the patient that the symptoms will improve when treatment has had time to
be effective.

20. Which of the following is an example of a pertinent negative finding during a physical
examination?

a) Chest pain that does not radiate to the arm

b) Elevated blood pressure in a patient with hypertension
c) Pupils that are equal and react to light and accommodation
 d) Clear and full lung sounds in a patient with chronic bronchitis

21. Which of the following is the correct sequence of examination techniques that should be
used when assessing the patient's abdomen?

a) Inspection, palpation, auscultation, percussion

b) Palpation, percussion, auscultation, inspection
c) Auscultation, inspection, percussion, palpation
d) Inspection, auscultation, percussion, palpation

22. When performing a physical examination, which of the following approach is MOST
IMPORTANT for the nurse to use?

a) A head-to-toe approach to avoid missing an important area

b) The same systematic, efficient sequence for all examinations
c) A sequence that is least revealing and embarrassing for the patient
d) An approach that allows time to collect the nursing history data while performing the
examination

23. On the first encounter with the patient, the nurse will complete a general survey. Which
features are excluded (more than one may apply)?

a) Mental state and behavior

b) Lung sounds and bowel tones
c) Body temperature and pulses
d) Speech and body movements
e) Body features and obvious physical signs
f) Abnormal heart murmur and limited mobility

ETHICO-LEGAL

24. Licensure of the Registered General Nurse is required PRIMARILY to protect

the_________.

a) nurses
b) public
c) Nursing Council
d) Health-care agency

25. Placing a patient in restraints without the patient’s approval may be interpreted
as__________ if there is not a reasonable safety risk.

a) Assault
b) Battery
c) Neglect
d) False imprisonment
26. Which of the following factors differentiates malpractice from negligence?

a) The action did not meet standards of care

b) The inappropriate care is an act of commission
c) There is harm to the patient as a result of the care
d) A contractual relationship between the nurse and patient

27. When completing an Incident Report, for a patient who falls out of bed while unassisted,
the nurse understands that its MAIN purpose is to ___________.

a) ensure that all persons document what happened

b) help establish who is responsible for the incident
c) make data available for quality control analysis
d) document the incident on the patient’s chart

28. When the nurse administers a drug that has PRN after the order, the nurse
functions__________.

a) Collegially
b) Dependently
c) Independently
d) Interdependently

29. The main purpose of Nursing Associations is to ___________.

a) Function as “watch dogs” for the profession

b) Recognize academic achievement in nursing
c) Monitor educational institutions granting degrees in nursing
d) Prepare nurses to become members of the nursing profession

30. The nurse says, “If you do not take your medication, I will withhold your supper” to a
patient is committing ____________.

a) Assault
b) Battery
c) Negligence
d) Malpractice

31. The laws in the land of Jamaica are responsible for __________.

a) Standardized care plans

b) Enactment of Nursing Practice Acts
c) Accreditation of educational nursing programs
d) Certification in specialty areas of nursing practice
 32. The nurse should be aware of legal principles associated with nursing practice.
Therefore, the nurse should understand that related to the doctrine of respondeat superior
________.

a) Nurses must respond to the Supreme Court when they commit acts of malpractice
b) Health-care facilities are responsible for the negligent actions of the nurses whom
they employ
c) Nurses are responsible for their actions when they have contractual relationships with
patients
d) The laws absolve nurses from being sued for negligence if they provide inappropriate
care at the scene of an accident

33. When attempting to administer a 10:00 PM sedative medication, the nurse assessed that
the patient appeared to be asleep. What should the nurse do?

a) Withhold the drug until the next time it is due

b) Notify the doctor that the patient is asleep
c) Awaken the patient to administer the drug
d) Administer it later if the patient awakens during the night

MENTAL ILLNESS

SCENARIO I

A 56 year old client was brought to the Emergency Room for the first time where impaired
communication and auditory hallucination were displayed. The client stood in one position for an
extended period, and then suddenly broke out into episodes of hysterical laughter. He was diagnosed
with Schizophrenia

QUESTION 26-35 RELATE TO THE SCENARIO ABOVE

NOTE: questions require critical thinking, prioritization, judgement & decision making

34. In the client diagnosed with Schizophrenia which of the following manifestations would
MOST LIKELY be present?

(a) Hallucinations, delusions, hygiene practices

(b) Perceptual deficits, dirty clothing, disturbed thoughts
(c) Intermittent thoughts, perceptual deficits, dirty clothing
(d) Disturbed thoughts, auditory hallucinations, hygiene practices

35. The client who was eventually admitted on the unit for the first time had four possible
nursing diagnoses. Of the four, which would the nurse consider to be of HIGHEST
PRIORITY?
 a) Anxiety related to fear of hospitalization.
b) Defensive coping related dysfunctional family process.
c) Risk for self-directed violence related to depressed mood.
d) Impaired social interactions related to lack of social skills.

36. Which of the following class of medications would MOST LIKELY cause the patient to
carry out activities of daily living normally?

(a) Psychotropics, Sedatives, Analgesics

(b) Analgesics, Psychotropics, Sedatives
(c) Sedatives, Neuroleptics, Antipsychotics
(d) Antipsychotics, Neuroleptics, Psychotropics

37. The PRIORITY nursing management for this client would include symptoms reduction,
and protection of the___________

(a) patient
(b) family members
(c) members of staff
(d) patient and others

38. When planning intervention strategies for the patient’s schizophrenic condition the nurse
determines that a PRIORITY nursing diagnosis would be _________________.

(a) Risk for Self Mutilation related to auditory hallucination

(b) Risk for injury (self or other directed) related to hallucinations
(c) Impaired verbal communication related neurochemical imbalance
(d) Disturbed Sensory Perception related to voices telling him to stand in the sun

39. The nursing diagnosis that would BEST reflect the patient’s report that the nurse is
working obeah on him would be?

(a) Ineffective protection

(b) Disturbed thought process
(c) Disturbed personal identity
(d) Disturbed sensory perception

40. The MOST APPROPRIATE short term expected outcome for the client who now has
body image disturbance due to tardive dyskinesia would be __________________.

(a) participation in self-care 5 days post admission

(b) expression of two positive attributes about self by day 3
(c) interaction with peers in his half of the ward by time of discharge
(d) demonstration of at least one coping skill to decrease anxiety by day 4
 41. The nurse as part of her assessment data did Mr. James’ Mental Status Examinations. The
MOST common affect to be found in a schizophrenic client is __________________.

(a) Anger and hostility

(b) Happiness and euphoria
(c) Sadness and depression
(d) Apathy and constriction

42. The client is experiencing persecutory delusions, a depressed mood, and apathy for the
last 6-7 months. Which of the following would LEAST indicate his diagnosis of
Schizophrenia?

a) The client is a middle aged adult

b) Symptoms of ambivalence/anhedonia
c) The client complains of depressed mood.
d) The client has a co-existing medical condition

43. In assessing a patient’s antisocial personality disorder the nurse is expected to find which
of the following as the MAJOR distinguishing feature? A history of ___________.

(a) being quiet and withdrawn

(b) paying attention to detail and order
(c) submissive and dependent behavior
(d) breaking the law and societal norms

SCENARIO II

Anxiety is defined as a diffusive apprehension that is vague and associated with feelings of
uncertainty and helplessness

QUESTIONS 36 RELATES TO THIS SCENARIO

Note: some questions require prioritization

44. A client is experiencing an anxiety attack while in the emergency room. The MOST
appropriate nursing intervention for this client should be _______________

a) leaving the client alone in a room for a few hours

b) staying with the client and speaking in short sentences
c) asking the client to play candy crush with other clients
d) turning on the television to programme the client enjoys

45. A patient diagnosed with Panic Attack has a nursing diagnosis of Social Isolation related
to fear. Using a cognitive approach, The MOST APPROPRIATE nursing intervention
would be__________________.

a) discuss with the client the situation before the occurrence of a panic attack
 b) remind the client to write in a journal feelings surrounding the panic attack
c) during a panic attack, remind the client to say, “i know this attack will last only a few
minutes”
d) encourage the client to acknowledge two trusted individuals who can assist the client
during a panic attack

46. A patient with a Panic Anxiety is expected to display which of the following
manifestations?

(a) Flat, bland inappropriate tone

(b) Racing heart rate, increased pulse tone
(c) Flat affect, racing heart, inappropriate tone
(d) Inappropriate tone, Increase pulse tone, flat affect

47. A patient with a psychotic response to an anxiety attack is MOST likely to display which
of the following disorders?

(a) Schizophrenic, delusional

(b) Panic attack, schizoaffective
(c) Delusional, obsession-compulsion
(d) Schizoaffective, obsession-compulsion

48. A nurse is discharging a patient diagnosed with Obsessive-compulsive Disorder. The

employment opportunity MOST LIKELY to be recommended by the doctor would be
a______________________.

a) prison warder
b) street sweeper
c) security guard
d) construction work

49. On a psychiatric ward, a nurse is completing a risk assessment on a newly admitted client
who has increased levels of anxiety. Which of the following would the nurse document as
being the MOST important cognitive symptom?

a) Grinding of the teeth

b) Mania like behaviour
c) Bipolar like symptoms
d) Misinterpretation of stimuli

RESEARC

50. A nurse researcher is attempting to evaluate the strength of a body of evidence used in a
research study. How can the researcher grade the evidence for consistency? Consistency
is ___________.
 a) the strength of the findings from the data analyses
b) the extent to which the study’s design, implementation, and analysis minimize bias
c) the number of studies that have evaluated the research question, including overall
sample size across studies
d) the degree to which studies that have similar and different designs (but investigate the
same research question) report similar findings

51. A nurse researcher in a tertiary hospital is asked to conduct research on the effects of
structured discharge plan for post-open heart surgery patients. The researcher stated the
significance of the research problem. Which of the following statements would be MOST
significant for this study?

a) Improvement in patient care

b) Improves the image of nursing
c) Increase the accountability of nurses
d) Development of a theoretical basis for nursing

52. There are various sources from which nurses obtain knowledge. Which of the following
options reflects the “authority” approach to knowledge development?

a) The nurses on the unit have used a variety of approaches to a client care problem,
trying to find one that is effective.
b) When faced with a question regarding provision of nursing care, the nurse consults a
nursing textbook for instruction.
c) A nurse approaches a client care situation in a specific manner because “that is what
seems to be the best thing to do.”
d) When asked why client care is organized in the current manner the nurse manager
states, “We’ve always done it that way.”

53. A researcher wants to determine some of the problems that are experienced by clients
with Chronic Renal Failure when using the Continuous Ambulatory Peritoneal Dialysis
(CAPD). The researcher went to a clinic where the patients on CAPD are known to him.
This type of sampling is called_______________.

a) probability
b) Purposive
c) incidental
d) snowball

54. Which of the following studies would MOST LIKELY be conducted using a qualitative
approach?
 a)  A study investigating changes in family dynamics following the sudden death of a
child.
b) A study designed to measure weight-loss trends in middle adults who increase
walking.
c) A study comparing the results of two antihypertensive medications given to patients
who have diabetes mellitus.
d) A study tracking change in reading level for children treated with behavioral therapy
for attention-deficit activity disorder

55. Student nurses at a tertiary institution have decided to use the interview schedule as a
data collection instrument for their study. One advantage of the interview schedule is
______________.

a) tendency for interviewing bias

b) requires minimum explanation
c) opportunity to clarify questions
d) makes it possible to record behavior as it occurs

56. In any research study where individual persons are involved, it is important that an
informed consent of the study is obtained. The following are essential information about
the consent that must be disclosed to the informant EXCEPT_____________.

a) assurance of anonymity and confidentiality

b) description of benefits & discomfort
c) consent to not complete the process
d) explanation of the procedure

57. What is the dependent variable in the following hypothesis, “the utilization of technology
in teaching improves the retention and attention of nursing students?”

a) Improvement in the retention and attention

b) Utilization of technology
c) Nursing students
d) Teaching

58. “There is evidence that one in four girls and one in seven boys are sexually abused in
some way prior to their 18th birthday…..The long term consequences of child sexual
abuse make it one of the most severe offenses against a child’s dignity and sense of
wellbeing… Thus the need for a systematic assessment tool to identify childhood incest
in this high-risk population is imperative.” This constitutes a _________.
a) problem statement
b) study findings
c) study purpose
d) population
59. A group of students attending an institution are deliberating whether or not to use the
mailed questionnaire as their data collection instrument. One MAJOR disadvantage of
this method is that ______.
a) it does not eliminate literacy barriers
b) it requires maximum explanation by others
c) the participant’s action may be interpreted in a way to suit the researcher
d) validity is undermined because of possible difference in the interpretation by
respondents

60. The statement, “Ninety percent (90%) of the respondents are female staff nurses validates
previous research findings that the nursing profession is largely a female dominated
(Jones, 2011; Anthony, 2015) profession.” This statement is an example of
a/an___________.
a) analysis
b) conclusion
c) implication
d) Interpretation
61. A patient is participating in a study on Congestive Cardiac Failure in which his doctor is
directly involved. Which statement by the patient indicates a lack of understanding about
his right as a participant?
a) “ I will have to find a new doctor if I do not complete this study”
b) “My confidentiality will not be compromised in this study”
c) “I understand the risk associated in this study”
d) “I can withdraw from this study anytime”

LEADERSHIP & MANAGEMENT

62. According to Henri Fayol, the functions of planning, organizing, coordinating, and
controlling are considered which of the following aspect of management?

a) Roles
b) Functions
c) Process
d) Taxonomy

63. Which of the following is considered a decisional managerial role?

a) Disseminator
b) Leader
c) Figurehead
d) Entrepreneur

64. A nurse manager meets regularly with other nurse managers, participates in the
organization’s committees, and attends meetings sponsored by professional organizations
 in order to manage relationships. These activities are considered which of the following
functions of a manager?

a) Informing
b) Monitoring
c) Problem solving
d) Networking

65. A nurse is appointed to a leadership position in a local hospital. The nurse’s position
could be considered ____________.

a) Informal leadership
b) Leadership
c) Formal leadership
d) Management

66. A nursing group has been very successful in achieving its goals even though the group
lacked leadership. Which of the following factors is probably MOST responsible for the
group’s success in goal achievement?

a) Life experience
b) Informal organizational structures
c) Extrinsic satisfaction
d) Cohesive groups

67. The new charge nurse of a medical unit focuses on day-to-day operations and short-term
goals, while the charge nurse of the mental health unit is committed to the vision that
empowers the staff. The charge nurse of the medical unit would MOST likely be
considered a _______________ leader

a) Transformational
b) Transactional
c) Charismatic
d) Autocratic

68. The nursing staff perceives the newly hired Director of Nursing as a leader who is
committed to a vision that empowers others. The Director of Nursing Services is MOST
likely employing the ______________ leadership style.

a) Transformational
b) Transactional
c) Charismatic
d) Autocratic
69. A nurse manager on one of the hospital units views the staff as lazy and only motivated
by threats and coercion. Which theory on motivation would support the manager’s
beliefs?

a) Theory W
b) Theory Y
c) Theory X
d) Theory Z

70. A nurse manager finds two employees arguing about the allocation of duties. Which of
the following roles would be appropriate for the nurse manager to adopt at this time?

a) Advocate role
b) Decision-making role
c) Interpersonal role
d) Information-processing role

71. A nurse manager who implements the bureaucratic management style will MOST likely
do which of the following?

a) Emphasize efficiency
b) Use explicit rules and regulations for governing activities
c) View the individual worker as the source of control, motivation, and productivity
d) Expect unity of command and direction

72. A nursing supervisor has traditionally made rounds at the same time each day. When the
supervisor visits each unit, the staff appear to be extremely busy even when the census is
very low. Today the supervisor visited a unit two hours early and found several staff
members watching soap opera and drinking coffee at the nursing station. The supervisor
recognized that the staff’s previous behavior would have been as a result of which of the
following?

a) Coincidence
b) Diligence of staff
c) Hawthorn effect
d) Time management

73. A post-operative patient is hemorrhaging. The charge nurse instructs a registered nurse to
call the surgical resident and an enrolled nurse to gather specific equipment from the
treatment room. This leadership style would be referred to as ______.

a) directive
b) autocratic
c) democratic
d) laissez faire
 74. A final year nursing student had her span of duty examination terminated because she did
not received consent from the patient before doing the vital signs. The termination of this
examination would have been due to ___________.

a) invasion of privacy
b) breach of duty
c) battery
d) assault

75. The Chairman of the Nursing Council while visiting a unit overheard two nurses telling a
restrained patient that he got what he deserved. Consequently, no care would be rendered
for the shift. The nurses would have breached the ethical/legal principle of ___________.

a) Veracity
b) Malpractice
c) Maleficence
d) Beneficence

76. A nurse makes the decision of placing a patient who needs constant observation but has a
communicable disease in the isolation room. This decision is based on the
principle/theory of________________.

a) formalist thinking
b) utilitarian thinking
c) deontological thinking
d) moralist thinking

77. A nurse overhears a colleague making a disrespectful comment about a co-worker. The
FIRST action of the nurse should be to____________.

a) encourage the offender to apologize to the colleague immediately

b) advise the offender that this type of behaviour is unacceptable
c) ask the offender to give a reason for the comment
d) report the incident immediately to a supervisor

COMMUNICATION

COMMUNICATION IN MANAGEMENT

78. During a unit meeting, the nurse manager discusses ways to deal with a hostile patient.
The staff nurse suggests that more time be spent with the patient. How does the nurse
manager enhance the value of the staff nurse’s suggestion?

a) Identify the staff nurse’s merits

b) Dismiss what the staff nurse said
c) Enhance the value of the unit
 d) Accept others’ suggestions

79. The chief executive officer (CEO) of the institution asked the nurse manager to compile
data on how many clients on the unit were considered to have a status of “critical.” Using
upward communication, the nurse manager:

a) Reviewed the charts and reported the data to the CEO

b) Called a meeting of team leaders to discuss the status of clients
c) Called the business office for a list of medical diagnoses
d) Assessed each client on the floor to find those whose status was “critical”

80. A group of nursing assistants approached the nurse manager to discuss extra
sessionals/overtime on another unit. This is a form of ____________.

a) Upward communication
b) Lateral communication
c) Diagonal communication
d) Informal communication

81. The staff nurse was providing discharge instructions to the client. After the nurse
discussed the importance of making an appointment the following week for a follow-up
visit with the physician, the client said, “I wonder if I can go visit my daughter who lives
out of town next week.” The nurse determined that the client _______

a) Used selective perception to hear what she wanted to hear

b) Decided not to see the doctor for a follow up
c) Had poor cognitive abilities
d) Mistrusted the nurse’s instructions

82. A staff nurse was approached by a nursing assistant who wanted to give a report about a
client’s condition. The nurse said, “I don't have time to listen right now.” This is an
example of ______________communication.

a) Upward
b) Barrier to
c) Downward
d) Grapevine

83. Two nurses, one male and one female, were discussing client assignments. Which of the
following best illustrates gender differences between these two colleagues?
a) a) Male: “I think the client needs to have a nursing assistant assigned on a
one-to-one basis.” Female: “I agree with you.”
b) b) Male: “I think the client is experiencing a loss related to the fact that he is
no longer the breadwinner of the family.” Female: “I think the client is
grieving.”
c) c) Male: “I wonder if the client has expressed to his family his feelings of
loss.” Female: “I think he is dealing with his feelings.”
d) d) Male: “I plan to care for the client as part of my assignment—he will
confide in me because I am a male.”Female: “I am just as competent to
care for the client as you are.”

84. In assessment of cross-cultural communication, which of the following nonverbal

behavior would be MOST important?

a) Placement of hands
b) Facial expression
c) Use of words
d) Eye contact

85. The BEST response for the nurse manager to use with an angry employee is
____________.

a) “Tell me what is wrong?”

b) “You are really inappropriate with your anger”
c) “If you would like to talk, we can go into my office”
d) “I'm not sure why you are angry, but don’t take it out on me”

86. The nurse manager’s BEST response to a staff nurse who is exhibiting what is commonly
called an adult tantrum would be __________.

a) Call the staff nurse by name

b) Discourage the staff nurse from talking
c) Allow the staff nurse to finish the outburst
d) Ask the staff nurse open ended questions

87. During a performance evaluation, the staff nurse tells the nurse manager, “I'm not the
only one who takes a long lunch break, so I shouldn't be penalized for doing that.” The
nurse manager understands that the staff nurse’s behavior is that of a/an ___________.

a) Exploder
b) Sniper
 c) Unresponsive person
d) Complainer

88. Which of the following is indicative of “trashing” other nurses? Nurses’ ________.

a) Working together as a team

b) Committing themselves to actions not completed
c) Identifying with colleagues of the opposite sex
d) Talking about other nurses behind their back

89. A staff nurse exploded angrily at the charge nurse and said, “I don't have time to turn the
client because I have to catch up on my charting.” The charge nurse replied, “I want to
see you in my office right now!” This is an example of which of the following type of
transactional pattern?

a) Adult to adult
b) Child to child
c) Parent to parent
d) Parent to child

90. Which of the following is the most prominent feature of public health nursing?

a) It involves providing home care to sick people who are not confined in the hospital
b) Services are provided free of charge to people within the catchment area
c) The public health nurse functions as part of a team providing a public health nursing
service
d) Public health nursing focuses on preventive, not curative services

80. Which of the following is the PRIMARY goal of community health nursing?

a) To support and supplement the efforts of the medical profession in the promotion of
health and prevention of illnesses
b) To enhance the capacity of individuals, families and communities to cope with their
health needs
c) To increase the productivity of the people by providing them with services that will
increase their level of health
d) To contribute to national development through promotion of family welfare, focusing
particularly on mothers and children

81. Which of the following level of health facility is the usual point of entry of a client into
the health care delivery system?

a) Primary
b) Secondary
c) Intermediate
 d) Tertiary

82. Which of the following is a supervisory function of the public health nurse?

a) Referring cases or patients to the midwife

b) Providing technical guidance to the midwife
c) Proving nursing care to cases referred by the midwife
d) Formulating and implementing training programs for midwives

83. The public health nurse conducts a study on the factors contributing to the high mortality
rate due to heart diseases in the community where the clinic is located. Which of the
following branch of epidemiology does the nurse practice in this situation?

a) Descriptive
b) Analytical
c) Therapeutic
d) Evaluation

84. The number of cases of Flu/Rhinitis fever usually increases towards the end of the rainy
season. This pattern of occurrence of fever Flu/Rhinitis is BEST described as?

a) Epidemic occurrence
b) Cyclical variation
c) Sporadic occurrence
d) Secular occurrence

85. Primary health care is a total approach to community development. Which of the
following is an indicator of success in the use of the primary health care approach?

a) Health services are provided free of charge to individuals and families

b) Local officials are empowered as the major decision makers in matters of health
c) Health workers are able to provide care based on identified health needs of the people
d) Health programs are sustained according to the level of development of the
community

86. Sputum examination is the major screening tool for Pulmonary Tuberculosis. Clients
would sometimes get false negative results in this exam. This means that the test is not
perfect in terms of which of the following characteristic of a diagnostic examination?

a) Effectiveness
b) Efficacy
c) Specificity
d) Sensitivity
87. The nurse is computing the crude rate of a community, with a total population of about
18,000 for last year. There were 94 deaths. Among those who died, 20 died because of
diseases of the heart and 32 were aged 50 years or older. What is the crude death rate?

a) 4.1/1000
b) 5.2/1000
c) 6.3/1000
d) 7.3/1000

88. Knowing that malnutrition is a frequent community health problem, the public health
nurse decided to conduct nutritional assessment. Which of the following population is
particularly susceptible to protein energy malnutrition (PEM)?

a) Pregnant women and the elderly

b) Over 5 year old children
c) 1-4 year old children
d) School age children

87. Mosquito-borne diseases are prevented mostly with the use of mosquito control
measures. Which of the following would be LEAST appropriate for Chick and Zik V
control?

a) Use of chemically treated mosquito nets

b) Seeding of breeding places with larva-eating fish
c) Destruction of breeding places of the mosquito vector
d) Use of mosquito-repellants with citronella and DEET

88. In order to control a disease effectively, which of the following must FIRST be known?

a) The conditions surrounding its occurrence, the condition that do not favour its
development
b) The conditions surrounding its occurrence, factors that favor’s its development
c) Factors that do not favour its development, the conditions that do not favour its
development
d) Factors that do not favour its development, factors that favours its development

89. The nurse is planning to teach an older client how to check her blood sugar. To promote
short-term memory activity, the nurse should _______.

a) have the client repeat the steps of the procedure back to the nurse.
b) ensure environment is free of distracting stimuli.
c) review the procedure with client on several occasions.
d) limit teaching session to 5 to 10 minutes in length.
90. When doing a physical assessment of an old-old client, the nurse could expect to see
which of the following?

a) dilated pupils
b) thin and brittle nails
c) an increase in tear production
d) a decrease in pubic hair

89. A client who was previously independent with bathing is hospitalized for a possible
bowel obstruction. When the client asked the nurse for help with bathing the nurse
recognized the client’s need to ______________.

a) revert to a more dependent stage of development.

b) adjust for disease symptoms by restricting activity.
c) use the physical ailment to solicit more attention for himself.
d) have more physical contact with another human being.

90. An elderly client is seen in the clinic. When reviewing his health care maintenance, the
nurse recommends that the client should have ____________.

a) a digital rectal examination for prostate enlargement every 3 months.

b) a blood test for prostate specific antigen (PSA) yearly.
c) a monthly screening for fecal occult blood.
d) An eye examination every 2 years

COMMUNICATION

91. To provide the MOST therapeutic communication with a patient that is being admitted,
the nurse should___________

a) Use probing questions

b) Teach about hygiene
c) Ask direct questions
d) Listen attentively

92. A patient’s son who has just died, stated,” I can’t believe that I have lost my son. Can
you believe it?”The nurse’s BEST response would be to___________.

a) Touch the patient’s hand and say, “I understand your feelings.”

b) Encourage a family member to stay and provide support.
c) Leave the room and allow the patient to grieve privately.
d) Assume a serious facial expression and say, “I can’t believe it either.”
 93. Which of the following nursing interventions would be the LEAST effective in meeting
a patient who has just being admitted psychosocial needs?

a) Addressing a patient by name

b) Assisting a patient with meals
c) Identifying achievement of goals
d) Explaining care before it is to be given

96. When communicating with patients, it is important for the nurse to remember that
__________.

a) Progress notes are a form of nonverbal communication.

b) Patients with expressive aphasia cannot communicate.
c) Touch has various meanings to different people.
d) Words have the same meaning for all people. .

97. The nurse identified that a patient who is usually very talkative is now withdrawn. The
nurse’s BEST response would be _____________.

a) “You are very quiet today.”

b) “What is it that’s bothering you?”
c) “Tell me what you’re upset about.”
d) “Why are you so withdrawn today?”

98. A patient’s who lost his wife recently begins to cry while reminiscing about their life
together. The nurse’s BEST response would be to ____________.

a) Leave the patient alone to provide privacy

b) Say, “Things will get better as time passes.”
c) Encourage the patient to get grief counseling
d) Say, “This must be a very difficult time for you.”

99. A patient who has a history of verbally aggressive behaviour starts to shout at another
patient in the unit. The MOST appropriate statement by the nurse would be to say
____________

a) “Stop what you are doing.”

b) “Let’s go talk in your room.”
c) “Please sit down until you are calm.”
d) “Do not raise your voice in a hospital.”
100. While the nurse was preparing a discharge summary for a patient, the patient stated, “I
feel that nobody cares about me.” The BEST response by the nurse would be to
say___________

a) “You feel as if nobody cares.”

b) “We all are concerned about you.”
c) “It’s hard to be angry at your family.”
d) “Your family doesn’t have the skills to care for you.”

101. A female patient who talked about her children when they were young, stated, “I was a
very strict mother.” A response by the nurse that reflects the technique of paraphrasing
would be____________.

a) “It must have been difficult to be a disciplinarian”

b) “Sometimes we are sorry for our past behaviors”
c) “You believe you were a firm parent”
d) “You were a very strict mother”

102. Which behavior by a patient with a chronic illness supports the nurse’s conclusion that
the patient may be depressed?

a) Wishing to attend a niece’s wedding

b) Seeking multiple medical opinions
c) Evading activities of daily living
d) Being sarcastic to caregivers

103. A patient who has been withdrawn stated, “When the opportunity presents itself, I am
going to commit suicide.” The BEST response by the nurse would be to say
_____________.

a) “You have a lovely family. They need you.”

b) “Let’s explore the reasons you have for living.”
c) “You must feel overwhelmed to want to kill yourself.”
d) “Suicide does not solve problems. Tell me what is wrong.”