CHN WITH IMCI

Date: December 19, 2022

Time: 8AM - 2PM Bag Technique
Concept: CHN W/ IMCI →Tool to render effective nursing care
Lecturer: PROF. JESSIE DACLIS
Principles:
CHN: outside the hospital, most of the – MOST IMP! Prevent the spread of infection
patients are healthy. Can be private. – last priority: px with contagious diseases
– save time & effort
Primary responsibility: – performed in a variety of ways
→Health education – not overshadow concern for patient
→Health teaching
Focus: health promotion & illness
prevention

Health promotion - ↑ level of health,

healthy today, should be healthier
tomorrow
→Healthy lifestyle
Diet
Exercise
Rest
Stop smoking

Illness prevention - maintain health,

healthy today, healthy tomorrow
→Specific protection. eg.
condom, ppe, handwashing

PUBLIC HEALTH NURSING (PHN)

- Salary from government

SG15 entry-level position, applicable to all

Family care plan
government employees. 36k/month
– use nursing process, systematically

CLIENTS OF CHN
APIE
Individual - patient with specific ek ek
Family - home visit
ASSESSMENT: data collection
Group/population/aggregate - shares
First level assessment
common characteristics. Eg. pregnant, post
– what are the problems
partum, elderly
Categories
Community - primary client
a. Wellness state: healthy. Eg. regular
exercise
HOME VISIT
b. Health deficit: (+) disease, disability.
Principle:
Eg. high blood, diabetes
Purpose/objective: help the client
c. Health threat: ↑ risk for illness & injury.
Use of available information:
eg. wet floor, scattered things
Needs: not the financial, only health
d. Foreseeable crisis/stress points:
Involve: active participation
anticipated problem → developmental
Flexible
/ social. Eg. migration, pregnancy,
college, adjustment
Public Health Bag
→ carry
Examples of types of nursing problem
→ equipment that is necessary - syringe, NO
(1) Wellness state
bp apparatus (not sterile)
(2) Health deficit - pregnant w/ eclampsia
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 CHN WITH IMCI

(3) Health threat - pregnant taking ↑ Walang antibiotic - S

sodium
(4) Foreseeable crisis - pregnant SANITATION
→ environmental
Second level assessment PD 856: sanitation code of PH
– why? → general
PD 825: garbage disposal act. From 8oclock
PLANNING 2 5oclock may pasok, need magtapon basura
Goal setting - SMART
Construct plan of action Food establishment
Choose nursing intervention Sanitary permit: owner
Develop an operational plan - prioritization Health certificate: Food handlers
Xray, stool, blood
4 criteria of prioritization wt.
(1) Nature of problem 1 Class A: excellent
(2) Modifiability of problem 2
(3) Preventive potential 1 Class B: very satisfactory
(4) Salience 1
TOTAL 5 Class C: satisfactory
* Lowest score, lowest priority
4 rights in food safety
Nature of problem - type of nursing problem (1) Right source: fresh
Modifiability of problem - solution of the (2) Right preparation: wash
problem (3) Right cooking: 70degrees
Preventive potential - future recurrence of (4) Right storage
problem Room temperature: max 2 hrs
Salience - perception of client to the problem Cool: 10degrees
Warm: 60degrees
IMPLEMENTATION
3 types of nursing intervention MNEMONICS: SPCS - saint paul college
school
Independent - scope of nursing practive, no
doctor
Levels Water Facility
Dependent - requires doctors order
Level 1 approved
Interdependent - collaborative care – point source
– developed spring
EVALUATION – protected well
→ check outcome of care – avoid > 250 meters away from the source
→ QAE - quality assurance elements – should be clean
(1) Structural elements - physical
settings. Public or private. Manpower. Level 2 approved
Money. Material. – communal faucet
(2) Outcome elements - changes – stand posts
resulting from nursing intervention. – 1:4-5 household
Eg. paracetamol given. From 39 to 38.
1 degree change is the outcome Level 3 approved
(3) Process elements - steps of nsg – individual household connection
process. – waterworks system
– nawasa, maynilad
Q’s – cleanest among all levels, rigid water
Nagpaculture sensitivity for antibiotic - O treatment
Kumain na ba before giving antib - P

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 CHN WITH IMCI

TOILET FACILITY ASSESSMENT

Danger sign (4)
Level 1 Convulsion/seizure
– nonwater carriage Unable to drink/feed
pit latrines (25 meters away from Vomits everything
home) Abnormal sleepy/lethargy/stupor
– small amount water toilet facility **Atleast 1 danger sign = very severe
pour flush toilet ds.

Level 2 Main symptoms (4)

– water sealed/ flushed type → septic tank DOB/cough
Diarrhea
Level 3 Fever
– level 2 but better Ear problem
– sewerage system → tx plant Mnemonic: DeDe ni FE
– cleanest, rigid treatment process Minor symptoms:
Malnutrition
Anemia
HIV status
Mnemonic: MalAneH
IMCI - INTEGRATED MANAGEMENT
CHILDHOOD ILLNESS MAIN SYMPTOMS
→ 5yrs below
DOB/COUGH
1. Greet the client
2. Ask
CLASS ASSESS TX
Problem/s
✓ Common childhood prob Severe pneu – Stridor → – FAB(IM) →
Ø Rare / very severe harsh sound ampicillin
Ø Trauma disease during Gentomycin
Ø Genetic inspiration – refer to
– danger doctor
Age
sign (1)
Sick infant: 0-2mo
Sick child: 2mo-5yrs Pneumonia – fast – oral
Visit breathing antibiotic
Initial: new problems – chest – amoxicillin
Follow up indrawing for 5 days
*atleast 1

No Cough Home:
CASE MANAGEMENT PROCESS pneumonia breastmilk, a
medication
A C I T C Fol in IMCI

Assess Fast breathing:

Classify 0-2 mo: 60 ↑
Pink: severe→ hospital, except severe 2-12 mo: 50↑
dehydration 12-60 mo: 40↑
Yellow: moderate → RHU
Green: mild → home Chest Indrawing
Identify treatment When a child Breath in, the Lower Chest wall
Treat the child goes in
Counselling
Follow up

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 CHN WITH IMCI

QUESTION #1 DEHYDRATION
– 2 or more signs should be present
– ORS - orisol
CLASS ASSESS TX

Severe – ASIS – plan C: RHU

DHN very slowly – IVF →
LR(isotonic) / NSS

Some – RIDS – plan B: RHU

DHN slowly – ORS amount:
75ml x wt(kg) – 4
hrs
Answer: No danger sign. 18 months, 41
No Not Plan A: HOME
breaths per minute = fast breathing. DHN enough Feeding: breast
PNEUMONIA. signs Fluids - ORS
Zinc→ daily for 14
QUESTION #2 days
When to return

SOME SEVERE

Restless Abn sleepy/lethargy

Irritable Strupor

Drink eagerly/thirsty Inability to drink/feed

Sunken eyes Sunken eyes

Skin turgor: Slowly < Skin turgor: Very

2sec slowly > 2 sec
Answer: 10 months, 55 breaths/ min = fast.
With stridor → Severe Pneumonia Notify immediately

Other tables:
DIARRHEA
1Pink sign + 1Yellow sign = Pink classification
→ 3 or ↑ loose stool/day
*DHN = dehydration
DHN table:
CLASS ASSESS TX 1Pink sign+1Yellow sign = yellow (some
DHN)
Severe (+) DHN – refer to
persistent > 14 days doctor
diarrhea – Vit A QUESTION #1
(retirol)

Persistent (-) DHN – Vit A

diarrhea > 14 days (retirol)
– fluids

Dysentery – blood in – cifloxacin

stool for 3 days
(shigella)
● Vit A is a medication in IMCI used for Answer: P+Y= yellow, some. blood stool,
strengthening of mucous membrane dysentery. Abn sleepy, severe. Thirsty, some.
● No one dies from diarrhea, it’ll worsen Skin turgor, slow, some.
turning out to be dehydration

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 CHN WITH IMCI

QUESTION #2
ayaw niya
kumain ng lumi
sa canteen

Malaria (-) blood Paracetamol if ≥

unlikely smear 38.5° C
(+) s/sx
measles
Answer: SEVERE. Y, restless.Y/P, sunken
eyes. P, not able to drink. P, skin turgor v
MEASLES
slowly.
– “tigdas”

QUESTION #3 CLASS ASSESS TX

Severe – clouding – FAB(IM) →

complicated of cornea ampicillin
measles – deep Gentomycin
mouth ulcer – refer to
doctor

Measles – pus → tetracycline

with eye & discharge ointment
mouth – mouth → gentian
complication ulcer violet
Answer: SEVERE. Y/P, sunken eyes. P,
difficult to feed. P, v slowly turgor. There is no Measles – red eyes Paracetamol if
very severe dehydration!! – runny ≥ 38.5° C
nose
– cough
– rashes

FEVER
Axillary: ≥ 37.5° C DENGUE
Rectal: ≥ 38° C CLASS ASSESS TX
High Fever: ≥ 38.5° C, paracetamol
Severe (+) tourniquet – Plan B/C
3 causes: dengue test – refer
with high – persistent – ORS/IVF
Malaria fever abdominal pain
Measles – Persistent
Dengue vomitting
– bleeding, low
platelets count
MALARIA: – slow capillary
refill < 3 secs
Risk: malaria-endemic place (past 4 wks)
Blood transfusion (last 6 mo) Dengue (-) No aspirin
unlikely
CLASS ASSESS TX

Very – stiff neck – FAB(IM) →

severe – danger ampicillin
febrile ds/ sign Gentamycin
malaria – refer to doctor

Malaria (+) blood – oral

smear antimalarial
(-) s/sx drugs
measles – artemether -
lumefrantine
Arte ni meter

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 CHN WITH IMCI

EAR PROBLEM
CLASS ASSESS TX

Mastoiditis – tender – FAB(IM) →

swelling Ampicillin
behind ear Gentamycin
– refer to
doctor

Chronic ear – no ear → quinolone

infection pain otic drops 14
– pus days
discharge > – wicking -
14 days antibiotic
– no
cottonbuds

Acute ear – pus – wicking

infection discharge – antibiotic
<14 days amoxicillin for
5 days
– ear pain – paracetamol

No ear (-) (-)

infection

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 CHN WITH IMCI

CHN W/ IMCI PRE-TEST C. Family

D. Individual client
1. A home health nurse is made aware that a
client and family are about to lose their home 7. The most important role of a community
due to foreclosure. The nurse contacts the health nurse is in the area of:
social service department of the home health A. Change agent
care agency for assistance in finding housing B. Health education
for the family. The actions taken by the nurse C. Advocacy
best exemplify which of the following roles of D. Care provider
the community health care nurse?
a. clinician 8. When you have already organized,
b. advocate follow-up visits are likewise needed. Which of
c. consultant the following should you do first?
d. researcher A. Explain the purpose of the visit
B. Wash your hands and perform the
2. During home visits, Ruthie identified cases necessary procedure
of severe dehydration among children and C. Do an environmental surveillance
immediately referred them to the district D. Greet the patient/resident introduce self
hospital. Which among the following roles is
she performing? 9. During a home visit, socialization is
a. Clinician important in order to:
b. Researcher A. Do procedures
c. Leader B. Establish rapport and put the client ease
d. Health educator C. Identify the needs of the client
D. Evaluate the visit
3. Mrs. Tadejo came to the health center and Situation – While working in the community,
asked about ways on how to conceive a child. nurses observe various situations that require
She has history of repeated miscarriages. attention.
This condition falls under:
A. Heath deficit 10. Nurse Sussy was doing case finding in a
B. Health threat barangay in the rural communities of Cuilon.
C. Foreseeable crisis Her target is to identify undocumented
D. Stress point Hansens Disease cases. Seeing her in
uniform, a woman remarks. “You’re not a
4. It includes stressful occurrences such as nursing student are you? I have may chores
death or illness of a family member: to do today, please!” and ignores the nurse.
A. Heath deficit Sussy’s IMMEDIATE course of action would
B. Health threat be to:
C. Foreseeable crisis a. Visit the next house so as not to waste the
D. Stress points day’s activity and return to re-visit this home
after a day or two.
5. This refers to the tool which enables the b. Communicate the incident to the Barangay
nurse during her visit, to perform a procedure Captain and get him/her to join her in her next
with ease and deftness, to save time and visit.
effort, with the end view of rendering effective c. Ignore the woman’s behavior, turn around
nursing care. and simply leave her alone
A. Bag technique d. The feelings and behavior manifested by
B. Public health bag the woman and get to the root causes of such
C. Home visit a behavior.
D. Black bag
11. The following are nursing interventions to
6. The basic unit of care in CHN is: address the problems on parasitism EXCEPT:
A. Community A. Treatment of patients with the broad
B. Groups spectrum antihelmintics

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 CHN WITH IMCI

B. Stress that vegetables should be

thoroughly washed especially if eaten raw
C. Teach proper disposal of stools and stress
that is shouldn’t be use a fertilizer
D. Encouraging hand washing before and
after eating

Situation – Carol is 15 months old, weighs

8.5 kgs, is not eating well and is unable to
breast feed. She is not vomiting, has no
convulsion and not abnormally sleepy or
difficult to awaken. Her temperature is 38.5
C. Use the Integrated Management of
Childhood Illness or IMCI strategy.

12. If you were the nurse in charge of Carol,

how will you classify her illness?
a. febrile with a general danger sign
b. very severe disease
c. severe pneumonia
d. severe malnutrition

13. Which of the following signs is considered

to be a general danger sign in Carol’s case?
a. no vomiting
b. has no convulsion
c. temperature of 38.5 C
d. unable to breastfeed

14. Which of the following signs is NOT

included in the general danger sign?
a. vomits everything
b. unable to drink or breast fed
c. has had convulsion
d. fast breathing

15. Which of the following steps is NOT

included in the IMCI strategy?
a. identify treatment
b. counsel and follow up
c. referral
d. assess and classify

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CHN W/ IMCI POST-TEST
SITUATION: The public health nurse
analyzes the data collected in community
health assessment in accordance with the
nurse’s conception of the source of the
problems and needs that can be met through
nursing interventions.
1. What category of health problem occurs
when there is a gap between actual and
achievable health status?
A. Heath deficit
B. Health threat
C. Foreseeable crisis
D. Health need
2. These are conditions that promote disease
or injury and prevent people from realizing
their health potential.
A. Heath deficits
B. Health threats
C. Foreseeable crisis
D. Stress point
3. In an epidemiological study conducted in
Barangay C, it was noted that the children
eligible for basic immunization are not
adequately immunized against Hepatitis B
and Measles. This situation is considered:
A. Heath deficit
B. Health threat
C. Foreseeable crisis
D. Stress point
4 . With the stated problems, the nurse and
the community prioritizes these using a set of
criteria. Which of the following criteria refers
to the probability of reducing, controlling, or
eradicating the problem?
A. Modifiability of the problem
B. Preventive potential
C. Magnitude of the problem
D. Nature of the problem
5. When beginning a relationship with a
family on home visit, the community health
nurse:
a. is accepting and listens carefully to
problem of all family members
b. allows the discussion to be open and
non-directional
c. focuses on the problem of one of the family
member
CHN WITH IMCI
d. encourages others to speak for the main
client to get an unbiased view
6. Ana has been caring for a child in the
home. She has a tracheostomy tube and is
oxygen dependent. Ana prefers to do the
care early in the morning due to a heavy
caseload. The family requests that care be
done when the child is awake by 10am. The
BEST response by Ana would be:
a. “I will see if I can find another nurse who
can meet your preferred schedule.”
b. “If I give the care at 10am, other children
needing my care may not be attended to.”
c. “I’m sorry, I wish I could, but I cannot do so
due to heavy workload.”
d. “Let’s look at what time is in the child’s best
interest and then we can work out a better
schedule.” – flexibility
7. Which of the priority conditions will be
determining factors on the frequency of home
health visits?
A. Acceptance of the community of the said
health practice interventions
B. the level of health need of the family
C. The result of the studies conducted and
level of family understanding
D. Administration of medication and the
schedules set
Situation – One of your responsibilities as a
community health nurse is to conduct home
visits to evaluate the health condition of
families and communities
8. In every home visit, you are not only
concerned with the client but you should also:
A. Pay particular attention to the economic
status of the family
B. Observe the family and environment
C. Put emphasis on the children’s education
D. Observe the family’s spiritual practices.
9. In your community home visits, you have
scheduled several cases. Who is your LAST
priority?
A. Family planning defaulters
B. PTB case on D.O.T.S.
C. G4P3 3 day Post Partum
D. G3P2 36 weeks AOG
Situation – One of your responsibilities as a
community health nurse is to conduct home
9

visits to evaluate the health condition of
families and communities
10. Which of the following signs should NOT
be included in deciding that “the child vomits
everything”?
a. child experience occasional vomiting
b. when offered fluids, may not be able to
drink
c. maybe too weak to drink and eat at all
d. child is not able to keep anything down at
all (what goes down comes back)
Situation: Applying IMCI as an approach to
the management of childhood illnesses
improves nursing care of the child under
general conditions.
11. Vitamin A is given to a child with measles
because it:
a. resists the viral infection in the eyes, cell
layers in the lungs gastrointestinal tract,
mouth and throat
b. reinforces the body’s immune response
c. is needed for supplementation
d. helps the immune system prevent other
infections
12. The child’s symptoms are under the
classification of severe dengue hemorrhagic
fever of the IMCI strategy. Which of the
following treatments should be done
IMMEDIATELY?
a. observe the patient at the health center
and refer urgently if the condition worsens
b. give fluids or ORS and refer urgently to the
hospital
c. immunize the child before referral
d. give the first dose of appropriate antibiotics
and refer urgently to the hospital
13. Health deficit is another component of a
health problem. Which is an example of
health deficit?
A. Father with active tuberculosis
C. a pregnant mother
B. No regular health supervision
D. untimely disability and death
14. One family presents several problems.
Which of the following criteria will you apply
to determine the priority health problems?
A. Family involvement in identifying the
problem
B. Modifiability of the problem
CHN WITH IMCI
C. Expected consequence of the problem
D. Cooperation and support of the community
Situation– Management of resources and
environment includes every potential and
existing resources which the nurse can utilize
to promote and maintain health, prevent
illness, and assist in the task of cure and
rehabilitation. The IMCI chart prescribed by
the World Health Organization is one such
resource. The following questions apply.
15. The Integrated Management of Childhood
Illness (IMCI) chart provides the necessary
procedure when identifying the appropriate
interventions to be done. However, the
community health nurse should be aware that
the following factor should be considered in
utilizing the case management chart:
a. age of the child
b. chief complaint
c. danger signs
d. problem of the child
16. In the IMCI classification tables, color
yellow indicates that a:
a. child needs an appropriate antibiotic or
other treatment
b. child does not need specific medical
treatment
c. referral or admission is needed
d. chief complaint that needs an urgent
attention
Situation– Karina, 5 months old, weighs 5.2
kgs, temperature 38 C., is brought to the
center. Her mother says she is not eating
well, feels hot to touch, able to drink, no
vomiting, no convulsions and not lethargic, no
cough. They live in a malaria risk area. Her
fever started 2 days ago. She has no signs of
measles, no stiff neck or runny nose.
17. How will you classify Karina’s illness?
a. plain fever
b. malaria
c. sever febrile disease
d. fever: no malaria
18. The following treatments are appropriate
for Karina EXCEPT:
a. follow up in 2 days
b. give oral anti malaria drugs
c. advise when to return immediately
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d. give 1 dose of paracetamol for temp. 37.5
C assessing the child for chest in drawing
19. After assessing Junjun, your nursing
diagnosis is dehydration secondary to
diarrhea. ORS was administered. Which
health instruction regarding ORS therapy will
you give the mother once the diarrhea has
stopped?
a. Increase the administration of ORS
b. Return to the clinic
c. Stop the administration of ORS
d. Decrease the administration of ORS
Situation – the integrated Management of
Childhoods illness of IMCI technology is a
World health organization strategy which
aims to curb the growing infant/child mortality
and morbidity concerns in many countries
especially the 3rd world economies like the
Philippines. This program integrates many
dependent health programs to singular
approach. Safety and quality would be any
nurse’s focus. The following questions apply.
20. James is an 18 month old child who has
cough for 7 days with no general danger
signs with temperature 37.50 C and
respiratory rate of 41 breaths/minute. How
will you classify jame’s breathing?
A. Slow breathing
B. Fast breathing
C. Normal breathing
D. Very fast breathing
21. James illness can be classified as:
A. Pneumonia
B. Very service disease
C. Severe pneumonia
D. No pneumonia
22. After 3 days, the nurse notes that
james has chest in drawing and stridor. His
mother returned him to the health center
immediately. The nurse should:
A. Change the medicine to the second line
antibiotics
B. Advice mother to observe the child and
continue giving the antibiotics
C. Give first dose of antibiotics and refer
urgently
D. Observe the child in the center
CHN WITH IMCI
23. The nurse should consider the following
EXCEPT:
A. Chest in drawing should be present at all
time
B. The lower chest wall does not go in when
the breaths in
C. The lower chest goes in when the child
breaths in
D. The child should be calm
24. If a child is 2 months to 5 years. Which of
the following steps is NOT appropriate in
checking for general danger signs?
A. Ask if the child has fever
B. Ask if the child is feeding?
C. Look and see if the child is abnormally
sleepy or difficult to awaken
D. Ask if the child has convulsion
Situation–Diarrhea in young children may be
life-threatening and requires immediate
attention.
25. Joel, 3 years old, has had diarrhea for 5
days and is irritable. He has sunken eyeballs
but has no blood in his stools. He drinks
eagerly when offered liquid. Skin pinch at the
abdomen shows slow return. Using
Integrated Management of Childhood Illness
(IMCI), Joel’s illness maybe classified as:
A. No dehydration
B. Some dehydration
C. Severe dehydration
D. Persistent Diarrhea
26. Which of the following treatments should
be immediately considered in Joel’s case?
A. Reassess the child after 4 hours and
classify his dehydration
B. Give 900-1,400 ORS during the first four
hours
C. Explain to the mother how to prepared
ORS
D. Continue feeding
27. The nurse should know that the
examination of drinking water by the
government or non-government personnel
must be coordinated by the municipality
through the RHU. Certification of potability of
an existing water source is issued by the:
A. Sanitary Engineer
B. Municipality
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 CHN WITH IMCI

C. Secretary of Health or his representative

D. DOH

28. Level 1 approved type of water facility is:

A. Communal faucet and system or individual
house connections
B. Point source
C. Waterworks system or individual house
connections
D. Unapproved type of water facility

29. Approved type of toilet facilities may need

water or not depending on receiving space.
What type of toilet is without need of water
A. Pit latrines
B. Water sealed
C. Flush toilet
D. Aqua prives

30. The level of toilet facility commonly found

in highly urbanize communities that have
sewerage systems and treatment plants are:
A. Level I
B. Level II
C. Level III
D. Level IV

12
 TRICIA JESHIEL P. TORRES, RN
Date: December 26, 2022
Time: 9 AM - 4 PM
Concept: OB
Lecturer: PROF. ARCHIE ALVIZ
Maternal and Child Nursing (MCN)
– manages child & mother
Pregnancy
– 3 periods: 1st-3rd trimester
First Trimester
– organogenesis: creation of organs
– most critical part: teratogenic effects
– OTC medications not allowed. Safest
drugs: category A: biogesic/paracetamol
– development of germ layers
Ectoderm–brain
Mesoderm–heart
Endoderm–GI
– ambivalence: presence of opposing feelings
Second Trimester
– easiest part (adapted to pregnancy) /
comfortable
– increased libido (sexual urge)
Third Trimester
– feelings of unattractiveness, low
self-esteem → sudden hormonal increase
– talk to the husband to ↑ self-esteem of
mother. If single mom, talk to the family or
siblings or friends
SIGNS AND SYMPTOMS OF PREGNANCY
Presumptive sign
– subjective from the mother
Breast changes
Amenorrhea
Urinary changes
Nausea & vomiting
OBSTETRICS
Continued vomiting → fluids &
electrolyte imbalance → respiratory
alkalosis
Quickening: movement felt by mother. Real
quickening happens at 5th month (20wks)
Chloasma/Melasma – mask of pregnancy,
discoloration of face&neck
Probable signs
– objective signs, seen by nurse
Hegar sign: thinning of uterus
Chadwicks: vaginal blue/purplish
discoloration ← lack of circulation
Goodell’s: softening of cervix
Non pregnant state: soft as nose
Pregnant state: soft as earlobe
Labor state : soft as butter
HCG– human chronic gonadotropin (+) PT
Braxton Hicks contraction: painless, irregular
Ballotement: bouncing of fetus
Ballotable–not engaged
Non ballotable–engaged
Positive signs
– confirmatory
UTZ: ultrasound
Transvaginal: early pregnancy.
Bladder empty
Abdominal: late pregnancy. Drink
water (2-3 glasses) to distend
abdomen→push uterus up→easy
visualization
FHT: fetal heart tone
normal:120-160 bpm. If brady/tachy
→ fetal distress
Movement felt by examiner
ADAPTATIONS IN PREGNANCY
– systemic changes in pregnancy
Cardio/Circulatory changes
– ↑ total cardiac output-
– palpitations (should be temporary)
– edema
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 TRICIA JESHIEL P. TORRES, RN
Lower extremities: normal → elevate
foot
Upper extremities /anasarca
(generalized edema)/periorbital:
abnormal. Sign of PIH:
pregnancy-induced hypertension
– varicosities of lower extremities/varicose
veins: tortuous veins/vein enlargement ←
pooling of circulation in lower extremity →
elevate
Homan’s sign: triggered by
dorsiflexion of foot→ pain in calf
muscle → (+) → thrombus formation
→ DONT massage, blood clot will
dislodge → elevate
– DVT: deep vein thrombosis
Virchow’s triad:
Venoustasis→ anti-embolic stockings
Venal wall damage→
Vlood coagulation
GASTROINTESTINAL CHANGES
– morning sickness: hypoglycemia in the
morning (continuous getting of glucose of
fetus at night) →simble carbohydrates:
crackers/dry toast → before getting out of bed
– hyperemesis gravida → excessive vomitting
→ SFF: small frequent feeding
– constipation & flatulence → high fiber diet +
↑ OFI (oral fluid intake) → stimulate
peristalsis
– hemorrhoids→↑ intraanal pressure →
bulging veins in anal area
Internal: asymptomatic
External: painful
***warm sitz bath/witch hazel
(astringent/ vesicant)
– heartburn: chest pain→ HCL reflux→ (SFF)
OBSTETRICS
RESPIRATORY SYSTEM CHANGES
– SOB→ gravid uterus → inadequate lung
expansion
URINARY SYSTEM CHANGES
→ inc urinary freq (compression of bladder by
gravid uterus)
→ dec urinary threshold
MUSCOSKELETAL SYSTEM CHANGES
→ lordosis (pride of pregnancy) → loss of
balance→safety
→ leg cramps/backpain→ rest/elevate
Temperature→ increased → ↑BMR (basal
metabolic rate), to suffice for the growing
fetus
Adrenal Glands: inc activity(inc glucose prod.
→ suffice fetus)
Skin changes:
– melasma/chloasma: mask pregnancy (face
and neck)
– linea nigra: blackish ine in abdomen during
pregnancy→ linea alba: whitish line after
– striae gravidarum→ cocoa butter:minimize
scarring
Uterus:
– hegar’s sign: thinning of uterus
Cervix:
– goodell’s sign: softening of cervix
Vagina:
– chadwick’s sign: purplish/bluish
discoloration of vagina. No management.
Only temporary
– vaginal pH: slightly acidic (normal: 5.5-6.5)
→ Protects vagina from certain infection
** UTI→ preterm labor
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 TRICIA JESHIEL P. TORRES, RN OBSTETRICS

FETAL DIAGNOSTIC PROCEDURES

Amniocentesis: amniotic fluid sample
AFP (Alpha FetoProtein)
Increased: neural tube defects:
hydrocephalus, menigocele,
anencephaly
Dec.: down’s syndrome/trisomy 21

PREGNANCY DIAGNOSTIC PROCEDURES

Ultrasound
STAGES OF FETAL DEVELOPMENT Purpose
– diagnose
Fertilization (ampulla) → implantation – confirms sex
(uterus/upper uterine segment) → – confirm growth & abnormalities
** implantation in lower uterine segment: – fetal maturity (AOG)
placenta previa Types:
– transvaginal: early pregnancy, empty
bladder
Conceptus Period
– abdominal: late pregnancy, drink water →
Ovum Ovulation→ easier visualization
fertilization

Zygote Fertilization→
imPLANTation

Embryo Implantation→ eight

weeks

Fetus 8 weeks → Full term

Amniotic Fluid LEOPOLD’S MANEUVER

– protection – palpation → empty bladder
– temperature regulation
– supports growth 1st
– fetal movement – fundal grip→ presentation (cephalic,
breech, transverse, footling)
Umbilical cord
– AVA: normal 2nd
– VAV: abnormal→ congenital heart defects – umbilical grip → fetal back (PMI: point of
– wharton’s jelly: protective covering of maximum impulse), FHT is most audible
umbilical cord
3rd
– Pawlick’s grip → engagement→ stations
-3 floating (above ischial spine)
-2 floating (above ischial spine)
-1
0 engaged → at the level
+1
+2 crowning (below ischial spine)
+3 crowning (below ischial spine)

4th
– pelvic grip→attitude/fetal lie(degree of
flexion & extension of fetus)

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 TRICIA JESHIEL P. TORRES, RN OBSTETRICS

Psyche: overall status of mother (physical,

emotional, psychological)

Clean catch urine

FALSE LABOR
– method of collecting urine sample
– remain irregular
First stream: discard (contaminated)
– confined in abdomen
Second stream/middle: use
– no increase in frequency, duration, interval
– purpose: detects UTI
– relieved by ambulation
– absent cervical changes / no cervical
Discomforts of pregnancy
dilatation and effacement
– nausea & vomiting → SFF/dry
crackers/toast
TRUE LABOR
– breast tenderness → supportive bra (firm
– regular and predictable
fitting)
– pain in lower back to abdomen
– ptyalism (excessive salivation) →
– increased frequency, duration, shortened
mouthwash, gum, hard candy
interval
– ankle edema → elevate/no prolonged
– not relieved by ambulation
standing
– with cervical dilatation and effacement/with
– backache: low heeled shoes with grip
cervical changes
– constipation→ high fiber diet, OFI
– bloody show/mucus plug erxpulsion
– heartburn → SFF
– rupture of BOW (bag of water)
– hemorrhoids: warm sitz bath + witch hazel
– SOB→pillows, left lateral position (prevents
orthostatic hypotension/venacava syndrome)
– travelling: every 2-3 hrs, rest for 15-20 mins

1. DILATATION STAGE
3 phases:
Latent: 0-3cm, mother able to communicate
(health teachings)
Components of Labor Active: 4-7cm, inc frequency, duration,
shortened interval, mother loses self-control,
Passenger: fetus FOCUS: Pain
Passageway: pelvis(main), cervix, vagina Transition: 8-10cm, fully dilated and fully
**Cephalopelvic disproportion (CPD)→ CS effaced, transfer mother froim labor room to
Power delivery room
Primary: uterine contraction, stronger
Secondary: bearing down

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 TRICIA JESHIEL P. TORRES, RN
2. EXPULSION STAGE/FETAL EXPULSION
Mechanisms of labor:
Descent: feal head goes down to maternal
pelvis(engagement)
Flexion: preparation of fetal head to pass the
cervix
Internal Rotation: actual passage of fetal
head to cervix
Extension: expulsion of fetal head
External Rotation: expulsion of fetal
shoulders (lack of external rotation: shoulder
dystocia)
Expulsion: expulsion of the whole fetus
3. PLACENTAL STAGE
3 signs of placental separation
– lengthening of the cord
– sudden gush of blood
– Culkin’s sign: uterus becomes firm and
globular (well contracted)
** uterus not well contracted (soft and boggy)
→ bleeding → massage uterus, give oxytocin
** uterus dislodge to the right (full bladder) →
encourage to urinate/catheter
**if given oxytocin, uterus doesn't contract →
re-clean uterus, placental fragments
** uterus well contracted, but there’s bleeding
→ perineal laceration
OBSTETRICS
Types of placenta
Schultze : S-hiny
Duncan: D-irty/meaty (risky: higher chance of
placental fragment retention
** count cotyledons: 20-30
4. RECOVERY AND BONDING/POST
PARTUM
– first 1-4hrs after delivery
– most critical stage, rapid deterioration of
mother, continuous monitoring
Considerations:
– assess fundus (firm and globular)
– lochia
Rubra: 0-3 days, reddish
Serosa: 4-9 day, pinkish to brownish
Alba : 10th day to 6 wks, whitish →
normal involution: return of the organs
to the non-pregnant state
– bladder: empty
– perineum: s/sx of infection
– lactation
Oxytocin: milk ejection/milk letdown →
uterine contraction
Prolactin: milk production
– blood pressure: s/sx of shock →
hypotension, tachycardia, tachypnea
– blood loss
NSD: 500ml
CS: 800-1000ml
EPISIOTOMY/EPISIORRAPHY AND
PERINEAL CARE
– ice pack: stop bleeding (first 24 hrs)
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 TRICIA JESHIEL P. TORRES, RN OBSTETRICS

– warm sitz bath: healing (after 24 hrs) MANAGEMENT:

– witch hazel: hemorrhoids 1. Cervical Cerclage
– use cotton underwear (absorbent) - prevent 2. Vaginal rest
infection 3. Prepare for child birth if with rupture of
membranes
** cleaning of perineum: single stroke then
discard. Front to back.
ABRUPTIO PLACENTA
– increase fiber and OFI: prevent - Premature separation of the placenta after 20th
constipation/ encouraging early ambulation week of AOG
– sexual activity
Vaginal bleeding stopped MANIFESTATIONS:
episiotomy/episiorraphy is healed (6 1. painful, dark red vaginal bleeding
weeks) TOXEMIA/PIH
• GESTATIONAL HYPERTENSION
HANDOUT BY SIR ARCHIE ALVIZ • CHRONIC HYPERTENSION • PIH
MATERNAL COMPLICATIONS - triad: hypertension, edema, albuminuria
ANTEPARTUM COMPLICATIONS A. Mild Pre-Eclampsia
ABORTION B. Severe Pre-Eclampsia
▪ Threatened ▪ Imminent ▪ Therapeutic C. Eclampsia
▪ Missed
HEMOLYTIC DISEASE OF THE NEWBORN
MANAGEMENT: - Rh incompalibility
• CBR 12-24 hrs DIAGNOSTICS:
• D and C 1. Amniocentesis – measures bilirubin in amniotic
fluid
HYDATIDIFORM MOLE 2. Direct Coomb’s test – measures Rh antigen in
• Aka Gestational Trophoblastic Disease the baby
• No fetus, no amniotic sac, no blood vessels 3. Indirect Coomb’s test – measures Rh antibody
in the maternal circulation
Manifestations:
• High levels of HCG MANAGEMENT:
• rapid increase in fundic height Rhogam administration:
1. At 28 weeks AOG
Interventions: 2. Within 72 hours after birth
• D & C • Use of methotrexate INTRAPARTUM COMPLICATIONS
PREMATURE RUPTURE OF MEMBRANES
ECTOPIC PREGNANCY
Common sites: fallopian tube, ovary, cervix, MANIFESTATIONS:
peritoneal cavity - Amniotic fluid gushing into the vagina
- Fetal tachycardia
Manifestations:
▪ severe sharp stabbing knifelike abdominal pain MANAGEMENT;
▪ spotting 1. minimize IE
▪ (+) Cullen’s Sign – means RUPTURE 2. Assess for signs of infection
▪ Cushing’s Triad
CAESARIAN BIRTH TYPES:
Interventions: 1. Classic or vertical
▪ Combat SHOCK 2. Transverse or Pfannenstial
▪ Elevate foot of bed
Factors leading to CS
INCOMPETENT CERVICAL OS 1. CPD
• painless cervical dilatation os without 2. Herpes
contractions 3. Previous cs
• 20th week of AOG 4. Hypertension or heart disease
5. Placenta previa
MANIFESTATIONS: 6. Abruption placenta
1. Cervical dilation 7. Transverse lie
2. Prolapse of the membranes 8. Fetal distress
9. macrosomia

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 TRICIA JESHIEL P. TORRES, RN
OB PRE TEST
PRETEST
1. Juday has been experiencing regular,
coordinated contractions with cervical dilation
moving from 4 cm to 6 cm in the last half, and
her membranes are still intact. Juday is in
which of the following stages of labor?
A. Latent phase of the second stage of labor
B. Active phase of the first stage of labor
C. Placental stage or the third stage of labor
D. Predelivery stage or the prelabor stage of
labor
2. Lhia is admitted in active labor. The
nurse locates fetal heart sounds in the upper
left quadrant of her abdomen. The nurse
recognizes which of the following?
A. Lhia will probably deliver very quickly and
without problems.
B. This indicates Lhia will probably have a
breech delivery.
C. The fetus is in the most common anterior
fetal position.
D. This position is referred to as being left
anteropelvic.
3. After the third stage of labor, the nurse
may have which of the following
responsibilities?
A. Administration of intramuscular oxytocin to
facilitate uterine contractility.
B. Monitoring for blood loss greater than 60
cc, which would indicate gross hemorrhage.
C. Noting if the placenta makes a Schultze
presentation, which is a sign of gross
complication.
D. Pushing down on the relaxed uterus to aid
in the removal of the placenta
4. Which action of the following instructions
to a child would be most appropriate before a
painful procedure?
A. “Do not tell the child anything, just proceed
with the procedure.
B. “This won’t hurt at all.”
C. “This is going to hurt.”
D. “Would you like t help me?”
5. Which method would be helpful when
administering liquid medication to a
preschool-aged child?
OBSTETRICS
A. Ask the child if he/she would like to take
the medication from a cup or spoon.
B. Give the child a drop or two of liquid over
an hour top help prevent spitting it out.
C. Tell the child the medicine is sweet candy
syrup that he/she will like.
D. Tell the child firmly to take the medicine.
6. After a tubal ligation, it is not uncommon
for the woman to complain of:
A. shoulder pain.
B. hemorrhoids.
C. leg pain.
D. breast tenderness.
7. When examining a postpartal woman,
the nurse should immediately report:
A. a fundus that is palpated 2 cm below the
umbilicus on the second postpartal day.
B. a fundus that cannot be located by
palpation on the ninth postpartal day.
C. a soft, spongy uterine fundus noted during
the first four hour postpartum.
D. red, bloody vaginal discharge on the
perineal pad on the first day postpartum..
8. Which of the following clinical practices
is appropriate to solicit initial respiration of the
high-risk newborn?
A. Rubbing the back
B. Spanking the buttocks
C. Slapping the face
D. Squeezing the thorax
9. On the third hospital day in the nursery,
Mr. and Mrs. Smith’s newborn baby girl Rhian
is diagnosed with Rh incompatibility. Mrs.
Smith is a gravida 2, para 1, abortion 1. This
disease causes blood cell hemolysis that is
probably directly due to
A. the exchange of fetal and maternal blood
in the utero
B. Rh positive fetus and Rh positive father
C. Rh negative mother, Rh positive father
D. the sin of the abortion of the first child
10. Baby girl Luisa was born large for
gestational age. After being delivered
vaginally, this infant should be carefully
assessed for:
A. increased intracranial pressure
B. hypothermia
C. decreased red blood levels (anemia)
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 TRICIA JESHIEL P. TORRES, RN OBSTETRICS

D. hyperglycemia

11. Which of the following should the

examiner do to assess for scoliosis?
A. Assist the child to look in a mirror for
characteristic curing.
B. Have the child place the chin on the chest,
place hands together, bend over, and let the
hands hang freely.
C. Have the child turn sideways, and look for
bulging in the thoracic region.
D. Palpate the spine for indentation in the
lower back.

12. During an episode of somnambulism, it

would be appropriate for the nurse to:
A. ask the child what he/she is doing
B. immediately wake the child.
C. pull the child back to bed.
D. observe for safety measures to avoid
injury.

13. Which instruction should the nurse

provide the adolescent who is experiencing
acne?
A. Avoid chocolate in the diet.
B. Inspect skin for adverse reactions to
treatment.
C. Pop pimples only when they are white with
pus.
D. Scrub skin twice a day with prescribed
medication.

14. Which of the following is an inappropriate

technique to use when giving a back rub?
A. Long, even upward strokes
B. Tapping lightly with the edge of the hand
C. Firm scratching motion
D. Application of lotion

15. You are giving a parenting class. You will

discuss which of the following with the
parents of Dora, a 2-year old child?
A. Dora can be expected to be cooperative
and easily cooperative and easily controlled
at this stage of development.
B. Dora may prefer finger foods and clothing
she can put on without assistance at this age.
C. Expect Dora to want to be held and
cuddled a great deal at this stage of her
development.
D. At this age, Dora will take the initiative in
activities and will question everything.

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 TRICIA JESHIEL P. TORRES, RN OBSTETRICS

OB POST-TEST
7. The client begins to question the nurse
1. Which drug category may be safely about sexuality and becoming sexually active.
administered during pregnancy? During sexual counseling, the nurse should
A. Category A place a major point of emphasis on:
B. Category B A. douching after sexual intercourse.
C. Category C B. sex during menstruation.
D. Category D C. performing Kegsl exercises.
D. safe and responsible sex.
2. Which of the following is a positive
indication of pregnancy? 8. Using Naegle’s Rule, calculate the
A. Quickening estimate date of delivery if the woman’s LMP
B. Chadwick’s sign was October 1.
C. Auscultation of fetal heart sounds A. June 23
D. Ballottement B. July 8
C. December 23
3. During the last months of pregnancy, the D. January 8
nurse should instruct the client to:
A. rest on her left side for at least 1 hour in
the morning and afternoon
B. sleep on her back during the night and
during naps
C. start nipple exercises and stimulation twice
9. Which of the following would be
a day
appropriate to teach the pregnant woman
D. start to cut back on water intake,
regarding exercise?
especially at night
A. Avoid any physical activity during the
second trimester
4. When teaching a pregnant woman about
B. Contact sports are allowed during the first
traveling during the pregnancy, it is important
trimester
to focus on which of the following?
C. Extremely active women should reduce
A. If traveling by car, stop every 2 hours for
the level of exertion
10 minutes
D. Relaxation and stretching exercises should
B. Get plenty of rest before long trips made in
be discontinued.
automobiles
C. Travel in any type of aircraft is acceptable
10. One of the functions of the amniotic fluid
D. Travel can be completed anytime
is to:
throughout the pregnancy
A. exchange nutrients from mother to fetus
B. immobilize the fetus
5. Which of the following is recommended
C. protect the woman’s uterus
for all women during the childbearing age?
D. regulate temperature
A. Additional B vitamins
B. Additional vitamin A
11. A feeling of ambivalence about the
C. Folic acid supplement
pregnancy is:
D. Vitamin C supplement
A. a sign of unwanted pregnancy
B. normal in early pregnancy
6. An 18-year old girl visits to obtain a
C. rare at any stage of pregnancy
contraceptive. She elected to use the
D. typical in late pregnancy
intrauterine device (IUD) as a method of birth
control. The major concern with the use of the
12. Which assessment relates most directly
IUD is:
to rupture membranes and release of
A. thrombophlebitis.
amniotic fluid?
B. pain on intercourse.
A. Bloody show
C. infection.
B. Fluid with a pH of 7.0 to 7.5 with nitrazine
D. abnormal bleeding and hemorrhage.
test
9
 TRICIA JESHIEL P. TORRES, RN
C. Fluid with a pH of 5.0 with nitrazine test
D. Woman complains of urge to push
13. When the placenta is delivered with
the dull side out (Duncan presentation), the
woman is at risk for:
A. excessive bleeding
B. hemorrhoids
C. increased lacerations of the perineum
D. sterility
14. To assess the uterine contraction
during labor, the nurse:
A. asks the woman if she is having a
contraction.
B. palpates above the symphysis pubis.
C. palpates just below the xyphoid process of
the sternum.
D. performs a sterile vaginal examination.
15. The nurse knows that a postpartum
client’s susceptibility to hemorrhage is most
likely related to a:
A. boggy uterus
B. firm fundus
C. long labor
D. negative Homan’s sign
16. Between 24 and 28 weeks, all pregnant
women should be screened for:
A. Anemia
B. Bladder infections
C. Diabetes
D. Neural tube defects
17. Which of these measures would be
helpful for the pregnant client complaining of
sleeplessness?
A. Eat evening meal close to bedtime
B. Sit in a sitz bath before bedtime
C. Try to remain in one position when
sleeping
D. Use pillows to help find a comfortable
position
18. Why is the first 8 weeks of pregnancy
known as the critical period of human
development?
A. By the time this period ends, the embryo is
completely safe from any damage
B. Many embryos die during this period
C. The infant’s sex is determined at the end
of the eight week
OBSTETRICS
D. The major structures of the embryo are
forming, and damage can result in major birth
defects
19. Which of these statements is most
accurate about the placenta?
A. The blood of the baby mixes with the
mother’s blood to permit exchange of
nutrients and oxygen.
B. The blood of the baby and the mother do
not mix; exchange occurs across blood
vessels and the walls of the villi.
C. The placenta lets the blood from the fetus
cross to the mother, but the mother’s blood
does not cross to the fetus.
D. The placenta serves as a complete barrier
between the baby and mother so that any
drugs the mother takes do not cross the baby.
20. Which of the following is the best
recommendation about taking medicines
during pregnancy?
A. All over-the-counter (OTC) drugs are safe
during pregnancy
B. All herbal preparations are safe during
pregnancy
C. Don’t take anything during pregnancy
without asking your health care provider
D. Take an OTC diuretic if you have swelling
during the pregnancy
21. When providing postpartum teaching
about self-care, one of the danger signs that
a lactating woman should know to report to
the birth attendant is:
A. breast engorgement to a degree that the
baby can’t latch on.
B. breast fullness just before feeding .
C. nipple soreness after feedings.
D. nipple dryness before feedings.
22. “Show” is usually present in:
A. Braxton Hicks contraction.
B. false labor.
C. true labor.
D. Second stage of labor only.
23. APGAR score assessments are
completed at:
A. birth and 10 minutes.
B. 1 and 5 minutes.
C. 5 minutes and upon arrival to the nursery.
D. the time of birth.
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 TRICIA JESHIEL P. TORRES, RN
24. A newborn of 4 hours displays grunting
respirations and a respiratory rate of 70
breaths/minute. The priority nursing
intervention would be to:
A. begin resuscitative measures and call for
help.
B. continue to monitor respiratory status
variations are normal.
C. obtain vital signs every 15 minutes.
D. transfer the newborn to the mother’s room
for feeding.
25. Which measure would be used to
prevent loss of heat in the newborn?
A. Immediately give the baby a bath
B. Place the baby on the mother’s bare
stomach
C. Offer the baby warm glucose water
D. Wrap the baby in room-temperature
blankets
26. Which of the following indicates that the
new mother understands how to handle
breast milk safely?
A. “I can store fresh milk in the refrigerator for
only 24 hours.”
B. “I can store frozen breast milk for up to 1
month.”
C. “I need to express my breast milk into a
clear glass.”
D. “I should never store my breast milk in a
frozen-food locker.”
27. To prevent infection of the perineal area
after delivery, the nurse should instruct the
client to:
A. Begin sitz bath at the first sign of infection
B. Pull panties straight down
C. Use hot water to cleanse the area after
bowel movement
D. Wipe with sweeping motion, from front to
back
28. Analgesics given too late in labor can
result in which of the following?
A. Contractions that increase in intensity
B. Early deceleration
C. FHR dropping to 100 beat per minute
D. Pain during contractions
29. In evaluating the effects if oxytocin after
delivery, the nurse should monitor for:
A. effective breastfeeding.
B. engorged breasts.
OBSTETRICS
C. relief of pain.
D. the uterus remaining firm.
30. During active labor, the mother usually
exhibits which of the following behaviors?
A. Difficulty following directions
B. Excitedness and talkativeness
C. Frustration and irritability
D. Serious expression and apprehension
31. When evaluating the effectiveness of
instruction regarding breastfeeding, which of
the following responses by the mother
indicate that she understands the teaching?
A. “I need to rub my nipples to toughen them
up.”
B. “I should apply lotion to my nipples to
prevent cracking.”
C. “I should nurse at least 10 minutes on one
breast before offering the next breast.”
D. “I should use soap and water to gently
cleanse my breast gently.”
32. Which of the following should the nurse
recommend to the breastfeeding mother to
limit in her diet?
A. Cheese
B. Fruit
C. Strongly flavored foods
D. Vegetables
33. The fontanels are soft spots formed by
the:
A. blood accumulated between the bone and
periosteum.
B. edema of the scalp from birth pressure.
C. junction of individual skull bones.
D. pressure of a vacuum extractor.
34. Signs of respiratory distress in a neonate
include:
A. grunting with expiration.
B. respiratory rate of 50 breaths per minute.
C. synchronized movement of the baby’s
chest and abdomen.
D. the baby’s chest expanding as a whole.
35. The most efficient way for a baby to
regulate temperature is to:
A. burn body fat.
B. move arms and legs.
C. shiver.
D. use brown fat.
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 TRICIA JESHIEL P. TORRES, RN
36. Which measure would be most effective
in preventing the transfer of gonorrhea or
Chlamydia to the infant’s eyes from the
mother?
A. Administering Vitamin K
B. Bathing the newborn
C. Cleaning the infant’s eyes with warm
saline
D. Applying erythromycin ointment
37. A newborn will respond to sudden noises
or jarring movement by throwing out the arms
and drawing up the legs. This is called a:t
A. Moro reflex
B. Babinski reflex
C. Rooting reflex
D. Tonic neck reflex
38. The nurse is caring for a newborn at 12
hours of life. The newborn has just voided.
The most appropriate response by the nurse
would be:
A. immediately check vital signs.
B. notify the physician.
C. continue to monitor voiding patterns.
D. obtain an order for a straight catheter.
39. Which position should newborns be
placed when sleeping?
A. Back
B. Head of bed elevated
C. Prone
D. Side lying with pillow
40. Most babies should be fed:
A. Every 1 to 2 hours
B. Every 2 to 4 hours
C. Every 4 to 6 hours
D. On demand
41. Which of the following drugs can be
given to the mother before a preterm birth to
help reduce the severity of respiratory
distress syndrome?
A. Betamethasone
B. Diazepam
C. Phenobarbital
D. RhoGAM
42. Which intervention is the priority
immediately after the delivery of a newborn
who does not breathe?
A. Clear air passages of obstructive
substances
OBSTETRICS
B. Keep the mother calm
C. Place bulb suction at head of the bed
D. Rub the baby’s back
43. In which position should the newborn
with intracranial hemorrhage be placed?
A. Prone
B. Side-lying
C. Slightly elevated head of bed
D. Supine
44. Which of the following contraceptive
methods also offers protection against
sexually transmitted infections?
A. Abstinence
B. Coitus interruptus
C. Fertility awareness methods
D. Oral contraceptives
45. In teaching the postoperative client who
has just had a vasectomy, it is important to
focus on:
A. asking how his partner feels about the
surgery.
B. alternate methods of expressing sexual
needs and desires
C. discussing that a vasectomy does not
make client less of a man
D. using birth control until sperm counts are
zero for 6 weeks.
46. Which assessment most closely relates
to a diagnosis of ectopic pregnancy?
A. Brownish red, tapioca-like vesicles
B. Elevated temperature
C. Spotting or bleeding 2 to 3 weeks after a
missed menstrual period
D. Sudden absence of fetal movement
47. The drug of choice to treat
pregnancy-induced hypertension is:
A. iron and vitamins
B. diazepam (valium)
C. furosemide (Lasix)
D. magnesium sulfate
48. Which nursing intervention would be
appropriate for a client who has a diastolic
blood pressure of more than 20 mmHg on
the “roll-over” test?
A. Increase intake of oral fluids
B. Rest on left side as much as possible
C. Schedule follow-up care every 2 weeks
D. Use the stairs to increase activity level
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 TRICIA JESHIEL P. TORRES, RN OBSTETRICS

49. A mother receiving medications for

pregnancy-induced hypertension should have
her diastolic blood pressure maintained in the
range of 90 to 100 mmHg to:
A. avoid causing fetal anoxia.
B. ensure progression of labor.
C. prevent premature contractions.
D. present sudden elevations in pulse.

50. Which of the following would be a priority

intervention for a client with the prolapsed
cord?
A. Cover the cord with a dry sterile tower
B. Monitor the mother’s vital signs
C. Place the woman in the Trendelenburg
position
D. Start medication as ordered

13
 TRICIA JESHIEL P. TORRES, RN ENDOCRINE & RESPIRATORY DISORDERS

Date: December 12, 2022

Time: 9AM - 4PM
Concept: RESPI ENDO
Lecturer: PROF. KEITH GARINO

Sir Keith’s Reminders:

Black: normal process
Red:
Blue pen: intervention

Pituitary Gland - anterior & posterior

Anterior Pituitary Gland - TSH, LH, FSH
Anterior: ↓TSH
Growth hormone ↓LH
Thyroid stimulating hormone ↓FSH → amenorrhea
Prolactin
ACTH
LH TSH (Thyroid stimulating hormone) → ↑TG
FSH (thyroid gland)
MSH - Melanocytes stimulating hormone 1. ↑T3 (Triiodothyronine) - ↑metabolism → ↓
weight ↑ appetite
Posterior: - ↑ GIT → diarrhea
Oxytocin - uterine contraction 2. ↑T4 (thyroxine)- ↑heat → heat intolerance
ADH/Vasopressin - for fluid retention & absorption → diaphoresis, sweating
in renal tubules 3. ↑Thyroid hormones → ↑SNS →
hyperactive → restless & irritable
→ ↑ V/S → thyroid storm (usually
affected HR)

Drugs - thioamides * GI irritant, taken with meal

→ methimazole
→ propylthiouracil (PTU)

* GI irritant, taken with meal

* A/E → agranulocytosis (↓ WBC, infection)
→ bleeding

↑ calorie & monitor daily wt

↑ fluid & ↓ fiber
HYPERTHYROIDISM Provide cool environment
↑ thyroid hormone Non-stimulating environment
Common cause - grave’s disease → autoimmune Thyroid storm → report
→ hyperactive thyroid gland Surgery: thyroidectomy
Appearance SUMMARY:
Inflammation → fat pads behind eyes → grave’s All increased except wt, menstruation, & FSH
ophthalmopathy: exophthalmos (bulging of the
eyeball) → can't blink eyes
Dryness → eye drops
Sun → sunglasses
Sleep → tape/eye patch

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 TRICIA JESHIEL P. TORRES, RN ENDOCRINE & RESPIRATORY DISORDERS

→ ↑absorption → empty stomach

→ taken in the morning
→ A/E or S/E→ “hyperthyroidism”

↓ calorie
↑ fluids↑ fiber
Warm environment
Assess LOC & avoid sedatives

HYPOTHYROIDISM
↓thyroid hormones

Adults - myxedema → puffiness of face

→ assess facial features
→ “ABC”

Children - cretinism (mental reatrdation)

Cause:
Hashimoto’s disease
→ autoimmune → destroy thyroid gland

ADRENAL GLANDS - APG

→ACTH - adrenal cortex
All decreased except wt & TSH →MSH - skin → melanin
SSS - sugar, salt, sex
APG
Adrenal Cortex - “steroids”
↑TSH
Glucocorticoids
TG → cortisol → natural release: morning
→ anti-inflammatory → ↓ immunity
1. ↓T3 ↓metabolism ↑wt ↓appetite → “stress”
(anorexia) → ↑ glucose
→ ↓ GIT → constioation → breaks down protein & bones
2. ↓T4 → heat → cold intolerance
3. ↓ Thyroid hormones → SNS → Mineralocorticoids
hypoactive →aldosterone → Na & H2O (reabsorption)
↓ V/S →↓K

Androgen (sex characteristics)

Drug: levothyroxine (thyroid hormone) → “for life” → testosterone
→ estrogen
2
 TRICIA JESHIEL P. TORRES, RN ENDOCRINE & RESPIRATORY DISORDERS

→ cardiac dysrhythmia - check V/S (HR)

↑ Androgen
↑ Testosterone - female → virilization → hirsutism
& amenorrhea
↑ Estrogen - male → feminization →
gynecomastia
*altered body image → allow px to verbalize
feelings

DRUGS:
MMK ↓ steroid prod.
Mitotane
Metyrapone
CUSHING’S SYNDROME Ketoconazole
↑ GMA

Cause:
Adrenal adenoma → adrenalectomy
Prolonged steroid therapy

↑Cortisol
Increases glucose - hyperglycemia
↑ insulin → ↑ fats → moon face
→ dorsocervical - buffalo hump
→ truncal/central obesity

↑Breakdown of protein
→ skin → thin w/ easy bruising
→ stretchmarks or strea
→ ext. → thin peripheral
→ bones are weak
ADDISON’S DISEASE
Adrenal insufficiency
→ auto immune → destroy → adrenal cortex →
↓ cortisol & ↑ aldosterone

Imunosuppressive action - ↑infection APG

INTERVENTIONS: ↑ACTH & ↑MSH

Avoid stress
Monitor blood glucose & avoid sweets A. Cortex skin
Avoid crowded places & ill person
↓Steroids ↑ melanin (Bronze skin)

↑ Aldosterone - hyperaldosteronism
* all decreased except bronze skin, ACTH & K
→ ↑Na - hypernatremia - ↓ Na diet (avoid salty
foods)
↓ Cortisol → ↓ glucose → monitor
→ ↑H2O - fluid volume excess - fluid restriction
→ ↓ coping mech. - stress, avoid
→ ↓K - hypokalemia - ↑ K diet
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 TRICIA JESHIEL P. TORRES, RN ENDOCRINE & RESPIRATORY DISORDERS

Urine specific gravity

Aldosterone → ↓ Na → ↑ Na diet →increase & concentrated
→ ↓ H2O - FUD → fluid replace
→ ↑ K → ↓K diet Drugs: Declomycin → blocks ADH
Removal of tumor
Drugs: Fluid restriction & check daily weight
Check I&O
Corticosteroids - “for life” Diuretics except Thiazide. causes opposite effects
→ GI irritants - w/ meal
→ immunosuppresant ↑ infection

DIABETES INSIPIDUS

Trauma/ Surgery (head)

↓ ADH → neurogenic
Damaged kidney → nephrogenic
↓ fluid retention → FUD → polydipsia
↑ urine (polyuria) ↓ USG, diluted

For Neurogenic: Drug: vasopressin (desmopressin)

→ A/E water intoxication
→ fluid intake

For nephrogenic: Drug: thiazide, clofibrate &

Anti Diuretic Hormone normal function chlorpropamide

↓fluids → posterior pituitary gland release Monitor daily weight & I&O
↓
ADH
↓
Kidneys → fluid retention
↓
↓ urine output

Syndrome of inappropriate antidiuretic hormone

secretion (SIADH)

Tumors → ↑ ADH

Kidneys → ↑ fluid retention → FVE →

delusional ↓Na → cerebral edema DIABETES MELLITUS

↓ urine Chronic disorder of carbohydrate, fat and protein

Oliguria Cause is unknown
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 TRICIA JESHIEL P. TORRES, RN ENDOCRINE & RESPIRATORY DISORDERS

1. Fasting blood sugar

Predisposing factors: → NPO 8-10hrs
Stress → ↑ cortisol ↑ glucose → normal: 70-110 mg/dL
Heredity
Obesity ↑ fats → insulin resistance 2. Capillary blood glucose
Autoimmune - destroy pancreas → B cell ↓ insulin → normal: 80-120 mg/dL
→ self-monitoring → report if 250mg/dL,
risk for DKA

3. Glycosylated hemoglobin (HGBA1C)

→ blood sugar for past 3 months
→ normal: 4-6%. DM goal: <7%

Types:

DM1 DM2

Juvenile onsite Adult onset

Thin Obese
↓ insulin Insulin resistance
Diabetic keto acidosis hyperosmolar
hyperglycemic
Mgt. DIE non-ketotic syndrome DM1
Diet → complex carbs
Insulin → primary Mgt. DIE OHA Glucose → insulin → cell
meds. Diet → hyperosmolarity
Exercise → moderate Insulin → ↑ viscosity → poor circulation
3-5x/wk Exercise ↓
S/E → hypogly Complication
→ eat prior exer. Oral hypoglycemic → hyperglycemia
agents → primary ↓
meds. Kidney
→SGLT2
→ glucose reabsorption (200mg/dL)
→ exceed → glycosuria →
Strenuous exercise → ↑ cortisol ↑ glucose
attracts h2o →polyuria → FVD →
polydipsia

→→→ cell → starvation → polyphagia

No insulin → breakdown of protein → thin
→ fats → ↑ ketones → DKA
→ lungs - fruity odor
→ kidney - ketonuria
→ brain - ↓ LOC

→→→ DKA → Metabolic Acidosis → ↓PH &

↓HCO3 ↓
Compensatory: lungs
→hyperventilation
DIAGNOSTIC TESTS →deep labored breathing

5
 TRICIA JESHIEL P. TORRES, RN ENDOCRINE & RESPIRATORY DISORDERS

→kussmaul’s respiration → avoid exercise, massage,

warm application

* lipodystrophy - hardening of subq

→ prevention - reuse of site after 2-3wks
→ distance: 1-1 ½ inch
→ room temperature
→ storage of unopened: ref
→ rotation of site

DM2

HYPOGLYCEMIA
Blood glucose below 60mg/dL

DKA & HHNS “Hunger” → neuro & SNS

Cause: stress ↑ cortisol ↑ glucose S/S

→ infection Sweating → SNS
→ surgery Tremors → Neuro
→ trauma Light headedness → neuro
Tachycardia → SNS
Mgt.
1. IV NSS → improve circulation Mgt
2. IV regular insulin Give 15-30g of fast acting carbohydrates
→“15-15 rule” 3x
Hard candy, 4tsp of sugar, ½ fruit juice or soda,
low-fat milk
In unconscious - give glucagon

INSULIN
Route: Subq → 45-90 degrees angle
→ thin: 45-60 degrees
→ insulin syringe: gauge 27-29 ½ inch
→ units
→ area: abdomen ↑ absorption
→ thigh, buttocks. Upper arm

6
 TRICIA JESHIEL P. TORRES, RN ENDOCRINE & RESPIRATORY DISORDERS

Date: December 12, 2022

Time: 9AM - 4PM
Concept: RESPI ENDO CHRONIC OBSTRUCTIVE PULMONARY
Lecturer: PROF. KEITH GARINO DISEASE

Types
1. Emphysema - the presence of
ASTHMA over-distended and non-functional
Problem with the airway, not breathing alveoli
Cause:
1. Extrinsic - allergens ↑ air trapped in alveoli → trapping → barrel
2. Intrinsic - temperature, stress, chest → ↑anterior-posterior diameter
exercise 2. Chronic bronchitis - productive cough
that lasts 3 months in each of 2
consecutive years, in a patient in
whom other causes of cough are
excluded

Cause:
1. Smoking
2. Environmental
3. Genetics - Alpha-1 Antitrypsin
Deficiency (AATD)
→ macrophage destroys elastin &
collagen → ↓ elasticity of lungs

Metered dose inhaler

Doctor’s order will be by puff
1. Shake
2. Press & inhale at the same time
→ use a spacer to ↑ absorption
3. Hold breath to ↑ absorption 10 secs.

7
 TRICIA JESHIEL P. TORRES, RN ENDOCRINE & RESPIRATORY DISORDERS

ALVEOLI FUNCTION Injury →↑permeability→fluid shifting in alveoli

→↑fluids ↑ hypoxemia
Normal: + gas exchange
COPD: - gas exchange → vasoconstriction Injury → type 2 cells →↓surfactant→ lung
→ ↓ blood flow collapse → atelectasis (lung collapse)
→ ↑ pressure (pulmonary
hypertension) Injury → healing → fibrotic → ↓ elasticity →
↓ lung compliance

Acute Respiratory Distress Syndrome

(ARDS)
- a form of acute respiratory failure that
occurs as a compilation of some other
condition; caused by a diffuse lung injury and
leads to extravascular lung fluid

8
 TRICIA JESHIEL P. TORRES, RN ENDOCRINE & RESPIRATORY DISORDERS

RESPI ENDO PRE TEST 7. Which of the following disorders which is

1. Which of the following statements best describe characterized by hyperglycemia due to a decreased in
Cushing Syndrome? secretion of insulin by the pancreas?
A. A group of sign and symptoms which is caused by an A. Diabetes type 1
increase in cortisol in the body. B. Diabetes type 2
B. A group of sign and symptoms which is caused by a C. Diabetes Insipidus
decrease in cortisol in the body. D. Gestational Diabetes
C. A group of sign and symptoms which is caused by a
decrease in melanin in the body. 8. Which of the following would a client experience
D. A group of sign and symptoms which is caused by when there is an excessive glucose in the blood?
an increase in melanin in the body. A. Anuria
B. Oliguria
2. Which of the following statements is true about C. Polydipsia
syndrome of inappropriate anti-diuretic hormone D. Diaphoresis
secretion (SIADH)?
A. It is characterized by an excessive water retention in 9. A client with asthma has pronounced wheezing upon
the renal tubules. auscultation. Suspecting an impending asthma attack, a
B. It is characterized by a decrease in water retention in nurse should:
the renal tubules. A. have the client cough and deep breathe.
C. It is characterized by a decrease in blood calcium B. prepare to intubate the client.
levels. C. prepare to administer a nebulized beta-2 adrenergic
D. It is characterized by an increase in blood calcium agonist.
levels. D. have the client lay on his or her right side

3. Which of the following signs and symptoms would 10. A client, newly diagnosed with asthma is preparing
you expect in a client with diabetes insipidus? for discharge. Which point should a nurse emphasize
A. Polyuria during the client’s teaching?
B. Concentrated urine A. Contact care provider only if nighttime wheezing
C. Fluid volume excess becomes a concern
D. Increase in body weight B. Limit exposure to sources that trigger an attack
C. Use peak flow meter only if symptoms are worsening
4. Which of the following disorders where a client may D. Use inhaled steroid medication as a rescue inhaler
experience exophthalmos?
A. Hypothyroidism 11. Which finding should a nurse expect when
B. Hyperthyroidism completing an assessment on a client with chronic
C. Hyperparathyroidism bronchitis?
D. Hypoparathyroidism A. Minimal sputum with cough
B. Pink, frothy sputum
5. Which of the following medications is given to client C. Barrel chest
with hypothyroidism? D. Stridor on expiration
A. Levothyroxine
B. Propylthiouracil 12. A home health nurse is visiting a client whose
C. Lugol’s solution chronic bronchitis has recently worsened. Which
D. Saturated Solution of Potassium Iodide instruction should the nurse reinforce with this client?
A. Increase amount of bedrest
6. All the following symptoms may be experienced by a B. Increase fluid intake
client who has Addison’s disease except: C. Decrease caloric intake
A. Hyperglycemia D. Reduce home oxygen use
B. Hyponatremia
C. Hyperkalemia 13. Following an unrestrained motor vehicle crash, a
D. Weight loss client presents to an emergency department with
multiple injuries, including chest trauma. A physician
notifies the care team that the client has progressed to
acute respiratory distress syndrome (ARDS) and

9
 TRICIA JESHIEL P. TORRES, RN ENDOCRINE & RESPIRATORY DISORDERS

requests that the family be updated on the client’s

condition. The nurse should plan to discuss with the
family that:
A. the condition generally stabilizes with positive
prognosis.
B. the client can be discharged with home oxygen.
C. the condition is always fatal.
D. the condition is highly life-threatening and that
end-of-life concerns should be addressed.

14. A nurse observes for early manifestations of acute

respiratory distress syndrome (ARDS) in a client being
treated for smoke inhalation. Which signs indicates the
possible onset of ARDS in this client?
A. Cough with blood-tinged sputum and respiratory
alkalosis
B. Decrease in both white and red blood cell counts
C. Diaphoresis and low SaO2 unresponsive to
increased oxygen administration
D. Hypertension and elevated PaO2

15. A client learning about chronic obstructive

pulmonary disease self-care at a community health
class, asks a nurse why the participants are being
taught about the “lip-breathing.” The nurse should
respond by explaining that pursed-lip breathing can
help to:
A. reduce upper airway inflammation.
B. reduce anxiety through humor.
C. expel trapped carbon dioxide
D. increase effectiveness of inhaled medication

10
 TRICIA JESHIEL P. TORRES, RN
RESPI ENDO POST TESTS
1. Which of these signs suggests that a male
client with the syndrome of inappropriate
antidiuretic hormone (SIADH) secretion is
experiencing complications?
A. Tetanic contractions - no connect
B. Neck vein distention
C. Weight loss - D.I
D. Polyuria - D.I
2. A male client is admitted for treatment of
the syndrome of inappropriate antidiuretic
hormone (SIADH). Which nursing intervention
is appropriate?
A. Infusing I.V. fluids rapidly as ordered -
B. Encouraging increased oral intake
C. Restricting fluids - FVE the PROBLEM
D. Administering glucose-containing I.V. fluids
as ordered
3. Which outcome indicates that treatment of
a male client with diabetes insipidus has been
effective?
A. Fluid intake is less than 2,500 ml/day. -
normal
B. Urine output measures more than 200
ml/hour. - polyuria
C. Blood pressure is 90/50 mm Hg. - low
D. The heart rate is 126 beats/minute. -high
4. The nurse is developing a teaching plan for
a male client diagnosed with diabetes
insipidus. The nurse should include
information about which hormone lacking in
clients with diabetes insipidus?
A. antidiuretic hormone (ADH).
B. thyroid-stimulating hormone (TSH).
C. follicle-stimulating hormone (FSH).
D. luteinizing hormone (LH).
5. The client is diagnosed of having
hyperthyroidism (Graves’ disease). Which of
the following is a drug of choice for his
condition?
A. Furosemide (Lasix) -FVE
B. Digoxin (Lanoxin)-HF
C. Propranolol (Inderal)-hypertension
D. Propylthiouracil (PTU)
6. The nurse is caring for a patient with a
diagnosis of hypothyroidism. Which nursing
diagnosis should the nurse most seriously
consider when analyzing the needs of the
patient?
ENDOCRINE & RESPIRATORY DISORDERS
A. High risk for aspiration related to severe
vomiting
B. Diarrhea related to increased peristalsis -
hyperthyroidism
C. Hypothermia related to slowed
metabolic rate - ↓T3 & T4
D. Oral mucous membrane, altered related to
disease process
7. The nurse should expect a client with
hypothyroidism to report which health
concerns?
A. Increased appetite and weight loss -
hyperthy
B. Puffiness of the face and hands -
myxedema
C. Nervousness and tremors - hyper
D. Thyroid gland swelling - hyper
8. The nurse is assessing a client with
possible Cushing’s syndrome. In a client with
Cushing’s syndrome, the nurse would expect
to find:
A. Hypotension.- fve → hypertension
B. Thick, coarse skin. → breakdown of
protein → thin
C. Deposits of adipose tissue in the trunk
and dorsocervical area. - buffalo hump
D. Weight gain in arms and legs. - should be
thin
9. The nurse evaluates no need for further
instruction for self-care for patient with
Cushing syndrome who states:
A. “ I know I should have salt to everything I
eat.” - ↑ Na
B. “ I make a point to avoid excessive
exposure to sun.” - irrelevant
C. “ I avoid to being exposed to anyone
with an infection.”
D. “I am careful to wear well-fitted shoes.” -
DM, foot care
10. A patient has diabetes type 2. The nurse
has taught him about the illness and
evaluates learning has occurred when the
client makes which statement?
A. “My cells have increased their receptors,
but there is enough insulin.”
B. “My peripheral cells have increased
sensitivity to insulin.” - decreased
C. “My beta cells cannot produce enough
insulin for my cells.” - for DM1
11
 TRICIA JESHIEL P. TORRES, RN
D. “My cells cannot use the insulin my
pancreas makes.”
11. A client with a diagnosis of diabetic
ketoacidosis (DKA) is being treated in the ER.
Which finding would a nurse expect to note
as confirming this diagnosis?
A. Elevated blood glucose level and a low
plasma bicarbonate
B. Decreased urine output - polyuria
C. Increased respirations and an increase in
pH - acidosis
D. Comatose state
12. A nurse is preparing a plan of care for a
client with DM who has hyperglycemia. The
priority nursing diagnosis would be:
A. High risk for deficient fluid volume
B. Deficient knowledge: disease process and
treatment
C. Imbalanced nutrition: less than body
requirements = should be more than
D. Disabled family coping: compromised.
13. A nurse is caring for a client admitted to
the ER with DKA. In the acute phase the
priority nursing action is to prepare to:
A. Administer regular insulin
intravenously
B. Administer 5% dextrose intravenously =
no, it contains glucose
C. Correct the acidosis
D. Apply an electrocardiogram monitor.
14. A nurse performs a physical assessment
on a client with type 2 DM. Findings include a
fasting blood glucose of 120mg/dl,
temperature of 101, pulse of 88, respirations
of 22, and a bp of 140/84. Which finding
would be of most concern of the nurse?
A. Pulse
B. BP
C. Respiration
D. Temperature = fever, infection, stress, ↑
cortisol ↑ clucose → HHNS
15. A 39-year-old company driver presents
with shakiness, sweating, anxiety, and
palpitations and tells the nurse he has Type I
Diabetes Mellitus. Which of the follow actions
should the nurse do first? = hypoglycemia
A. Inject 1 mg of glucagon subcutaneously.
B. Administer 50 mL of 50% glucose I.V.
ENDOCRINE & RESPIRATORY DISORDERS
C. Give 4 to 6 oz (118 to 177 mL) of orange
juice. = 15-15 rule
D. Administer insulin
16. Which of this explains why epinephrine is
given to patient having asthma? =
bronchodilator
A. It increases patients output thereby
relieving the patient difficulty of breathing.
B. It dilates the bronchus thereby enable
the patient to breath easily.
C. It loosens mucous secretions of the
patient.
D. It relieves dilation of the bronchus.
17. Which of the following positions would
you place a client who is having an asthmatic
attack?
A. lateral
B. orthopneic
C. dorsal recumbent
D. supine
18. Which of the following assessment
findings would help confirm a diagnosis of
asthma in a client suspected of having the
disorder?
A. Circumoral cyanosis
B. Increased forced expiratory volume
C. Inspiratory and expiratory wheezing =
narrowed airway
D. Normal breath sounds
19. Which of the following types of asthma
involves an acute asthma attack brought on
by an upper respiratory infection?
A. Emotional
B. Extrinsic = allergy
C. Intrinsic
D. Mediated
20. A client with acute asthma showing
inspiratory and expiratory wheezes and a
decreased expiratory volume should be
treated with which of the following classes of
medication right away?
A. Beta-adrenergic blockers = should be
agonist
B. Bronchodilators = fast acting
C. Inhaled steroids
D. Oral steroids
21. Which of the following acid-base
imbalance is present in the early stage of
asthma?
12
 TRICIA JESHIEL P. TORRES, RN
A. Respiratory alkalosis
B. Respiratory acidosis = late stage
C. Metabolic acidosis
D. Metabolic alkalosis
22. A 58-year-old client with a 40-year history
of smoking one to two packs of cigarettes a
day has a chronic cough producing thick
sputum, peripheral edema, and cyanotic nail
beds. Based on this information, he most
likely has which of the following conditions?
A. Adult respiratory distress syndrome
(ARDS) = blue bloaters
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema
23. A 66-year-old client has marked dyspnea
at rest, is thin, and uses accessory muscles
to breathe. He’s tachypneic, with a prolonged
expiratory phase. He has no cough. He leans
forward with his arms braced on his knees to
support his chest and shoulders for breathing.
This client has symptoms of which of the
following respiratory disorders?
A. ARDS
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema
24. Its highly recommended that clients with
asthma, chronic bronchitis, and emphysema
have Pneumovax and flu vaccinations for
which of the following reasons?
A. All clients are recommended to have these
vaccines
B. These vaccines produce bronchodilation
and improve oxygenation.
C. These vaccines help reduce the tachypnea
these clients experience.
D. Respiratory infections can cause
severe hypoxia and possibly death in
these clients.
25. Clients with chronic obstructive bronchitis
are given diuretic therapy. Which of the
following reasons best explains why?
A. Reducing fluid volume reduces oxygen
demand.
B. Reducing fluid volume improves clients’
mobility.
C. Restricting fluid volume reduces sputum
production.
D. Reducing fluid volume improves
respiratory function.
ENDOCRINE & RESPIRATORY DISORDERS
26. A client with emphysema should receive
only 1 to 3 L/minute of oxygen, if needed, or
he may lose his hypoxic drive. Which of the
following statements is correct about hypoxic
drive?
A. The client doesn’t notice he needs to
breathe.
B. The client breathes only when his oxygen
levels climb above a certain point.
C. The client breathes only when his
oxygen levels dip below a certain point.
D. The client breathes only when his carbon
dioxide level dips below a certain point.
27. A nurse is teaching an elderly client about
the importance of using a spacer that is
attached to the inhaler. The nurse should
explain that a spacer:
A. allows for a greater amount of
medication to be delivered.
B. lets the client see the medication as it is
delivered.
C. keeps the mouthpiece sterile.
D. allows for activating the medication
canister by simply inhaling
28. Wich of the following disorders is a
complication of COPD?
A. Pulmonary hypotension = hypertension
B. Cor pulmonale
C. Left sided heart failure = right
D. Emphysema
29. A client was admitted to the hospital 24
hours ago after sustaining blunt chest trauma.
Which earliest clinical manifestation of acute
respiratory distress syndrome (ARDS) should
the nurse monitor for?
A. Cyanosis and pallor
B. Diffuse crackles and rhonchi on chest
auscultation
C. Increase in respiratory rate from 18 to
30 breaths per minute
D. Haziness or “white-out” appearance of
lungs on chest radiograph
30. Which of the following positions would
you place a client who has a diagnosis of
acute respiratory distress syndrome?
A. Supine
B. Trendelenburg
C. High fowler’s
D. Reverse Trendelenburg
13
TRICIA JESHIEL P. TORRES, RN PEDIATRICS

Date: February 20, 2022 hips of patient to prevent

Time: 2-8PM (PEDIA) brain hernation
Concept: PEDIA ■ Mannitol
Lecturer: PROF. ALENI IRAY ○ HOB slightly elevated → drain
CSF
MENINGITIS ○ Monitor VS
● Causative agent: ○ Measure Urine Output
○ Haemophilus Influenza → ■ Because of Mannitol
acute epiglottis ○ Assess LOC → GCS
○ Streptococcus Pneumonae →
Bacterial Viral
pneumonia
○ Neisseria Meningitidis → CHON ↑ >200g/dl <200g/dl
meningitis 15-45 g/dl
● Usually caused by respiratory
Turbidity Turbid Clear
diseases. From lungs to brain.
● Manifestations WBC ↑ 1000-2000 <300
○ Abrupt onset <8cells/μl lymphocyte
○ Fever
○ Chills Glucose ↓ Normal
○ Vomiting →
○ Seizure HYDROCEPHALUS
○ High-pitched crying and
bulging fontanels in younger
children
○ Irritability
○ Nuchal rigidity
○ Opisthtotonic region →
excessive arching of back
○ +Kernig’s Sign → knee, flexion
will cause hamstring muscle
pain = sign of meningococcal
● Choroid Plexus 400-600mL →
irritation
Arachnoid Villi (absorbs)
○ +Brudzinski Sign → nape
● 2-3-4
(batok), flexion will cause
● FAFA
flexion of the knee = sign of
● 2nd lateral ventricles → foramen of
meningococcal irritation
monroe → 3rd lateral ventricles →
● Monroe-Kellie doctrine
aqueduct of Sylvius → 4th lateral
○ 3 things constant in Brain
ventricles → foramen of luschka &
■ CSF
magendi → arachnoid villi
■ Brain volume
■ Intra Cerebral Blood
2 types:
○ Alterations in these ↑ ICP
1. Communicating
● Diagnostic tests
○ from Choroid Plexus
○ L3-L4 lumbar puncture
(CP) to Arachnoid Villi
● Management
(AV)
○ Respiratory isolation
○ Increased production
○ Antibiotic therapy →
of CP
Ceftriaxone (great penetrant
○ Or underabsorption of
from brain barrier)
AV
○ IVF Therapy → isotonic,
2. Non-communicating
0.9NaCl, PNSS
● Manifestations
○ Seizure precaution→dim light
○ Head enlargement
environment, safety, airway,
○ Bulging fontanels
duration of seizure
○ Separated suture lines
○ Control of increased ICP →
○ Dilated scalp vein
avoid unnecessary bending of

1
 TRICIA JESHIEL P. TORRES, RN PEDIATRICS

○ Irritability ○ Translumination → check for

○ Child: crying, irritability fetal lung maturity in 3rd
○ Adult: confusion, trimester
lightheadedness ○ UTZ - locate placenta, locate
● Late signs fetus, locate amniotic fluid
○ Fontal enlargement pools
○ Sunset eyes ● Management
○ Lethargy ○ Prevent damage to the sac
○ Brief, shrill, high pitched cry, ■ Apply sterile, moist
headache non-adherent packs to
● Diagnostic evaluation prevent drying
○ CT SCAN ■ Sac is closely
○ MRI inspectedfor leaks or
○ Xray irritations
● Management ■ Sac must be cleansed
○ Removal of obstructing mass carefully if it becomes
○ Shunting solid
○ Spinal tap ○ Prevent complications
○ Support the head while ■ Prone positions
handling the patient ■ No diapers
○ Position on unoperated side ■ Soft foam
○ Keep child flat on bed ● Short term complication →
meningitis
NEURAL TUBE DEFECT ● Long term complication →
● Folic acid deficiency of pregnant hydrocephalus
mother
● Eggs, peanut, banana, organ meat DOWN SYNDROME
● Types
○ Anencephaly
■ Without a skull
○ Spina Bifida
■ Failure to fuse
■ Occulta - hidden →
Dimpling, tufts of hair
■ Cystica - sac with CSF
■ B1 meningocele - sac
with CSF with
meninges
■ B2 myelomeningocele
- sac with CSFwith
meninges & spinal
cord Physical assessment
● Flat, broad nasal brdige
● Inner epicanthal eye folds
● Upward, outward slanting of eyes
● Protruding tongue
● Short neck
● Simian crease
● Sandal sign
● Cystica - below L2
● Diagnostic evaluation Associated problems
○ Amniocentesin → first ● Cardiac defects
trimester, check for neural ● Respiratory infection
tube defects ● Feeding difficulties
● Delayed developmental skills
● Mental retardation

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 TRICIA JESHIEL P. TORRES, RN PEDIATRICS

○ Provide safe environment

Hemolytic Disease of the Newborn ○ No contact sports
○ Soft bristle toothbrush
RH incompatibility ● Recognize and control bleeding
● 1st 72hrs after delivery give rhogam ●

Erythroblastosis fetalis
● Very yellow baby → hemolysis
Hydrops fetalis
● ↓ O2 carrying cap
● a condition in which large amounts
of fluid build up in a baby's tissues
and organs, causing extensive
swelling (edema).
ABO incompatibility
● Diagnostic evaluation
○ Phototherapy
○ RhoGAM
○ Exchange transfusion
Hemophilia
● Types
○ Factor VIII or hemophilia A
○ Factor IX or hemophilia B
○ Factor XI or hemophilia C
● Manifestations
○ Prolonged bleeding
○ Hemorrhage
○ Easy bruising
○ Hemarthrosis → hallmark sign
○ Spontaneous hematuria →
classic sign
● Replacement of the missing factor
○ Factor VIII concentrate
○ Cryoprecipitate
○ DDVAP or 1-deamino-8-D
arginine
● Prevent bleeding
SICKLE CELL ANEMIA
● Sickle cells that block blood flow to
organs deprive the affected organs of
blood and oxygen. I
● Manifestation
○ Growth retardation
○ Chronic anemia
○ Delayed sexual maturation
○ Marked susceptibility to
sepsis
● Types
○ Vaso-occlusive → dehydration
■ Pain → morphine
sulfate
■ OFI
■ Dont give demerol
○ Sequestration crisis
■ Trapping of blood in
the liver, and pooling
of blood in spleen
■ Blood coming from
the spleen to the
systemic circulation is
lessened
■ Problem: hypovolemia
■ Splenectomy → high
risk for infection
■ Spleen is responsible
for the maturation of
WBC
■ Pneumovax 23
○ Aplastic crisis
■ Decreased RBC
■ Exposure to benzene
○ Hyperhemolytic crisis
■ G6PD deficiency
(glucose-6-phosphate
dehydrogenase) →
maintains the shape of
RBC
■ RBC will burst

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TRICIA JESHIEL P. TORRES, RN PEDIATRICS

● Diagnostic evaluation
○ Sickledex (sickle turbidity test)
■ + turbid
○ HgB electrophoresis
■ Screens abnormal
blood
● Management
○ Bed rest
○ Oral & IV hydration
○ Electrolyte replacement 4. Coarctation of the aorta
○ Analgesic for pain - High bp upper extremities
○ Blood replacement - Low bp distal extremities
○ Antibiotics - Bounding pulse
○ O2 - Signs of arterial insufficiency
○ Exchange transfusion with o2
therapy

CONGENITAL HEART DEFECTS

Acyanotic Heart Defects

1. Atrial septal defects
- Patient may be
asymptomatic
- RV and PA enlarge 5. PuLmonic stenosis
- Bruit in 2nd-3rd Intercostal
Space, left
- May have some cyanosis of
CHF
- Characteristic murmur
- Evident cardiomegaly
- Management: balloon
angioplasty
2. Ventricular septal defect 6. AoRtic stenosis
- CHF - Bruit in 2nd-3rd Intercostal
- Bacterial endocarditis Space, right
- Ventricular hypertrophy - Manifestations
- Decreased CO
- Faint pulses,
hypotension,
tachycardia
- Chest pain
- Characteristic murmur
- Infection

3. Patent ductus arteriosus

CYANOTIC HEART DEFECTS
- May be asymptomatic
1. Tetralogy of Fallot
- Characteristic machinery like
a. Ventricular septal defect
murmur
b. Right ventricular hypertrophy
- Pulmonary vascular
c. Pulmonic stenosis
obstructive disease
d. Overriding of aorta
- Management
● Difficulty with feeding
- Indomethacin
● Failure to thrive
- Surgical ligation
● Episodes of bluish pale skin during
crying
● Exertional dyspnea

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 TRICIA JESHIEL P. TORRES, RN PEDIATRICS

● QRS prolongation may result from - Dopamine → + ino, +chrono

right ventricular dilatation
● Management
○ Palliative
○ Blalock trausig shunt
2. Transposition of the Great Vessel
● Management
○ To provide mixing →
blalock-trausig
● Diagnostic exam
○ ECG
○ Cardiac catheterization
○ ● Salicylates
- Morphine
- Antibiotic
- Antihypertensives
RHEUMATIC HEART FEVER
General manifestations
● Low-grade fever
● Unexplained epistaxis
● Abdominal pain
● Arthalgia without arthritic changes
● Weakness
● Fatigue
Major manifestations
● Carditis
● Migratory polyarthritis
● Chorea
● Subcutaneous nodule
Diagnostic evaluation
● Jones criteria → 2 major / 1 major, 2
minor
● ASO titer
● ESR
Management
● Srict bed rest
● Monitor VS
● Oxygen therapy
● Bed cradle for optimum comfort
● Provide adequate nutrition
Drugs
● Penicillin
● Erythromycin
● Prophylactic treatment

KAWASAKI DISEASE
● Constant fever
● Strawberry tongue

Diagnostic criteria
● Changes in peripheral extremities
● Polymorphous edema
● Bilateral, painless, bulbar
cionjunctival infection without
exudate
Management for Congenital Heart Disease Management
- Positioning ● High doses of IV gamma globulin
- Oxygen therapy ● Salicylate therapy
- Small frequent feedings
- No cnstrictuve clothing CYSTIC FIBROSIS
- Prepare for surgery Manifestations
- Drugs ● All secretions are viscious
- Cardiac glycoside ● Meconium ileus
- Diuretics ● Thich bronchial secretion
- Prostaglandin E ● Increased sweat chlorides
- Indomethacin ● Decreased fertility in females

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 TRICIA JESHIEL P. TORRES, RN PEDIATRICS

● Sterility in males ● Cleft palate - at age 18 months or

Evaluation older
● Iontophoretic pilocarpine test Preoperative care
● Duodenal analysis ● Feed in upright position
Management ● Place child on restraints periodically
● Pulmonary therapy ● Feed with rubber tipped asepto
● Gastrointestinal therapy syringe: small frequent feeding
○ Apple sauce mix with food Post operative care
but not hot ● Application of logan bow
● Aerosol therapy ● Elbow restraints
● Diet: clear liquid
PHENYLKETONURIA ● Prevent crying
Diagnostic evaluation ● Cleanse it free from serosanguinous
● Guthrie test fluid
○ Encourage breastfeedng ● Feed with cups: no bottles
● Phenistix ● Avoid straws, utensils, popsicle sticks,
● Ferric chloride chewing gums
Management ● Prone position/on the sides
● Dietary ● Avoid use of suction on the mouth
● If planning to be pregnant: 3 months ● Application of restraints (elbow and
before conception, no phenylalanine wrist)

ACUTE EPIGLOTTITIS TRACHEOESOPHAGELA FISTULA AND

Manifestation ATRESIA
● High fever ● Fistula - abnormal opening
● Sore throat ● Atresia - abnormal closing
● Dysphagia Manifestations
● Muffled voice, no hoarseness ● Excessive salvation and drooling
● Inspiratory stridor ● 3Cs of TEF: cough, choking, cyanosis
● Drooling ● Apnea
Causative agent ● Respiratory distress
● H. Influenza Diagnostic evaluation
Management ● Aspiration of stomach contents
● Keep child upright ● Radiography of abdomen
● Never use restraints Management
● Never use tongue blades ● Prevent aspiration pneumonia
● Corticosteroids → for inflammation
Hyperthropic pyloric stenosis
LARYNGOTRACHEOBRONCHITIS Manifestations
Manifestations ● Projectile vomiting
● Inspiratoiry stridor ● Non-bilous vomitus
● Suprasternal reractions ● Metabolic alkalosis
● Seal bark cough ● Weight loss
● Progressive hoarseness, followed by ● Palpable olive shaped mass at RUQ
aphonia ● Visible peristaltic movement
● Nasal flaring ● Distended upper abdomen
● Hypoxia ● Signs of dehydrations
● Management ● Constipation
● Corticosteroids Management
● Maintain hydration ● Pyloromyotomy
● Intubation if needed
● Semi fowler;’s position CELIAC DISEASE
Manifestations
CLEFT LIP/PALATE ● Impared fatnutrients absorption
● Surgical correction ● Behavioral changes
● Cleft lip - at age 2 months ● Celiac crisis

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 TRICIA JESHIEL P. TORRES, RN PEDIATRICS

Diagnostic evaluation Acute phase

● Jejunal biopsy ● Hematuria → tea cola urine
Management ● Oliguria-anuria
● No BROW - barley, rye, oat, wheat ● Increased specific gravity
● Proteinuria mild to moderate edema
INTUSSUSCEPTION ● Increased weight
● Manifestations ● Hypertension
● Sudden acute abdominal pain ● Diretic phase
● Passage of red currant jelly like stool ● Decreased weight
● Tender distended abdomen ● Decreased gross hematuria
● Palpable sausage-shaped mass in Diagnostic evaluation
RUQ ● Urinalysis
Diagnostic evaluation ● Increased ASO titer
● Barium enema ● Increased ESR
Management ● + throat culture for group A
● Barium enema Beta-Hemolytic Streptococci
● Pneumatic insufflation
● Laparotomy WILMS TUMOR

HIRSCHPRUNGS DISEASE

Nephroblastoma → capsulated
Agangliomic megacolon No massage
Manifestations No palpation
● Failure to pass meconium
● Reluctance to ingest food Manifestations
● Bile stained vomitus ● Abdominal swelling
● Abdominal distention ● Hematuria
● Foul breath ● Fatigue
● Ribbon-like stool ● Weight losss
● Visible peristalsis ● Fever
● Palpable fecal mass ● If + metastasis symptom of lung
Diagnostic evaluation involvement
● Xray ○ Dyspnea
● Rectal exam ○ Cough
● Rectal biopsy ○ SOB
● Barium enema ○ Chest pain
● Management
ACUTE GLOMERULONEPHRITIS ● Surgery
● Anti-neoplastic agents
○ Vincristine
○ B-interferons
● Diagnostic evaluation
● IV pyelogram

HYPOSPADIAS AND EPISPADIAS

Manifestations
● Abnormal placement of meatus
Manifestations
● Altered coding stream

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TRICIA JESHIEL P. TORRES, RN PEDIATRICS

● Presence of chordee→ cobra like

appearance of penis
Management
● Urethroplasty

LEUKEMIA
Manifestation
● Bleeding tendencies
● Petechiae
● Nosebleeding
● Bleeding gums
● Ecchymoses

RANDOM BULLET POINTS

● Anterior Fontanel closes at 12-18
months
● Posterior Fontanel closes at 2-3
months
● Why only prick an infant, not
puncture → to prevent bone damage
● Fruit to decrease hyperactivity –?
Marang & durian
● Inotropic - something to do with the
force of the heart
● Chronotropic - something to do with
heart rate
● Great imitator - age 3
● 20 temporary teeth - age 2

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 TRICIA JESHIEL P. TORRES, RN PEDIATRICS

PEDIA POST TEST C. Cracking

1. What is the shape of an infant’s anterior D. Redness
fontanel?
A. Oblong 9. The best assessment for spina bifida
B. Triangle occulta is:
C. Diamond A. Sack with CSF
D. Square B. Sack with spinal cord
C. Sack with meninges
2. At what age does a child have a complete D. Dimpling
set of deciduous teeth?
A. 3 yrs old 10. (+)Brudzinski sign is best elicited by:
B. 2 yrs old A. Passively flexing the neck while patient
C. 5 yrs old lies prone results to flexion of knees.
D. 6 yrs old B. Passively flexing the neck while patient
lies to side results to flexion of knees.
3. A child aged 1 and a half years old is best C. Passively flexing the neck while patient
describe by nurse Beverly to be: lies prone results to extension of knees.
A. Having temper tantrums D. Passively flexing the neck while patient
B. The great imitator lies supine results to flexion of knees.
C. Selfish and impatient
D. To wild 11. Foods high in gluten includes the
following except:
4. A Patient is to undergo Guthrie test. The A. Pizza
nurse should instruct client to have which of B. Hotdogs
the following the day before the test? C. Sausage
A. Nothing per orem D. Rice
B. High CHON diet
C. High Gluten Diet 12. All of the following except one are
D. Increase fluid intake hallmark signs of nephrotic syndrome:
A. Hypoproteinemia
5. A breastfed infant’s stool is expected to B. Hypercholesterolemia
be? C. EDEMA
A. Having an offensive color D. Hypertension
B. Light yellow in color
C. Firm in consistency 13. A patient is having projectile vomiting for
D. Sour but clean odor the past 4 hrs. The complication best
associated with vomiting is:
6. Effect of cystic fibrosis to male babies A. Hypertension
includes: B. Metabolic Acidosis
A. sterility C. Metabolic Alkalosis
B. infertility D. Palpitations
C. Testosterone surge
D. BPH 14. Nurse must recognize that the long term
complication of spina bifida is?
7. Nurse must recognize that the short term A. Hydrocephalus
complication of spina bifida is? B. Meningitis
A. Hydrocephalus C. Learning disabilities
B. Meningitis D. Mental retardation
C. Learning disabilities
D. Mental retardation 15. A lumbar puncture was performed to a
child. The best position after the procedure
8. Nurse Paul is taking care of a baby with is?
Trisomy 21, the baby’s palm is expected to A. Flat on bed with 2 pillows
have: B. Flat on bed without pillow
A. Palmar creases C. Horizontal recumbent
B. Simian creases D. Semi-Fowler’s

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 TRICIA JESHIEL P. TORRES, RN PEDIATRICS

D. Rolls over from back to abdomen

16. In planning care for a teenager in sickle
cell crisis, the nurse should base any actions 23. The best position for the D.R. nurse to
on the knowledge that vaso-occlusive crises place the baby in myelomeningocele is:
arises from? A. Prone
A. Increased RBC destruction B. Supine
B. Hepatosplenomegaly C. Side-Lying
C. Occlusion of small blood vessels D. Trendelenburg
D. Sequestration of blood
24. A client with renal failue is having
17. Exaggerated arching of the back is difficulty in defecation. What is the best
termed as: nursing intervention for this?
A. Kernig Sign A. Increase fluid intake
B. Bruzinski sign B. Increase ambulation
C. Opisthotonus C. Laxative as ordered
D. Nuchal Rigidity D. Increase fruit in the diet

18. What will be the vomitus of a client with 25. What is the best diet for a patient with
pyloric stenosis? Nephrotic syndrome?
A. Stomach contents only A. Increased K
B. Stomach contents plus bile B. Increased Na
C. Stomach contents streaked with blood C. High Biologic Protein
D. Stomach contents stread with flecks of D. High CHO
feces
26. All of which contains high folate except:
19. Hyperhemolytic crisis results from A. Egg
deficiency in? B. Organ Meat
A. Amino acid C. Green Leafy Vegetables
B. Folate D. Squash
C. G-6-PD
D. Oxygen 27. Which among the following is not
classified as acyanotic heart defect?
20. To promote healthy teeth in a 2-yr old A. Tetralogy of Fallot
child, the nurse should: B. PDA
A. Teach child tooth brushing C. VSD
B. Encourage parents to provide tooth D. ASD
cleaning
C. Set-up dental opportunities 28. The most common sight for bleeding in
D. Teach children to rinse their mouth hemophilia is?
A. Eyes
21. Hemophilia is a bleeding disorder B. Abdomen
involving: C. Joints
A. Father as the carrier D. Skin
B. Mother as the one manifesting the
disease 29. The characteristic murmur in pulmonic
C. Mother passing the carrier state to the stenosis is located:
son A. Bruit on 2ND ICS to the left
D. Mother passing the carrier state to the B. Bruit on 2-3rd ICS to the right
daughter C. Bruit on the 5th ISC on the left
D. Bruit on 5th ICS to the right
22. Which one behavior should the nurse
expect in a 3-yr old to be capable of 30. The characteristic murmur in aortic
demonstrating? stenosis is located:
A. Climbs in stairs with alternate step A. Bruit on 2-3rd ICS to the left
B. Climbs in stairs one foot at a time B. Bruit on 2ND ICS to the right
C. Plays rattle C. Bruit on the 5th ISC on the left

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 TRICIA JESHIEL P. TORRES, RN PEDIATRICS

D. Bruit on 5th ICS to the right B. parents should play with child
C. provide sleeping
31. Complete repair of Transposition of the D. give Demerol
Great Vessel is:
A. Jatene Procedure 39. Nurse Lester is caring for a patient with
B. Blalock Procedure status epilepticus. Which nursing
C. Down’s Procedure intervention is most appropriate for the
D. Ren Procedure client?
A. IV injection
32. Best diagnostic test for Intussuception B. IM Demerol
is? C. give O2
A. Barium Enema D. put tongue depressor/blade
B. Angiogram
C. X-ray 40. The reason why to prick and not to inject
D. Doudenal Acidity Test or puncture in done in obtaining blood for
NBS?
33. Best sign in determining KAWASAKI A. prevent damage of tissue
disease is? B. prevent damage of blood vessels
A. Berry red Tongue C. prevent bone damage
B. L-R Shunting D. prevent muscle damage
C. R-L Shunting
D. High/Constant Fever 41. There are a lot of fruits in the market.
What type of fruits may help the client with
34. The 2 most common type of accidents hyperactivity?
among infants are: A. Marang and durian,
A. Accident and falls B. Apples and grapes,
B. Malaria and Dengue Fever C. Guava and atis,
C. Dengue and Kawasaki Disease D. Banana and papaya
D. Tetralogy of Fallot
42. The nurse is to take the blood specimen
35. If the child is having epiglottitis the nurse for NBS. The nurse should take the blood
must remember that: specimen from the newborns:
A. Eliciting gag reflex is avoided a. Umbilicus
B. There is no fever involve b. Heel
C. There is no inflammation involve c. Fingers
D. No need for intubation d. Brachial area

36. Before administering an injectable 43. Mella, a mother of a 6-year-old child

medication, as nurse you’ve learned that the having chicken pox asked the CHN nurse
proper injection site for infants is at: how to minimize itchiness. What would be
A. vastus lateralis, the most appropriate nursing intervention
B. gluteal area for the itchiness in patients with chicken
C. deltoid pox?
D. rectus femoris A. calamine lotion
B. talcum powder
37. In cystic fibrosis, the sweat chloride test is C. baking soda
expected to be: D. 70% alcohol
A. Decreased
B. Lofty 44. While admitting an infant, the nurse
C. Plummeted notes that which one is classic of a client
D. Normal with Hirschprung’s Disease?
A. Olive shape mass
38. Which of the following is appropriate for B. Projectile vomiting
the safety of the client with ADHD while C. Bile stained vomitus
playing? D. Diarrhea
A. padded toy

11
 TRICIA JESHIEL P. TORRES, RN PEDIATRICS

45. The characteristic stool of a client with

intussusception is:
A. Black saffron
B. Currant jelly-like
C. Musty odor
D. Bloody

46. The characteristic mass in a client with

intussusception is:
A. Olive-shaped mass in LLQ
B. Olive-shaped mass in RUQ
C. Sausage-shaped mass in RUQ
D. Sausage-shaped mass in LUQ

47. Classic sign of hemophilia is:

A. Epistaxis
B. Nose bleeding
C. Spontaneous hematuria
D. Easy bruising

48. In Sickle Turbidity Test, blood is

considered sickled if the result is:
A. Turbid
B. Bluish
C. Cherry red
D. Cyanotic

49. Cystic Fibrosis can result to multiple

system disorder. As a nurse, which is your
priority?
A. Decrease fertility
B. Thick Bronchial Secretions
C. Sterility in Males
D. Meconium Ileus

50. A child is diagnosed with celiac disease.

Which of the following foods will you give
the child?
A. Rice oatmeal
B. Rice
C. Peanut Butter Sandwich
D. Wheat bread

ANSWER KEY
CBBBD ABBDD
DDCAB CCACC
DAACC DACAB
AADAA ABBCC
ABACB CDABB

12
 TRICIA JESHIEL P. TORRES, RN RESEARCH

Date: February 6, 2022

Time: 9 AM - 4 PM CHAPTER 1: INTRODUCTION
Concept: RESEARCH Research Problem
Lecturer: PROF. RAYMUND MANAGO ● “What is wrong?”
○ Knowledge gap
○ Problems in society
VARIABLES ● Curiosity and interests
1. Independent variable: cause
2. Dependent variable: effect Statement of purpose
3. Confounding variable ● What do you want to happen?
● Goals and objectives
RELATIONSHIPS ○ Goals → general
○ Objectives → specific

Causal = effects
Associative = correlation

Research Question (PIRD)

● Population
○ Subjects / people
● Independent Variable
● Relationship
● Dependent variable

Among young adults (P) , is sedentary lifestyle (IV)

ETHICAL PRINCIPLES associated with (R) hypertension (DV)?
1. Beneficence: do good
2. Non-Maleficence: do no harm CHAPTER 2: RRL
3. Justice: equal risks and benefits Paraphrase + cite : to avoid plagiarism
4. Autonomy: voluntary decision
→ right to refuse/withdraw TYPES OF SOURCES
5. Veracity: complete information 1. Primary source
→ truth-telling → original study
6. Confidentiality: data not revealed → primary > secondary
→ data stored in secure computer 2. Secondary sources
7. Anonymity: data not linked to a person → reports based on an original study
→ remove identifying information (name, → critique, literature review
address, phone #, email, photos)
CHAPTER 3: METHODOLOGY
INFORMED CONSENT
Decision – Accept of decline participation QUANTITATIVE RESEARCH DESIGN
Protects autonomy
Elements (VICS): I. EXPERIMENTAL (True)
● Voluntary - no coercion, no bribery ● Randomized Controlled Trial (RCT)
● Informed - fully understood ○ Strongest design
● Competent - able to decide, (1) legal age, (2) ○ 3 elements (CRM)
coherent ■ Control group
● Signature - (1) subject, (2) witnesses: verifies
the signature of subject

1
 TRICIA JESHIEL P. TORRES, RN RESEARCH

1. Descriptive
→ describe and document variables
→ no relationship established
→ ex: amount of alcohol intake (variable) of
Filipino young adults (Population)
2. Correlational
→ relationship between variables
→ ex: the relationship between alcohol intake
(IV) and happiness levels (DV) among Filipino
young adults (pop)
3. Prospective/Cohort
→ follow to the future
→ used in epidemiologic studies
Example:

→ longitudinal: multiple data collection

4. Retrospective / case-control
→ look back to the past
→ used in epidemiologic studies

■ Randomization - Random → cross-sectional: single data collection

assignment to exp and
control groups

QUALITATIVE RESEARCH DESIGNS

Identifies themes
■ Manipulation - giving
treatment/intervention to 1. Ethnography
EXP group → cultural patterns and lifeways
→ 2 perspectives:
II. QUASI-EXPERIMENTAL (“almost”) – emic: insider’s view (participant)
→ absence of randomization – etic: outsider’s view (researcher)
→ EXP and CTRL groups: non equivalent 2. Phenomenology

3. Grounded theory

III. NON EXPERIMENTAL

→ no manipulation (no treatment)
→ researchers are observers

2
 TRICIA JESHIEL P. TORRES, RN RESEARCH

4. Case Studies → strata is a subgroup based on specific

characteristics.
→ Ex: year level
4. Purposive/ Judgemental sampling
→ hand-picking samples
→ inlcuison and exclusion criteria
5. Participatory action research (PAR)
B. Probability Sampling
→ random
→ all can be included
→ high representatives
1. Simple random
→ Uses sampling frame (list)
→ eg. draw lots, spin the wheel
2. Stratified random
SAMPLING → strata, random
→ selecting a portion of the population → “sample” → strata is a subgroup based on specific
→ Population (N), Sample (n) characteristics.
→ GOAL: representativeness, the sample must → Ex: year level
represent the population 3. Systematic sampling
→ uses sampling interval (k)
Sample size
1. Quantitative

4. Cluster/Multistage
→ successive sampling
Ph → regions→ provinces→ cities→
Brgy.--> TB patients
→ geographic locations

CHAPTER 4: DATA ANALYSIS

1. Descriptive statistics
→ simplest
→ synthesize and describe data
→ frequency and percentages
e– margin of error
→
Measure of central tendency
2. Qualitative
Mean: average
Data saturation:repetitive data
Median: middle
Mode: most frequent
TYPES OF SAMPLING

2. Inferential statistics
A. Non-probability
→ proves relationship between variables
→ non random
→ not all can be included
→ low representativeness

1. Convenience Sampling
→ conveniently available people
→ easiest, but most common
2. Snowball Sampling
→ referrals
3. Quota Sampling
→ strata, non-random

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 TRICIA JESHIEL P. TORRES, RN RESEARCH

RESEARCH PRETEST 7. You plan to conduct a survey on the eating habits

of preschoolers in a barangay. The population of
1. A researcher divided the province into cities and preschoolers is 1, 400 with a set margin of error of 5%.
randomly selected from those with the highest Compute for the sample size.
populations. He further randomly sampled those who a. 311
are aged 18 and above. What type of sampling did the b. 297
researcher employ? c. 302
a. Stratified d. 465
b. Simple Random
c. Systematic 8. In the RESEARCH question, “Among senior
d. Cluster citizens in Manila, is the free cinema screening
associated with their happiness levels?”, the “free
2. Which of the following is an example of a primary cinema screening” is referred to as:
source in a research study? a. Population
a. A published commentary on the findings of another b. Dependent variable
study c. Independent variable
b. A doctoral dissertation that critiques all research in d. Intervention
the area of attention deficit disorder
c. A textbook of medical-surgical nursing 9. The following are characteristics of a qualitative
d. An original journal article about cancer prevention design, except:
a. Naturalistic
3. What is the first step in the qualitative research b. Flexible
process? c. Controlled
a. Data analysis d. Narrative data
b. Sample
c. Review of literature 10. The title of a study is, “Discovering meaning in
d. Study design the experiences of Metro Manila college students who
moved from provinces.” The design of the study is most
4. The following are elements of a research likely:
question, except: a. Correlational
a. A relationship between two or more variables b. Randomized controlled trial
b. An operational definition of each variable c. Ethnography
c. The population being tested d. Phenomenology
d. Independent and dependent variables
11. A student nurse arrived at a sitio of Igorot people
5. Which criteria is used to determine testability of a with the purpose of observing and studying their culture
hypothesis? and lifeways. The design of the study is most likely:
a. Avoiding use of quantifiable words such as greater a. Ethnography
than or less than b. Case Study
b. A hypothesis stated in such a way that it can be c. Participatory action research
clearly supported or not supported d. Phenomenology
c. The use of biased words in a hypothesis
d. Data-collection efforts that prove the validity of the 12. Which of the following is a characteristic of a
hypothesis quantitative study?
a. Empirical – based on hunches and intuition
6. Given the following distribution of 10 scores from b. Firm/rigid research proposal
an exam of obstetric nursing, provide the mode score: c. Analysis of transcripts of interviews
95 90 89 89 90 91 92 89 93 94. d. Understands human experience
a. 94
b. 90 13. Nurse Nikki knows that the hallmark of a
c. 89 quasi-experimental design is the:
d. 91 a. Manipulation of independent variable
b. Presence of control group
c. Use of a treatment

4
 TRICIA JESHIEL P. TORRES, RN RESEARCH

d. Absence of randomization

14. A prospective/cohort design involves the use of

multiple data collection points to gather complete data
about the subjects. Multiple data collection is called:
a. Longitudinal
b. Survey
c. Cross-sectional
d. Case-control

15. The results of a prospective study is considered

as more reliable than those of a retrospective study
because:
a. Prospective study is cheaper and requires less
resources.
b. The status of subjects can be followed and
monitored.
c. There is lesser recall bias in a retrospective study.
d. Prospective study is easier to conduct than
retrospective.

ANSWER KEY

DDCBB CACCD
ABDAB

5
 TRICIA JESHIEL P. TORRES, RN RESEARCH

RESEARCH POST TEST a. Verbal assent

b. Assent form
1. Research refers to a systematic and disciplined c. Informed consent form
inquiry that seeks to answer questions and solve d. No assent needed
problems using a structured series of steps. The goal of
clinical nursing research is to: 6. An ICU nurse taking up her master’s degree came
a) Understand challenges and create improvements in up with the research title “Effects of Hospital Visitation
nursing education. on Anxiety among Intensive Care Unit Patients in Cebu”
b) Develop and expand the body of scientific for her thesis. Which is the independent variable?
knowledge. a. Intensive Care Unit Patients
c) Update best practice in nursing and improve quality b. Anxiety
of life. c. Cebu
d) Prove that sound evidence is an excellent basis for d. Hospital Visitation
clinical nursing practice
7. In the same research title mentioned above,
2. Quantitative research is different from qualitative which is the dependent variable?
research in all the following ways except: a. Intensive Care Unit Patients
a. Quantitative research is based on numerical and b. Hospital Visitation
narrative data, while qualitative research is based on c. Anxiety
objective and statistical inputs. d. Effects
b. Qualitative research is best conducted in a location
which the subjects consider as their habitat. 8. A nursing student wanted to study whether health
c. Increasing validity and decreasing bias is essential education affects the knowledge on self-care practices
for quantitative research. among patients with diabetes mellitus. Which of the
d. In qualitative research, the design and procedures following would be his independent variable?
are seen as flexible and allows for change. a. Self-care practices
b. Diabetes Mellitus
3. Which of the following statements demonstrate an c. Knowledge
associative relationship? d. Health education
a. An increase in the serum sodium level of a client
caused the increase in blood volume and pressure. 9. In the above study, which of the following is the
b. A black cat that passed by the road caused bad luck dependent variable?
to a motorist and suffered from a vehicular accident. a. Self-care practices
c. Sedentary lifestyle of Ms. Patricia is more likely to b. Diabetes Mellitus
increase her chances of developing diabetes mellitus. c. Knowledge
d. A fire alarm that set off in the building has resulted in d. Health education
rapid evacuaiton of the tenants.
10. Which is the dependent variable in the following:
4. A participant in your study is asking if you can “The Role of Feedback in Enhancing Students’
provide him the treatment dosage that is 5 times higher Academic Performance in Colleges”?
than prescribed. Upon reading the BON Resolution No. a. Academic Performance
220, the best response is to: b. Colleges
a. Follow the wishes of the participant in order to protect c. Feedback
right to self-determination. d. Students
b. Decline the request since this may deplete the funds
of the research project. 11. In the above study, which is the independent
c. Explain that the priority of the study is to protect the variable?
safety of the participants at all times. a. Academic Performance
d. Report the statement of the participant to your b. Colleges
co-researchers to discuss possible actions to take. c. Feedback

5. On the other hand, if the subject is already 18 d. Students

years old or above, which document is used to protect
their autonomy?

6
 TRICIA JESHIEL P. TORRES, RN RESEARCH

12. A nurse seeks to determine the barriers to a. In quasi-experimental designs, there are possible
contraceptive use among postpartum adolescents. She confounding variables.
identified the following inclusion criteria in recruiting her
subjects: (1) aged 14 – 17 years old; and (2) had been b. Experimental designs are more practical and
pregnant. The exclusion criteria were: (1) acutely ill or in acceptable.
a medical emergency; and (2) mental or physical c. Quasi-experimental designs offer more flexibility in
disabilities. What kind of sampling design did the nurse performing research.
employ? d. Experimental designs involve manipulation.
a. Convenience
b. Purposive 18. In participatory action research (PAR),
c. Stratified Random researchers and participants collaborate in conducting
d. Cluster research and empowering people. Which of the
following is the type of PAR?
13. Which of the following sampling designs would a. Qualitative
least likely result in selection threat to validity? b. Quantitative
a. Snowball c. Action research
b. Quota d. Survey
c. Simple Random
d. Purposive 19. Which of the following is a type of probability
sampling method?
14. Given the research title “The relationship a. Simple random sampling
between clinical performance and years of experience b. Purposive sampling
of staff nurses in Manila,” which is the independent c. Quota sampling
variable? d. Snowball sampling
a. Clinical performance
b. Staff nurses 20. Nurse Minnie interpreted the Pearson’s r value in
c. Manila her study as low positive correlation. Which of the
d. Years of experience following values might she have computed?
a. + 0.45
15. The following are the elements of an b. – 1.0
experimental design. Which of the following is most c. + 0.21
capable of strengthening the claim of the experiment? d. + 0.82
a. Control group
b. Randomization 21. A study would like to determine the effect of a
c. Manipulation novel drug on the blood glucose levels of patients with
d. Integration diabetes mellitus. The type of relationship being
LM POST-TEST determined is:
15 of 15 points a. Associative
b. Causal
16. Nurse Kim seeks to understand the correlation of
hair dye and skin cancer. She gathered 2 groups of c. Both A and B
women who do and do not have skin cancer and asked d. Neither A nor B
which among them regularly dyed their hair in the past.
She utilized which design? 22. A researcher would like to know the correlation
a. Cohort between two variables. This means that the type of
b. Prospective relationship he aims to establish is:
c. Longitudinal a. Associative
d. Retrospective b. Causal
c. Both A and B
d. Neither A nor B
17. Why do quasi-experimental designs yield
conclusions that are weaker that those from 23. Which of the following demonstrates
experimental designs? convenience sampling?
a. Asking for student nurses to volunteer as subjects

7
 TRICIA JESHIEL P. TORRES, RN RESEARCH

b. Selecting the subjects through lottery method 30. The following are components of a research
c. Recruiting participants through social media networks question, except:
d. Using random numbers to number the population a. Independent variable
b. Population
24. Which of the following demonstrates systematic c. Comparison
sampling? d. Relationship
a. Selecting every 15th person in the population
b. Conducting 4 successive randomizations ANSWER KEY
c. Defining the exclusion criteria
d. Asking for referrals CACCC DCDCA
CBCDB DACAC
25. Which of the following statements is true BAAAB AABBC
regarding sampling?
a. Non-probability sampling is better than probability
sampling.
b. Probability sampling has high representativeness.
c. Non-probability sampling gives a chance for all to be
selected.
d. Probability sampling involves non-random methods.

26. Which statement best describes qualitative

research?
a. Studies are conducted in natural settings.
b. Data are collected from a large number of subjects.
c. Data collected tend to be numeric.
d. The research design is systematic and objective.

27. What does a critique of a research study always

include?
a. Determining its strengths and weaknesses
b. Researching similar studies
c. Using critical listening skills
d. Explaining your own personal opinions

28. For which of the following research questions

would qualitative methods be most appropriate?
a. Which pain medications decrease the need for sleep
medication in elderly patients?
b. What is the meaning of health for migrant
farm-worker women?
c. Under what conditions does a decubitus ulcer heal
most quickly?
d. How does frequency of medication administration
impact the degree of pain experienced following knee
replacement surgery?

29. Given the following distribution, which is the

median score? 7 4 2 9 1 3 3 2 7.
a. 4
b. 3

c. 2
d. 7

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 TRICIA JESHIEL P. TORRES NURSING LEADERSHIP MANAGEMENT

Date: February 20, 2022

followers are and have
Time: 7am-1pm willing to authority to
Concept: LM follow enforce
Lecturer: PROF. ALENI IRAY decision

Relationship In intuitive Relate to

Nursing leadership and people
● Process whereby a nurse influences empathetic according to
manner rule
one or more persons to achieve
specific goals in the provision of Reward Rewarded Fulfill
nursing care for one or more patients from personal organizational
achievement mission
Nursing management
Position May or may Managers as
● Process of working through the not be long
nursing staff personnel or members successful appointment
to provide care, cure, and comfort to holds
patient Rules Interested in Cary out
risk-taking predetermined
Level of Management and exploring policies rules
new ideas and regulations
● Top → chief nurse
● Middle → supervisor Others Influence Maintain an
● Low → head nurse others toward orderly,
goal setting controlled
national
Types of Scheduling
equitable
1. Centralized scheduling → based on structure
the master staffing pattern. Mostly
carried out by one person; chief
Scientific Management
nurse.
● Frederick W. Taylor
2. Decentralized scheduling → carried
○ Proposed set of techniques to
out by middle & lower level
increase efficiency and
managers; head nurse.
productivity of each worker
3. Self-scheduling
○ Automation → observation,
4. Permanent scheduling
experimentation, analysis
5. Alternating or rotating work shift →
● Henri Fayol’s
personnel have alternating work
○ Father of modern
hours among days, evenings, and
management theory/process
nights (7am-3pm or 3pm-11pm)
○ 14 principles of management
6. Block / Cyclical scheduling →
1. Division of labor -
staffing pattern repeats itself every
according to their
4-6 weeks
knowledge and
7. Variable scheduling → determining
expertise
the number and mix of staff based
2. Authority - managers
on patient’s need
need to be able to give
○ Mix of staff = ratio of
orders so that they can
professionals to
get things done
non-professionals (RN:NA)
3. Discipline - members
8. Flex time → excess hours from
in the organization
overtime can be used to adjust
must respect the rules
tomorrow’s schedule
and the organization
that govern them
Leader Manager 4. Unity of command -
each employee must
Appointment May or may Officially
not have appointed receive his/her
official instructions about a
appointment particular operation
from 1 person
Power As long as the Have power

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TRICIA JESHIEL P. TORRES NURSING LEADERSHIP MANAGEMENT

5. Unity of direction - change to maximize

those operations efficiency
within the 13. Initiative - employees
organization that have should be encouraged
the same objectives to develop and carry
should be directed out plans for
with only one plan improvement
6. Subordination of 14. Esprit de corps -
individual interest to organizations should
a common goal – in strive to promote team
any undertaking the spirit, unity, and
interest of the morale
employees should not ● Max Weber’s Bureaucratic
take precedence over organizational theory
the interest of the ○ Contributed to the
organization as a development of a classical
whole approach to organizational
7. Remuneration - design
compensation for ○ Tasks must be divided
work should be fair to ● Elton Mayo’s Behavioral School
both employees and ○ Hawthorne effect →
employers individuals react differently
8. Centralization - when they know that they are
balancing centralized being observed
decision-making (from ● Douglas McGregor’s Motivational
the top) with letting Theory
employees make
THEORY X THEORY Y
decisions. “A place for
everyone and Lazy Loves to work
everyone in his place”
9. Scalar chain - To exercise To provide
strict control opportunities for the
employees should
over his subordinates to be
know where they
subordinate to creative and productive
stand in the ensure that the and to encourage
organization’s work is carried growth and provide
hierarchy and who to out properly guidance
speak to within a chain
of command Be strict Provide opportunity
10. Order - “the right man
in the right place” ● William Ouchi’s Theory Z
forms an effective ○ Long term employment
social order. He
applied the same LEADERSHIP THEORIES
maxim to materials: 1. The Great Man Theory - leaders are
right one, right place born not made
11. Equity - managers 2. Trait theory - born with a
should be fair to all characteristic of a leader (charisma,
employees through a intelligence)
“combination of 3. Situational theory
kindliness and justice” ○ LEADERSHIP STYLES
12. Stability of tenure of i. Autocratic - High
personnel - concerns for task
organizations should accomplishment;
minimize staff Leader-oriented
turnover and role ii. Democratic -
People-oriented focus

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 TRICIA JESHIEL P. TORRES NURSING LEADERSHIP MANAGEMENT

on human aspects and

builds effective KINDS OF BUDGETS
teamwork. The leader 1. Direct Cost
acts as a facilitator ○ Directly related to patient
iii. Permissive / care within a manager’s unit
Laissez-faire - Leaders ○ Salary, supplies
appointed as 2. Indirect Cost
managers ○ Not directly related but
4. Contingency theory necessary to provide care
○ Task structure ○ Electricity, maintenance
○ Position power 3. Fixed Expenses
○ Relationship ○ Don't vary in volume
5. Path goal theory ○ Rent, monthly salary
○ A leader’s traits & behaviors 4. Variable Expenses
can directly affect the ○ Increase or decreased
satisfaction, motivation & depending on the # of
performance of their team patients
members ○ Patient meals, laundry of
linens
I. PLANNING 5. Controllable Cost
● Forecasting of events, making ○ Controlled and varied by
decisions, setting goals, setting managers
priorities, developing policies, and ○ Staffing pattern & mix
setting standard 6. Uncontrollable Cost
○ Equipment depreciation,
Types of planning overtime in response to
I. Strategic planning emergency
- Long-range goal
II. Operational planning II. ORGANIZING
- Deals with the day-to-day ● Grouping of activities for the purpose
maintenance of activity of achieving objectives
Organization: to accomplish goals and
Mission objectives of the organization efficiently
● Reasons for the organization's human and material resources are essential
existence
● States the services the organization
INFORMAL FORMAL
will provide
● DOH: ensure accessibility and quality Consists of personal Describes the
of health care to improve the quality and social positions, the
of all Filipinos, especially the poor relationships responsibilities of
Vision among members of those occupying
the organization the positions and
● What you want to become in the
the working
future Meets the needs of relationships
● DOH: Filipinos are among the individuals with among the various
healthiest people in SEA by 2022 similar units or
Philosophy backgrounds departments
● Reflects the values and beliefs of the
organization TYPES OF AN ORGANIZATION CLASSIFIED
Goals and Objectives BY NATURE OF STRUCTURE
● Goal: general, long term 1. Line organization
○ Ex. to improve ○ Simplest and most direct type
documentation in which position has general
● Objective: specific, short-term authority over the lower
○ Ex. an increase in form positions in the hierarchy
completion by 5% in the first 2. Informal organization
quarter of 2023

3
 TRICIA JESHIEL P. TORRES NURSING LEADERSHIP MANAGEMENT

○ Refers to horizontal produce a desired level of care and to

relationships meet the patient's need
3. Staff organization ● RA 5901 - forty-hours/week law
○ Purely advisory ○ > 100-bed capacity → RNs will
○ Broken lines work 40hrs/wk (5 days)
4. Functional organization ○ < 100-bed capacity → RNs will
○ Each unit is responsible for a work 48hrs/wk (6 days)
given part of the organization ● NHPPD - standard measure to
nursing time
Before you delegate ● RA 4226 - hospital licensure act
- Check for potential harm ● RA 7160 - local government code
- Check 5 rights of delegation
1. Right task NURSING CARE DELIVERY SYSTEM
2. Right circumstances ● Case method
3. Right person ○ Pros: total patient care
4. Right direction ○ Cons: different nurse, different
5. Right supervision/evaluation shifts, different days
● Functional system
Vertical chart ○ Pros: efficiency
● Depicts the chief executives at the ○ Cons: nurses do managerial
top with lines of authority following work. Nurses aides do patient
down the hierarchy care
● Team nursing
Horizontal chart ○ Pros: team effort
● Depicts the manager at the top with ■ Frees patient care
aside span of control coordinator to
● Communication in this structure is manage the unit
direct simple and fast with minimal ■ Nursing care plan
distortions of the message since the ■ Nurses are divided into
distance between the top and the groups
lower level is shorter ● Primary nursing
○ Admission to discharge
PRINCIPLES OF ORGANIZATION ○ Pros: RNs give total patient
1. Communication - top to bottom care
a. Downward = top level → ■ Primary nurse has 24
subordinate (memo, hr responsibility
termination) ○ Cons: confines nurses’ talents
b. Upward = subordinate → top to a limited number of
level (incident report, patients
resignation) ■ Associate nurse may
c. Horizontal = same level change care plan
(endorsement) without discussing
d. Diagonal = interdepartmental with primary nurse
2. Unity of command
3. Span of control TYPES OF POWER
4. Specialization 1. Reward power
*Chain of command refers to the orderly 2. Punishment or coercive power
command hierarchy within an incident 3. Information power
management organization. Unity of 4. Legitimate power
command means that each individual 5. Expert power
reports to only one designated supervisor. 6. Referent power

III. STAFFING Transformational leader → committed and

● Process of determining and has the vision to empower others
providing the acceptable number
and mix of nursing personnel to

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 TRICIA JESHIEL P. TORRES NURSING LEADERSHIP MANAGEMENT

LM PRE TEST D. Organizing

1. As a nurse manager, which of the
following best describes this function? 8. Bruce was chosen as one of the leaders
A. initiate modification on clients lifestyle in their community. He observed that his
B. protects clients life subordinates are not responding well to him
C. coordinate the activities of other and that they are all passive. He then
members of the health care team in changed his leadership style from
managing patient care democratic to authoritarian form of
D. provide in service education program, use leadership. What theory did he use, base on
accurate nursing audit, formulate leadership theories.
philosophy and vision of the institution A. The great man theory
B. Trait Theory
2. These are nursing intervention that C. Contingency Theory
requires knowledge, skills and expertise of D. Situational Theory
multiple health professionals
A. dependent 9. An example of a management function
B. independent of a nurse is:
C. interdependent A. directing and evaluating the staff nurse
D. intradependent B. Performing nursing procedures for clients
C. Teaching patient do breathing and
3. They may or may not have official coughing exercises
appointment D. Preparing for a surprise party to the client
A. Appointment
B. manager 10. Your head nurse in the unit believes
C. Leader that the staff nurses are not capable of
D. Officially appointed decision making so she makes the decisions
for everyone without consulting anybody.
4. Lelian a nurse manager observes that This type of leadership is
her employees are lazy and can’t work A. Democratic leadership
independently. Base on motivational theory B. Autocratic leadership
where can we classify this set of employees? C. Managerial Leadership
A. Theory A D. Laissez Faire Leadership
B. Theory B
C. Theory Y 11. Father of modern management:
D. Theory X A. Henri Fayol
B. Max Weber
5. Long Term form of Planning; C. Elton Mayo
A. improves efficiency D. Douglas McGregor
B. strategic planning
C. operational planning 12. Joedel nurse manager observes that her
D. mission employees ca work independently. Base on
motivational theory where can we classify
6. Knowing that these are the this set of employees?
characteristic of her subordinates what A. Theory A
leadership style would she use? (Refer to B. Theory B
question 4 for the situation.) C. Theory Y
A. authoritarian D. Theory X
B. democratic
C. laisez faire 13. Employees has one supervisor and there
D. leadership style is one plan for a group of activities with the
same objectives only to one supervisor
7. A statement that identify the reason of A. Unity of command
an organization: B. Span of Control
A. Philosophy C. Unity of direction
B. mission D. Specialization
C. objectives

5
 TRICIA JESHIEL P. TORRES
14. One of Nursing Care delivery system
where task are being divided.
A. Case System
B. Functional System
C. Team Nursing
D. Primary Nursing
15. Doing phase of management Process;
A. Leadership
B. Planning
C. Directing
D. Management
ANSWER KEY: CCCDB ABDAB ACXXC
LM POST TEST
SITUATION: A nurse leader who has
a considerable amount of work
experience would select a leadership
and management style that would
work best in any circumstance.
1. A nurse manager has the reputation of
being an autocratic leader. Which of the
following statements by this manager
would support that reputation?
a. "I'm putting a suggestion box in the break
room if anyone has ideas that would be
helpful to the unit"
b. "The new work schedule is posted for the
next 6 weeks"
c. "I put the new procedure manual out.
Please add your comments to the blank
sheet of paper attached to the front "
d. "I'd like to hear from you (addressing the
staff) what your ideas are for promoting
better morale in this unit"
2 .The nurse manager who practices the
leadership style that is leader-focused is
demonstrating which type of
a. Democratic
b. Laissez-faire
c. Autocratic
d. Synergistic
3.The leader of a work group acts as a
facilitator, serves as a resource person, and
encourages members to actively
participate. This leadership style would be
described as:
a. Democratic
b. Laissez-faire
c. Autocratic.
NURSING LEADERSHIP MANAGEMENT
d. Synergistic.
4. Which of the following statements about
situational or contingency leadership theory
is true?
a. High relationship behavior is much more
essential to a good manager than high task
behavior.
b. This leadership model is effective in
bureaucratic organizations because it is task
focused.
c. Management should be consistent in
different situations so workers understand
what is expected of them.
d. The leadership style chosen by a manager
should reflect the task/relationship behavior
of those being managed.
5. Which of the following statements depicts
leadership?
A leadership position is assigned.
b. A leadership position carries a legitimate
source of power.
c. Members of a group will only follow a
person in a leadership position by choice.
d. Leadership requires meeting
organizational goals
6.Which of the following is characteristic of
theory Z?
a. Nonconsensus decision making
b. Fitting employees to their jobs
c. Rapid career promotions
d. Authoritative problem solving
7. The person who is committed, has a
vision, and is able to empower others with
this vision is termed a(n)
a. Transactional leader
b. Transformational leader
c. Interactional leader
d. Bureaucratic leader
8.Which explains why nurses must be
leaders to be successful in client care?
a. Nurses must be effective at giving orders.
b. Only nurses as leaders have physician
respect.
c. Nurses must direct client care activities to
reach outcomes.
d. Only nurses as leaders can function in
managed care.
9.Which indicates leadership or
management positions in an organization
with legitimate authority?
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 TRICIA JESHIEL P. TORRES
1. Formal leaders 3. Nurse managers
2. Staff nurse 4. Informal leaders
a. All except 4
b. 1 and 3 only
c. 2 and 3 only
d. All of the above
10. The nursing leader has initiated a
measure to solve a problem. This leader is
demonstrating which characteristic
a. Critical thinking
b. Delegation
c. Risk taking
d. Initiating action
SITUATION: For nurses, knowledge of the
management process assures them of the
smooth functioning of their units to attain
their goal of quality care through the
judicious use of available human and
material resources within specified periods.
11. Managing conflict among staff members
would occur in which part of the
management process?
a. Planning
b. Organizing
c. Directing
d. Evaluating
12. Chief Nurse Donna is concerned on
developing and emphasizing definite and
consistent policies and procedures in
dealing with the staff nurses. This action by
chief nurse Donna reflects which of the
three-fold concept of management?
a. System of authority
b. An economic resource
c. Elite class
d. A level of coordination
13. According to Hospital Licensure Law
defines the term hospital as a place devoted
primarily to the maintenance and operation
of facilities for the diagnosis, treatment, and
care of individuals suffering from illness,
diseases or deformity, or in need of
obstetrical or other medical and nursing
care. This law is otherwise known as:
a. RA 4226
b. RA 7160
c. RA 4236
d. RA 7060
14. Nurse Nimfa is applying as a staff nurse
at a local community hospital. The chief
NURSING LEADERSHIP MANAGEMENT
nurse hired Nimfa and told her that she can
start. The chief nurse demonstrated which
basic role in management?
a. Informational role
b. Decisional role
c. Liaison role
d. Interpersonal role
15. Chester Barnard’s acceptance theory of
authority is described as:
a. Naturally forming social groups that can
become contributors to an organization
b. An individual worker who is the source of
control, motivation, and productivity in an
organization
c. People who have free will and choose to
comply with orders they are given
d. People who benefit and are productive
when they participate in decisions about
their work
16. The theory that includes maintenance
and motivation factors is:
a. Maslow’s hierarchy of needs
b. Herzberg’s two-factor theory
c. McGregor’s theory X and theory Y
d. Ouchi’s theory Z
SITUATION: Planning is defined as
predetermining a course of action in order
to arrive at a desired result.
17. A value statement of the principles and
beliefs that direct the organization’s
behavior is called:
a. Mission
b. Philosophy
c. Purpose
d. Strategic plan
18. Most organizations have mission
statements that address the following:
a. Educating professionals
b. Promoting research
c. Providing quality of care
d. Providing care
19. The pivotal value of strategic planning is
that it requires an organization to focus on:
a. Internal environments
b. External environments
c. Change
d. Mission
20. One of the purposes of a strategic plan is:
a. Various ideas are accepted
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 TRICIA JESHIEL P. TORRES NURSING LEADERSHIP MANAGEMENT

b. Resources are available d. Administration’s insight to financial

c. Diverse visions are accepted outcomes
d. Process varies
27. A standard measure that quantifies the
21. When planning for expenses that are nursing time available to each patient by
directly associated with patient care, it is available nursing staff is called:
known as: a. FTE
a. Fixed costs b. NHPPD
b. Indirect expenses c. Productive time
c. Direct expenses d. Nonproductive time
d. Variable costs
28. When a problem arises in the
22. Nurse Andrea, a nurse manager, is organization, Nurse Valerie first discusses it
preparing a budget plan for the year 2012. with the head nurse before bringing the
Costs like equipment depreciation,utilities, matter to the chief nurse. She is observing
fringe benefits, and salaries are considered: the principle of:
a. Fixed costs a. Chain of command
b. Variable costs b. Decentralization
c. Direct expenses c. Span of control
d. Indirect expenses d. Unity of command

23. Which of the following accounts for 29. As the unit manager, Nurse Tanya
approximately 50%-60% of operational costs: realizes that there is a limit on the number
a. Supplies of subordinates she can handle. This
b. Equipment principle is:
c. Salaries and benefits a. Span of control.
d. Pharmaceuticals b. Unity of command
c. Chain of command
24. Sick time, vacation time, and holiday d. Channel of communication
time is considered:
a. Productive time 30. A registered nurse in charge of the
b. Unproductive time nursing unit is preparing the assignments
c. Direct expenses for the day. The RN assigns a nursing
d. Variable costs assistant to make beds and bathe one of the
clients on the unit and assigns another
25. The Forty-Hour Week Law (Republic Act nursing assistant to fill the water pitchers
5901), provides that employees will work and serves juice to all the clients. Another
only 40 hours a week provided RN is assigned to administer all medications.
a. 50-bed capacity Based on the assignment designed, which
b. 75-bed capacity type of nursing care is being implemented?
c. 100-bed capacity a. Functional nursing
d. 150-bed capacity b. Team nursing
c. Exemplary model of nursing
SITUATION: Organizing is the d. Primary nursing
function of management which
follows planning. It is a function in ANSWER KEY:
which the synchronization and BCADC BBCDD
combination of human, physical and CABAC BBCDB
financial resources takes place. CACBC BBAAA

26. Overall, organization performance is

dependent on:
a. Managers’ insight to financial outcomes
b. Staff’s insight to quality and financial
outcomes
c. Organization’s strategic plan

8
Nursing Board Practice Test Compilation

FOUNDATION OF PROFESSIONAL NURSING PRACTICE 188

Contents ANSWER KEY - FOUNDATION OF PROFESSIONAL

NURSING PRACTICE I: FOUNDATION OF NURSING NURSING PRACTICE.................................................. 199
PRACTICE .......................................................................... 4 COMMUNITY HEALTH NURSING AND CARE OF THE
NURSING PRACTICE II ..................................................... 15 MOTHER AND CHILD .................................................... 200

NURSING PRACTICE III .................................................... 26 ANSWER KEY: COMMUNITY HEALTH NURSING AND
CARE OF THE MOTHER AND CHILD .......................... 211
NURSING PRACTICE IV.................................................... 36
Comprehensive Exam 1................................................ 213
NURSING PRACTICE V..................................................... 46
CARE OF CLIENTS WITH PHYSIOLOGIC AND
TEST I - Foundation of Professional Nursing Practice .... 56
PSYCHOSOCIAL ALTERATIONS...................................... 222
Answers and Rationale – Foundation of Professional
ANSWER KEY: CARE OF CLIENTS WITH PHYSIOLOGIC
Nursing Practice ......................................................... 66
AND PSYCHOSOCIAL ALTERATIONS ......................... 234
TEST II - Community Health Nursing and Care of the
Nursing Practice Test V ................................................ 235
Mother and Child ........................................................... 74
Nursing Practice Test V ................................................ 245
Answers and Rationale – Community Health Nursing
and Care of the Mother and Child ............................. 84 TEST I - Foundation of Professional Nursing Practice .. 255

TEST III - Care of Clients with Physiologic and Answers and Rationale – Foundation of Professional
Psychosocial Alterations ................................................ 91 Nursing Practice ....................................................... 265

Answers and Rationale – Care of Clients with TEST II - Community Health Nursing and Care of the
Physiologic and Psychosocial Alterations ................ 102 Mother and Child ......................................................... 273

TEST IV - Care of Clients with Physiologic and Answers and Rationale – Community Health Nursing
Psychosocial Alterations .............................................. 111 and Care of the Mother and Child ........................... 283

Answers and Rationale – Care of Clients with TEST III - Care of Clients with Physiologic and
Physiologic and Psychosocial Alterations ................ 122 Psychosocial Alterations .............................................. 290

TEST V - Care of Clients with Physiologic and Psychosocial Answers and Rationale – Care of Clients with
Alterations.................................................................... 133 Physiologic and Psychosocial Alterations ................ 301

Answers and Rationale – Care of Clients with TEST IV - Care of Clients with Physiologic and
Physiologic and Psychosocial Alterations ................ 144 Psychosocial Alterations .............................................. 310

PART III PRACTICE TEST I FOUNDATION OF NURSING . 153 Answers and Rationale – Care of Clients with
Physiologic and Psychosocial Alterations ................ 321
ANSWERS AND RATIONALE – FOUNDATION OF
NURSING .................................................................. 158 TEST V - Care of Clients with Physiologic and Psychosocial
Alterations.................................................................... 332
PRACTICE TEST II Maternal and Child Health ............... 162
Answers and Rationale – Care of Clients with
ANSWERS AND RATIONALE – MATERNAL AND CHILD
Physiologic and Psychosocial Alterations ................ 343
HEALTH..................................................................... 167
PART III ......................................................................... 352
MEDICAL SURGICAL NURSING ..................................... 173
PRACTICE TEST I FOUNDATION OF NURSING .............. 352
ANSWERS AND RATIONALE – MEDICAL SURGICAL
NURSING .................................................................. 178 ANSWERS AND RATIONALE – FOUNDATION OF
NURSING .................................................................. 357
PSYCHIATRIC NURSING ................................................ 180
PRACTICE TEST II Maternal and Child Health ............... 361
ANSWERS AND RATIONALE – PSYCHIATRIC NURSING
................................................................................. 185
 ANSWERS AND RATIONALE – MATERNAL AND CHILD
HEALTH..................................................................... 366
MEDICAL SURGICAL NURSING ..................................... 372
ANSWERS AND RATIONALE – MEDICAL SURGICAL
NURSING .................................................................. 377
PSYCHIATRIC NURSING ................................................ 379
ANSWERS AND RATIONALE – PSYCHIATRIC NURSING
................................................................................. 384
FUNDAMENTALS OF NURSING PART 1 ........................ 387
FUNDAMENTALS OF NURSING PART 2 ........................ 392
ANSWERS and RATIONALES for FUNDAMENTALS OF
NURSING PART 2 ...................................................... 397
FUNDAMENTALS OF NURSING PART 3 ........................ 401
ANSWERS and RATIONALES for FUNDAMENTALS OF
NURSING PART 3 ...................................................... 405
MATERNITY NURSING Part 1 ........................................ 409
ANSWERS and RATIONALES for MATERNITY NURSING
Part 1 ........................................................................ 418
MATERNITY NURSING Part 2 ........................................ 428
Answer for maternity part 2 .................................... 433
PEDIATRIC NURSING .................................................... 434
ANSWERS and RATIONALES for PEDIATRIC NURSING
................................................................................. 439
COMMUNITY HEALTH NURSING Part 1........................ 444
COMMUNITY HEALTH NURSING Part 2........................ 454
2
MEDICAL SURGICAL NURSING Part 1 ........................... 475
ANSWERS and RATIONALES for MEDICAL SURGICAL
NURSING Part 1 ........................................................ 479
MEDICAL SURGICAL NURSING Part 2 ........................... 481
MEDICAL SURGICAL NURSING Part 2 ....................... 485
ANSWERS and RATIONALES for MEDICAL SURGICAL
NURSING Part 2 ........................................................ 489
MEDICAL SURGICAL NURSING Part 3 ........................... 491
ANSWERS and RATIONALES for MEDICAL SURGICAL
NURSING Part 3 ........................................................ 495
PSYCHIATRIC NURSING Part 1 ...................................... 497
ANSWERS and RATIONALES for PSYCHIATRIC NURSING
Part 1 ........................................................................ 502
PSYCHIATRIC NURSING Part 2 ...................................... 504
ANSWERS and RATIONALES for PSYCHIATRIC NURSING
Part 2 ........................................................................ 509
PSYCHIATRIC NURSING Part 3 ...................................... 512
ANSWERS and RATIONALES for PSYCHIATRIC NURSING
Part 3 ........................................................................ 516
PROFESSIONAL ADJUSTMENT ...................................... 519
LEADERSHIP and MANAGEMENT ................................. 522
NURSING RESEARCH Part 1 .......................................... 532
NURSING RESEARCH Part 2 .......................................... 542
Nursing Research Suggested Answer Key ................ 546
3

NURSING PRACTICE I: FOUNDATION OF NURSING
PRACTICE
SITUATION: Nursing is a profession. The nurse should
have a background on the theories and foundation of
nursing as it influenced what is nursing today.
1. Nursing is the protection, promotion and
optimization of health and abilities, prevention
of illness and injury, alleviation of suffering
through the diagnosis and treatment of human
response and advocacy in the care of the
individuals, families, communities and the
population. This is the most accepted definition
of nursing as defined by the:
a. PNA
b. ANA
c. Nightingale
d. Henderson
2. Advancement in Nursing leads to the
development of the Expanded Career Roles.
Which of the following is NOT an expanded
career role for nurses?
a. Nurse practitioner
b. Nurse Researcher
c. Clinical nurse specialist
d. Nurse anaesthesiologist
3. The Board of Nursing regulated the Nursing
profession in the Philippines and is responsible
for the maintenance of the quality of nursing in
the country. Powers and duties of the board of
nursing are the following, EXCEPT:
a. Issue, suspend, revoke certificates of
registration
b. Issue subpoena duces tecum, ad
testificandum
c. Open and close colleges of nursing
d. Supervise and regulate the practice of
nursing
4. A nursing student or a beginning staff nurse who
has not yet experienced enough real situations
to make judgments about them is in what stage
of Nursing Expertise?
a. Novice
b. Newbie
c. Advanced Beginner
d. Competent
4
5. Benner’s “Proficient” nurse level is different
from the other levels in nursing expertise in the
context of having:
a. the ability to organize and plan activities
b. having attained an advanced level of
education
c. a holistic understanding and perception
of the client
d. intuitive and analytic ability in new
situations
SITUATION: The nurse has been asked to administer an
injection via Z TRACK technique. Questions 6 to 10 refer
to this.
6. The nurse prepares an IM injection for an adult
client using the Z track technique. 4 ml of
medication is to be administered to the client.
Which of the following site will you choose?
a. Deltoid
b. Rectus femoris
c. Ventrogluteal
d. Vastus lateralis
7. In infants 1 year old and below, which of the
following is the site of choice for intramuscular
Injection?
a. Deltoid
b. Rectus femoris
c. Ventrogluteal
d. Vastus lateralis
8. In order to decrease discomfort in Z track
administration, which of the following is
applicable?
a. Pierce the skin quickly and smoothly at
a 90 degree angle
b. Inject the medication steadily at around
10 minutes per millilitre
c. Pull back the plunger and aspirate for 1
minute to make sure that the needle did
not hit a blood vessel
d. Pierce the skin slowly and carefully at a
90 degree angle
9. After injection using the Z track technique, the
nurse should know that she needs to wait for a
few seconds before withdrawing the needle and
this is to allow the medication to disperse into
the muscle tissue, thus decreasing the client’s
discomfort. How many seconds should the nurse
wait before withdrawing the needle?
a. 2 seconds

b. 5 seconds
c. 10 seconds
d. 15 seconds
10. The rationale in using the Z track technique in an
intramuscular injection is:
a. It decreases the leakage of discolouring
and irritating medication into the
subcutaneous tissues
b. It will allow a faster absorption of the
medication 15.
c. The Z track technique prevent irritation
of the muscle
d. It is much more convenient for the nurse
SITUATION: A Client was rushed to the emergency room
and you are his attending nurse. You are performing a
vital sign assessment.
11. All of the following are correct methods in
assessment of the blood pressure EXCEPT:
a. Take the blood pressure reading on both
arms for comparison
b. Listen to and identify the phases of 16.
Korotkoff’s sound
c. Pump the cuff to around 50 mmHg
above the point where the pulse is
obliterated
d. Observe procedures for infection control
12. You attached a pulse oximeter to the client. You
know that the purpose is to: 17.
a. Determine if the client’s hemoglobin
level is low and if he needs blood
transfusion
b. Check level of client’s tissue perfusion
c. Measure the efficacy of the client’s anti-
hypertensive medications
d. Detect oxygen saturation of arterial 18.
blood before symptoms of hypoxemia
develops
13. After a few hours in the Emergency Room, The
client is admitted to the ward with an order of
hourly monitoring of blood pressure. The nurse
finds that the cuff is too narrow and this will
cause the blood pressure reading to be:
a. inconsistent
b. low systolic and high diastolic 19.
c. higher than what the reading should be
d. lower than what the reading should be
14. Through the client’s health history, you gather
5
that the patient smokes and drinks coffee. When
taking the blood pressure of a client who
recently smoked or drank coffee, how long
should the nurse wait before taking the client’s
blood pressure for accurate reading?
a. 15 minutes
b. 30 minutes
c. 1 hour
d. 5 minutes
While the client has pulse oximeter on his
fingertip, you notice that the sunlight is shining
on the area where the oximeter is. Your action
will be to:
a. Set and turn on the alarm of the
oximeter
b. Do nothing since there is no identified
problem
c. Cover the fingertip sensor with a towel
or bedsheet
d. Change the location of the sensor every
four hours
The nurse finds it necessary to recheck the blood
pressure reading. In case of such re assessment,
the nurse should wait for a period of:
a. 15 seconds
b. 1 to 2 minutes
c. 30 minutes
d. 15 minutes
If the arm is said to be elevated when taking the
blood pressure, it will create a:
a. False high reading
b. False low reading
c. True false reading
d. Indeterminate
You are to assessed the temperature of the
client the next morning and found out that he
ate ice cream. How many minutes should you
wait before assessing the client’s oral
temperature?
a. 10 minutes
b. 20 minutes
c. 30 minutes
d. 15 minutes
When auscultating the client’s blood pressure
the nurse hears the following: From 150 mmHg
to 130 mmHg: Silence, Then: a thumping sound
continuing down to 100 mmHg; muffled sound
continuing down to 80 mmHg and then silence.
 What is the client’s blood pressure?
a. 130/80
b. 150/100
c. 100/80
d. 150/100
20. In a client with a previous blood pressure of
130/80 4 hours ago, how long will it take to
release the blood pressure cuff to obtain an
accurate reading?
a. 10-20 seconds
b. 30-45 seconds
c. 1-1.5 minutes
d. 3-3.5 minutes
Situation: Oral care is an important part of hygienic
practices and promoting client comfort.
21. An elderly client, 84 years old, is unconscious.
Assessment of the mouth reveals excessive
dryness and presence of sores. Which of the
following is BEST to use for oral care?
a. lemon glycerine
b. Mineral oil
c. hydrogen peroxide
d. Normal saline solution
22. When performing oral care to an unconscious
client, which of the following is a special
consideration to prevent aspiration of fluids into
the lungs?
a. Put the client on a sidelying position
with head of bed lowered
b. Keep the client dry by placing towel
under the chin
c. Wash hands and observes appropriate
infection control
d. Clean mouth with oral swabs in a careful
and an orderly progression
23. The advantages of oral care for a client include
all of the following, EXCEPT:
a. decreases bacteria in the mouth and
teeth
b. reduces need to use commercial
mouthwash which irritate the buccal
mucosa
c. improves client’s appearance and self-
confidence
d. improves appetite and taste of food
24. A possible problem while providing oral care to
unconscious clients is the risk of fluid aspiration
6
to lungs. This can be avoided by:
a. Cleaning teeth and mouth with cotton
swabs soaked with mouthwash to avoid
rinsing the buccal cavity
b. swabbing the inside of the cheeks and
lips, tongue and gums with dry cotton
swabs
c. use fingers wrapped with wet cotton
washcloth to rub inside the cheeks,
tongue, lips and ums
d. suctioning as needed while cleaning the
buccal cavity
25. Your client has difficulty of breathing and is
mouth breathing most of the time. This causes
dryness of the mouth with unpleasant odor. Oral
hygiene is recommended for the client and in
addition, you will keep the mouth moistened by
using:
a. salt solution
b. petroleum jelly
c. water
d. mentholated ointment
Situation – Ensuring safety before, during and after a
diagnostic procedure is an important responsibility of
the nurse.
26. To help Fernan better tolerate the
bronchoscopy, you should instruct him to
practice which of the following prior to the
procedure?
a. Clenching his fist every 2 minutes
b. Breathing in and out through the nose
with his mouth open
c. Tensing the shoulder muscles while lying
on his back
d. Holding his breath periodically for 30
seconds
27. Following a bronchoscopy, which of the
following complains to Fernan should be noted
as a possible complication:
a. Nausea and vomiting
b. Shortness of breath and laryngeal
stridor
c. Blood tinged sputum and coughing
d. Sore throat and hoarseness
28. Immediately after bronchoscopy, you instructed
Fernan to:
a. Exercise the neck muscles
b. Refrain from coughing and talking

c. Breathe deeply
d. Clear his throat
29. Thoracentesis may be performed for cytologic
study of pleural fluid. As a nurse your most
important function during the procedure is to:
a. Keep the sterile equipment from
contamination
b. Assist the physician
c. Open and close the three-way stopcock
d. Observe the patient’s vital signs
30. Right after thoracentesis, which of the following
is most appropriate intervention?
a. Instruct the patient not to cough or deep
breathe for two hours
b. Observe for symptoms of tightness of
chest or bleeding
c. Place an ice pack to the puncture site
d. Remove the dressing to check for
bleeding
Situation: Knowledge of the acid-base disturbance and
the functions of the electrolytes is necessary to
determine appropriate intervention and nursing actions.
31. A client with diabetes milletus has a blood
glucose level of 644 mg/dL. The nurse interprets
that this client is at most risk for the
development of which type of acid-base
imbalance?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
32. In a client in the health care clinic, arterial blood
gas analysis gives the following results: pH 7.48,
PCO2 32 mmHg, PO2 94 mmHg, HCO3 24 mEq/L.
The nurse interprets that the client has which
acid base disturbance?
a. Respiratory acidosis
b. Metabolic acidosis
c. Respiratory alkalosis
d. Metabolic alkalosis
33. A client has an order for ABG analysis on radial
artery specimens. The nurse ensures that which
of the following has been performed or tested
before the ABG specimens are drawn?
a. Guthrie test
b. Romberg’s test
c. Allen’s test
7
d. Weber’s test
34. A nurse is reviewing the arterial blood gas values
of a client and notes that the ph is 7.31, Pco2 is
50 mmHg, and the bicarbonate is 27 mEq/L. The
nurse concludes that which acid base
disturbance is present in this client?
a. Respiratory acidosis
b. Metabolic acidosis
c. Respiratory alkalosis
d. Metabolic alkalosis
35. Allen’s test checks the patency of the:
a. Ulnar artery
b. Carotid artery
c. Radial artery
d. Brachial artery
Situation 6: Eileen, 45 years old is admitted to the
hospital with a diagnosis of renal calculi. She is
experiencing severe flank pain, nauseated and with a
temperature of 39 0C.
36. Given the above assessment data, the most
immediate goal of the nurse would be which of
the following?
a. Prevent urinary complication
b. maintains fluid and electrolytes
c. Alleviate pain
d. Alleviating nausea
37. After IVP a renal stone was confirmed, a left
nephrectomy was done. Her post-operative
order includes “daily urine specimen to be sent
to the laboratory”. Eileen has a foley catheter
attached to a urinary drainage system. How will
you collect the urine specimen?
a. remove urine from drainage tube with
sterile needle and syringe and empty
urine from the syringe into the
specimen container
b. empty a sample urine from the
collecting bag into the specimen
container
c. Disconnect the drainage tube from the
indwelling catheter and allow urine to
flow from catheter into the specimen
container.
d. Disconnect the drainage from the
collecting bag and allow the urine to
flow from the catheter into the
specimen container.
38. Where would the nurse tape Eileen’s indwelling
catheter in order to reduce urethral irritation?
a. to the patient’s inner thigh
b. to the patient’ buttocks
c. to the patient’s lower thigh
d. to the patient lower abdomen
39. Which of the following menu is appropriate for
one with low sodium diet?
a. instant noodles, fresh fruits and ice tea
b. ham and cheese sandwich, fresh fruits
and vegetables
c. white chicken sandwich, vegetable
salad and tea
d. canned soup, potato salad, and diet soda
40. How will you prevent ascending infection to
Eileen who has an indwelling catheter?
a. see to it that the drainage tubing
touches the level of the urine
b. change he catheter every eight hours
c. see to it that the drainage tubing does
not touch the level of the urine
d. clean catheter may be used since
urethral meatus is not a sterile area
Situation: Hormones are secreted by the various glands
in the body. Basic knowledge of the endocrine system is
necessary.
41. Somatocrinin or the Growth hormone releasing
hormone is secreted by the:
a. Hypothalamus
b. Posterior pituitary gland
c. Anterior pituitary gland
d. Thyroid gland
42. All of the following are secreted by the anterior
pituitary gland except:
a. Somatotropin/Growth hormone
b. Thyroid stimulating hormone
c. Follicle stimulating hormone
d. Gonadotropin hormone releasing
hormone
43. All of the following hormones are hormones
secreted by the Posterior pituitary gland except:
a. Vasopressin
b. Anti-diuretic hormone
c. Oxytocin
d. Growth hormone
44. Calcitonin, a hormone necessary for calcium
8
regulation is secreted in the:
a. Thyroid gland
b. Parathyroid gland
c. Hypothalamus
d. Anterior pituitary gland
45. While Parathormone, a hormone that negates
the effect of calcitonin is secreted by the:
a. Thyroid gland
b. Parathyroid gland
c. Hypothalamus
d. Anterior pituitary gland
Situation: The staff nurse supervisor requests all the staff
nurses to “brainstorm” and learn ways to instruct
diabetic clients on self-administration of insulin. She
wants to ensure that there are nurses available daily to
do health education classes.
46. The plan of the nurse supervisor is an example of
a. in service education process
b. efficient management of human
resources
c. increasing human resources
d. primary prevention
47. When Mrs. Guevarra, a nurse, delegates aspects
of the clients care to the nurse-aide who is an
unlicensed staff, Mrs. Guevarra
a. makes the assignment to teach the staff
member
b. is assigning the responsibility to the
aide but not the accountability for
those tasks
c. does not have to supervise or evaluate
the aide
d. most know how to perform task
delegated
48. Connie, the new nurse, appears tired and
sluggish and lacks the enthusiasm she had six
weeks ago when she started the job. The nurse
supervisor should
a. empathize with the nurse and listen to
her
b. tell her to take the day off
c. discuss how she is adjusting to her new
job
d. ask about her family life
49. Process of formal negotiations of working
conditions between a group of registered nurses
and employer is
 9

a. grievance d. It should disclose previous diagnosis,

b. arbitration prognosis and alternative treatments
c. collective bargaining available for the client
d. strike
55. Delegation is the process of assigning tasks that
50. You are attending a certification on can be performed by a subordinate. The RN
cardiopulmonary resuscitation (CPR) offered and should always be accountable and should not
required by the hospital employing you. This is lose his accountability. Which of the following is
a. professional course towards credits a role included in delegation?
b. in-service education a. The RN must supervise all delegated
c. advance training tasks
d. continuing education b. After a task has been delegated, it is no
longer a responsibility of the RN
Situation: As a nurse, you are aware that proper c. The RN is responsible and accountable
documentation in the patient chart is your responsibility. for the delegated task in adjunct with
the delegate
51. Which of the following is not a legally binding d. Follow up with a delegated task is
document but nevertheless very important in necessary only if the assistive personnel
the care of all patients in any health care is not trustworthy
setting?
a. Bill of rights as provided in the Philippine Situation: When creating your lesson plan for
constitution cerebrovascular disease or STROKE. It is important to
b. Scope of nursing practice as defined by include the risk factors of stroke.
RA 9173
c. Board of nursing resolution adopting the 56. The most important risk factor is:
code of ethics a. Cigarette smoking
d. Patient’s bill of rights b. binge drinking
c. Hypertension
52. A nurse gives a wrong medication to the client. d. heredity
Another nurse employed by the same hospital as
a risk manager will expect to receive which of 57. Part of your lesson plan is to talk about etiology
the following communication? or cause of stroke. The types of stroke based on
a. Incident report cause are the following EXCEPT:
b. Nursing kardex a. Embolic stroke
c. Oral report b. diabetic stroke
d. Complain report c. Hemorrhagic stroke
d. thrombotic stroke
53. Performing a procedure on a client in the
absence of an informed consent can lead to 58. Hemmorhagic stroke occurs suddenly usually
which of the following charges? when the person is active. All are causes of
a. Fraud hemorrhage, EXCEPT:
b. Harassment a. phlebitis
c. Assault and battery b. damage to blood vessel
d. Breach of confidentiality c. trauma
d. aneurysm
54. Which of the following is the essence of
informed consent? 59. The nurse emphasizes that intravenous drug
a. It should have a durable power of abuse carries a high risk of stroke. Which drug is
attorney closely linked to this?
b. It should have coverage from an a. Amphetamines
insurance company b. shabu
c. It should respect the client’s freedom c. Cocaine
from coercion d. Demerol

60. A participant in the STROKE class asks what is a
risk factor of stroke. Your best response is:
a. “More red blood cells thicken blood
and make clots more possible.”
b. “Increased RBC count is linked to high
cholesterol.”
c. “More red blood cell increases
hemoglobin content.”
d. “High RBC count increases blood
pressure.”
Situation: Recognition of normal values is vital in
assessment of clients with various disorders.
61. A nurse is reviewing the laboratory test results
for a client with a diagnosis of severe
dehydration. The nurse would expect the
hematocrit level for this client to be which of the
following?
a. 60%
b. 47%
c. 45%
d. 32%
62. A nurse is reviewing the electrolyte results of an
assigned client and notes that the potassium
level is 5.6 mEq/L. Which of the following would
the nurse expect to note on the ECG as a result
of this laboratory value?
a. ST depression
b. Prominent U wave
c. Inverted T wave
d. Tall peaked T waves
63. A nurse is reviewing the electrolyte results of an
assigned client and notes that the potassium
level is 3.2 mEq/L. Which of the following would
the nurse expect to note on the ECG as a result
of this laboratory value?
a. U waves
b. Elevated T waves
c. Absent P waves
d. Elevated ST Segment
64. Dorothy underwent diagnostic test and the
result of the blood examination are back. On
reviewing the result the nurse notices which of
the following as abnormal finding?
a. Neutrophils 60%
b. White blood cells (WBC) 9000/mm
c. Erythrocyte sedimentation rate (ESR) is
39 mm/hr
10
d. Iron 75 mg/100 ml
65. Which of the following laboratory test result
indicate presence of an infectious process?
a. Erythrocyte sedimentation rate (ESR) 12
mm/hr
b. White blood cells (WBC) 18,000/mm3
c. Iron 90 g/100ml
d. Neutrophils 67%
Situation: Pleural effusion is the accumulation of fluid in
the pleural space. Questions 66 to 70 refer to this.
66. Which of the following is a finding that the nurse
will be able to assess in a client with Pleural
effusion?
a. Reduced or absent breath sound at the
base of the lungs, dyspnea, tachpynea
and shortness of breath
b. Hypoxemia, hypercapnea and
respiratory acidosis
c. Noisy respiration, crackles, stridor and
wheezing
d. Tracheal deviation towards the affected
side, increased fremitus and loud breath
sounds
67. Thoracentesis is performed to the client with
effusion. The nurse knows that the removal of
fluid should be slow. Rapid removal of fluid in
thoracentesis might cause:
a. Pneumothorax
b. Cardiovascular collapse
c. Pleurisy or Pleuritis
d. Hypertension
68. 3 Days after thoracentesis, the client again
exhibited respiratory distress. The nurse will
know that pleural effusion has reoccurred when
she noticed a sharp stabbing pain during
inspiration. The physician ordered a closed tube
thoracotomy for the client. The nurse knows
that the primary function of the chest tube is to:
a. Restore positive intrathoracic pressure
b. Restore negative intrathoracic pressure
c. To visualize the intrathoracic content
d. As a method of air administration via
ventilator
69. The chest tube is functioning properly if:
a. There is an oscillation
b. There is no bubbling in the drainage
bottle

c. There is a continuous bubbling in the
waterseal
d. The suction control bottle has a
continuous bubbling
70. In a client with pleural effusion, the nurse is
instructing appropriate breathing technique.
Which of the following is included in the
teaching?
a. Breath normally
b. Hold the breath after each inspiration
for 1 full minute
c. Practice abdominal breathing
d. Inhale slowly and hold the breath for 3
to 5 seconds after each inhalation
SITUATION: Health care delivery system affects the
health status of every filipino. As a Nurse, Knowledge of
this system is expected to ensure quality of life.
71. When should rehabilitation commence?
a. The day before discharge
b. When the patient desires
c. Upon admission
d. 24 hours after discharge
72. What exemplified the preventive and promotive
programs in the hospital?
a. Hospital as a center to prevent and
control infection
b. Program for smokers
c. Program for alcoholics and drug addicts
d. Hospital Wellness Center
73. Which makes nursing dynamic?
a. Every patient is a unique physical,
emotional, social and spiritual being
b. The patient participate in the overall
nursing care plan
c. Nursing practice is expanding in the light
of modern developments that takes
place
d. The health status of the patient is
constantly changing and the nurse must
be cognizant and responsive to these
changes
74. Prevention is an important responsibility of the
nurse in:
a. Hospitals
b. Community
c. Workplace
d. All of the above
11
75. This form of Health Insurance provides
comprehensive prepaid health services to
enrollees for a fixed periodic payment.
a. Health Maintenance Organization
b. Medicare
c. Philippine Health Insurance Act
d. Hospital Maintenance Organization
Situation: Nursing ethics is an important part of the
nursing profession. As the ethical situation arises, so is
the need to have an accurate and ethical decision
making.
76. The purpose of having a nurses’ code of ethics is:
a. Delineate the scope and areas of nursing
practice
b. identify nursing action recommended for
specific health care situations
c. To help the public understand
professional conduct expected of
nurses
d. To define the roles and functions of the
health care givers, nurses, clients
77. The principles that govern right and proper
conduct of a person regarding life, biology and
the health professionals is referred to as:
a. Morality
b. Religion
c. Values
d. Bioethics
78. A subjective feeling about what is right or wrong
is said to be:
a. Morality
b. Religion
c. Values
d. Bioethics
79. Values are said to be the enduring believe about
a worth of a person, ideas and belief. If Values
are going to be a part of a research, this is
categorized under:
a. Qualitative
b. Experimental
c. Quantitative
d. Non Experimental
80. The most important nursing responsibility where
ethical situations emerge in patient care is to:
a. Act only when advised that the action is
ethically sound
 b. Not takes sides, remain neutral and fair
c. Assume that ethical questions are the
responsibility of the health team
d. Be accountable for his or her own
actions
81. Why is there an ethical dilemma?
a. the choices involved do not appear to be
clearly right or wrong
b. a client’s legal right co-exist with the
nurse’s professional obligation
c. decisions has to be made based on
societal norms.
d. decisions has to be mad quickly, often
under stressful conditions
82. According to the code of ethics, which of the
following is the primary responsibility of the
nurse?
a. Assist towards peaceful death
b. Health is a fundamental right
c. Promotion of health, prevention of
illness, alleviation of suffering and
restoration of health
d. Preservation of health at all cost
83. Which of the following is TRUE about the Code
of Ethics of Filipino Nurses, except:
a. The Philippine Nurses Association for
being the accredited professional
organization was given the privilege to
formulate a Code of Ethics for Nurses
which the Board of Nursing
promulgated
b. Code for Nurses was first formulated in
1982 published in the Proceedings of the
Third Annual Convention of the PNA
House of Delegates
c. The present code utilized the Code of
Good Governance for the Professions in
the Philippines
d. Certificates of Registration of registered
nurses may be revoked or suspended for
violations of any provisions of the Code
of Ethics.
84. Violation of the code of ethics might equate to
the revocation of the nursing license. Who
revokes the license?
a. PRC
b. PNA
c. DOH
d. BON
12
85. Based on the Code of Ethics for Filipino Nurses,
what is regarded as the hallmark of nursing
responsibility and accountability?
a. Human rights of clients, regardless of
creed and gender
b. The privilege of being a registered
professional nurse
c. Health, being a fundamental right of
every individual
d. Accurate documentation of actions and
outcomes
Situation: As a profession, nursing is dynamic and its
practice is directed by various theoretical models. To
demonstrate caring behaviour, the nurse applies various
nursing models in providing quality nursing care.
86. When you clean the bedside unit and regularly
attend to the personal hygiene of the patient as
well as in washing your hands before and after a
procedure and in between patients, you indent
to facilitate the body’s reparative processes.
Which of the following nursing theory are you
applying in the above nursing action?
a. Hildegard Peplau
b. Dorothea Orem
c. Virginia Henderson
d. Florence Nightingale
87. A communication skill is one of the important
competencies expected of a nurse. Interpersonal
process is viewed as human to human
relationship. This statement is an application of
whose nursing model?
a. Joyce Travelbee
b. Martha Rogers
c. Callista Roy
d. Imogene King
88. The statement “the health status of an individual
is constantly changing and the nurse must be
cognizant and responsive to these changes” best
explains which of the following facts about
nursing?
a. Dynamic
b. Client centred
c. Holistic
d. Art
89. Virginia Henderson professes that the goal of
nursing is to work interdependently with other
health care working in assisting the patient to

gain independence as quickly as possible. Which
of the following nursing actions best
demonstrates this theory in taking care of a 94
year old client with dementia who is totally
immobile?
a. Feeds the patient, brushes his teeth,
gives the sponge bath
b. Supervise the watcher in rendering
patient his morning care
c. Put the patient in semi fowler’s position,
set the over bed table so the patient can
eat by himself, brush his teeth and
sponge himself
d. Assist the patient to turn to his sides and
allow him to brush and feed himself only
when he feels ready
90. In the self-care deficit theory by Dorothea Orem,
nursing care becomes necessary when a patient
is unable to fulfil his physiological, psychological
and social needs. A pregnant client needing
prenatal check-up is classified as:
a. Wholly compensatory
b. Supportive Educative
c. Partially compensatory
d. Non compensatory
Situation: Documentation and reporting are just as
important as providing patient care, As such, the nurse
must be factual and accurate to ensure quality
documentation and reporting.
91. Health care reports have different purposes. The
availability of patients’ record to all health team
members demonstrates which of the following
purposes:
a. Legal documentation
b. Research
c. Education
d. Vehicle for communication
92. When a nurse commits medication error, she
should accurately document client’s response
and her corresponding action. This is very
important for which of the following purposes:
a. Research
b. Legal documentation
c. Nursing Audit
d. Vehicle for communication
93. POMR has been widely used in many teaching
hospitals. One of its unique features is SOAPIE
charting. The P in SOAPIE charting should
13
include:
a. Prescription of the doctor to the
patient’s illness
b. Plan of care for patient
c. Patient’s perception of one’s illness
d. Nursing problem and Nursing diagnosis
94. The medical records that are organized into
separate section from doctors or nurses has
more disadvantages than advantages. This is
classified as what type of recording?
a. POMR
b. Modified POMR
c. SOAPIE
d. SOMR
95. Which of the following is the advantage of SOMR
or Traditional recording?
a. Increases efficiency in data gathering
b. Reinforces the use of the nursing
process
c. The caregiver can easily locate proper
section for making charting entries
d. Enhances effective communication
among health care team members
Situation: June is a 24 year old client with symptoms of
dyspnea, absent breath sounds on the right lung and
chest x ray revealed pleural effusion. The physician will
perform thoracentesis.
96. Thoracentesis is useful in treating all of the
following pulmonary disorders except:
a. Hemothorax
b. Hydrothorax
c. Tuberculosis
d. Empyema
97. Which of the following psychological preparation
is not relevant for him?
a. Telling him that the gauge of the needle
and anesthesia to be used
b. Telling him to keep still during the
procedure to facilitate the insertion of
the needle in the correct place
c. Allow June to express his feelings and
concerns
d. Physician’s explanation on the purpose
of the procedure and how it will be done
98. Before thoracentesis, the legal consideration you
must check is:
a. Consent is signed by the client
 b. Medicine preparation is correct
c. Position of the client is correct
d. Consent is signed by relative and
physician

99. As a nurse, you know that the position for June

before thoracentesis is:
a. Orthopneic
b. Low fowlers
c. Knee-chest
d. Sidelying position on the affected side

100. Which of the following anaesthetics drug is used

for thoracentesis?
a. Procaine 2%
b. Demerol 75 mg
c. Valium 250 mg
d. Phenobartbital 50 mg

14
 15

D. Follicle stimulating hormone

NURSING PRACTICE II 5. The following month, Mariah suspects she is

pregnant. Her urine is positive for Human
Situation: Mariah is a 31 year old lawyer who has been chorionic gonadotrophin. Which structure
married for 6 months. She consults you for guidance in produces Hcg?
relation with her menstrual cycle and her desire to get A. Pituitary gland
pregnant. B. Trophoblastic cells of the embryo
C. Uterine deciduas
1. She wants to know the length of her menstrual D. Ovarian follicles
cycle. Her previous menstrual period is October
22 to 26. Her LMB is November 21. Which of the Situation: Mariah came back and she is now pregnant.
following number of days will be your correct
response? 6. At 5 month gestation, which of the following
A. 29 fetal development would probably be achieve?
B. 28 A. Fetal movement are felt by Mariah
C. 30 B. Vernix caseosa covers the entire body
D. 31 C. Viable if delivered within this period
D. Braxton hicks contractions are observed
2. You advised her to observe and record the signs
of Ovulation. Which of the following signs will 7. The nurse palpates the abdomen of Mariah.
she likely note down? Now At 5 month gestation, What level of the
1. A 1 degree Fahrenheit rise in basal body abdomen can the fundic height be palpated?
temperature A. Symphysis pubis
2. Cervical mucus becomes copious and B. Midpoint between the umbilicus and the
clear xiphoid process
3. One pound increase in weight C. Midpoint between the symphysis pubis
4. Mittelschmerz and the umbilicus
A. 1, 2, 4 D. Umbilicus
B. 1, 2, 3
C. 2, 3, 4 8. She worries about her small breasts, thinking
D. 1, 3, 4 that she probably will not be able to breastfeed
her baby. Which of the following responses of
3. You instruct Mariah to keep record of her basal the nurse is correct?
temperature every day, which of the following A. “The size of your breast will not affect
instructions is incorrect? your lactation”
A. If coitus has occurred; this should be B. “You can switch to bottle feeding”
reflected in the chart C. “You can try to have exercise to increase
B. It is best to have coitus on the evening the size of your breast”
following a drop in BBT to become D. “Manual expression of milk is possible”
pregnant
C. Temperature should be taken 9. She tells the nurse that she does not take milk
immediately after waking and before regularly. She claims that she does not want to
getting out of bed gain too much weight during her pregnancy.
D. BBT is lowest during the secretory Which of the following nursing diagnosis is a
phase priority?
A. Potential self-esteem disturbance
4. She reports an increase in BBT on December 16. related to physiologic changes in
Which hormone brings about this change in her pregnancy
BBT? B. Ineffective individual coping related to
A. Estrogen physiologic changes in pregnancy
B. Gonadotropine C. Fear related to the effects of pregnancy
C. Progesterone D. Knowledge deficit regarding nutritional
 requirements of pregnancies related to
lack of information sources
10. Which of the following interventions will likely
ensure compliance of Mariah?
A. Incorporate her food preferences that
are adequately nutritious in her meal
plan
B. Consistently counsel toward optimum
nutritional intake
C. Respect her right to reject dietary
information if she chooses
D. Inform her of the adverse effects of
inadequate nutrition to her fetus
Situation: Susan is a patient in the clinic where you work.
She is inquiring about pregnancy.
11. Susan tells you she is worried because she
develops breasts later than most of her friends.
Breast development is termed as:
A. Adrenarche
B. Thelarche
C. Mamarche
D. Menarche
12. Kevin, Susan’s husband tells you that he is
considering vasectomy After the birth of their
new child. Vasectomy involves the incision of
which organ?
A. The testes
B. The epididymis
C. The vas deferens
D. The scrotum
13. On examination, Susan has been found of having
a cystocele. A cystocele is:
A. A sebaceous cyst arising from the vulvar
fold
B. Protrusion of intestines into the vagina
C. Prolapse of the uterus into the vagina
D. Herniation of the bladder into the
vaginal wall
14. Susan typically has menstrual cycle of 34 days.
She told you she had coitus on days 8, 10, 15 and
20 of her menstrual cycle. Which is the day on
which she is most likely to conceive?
A. 8th day
B. Day 15
C. 10th day
D. Day 20
16
15. While talking with Susan, 2 new patients arrived
and they are covered with large towels and the
nurse noticed that there are many cameraman
and news people outside of the OPD. Upon
assessment the nurse noticed that both of them
are still nude and the male client’s penis is still
inside the female client’s vagina and the male
client said that “I can’t pull it”. Vaginismus was
your first impression. You know that The
psychological cause of Vaginismus is related to:
A. The male client inserted the penis too
deeply that it stimulates vaginal closure
B. The penis was too large that is why the
vagina triggered its defense to attempt
to close it
C. The vagina does not want to be
penetrated
D. It is due to learning patterns of the
female client where she views sex as
bad or sinful
Situation: Overpopulation is one problem in the
Philippines that causes economic drain. Most Filipinos
are against in legalizing abortion. As a nurse, Mastery of
contraception is needed to contribute to the society and
economic growth.
16. Supposed that Dana, 17 years old, tells you she
wants to use fertility awareness method of
contraception. How will she determine her
fertile days?
A. She will notice that she feels hot, as if
she has an elevated temperature.
B. She should assess whether her cervical
mucus is thin, copious, clear and
watery.
C. She should monitor her emotions for
sudden anger or crying
D. She should assess whether her breasts
feel sensitive to cool air
17. Dana chooses to use COC as her family planning
method. What is the danger sign of COC you
would ask her to report?
A. A stuffy or runny nose
B. Slight weight gain
C. Arthritis like symptoms
D. Migraine headache
18. Dana asks about subcutaneous implants and she
asks, how long will these implants be effective.
Your best answer is:
A. One month

B. Five years
C. Twelve months
D. 10 years
19. Dana asks about female condoms. Which of the
following is true with regards to female
condoms?
A. The hormone the condom releases
might cause mild weight gain
B. She should insert the condom before
any penile penetration
C. She should coat the condom with
spermicide before use
D. Female condoms, unlike male condoms,
are reusable
20. Dana has asked about GIFT procedure. What
makes her a good candidate for GIFT?
A. She has patent fallopian tubes, so
fertilized ova can be implanted on them
B. She is RH negative, a necessary
stipulation to rule out RH incompatibility
C. She has normal uterus, so the sperm can
be injected through the cervix into it
D. Her husband is taking sildenafil, so all
sperms will be motile
Situation: Nurse Lorena is a Family Planning and
Infertility Nurse Specialist and currently attends to
FAMILY PLANNING CLIENTS AND INFERTILE COUPLES.
The following conditions pertain to meeting the nursing
needs of this particular population group.
21. Dina, 17 years old, asks you how a tubal ligation
prevents pregnancy. Which would be the best
answer?
A. Prostaglandins released from the cut
fallopian tubes can kill sperm
B. Sperm cannot enter the uterus because
the cervical entrance is blocked.
C. Sperm can no longer reach the ova,
because the fallopian tubes are blocked
D. The ovary no longer releases ova as
there is nowhere for them to go.
22. The Dators are a couple undergoing testing for
infertility. Infertility is said to exist when:
A. A woman has no uterus
B. A woman has no children
C. A couple has been trying to conceive for
1 year
D. A couple has wanted a child for 6
months
17
23. Another client named Lilia is diagnosed as having
endometriosis. This condition interferes with
fertility because:
A. Endometrial implants can block the
fallopian tubes
B. The uterine cervix becomes inflamed
and swollen
C. The ovaries stop producing adequate
estrogen
D. Pressure on the pituitary leads to
decreased FSH levels
24. Lilia is scheduled to have a
hysterosalphingogram. Which of the following
instructions would you give her regarding this
procedure?
A. She will not be able to conceive for 3
months after the procedure
B. The sonogram of the uterus will reveal
any tumors present
C. Many women experience mild bleeding
as an after effect
D. She may feel some cramping when the
dye is inserted
25. Lilia’s cousin on the other hand, knowing nurse
Lorena’s specialization asks what artificial
insemination by donor entails. Which would be
your best answer if you were Nurse Lorena?
A. Donor sperm are introduced vaginally
into the uterus or cervix
B. Donor sperm are injected intra-
abdominally into each ovary
C. Artificial sperm are injected vaginally to
test tubal patency
D. The husband’s sperm is administered
intravenously weekly
Situation: You are assigned to take care of a group of
patients across the lifespan.
26. Pain in the elder persons requires careful
assessment because they:
A. experienced reduce sensory perception
B. have increased sensory perception
C. are expected to experience chronic pain
D. have a decreased pain threshold
27. Administration of analgesics to the older persons
requires careful patient assessment because
older people:
A. are more sensitive to drugs
 B. have increased hepatic, renal and
gastrointestinal function
C. have increased sensory perception
D. mobilize drugs more rapidly
28. The elderly patient is at higher risk for urinary
incontinence because of:
A. increased glomerular filtration
B. decreased bladder capacity
C. diuretic use
D. dilated urethra
29. Which of the following is the MOST COMMON
sign of infection among the elderly?
A. decreased breath sounds with crackles
B. pain
C. fever
D. change in mental status
30. Priorities when caring for the elderly trauma
patient:
A. circulation, airway, breathing
B. airway, breathing, disability (neurologic)
C. disability (neurologic), airway, breathing
D. airway, breathing, circulation
31. Preschoolers are able to see things from which
of the following perspectives?
A. Their peers
B. Their own and their mother’s
C. Their own and their caregivers’
D. Only their own
32. In conflict management, the win-win approach
occurs when:
A. There are two conflicts and the parties
agree to each one
B. Each party gives in on 50% of the
disagreements making up the conflict
C. Both parties involved are committed to
solving the conflict
D. The conflict is settled out of court so the
legal system and the parties win
33. According to the social-interactional perspective
of child abuse and neglect, four factors place the
family members at risk for abuse. These risk
factors are the family members at risk for abuse.
These risk factors are the family itself, the
caregiver, the child, and
A. The presence of a family crisis
B. The national emphasis on sex
C. Genetics
18
D. Chronic poverty
34. Which of the following signs and symptoms
would you most likely find when assessing and
infant with Arnold-Chiari malformation?
A. Weakness of the leg muscles, loss of
sensation in the legs, and restlessness
B. Difficulty swallowing, diminished or
absent gag reflex, and respiratory
distress
C. Difficulty sleeping, hypervigilant, and an
arching of the back
D. Paradoxical irritability, diarrhea, and
vomiting.
35. A parent calls you and frantically reports that her
child has gotten into her famous ferrous sulfate
pills and ingested a number of these pills. Her
child is now vomiting, has bloody diarrhea, and is
complaining of abdominal pain. You will tell the
mother to:
A. Call emergency medical services (EMS)
and get the child to the emergency room
B. Relax because these symptoms will pass
and the child will be fine
C. Administer syrup of ipecac
D. Call the poison control center
36. A client says she heard from a friend that you
stop having periods once you are on the “pill”.
The most appropriate response would be:
A. “The pill prevents the uterus from
making such endometrial lining, that is
why periods may often be scant or
skipped occasionally.”
B. “If your friend has missed her period,
she should stop taking the pills and get a
pregnancy test as soon as possible.”
C. “The pill should cause a normal
menstrual period every month. It
sounds like your friend has not been
taking the pills properly.”
D. “Missed period can be very dangerous
and may lead to the formation of
precancerous cells.”
37. The nurse assessing newborn babies and infants
during their hospital stay after birth will notice
which of the following symptoms as a primary
manifestation of Hirschsprung’s disease?
A. A fine rash over the trunk
B. Failure to pass meconium during the
first 24 to 48 hours after birth

C. The skin turns yellow and then brown
over the first 48 hours of life
D. High-grade fever
38. A client is 7 months pregnant and has just been
diagnosed as having a partial placenta previa.
She is stable and has minimal spotting and is
being sent home. Which of these instructions to
the client may indicate a need for further
teaching?
A. Maintain bed rest with bathroom
privileges
B. Avoid intercourse for three days.
C. Call if contractions occur.
D. Stay on left side as much as possible
when lying down.
39. A woman has been rushed to the hospital with
ruptured membrane. Which of the following
should the nurse check first?
A. Check for the presence of infection
B. Assess for Prolapse of the umbilical
cord
C. Check the maternal heart rate
D. Assess the color of the amniotic fluid
40. The nurse notes that the infant is wearing a
plastic-coated diaper. If a topical medication
were to be prescribed and it were to go on the
stomachs or buttocks, the nurse would teach the
caregivers to:
A. avoid covering the area of the topical
medication with the diaper
B. avoid the use of clothing on top of the
diaper
C. put the diaper on as usual
D. apply an icepack for 5 minutes to the
outside of the diaper
41. Which of the following factors is most important
in determining the success of relationships used
in delivering nursing care?
A. Type of illness of the client
B. Transference and counter transference
C. Effective communication
D. Personality of the participants
42. Grace sustained a laceration on her leg from
automobile accident. Why are lacerations of
lower extremities potentially more serious
among pregnant women than other?
A. lacerations can provoke allergic
responses due to gonadotropic hormone
19
release
B. a woman is less able to keep the
laceration clean because of her fatigue
C. healing is limited during pregnancy so
these will not heal until after birth
D. increased bleeding can occur from
uterine pressure on leg veins
43. In working with the caregivers of a client with an
acute or chronic illness, the nurse would:
A. Teach care daily and let the caregivers
do a return demonstration just before
discharge
B. Difficulty swallowing, diminished or
absent gag reflex, and respiratory
distress.
C. Difficulty sleeping, hypervigilant, and an
arching of the back
D. Paradoxical irritability, diarrhea, and
vomiting
44. Which of the following roles BEST exemplifies
the expanded role of the nurse?
A. Circulating nurse in surgery
B. Medication nurse
C. Obstetrical nurse
D. Pediatric nurse practitioner
45. According to DeRosa and Kochura’s (2006)
article entitled “Implement Culturally Competent
Health Care in your work place,” cultures have
different patterns of verbal and nonverbal
communication. Which difference does?
A. NOT necessarily belong?
B. Personal behavior
C. Subject matter
D. Eye contact
E. Conversational style
46. You are the nurse assigned to work with a child
with acute glomerulonephritis. By following the
prescribed treatment regimen, the child
experiences a remission. You are now checking
to make sure the child does not have a relapse.
Which finding would most lead you to the
conclusion that a relapse is happening?
A. Elevated temperature, cough, sore
throat, changing complete blood count
(CBC) with diiferential
B. A urine dipstick measurement of 2+
proteinuria or more for 3 days, or the
child found to have 3-4+ proteinutria
plus edema.
 C. The urine dipstick showing glucose in the
urine for 3 days, extreme thirst, increase
in urine output, and a moon face.
D. A temperature of 37.8 degrees (100
degrees F), flank pain, burning
frequency, urgency on voiding, and
cloudy urine.
47. The nurse is working with an adolescent who
complains of being lonely and having a lack of
fulfillment in her life. This adolescent shies away
from intimate relationships at times yet at other
times she appears promiscuous. The nurse will
likely work with this adolescent in which of the
following areas?
A. Isolation
B. Lack of fulfillment
C. Loneliness
D. Identity
48. The use of interpersonal decision making,
psychomotor skills, and application of
knowledge expected in the role of a licensed
health care professional in the context of public
health welfare and safety is an example of:
A. Delegation
B. Responsibility
C. Supervision
D. Competence
49. The painful phenomenon known as “back labor”
occurs in a client whose fetus in what position?
A. Brow position
B. Breech position
C. Right Occipito-Anterior Position
D. Left Occipito-Posterior Position
50. FOCUS methodology stands for:
A. Focus, Organize, Clarify, Understand
and Solution
B. Focus, Opportunity, Continuous, Utilize,
Substantiate
C. Focus, Organize, Clarify, Understand,
Substantiate
D. Focus, Opportunity, Continuous
(process), Understand, Solution
SITUATION: The infant and child mortality rate in the low
to middle income countries is ten times higher than
industrialized countries. In response to this, the WHO
and UNICEF launched the protocol Integrated
Management of Childhood Illnesses to reduce the
morbidity and mortality against childhood illnesses.
20
51. If a child with diarrhea registers two signs in the
yellow row in the IMCI chart, we can classify the
patient as:
A. Moderate dehydration
B. Severe dehydration
C. Some dehydration
D. No dehydration
52. Celeste has had diarrhea for 8 days. There is no
blood in the stool, he is irritable, his eyes are
sunken, the nurse offers fluid to Celeste and he
drinks eagerly. When the nurse pinched the
abdomen it goes back slowly. How will you
classify Celeste’s illness?
A. Moderate dehydration
B. Severe dehydration
C. Some dehydration
D. No dehydration
53. A child who is 7 weeks has had diarrhea for 14
days but has no sign of dehydration is classified
as:
A. Persistent diarrhea
B. Dysentery
C. Severe dysentery
D. Severe persistent diarrhea
54. The child with no dehydration needs home
treatment. Which of the following is not
included in the rules for home treatment in this
case?
A. Forced fluids
B. When to return
C. Give vitamin A supplement
D. Feeding more
55. Fever as used in IMCI includes:
A. Axillary temperature of 37.5 or higher
B. Rectal temperature of 38 or higher
C. Feeling hot to touch
D. All of the above
E. A and C only
Situation: Prevention of Dengue is an important nursing
responsibility and controlling it’s spread is a priority once
outbreak has been observed.
56. An important role of the community health
nurse in the prevention and control of Dengue
H-fever includes:
A. Advising the elimination of vectors by
keeping water containers covered

B. Conducting strong health education
drives/campaign directed towards
proper garbage disposal
C. Explaining to the individuals, families,
groups and community the nature of
the disease and its causation
D. Practicing residual spraying with
insecticides
57. Community health nurses should be alert in
observing a Dengue suspect. The following is
NOT an indicator for hospitalization of H-fever
suspects?
A. Marked anorexia, abdominal pain and
vomiting
B. Increasing hematocrit count
C. Cough of 30 days
D. Persistent headache
58. The community health nurses’ primary concern
in the immediate control of hemorrhage among
patients with dengue is:
A. Advising low fiber and non-fat diet
B. Providing warmth through light weight
covers
C. Observing closely the patient for vital
signs leading to shock
D. Keeping the patient at rest
59. Which of these signs may NOT be REGARDED as
a truly positive signs indicative of Dengue H-
fever?
A. Prolonged bleeding time
B. Appearance of at least 20 petechiae
within 1cm square
C. Steadily increasing hematocrit count
D. Fall in the platelet count
60. Which of the following is the most important
treatment of patients with Dengue H-fever?
A. Give aspirin for fever
B. Replacement of body fluids
C. Avoid unnecessary movement of patient
D. Ice cap over the abdomen in case of
melena
Situation: Health education and Health promotion is an
important part of nursing responsibility in the
community. Immunization is a form of health promotion
that aims at preventing the common childhood illnesses.
61. In correcting misconceptions and myths about
certain diseases and their management, the
21
health worker should first:
A. Identify the myths and misconceptions
prevailing in the community
B. Identify the source of these myths and
misconceptions
C. Explain how and why these myths came
about
D. Select the appropriate IEC strategies to
correct them
62. How many percent of measles are prevented by
immunization at 9 months of age?
A. 80%
B. 99%
C. 90%
D. 95%
63. After TT3 vaccination a mother is said to be
protected to tetanus by around:
A. 80%
B. 99%
C. 85%
D. 90%
64. If ever convulsions occur after administering
DPT, what should the nurse best suggest to the
mother?
A. Do not continue DPT vaccination
anymore
B. Advise mother to comeback after 1 week
C. Give DT instead of DPT
D. Give pertussis of the DPT and remove DT
65. These vaccines are given 3 doses at one month
intervals:
A. DPT, BCG, TT
B. OPV, HEP. B, DPT
C. DPT, TT, OPV
D. Measles, OPV, DPT
Situation – With the increasing documented cases of
CANCER the best alternative to treatment still remains to
be PREVENTION. The following conditions apply.
66. Which among the following is the primary focus
of prevention of cancer?
A. Elimination of conditions causing cancer
B. Diagnosis and treatment
C. Treatment at early stage
D. Early detection
67. In the prevention and control of cancer, which of
the following activities is the most important
 function of the community health nurse?
A. Conduct community assemblies.
B. Referral to cancer specialist those clients
with symptoms of cancer.
C. Use the nine warning signs of cancer as
parameters in our process of detection,
control and treatment modalities.
D. Teach woman about proper/correct
nutrition.
68. Who among the following are recipients of the
secondary level of care for cancer cases?
A. Those under early case detection
B. Those under post case treatment
C. Those scheduled for surgery
D. Those undergoing treatment
69. Who among the following are recipients of the
tertiary level of care for cancer cases?
A. Those under early treatment
B. Those under early detection
C. Those under supportive care
D. Those scheduled for surgery
70. In Community Health Nursing, despite the
availability and use of many equipment and
devices to facilitate the job of the community
health nurse, the best tool any nurse should be
wel be prepared to apply is a scientific approach.
This approach ensures quality of care even at the
community setting. This is nursing parlance is
nothing less than the:
A. nursing diagnosis
B. nursing research
C. nursing protocol
D. nursing process
Situation – Two children were brought to you. One with
chest indrawing and the other had diarrhea. The
following questions apply:
71. Using Integrated Management and Childhood
Illness (IMCI) approach, how would you classify
the 1st child?
A. Bronchopneumonia
B. Severe pneumonia
C. No pneumonia : cough or cold
D. Pneumonia
72. The 1st child who is 13 months has fast
breathing using IMCI parameters he has:
A. 40 breaths per minute or more
B. 50 breaths per minute
22
C. 30 breaths per minute or more
D. 60 breaths per minute
73. Nina, the 2nd child has diarrhea for 5 days.
There is no blood in the stool. She is irritable,
and her eyes are sunken. The nurse offered
fluids and and the child drinks eagerly. How
would you classify Nina’s illness?
A. Some dehydration
B. Severe dehydration
C. Dysentery
D. No dehydration
74. Nina’s treatment should include the following
EXCEPT:
A. reassess the child and classify him for
dehydration
B. for infants under 6 months old who are
not breastfed, give 100-200 ml clean
water as well during this period
C. Give in the health center the
recommended amount of ORS for 4
hours.
D. Do not give any other foods to the child
for home treatment
75. While on treatment, Nina 18 months old
weighed 18 kgs. and her temperature registered
at 37 degrees C. Her mother says she developed
cough 3 days ago. Nina has no general danger
signs. She has 45 breaths/minute, no chest in-
drawing, no stridor. How would you classify
Nina’s manifestation?
A. No pneumonia
B. Pneumonia
C. Severe pneumonia
D. Bronchopneumonia
76. Carol is 15 months old and weighs 5.5 kgs and it
is her initial visit. Her mother says that Carol is
not eating well and unable to breastfeed, he has
no vomiting, has no convulsion and not
abnormally sleepy or difficult to awaken. Her
temperature is 38.9 deg C. Using the integrated
management of childhood illness or IMCI
strategy, if you were the nurse in charge of
Carol, how will you classify her illness?
A. a child at a general danger sign
B. severe pneumonia
C. very severe febrile disease
D. severe malnutrition
77. Why are small for gestational age newborns at

risk for difficulty maintaining body temperature?
A. their skin is more susceptible to
conduction of cold
B. they are preterm so are born relatively
small in size
C. they do not have as many fat stored as
other infants
D. they are more active than usual so they
throw off comes
78. Oxytocin is administered to Rita to augment
labor. What are the first symptoms of water
intoxication to observe for during this
procedure?
A. headache and vomiting
B. a high choking voice
C. a swollen tender tongue
D. abdominal bleeding and pain
79. Which of the following treatment should NOT be
considered if the child has severe dengue
hemorrhagic fever?
A. use plan C if there is bleeding from the
nose or gums
B. give ORS if there is skin Petechiae,
persistent vomiting, and positive
tourniquet test
C. give aspirin
D. prevent low blood sugar
80. In assessing the patient’s condition using the
Integrated Management of Childhood Illness
approach strategy, the first thing that a nurse
should do is to:
A. ask what are the child’s problem
B. check for the four main symptoms
C. check the patient’s level of
consciousness
D. check for the general danger signs
81. A child with diarrhea is observed for the
following EXCEPT:
A. how long the child has diarrhea
B. presence of blood in the stool
C. skin Petechiae
D. signs of dehydration
82. The child with no dehydration needs home
treatment. Which of the following is NOT
included in the care for home management at
this case?
A. give drugs every 4 hours
23
B. give the child more fluids
C. continue feeding the child
D. inform when to return to the health
center
83. Ms. Jordan, RN, believes that a patient should be
treated as individual. This ethical principle that
the patient referred to:
A. beneficence
B. respect for person
C. nonmaleficence
D. autonomy
84. When patients cannot make decisions for
themselves, the nurse advocate relies on the
ethical principle of:
A. justice and beneficence
B. beneficence and nonmaleficence
C. fidelity and nonmaleficence
D. fidelity and justice
85. Being a community health nurse, you have the
responsibility of participating in protecting the
health of people. Consider this situation:
Vendors selling bread with their bare hands.
They receive money with these hands. You do
not see them washing their hands. What should
you say/do?
A. “Miss, may I get the bread myself
because you have not washed your
hands”
B. All of these
C. “Miss, it is better to use a pick up
forceps/ bread tong”
D. “Miss, your hands are dirty. Wash your
hands first before getting the bread”
Situation: The following questions refer to common
clinical encounters experienced by an entry level nurse.
86. A female client asks the nurse about the use of a
cervical cap. Which statement is correct
regarding the use of the cervical cap?
A. It may affect Pap smear results.
B. It does not need to be fitted by the
physician.
C. It does not require the use of
spermicide.
D. It must be removed within 24 hours.
87. The major components of the communication
process are:
A. Verbal, written and nonverbal
 B. Speaker, listener and reply
C. Facial expression, tone of voice and
gestures
D. Message, sender, channel, receiver and
feedback
88. The extent of burns in children are normally
assessed and expressed in terms of:
A. The amount of body surface that is
unburned
B. Percentages of total body surface area
(TBSA)
C. How deep the deepest burns are
D. The severity of the burns on a 1 to 5
burn scale.
89. The school nurse notices a child who is wearing
old, dirty, poor-fitting clothes; is always hungry;
has no lunch money; and is always tired. When
the nurse asks the boy his tiredness, he talks of
playing outside until midnight. The nurse will
suspect that this child is:
A. Being raised by a parent of low
intelligence quotient (IQ)
B. An orphan
C. A victim of child neglect
D. The victim of poverty
90. Which of the following indicates the type(s) of
acute renal failure?
A. Four types: hemorrhagic with and
without clotting, and nonhemorrhagic
with and without clottings
B. One type: acute
C. Three types: prerenal, intrarenal and
postrenal
D. Two types: acute and subacute
Situation: Mike 16 y/o has been diagnosed to have AIDS;
he worked as entertainer in a cruise ship;
91. Which method of transmission is common to
contract AIDS?
A. Syringe and needles
B. Sexual contact
C. Body fluids
D. Transfusion
92. Causative organism in AIDS is one of the
following;
A. Fungus
B. retrovirus
C. Bacteria
24
D. Parasites
93. You are assigned in a private room of Mike.
Which procedure should be of outmost
importance;
A. Alcohol wash
B. Washing Isolation
C. Universal precaution
D. Gloving technique
94. What primary health teaching would you give to
mike;
A. Daily exercise
B. reverse isolation
C. Prevent infection
D. Proper nutrition
95. Exercise precaution must be taken to protect
health worker dealing with the AIDS patients .
which among these must be done as priority:
A. Boil used syringe and needles
B. Use gloves when handling specimen
C. Label personal belonging
D. Avoid accidental wound
Situation: Michelle is a 6 year old preschooler. She was
reported by her sister to have measles but she is at
home because of fever, upper respiratory problem and
white sports in her mouth.
96. Rubeola is an Arabic term meaning Red, the rash
appears on the skin in invasive stage prior to
eruption behind the ears. As a nurse, your
physical examination must determine
complication especially:
A. Otitis media
B. Inflammatory conjunctiva
C. Bronchial pneumonia
D. Membranous laryngitis
97. To render comfort measure is one of the
priorities, Which includes care of the skin, eyes,
ears, mouth and nose. To clean the mouth, your
antiseptic solution is in some form of which one
below?
A. Water
B. Alkaline
C. Sulfur
D. Salt
98. As a public health nurse, you teach mother and
family members the prevention of complication
of measles. Which of the following should be
 25

closely watched?
A. Temperature fails to drop
B. Inflammation of the nasophraynx
C. Inflammation of the conjunctiva
D. Ulcerative stomatitis

99. Source of infection of measles is secretion of

nose and throat of infection person. Filterable
virus of measles is transmitted by:
A. Water supply
B. Food ingestion
C. Droplet
D. Sexual contact

100. Method of prevention is to avoid

exposure to an infection person. Nursing
responsibility for rehabilitation of patient
includes the provision of:
A. Terminal disinfection
B. Immunization
C. Injection of gamma globulin
D. Comfort measures
 c. 50 days
d. 14 days
NURSING PRACTICE III
Situation: As a nurse researcher you must have a very
Situation: Leo lives in the squatter area. He goes to good understanding of the common terms of concept
nearby school. He helps his mother gather molasses used in research.
after school. One day, he was absent because of fever,
malaise, anorexia and abdominal discomfort. 6. The information that an investigator collects
from the subjects or participants in a research
1. Upon assessment, Leo was diagnosed to have study is usually called;
hepatitis A. Which mode of transmission has the a. Hypothesis
infection agent taken? b. Variable
a. Fecal-oral c. Data
b. Droplet d. Concept
c. Airborne
d. Sexual contact 7. Which of the following usually refers to the
independent variables in doing research
2. Which of the following is concurrent disinfection a. Result
in the case of Leo? b. output
a. Investigation of contact c. Cause
b. Sanitary disposal of faeces, urine and d. Effect
blood
c. Quarantine of the sick individual 8. The recipients of experimental treatment is an
d. removing all detachable objects in the experimental design or the individuals to be
room, cleaning lighting and air duct observed in a non experimental design are
surfaces in the ceiling, and cleaning called;
everything downward to the floor a. Setting
b. Treatment
3. Which of the following must be emphasized c. Subjects
during mother’s class to Leo’s mother? d. Sample
a. Administration of Immunoglobulin to
families 9. The device or techniques an investigator
b. Thorough hand washing before and employs to collect data is called;
after eating and toileting a. Sample
c. Use of attenuated vaccines b. hypothesis
d. Boiling of food especially meat c. Instrument
d. Concept
4. Disaster control should be undertaken when
there are 3 or more hepatitis A cases. Which of 10. The use of another person’s ideas or wordings
these measures is a priority? without giving appropriate credit results from
a. Eliminate faecal contamination from inaccurate or incomplete attribution of materials
foods to its sources. Which of the following is referred
b. Mass vaccination of uninfected to when another person’s idea is inappropriate
individuals credited as one’s own;
c. Health promotion and education to a. Plagiarism
families and communities about the b. assumption
disease it’s cause and transmission c. Quotation
d. Mass administration of Immunoglobulin d. Paraphrase

5. What is the average incubation period of Situation – Mrs. Pichay is admitted to your ward. The
Hepatitis A? MD ordered “Prepare for thoracentesis this pm to
a. 30 days remove excess air from the pleural cavity.”
b. 60 days

26

11. Which of the following nursing responsibilities is
essential in Mrs. Pichay who will undergo
thoracentesis?
a. Support and reassure client during the
procedure
b. Ensure that informed consent has been
signed
c. Determine if client has allergic reaction
to local anesthesia
d. Ascertain if chest x-rays and other tests
have been prescribed and completed
12. Mrs. Pichay who is for thoracentesis is assigned
by the nurse to which of the following positions?
a. Trendelenburg position
b. Supine position
c. Dorsal Recumbent position
d. Orthopneic position
13. During thoracentesis, which of the following
nursing intervention will be most crucial?
a. Place patient in a quiet and cool room
b. Maintain strict aseptic technique
c. Advice patient to sit perfectly still
during needle insertion until it has been
withdrawn from the chest
d. Apply pressure over the puncture site as
soon as the needle is withdrawn
14. To prevent leakage of fluid in the thoracic cavity,
how will you position the client after
thoracentesis?
a. Place flat in bed
b. Turn on the unaffected side
c. Turn on the affected side
d. On bed rest
15. Chest x-ray was ordered after thoracentesis.
When your client asks what is the reason for
another chest x-ray, you will explain:
a. To rule out pneumothorax
b. To rule out any possible perforation
c. To decongest
d. To rule out any foreign body
Situation: A computer analyst, Mr. Ricardo J. Santos, 25
was brought to the hospital for diagnostic workup after
he had experienced seizure in his office.
16. Just as the nurse was entering the room, the
patient who was sitting on his chair begins to
have a seizure. Which of the following must the
nurse do first?
27
a. Ease the patient to the floor
b. Lift the patient and put him on the bed
c. Insert a padded tongue depressor
between his jaws
d. Restraint patient’s body movement
17. Mr Santos is scheduled for CT SCAN for the next
day, noon time. Which of the following is the
correct preparation as instructed by the nurse?
a. Shampoo hair thoroughly to remove oil
and dirt
b. No special preparation is needed.
Instruct the patient to keep his head
still and stead
c. Give a cleansing enema and give fluids
until 8 AM
d. Shave scalp and securely attach
electrodes to it
18. Mr Santos is placed on seizure precaution.
Which of the following would be
contraindicated?
a. Obtain his oral temperature
b. Encourage to perform his own personal
hygiene
c. Allow him to wear his own clothing
d. Encourage him to be out of bed
19. Usually, how does the patient behave after his
seizure has subsided?
a. Most comfortable walking and moving
about
b. Becomes restless and agitated
c. Sleeps for a period of time
d. Say he is thirsty and hungry
20. Before, during and after seizure. The nurse
knows that the patient is ALWAYS placed in what
position?
a. Low fowler’s
b. Side lying
c. Modified trendelenburg
d. Supine
Situation: Mrs. Damian an immediate post op
cholecystectomy and choledocholithotomy patient,
complained of severe pain at the wound site.
21. Choledocholithotomy is:
a. The removal of the gallbladder
b. The removal of the stones in the
gallbladder
c. The removal of the stones in the
 common bile duct
d. The removal of the stones in the kidney
22. The simplest pain relieving technique is:
a. Distraction
b. Deep breathing exercise
c. Taking aspirin
d. Positioning
23. Which of the following statement on pain is
TRUE?
a. Culture and pain are not associated
b. Pain accompanies acute illness
c. Patient’s reaction to pain Varies
d. Pain produces the same reaction such as
groaning and moaning
24. In pain assessment, which of the following
condition is a more reliable indicator?
a. Pain rating scale of 1 to 10
b. Facial expression and gestures
c. Physiological responses
d. Patients description of the pain
sensation
25. When a client complains of pain, your initial
response is:
a. Record the description of pain
b. Verbally acknowledge the pain
c. Refer the complaint to the doctor
d. Change to a more comfortable position
Situation: You are assigned at the surgical ward and
clients have been complaining of post pain at varying
degrees. Pain as you know, is very subjective.
26. A one-day postoperative abdominal surgery
client has been complaining of severe throbbing
abdominal pain described as 9 in a 1-10 pain
rating. Your assessment reveals bowel sounds on
all quadrants and the dressing is dry and intact.
What nursing intervention would you take?
a. Medicate client as prescribed
b. Encourage client to do imagery
c. Encourage deep breathing and turning
d. Call surgeon stat
27. Pentoxidone 5 mg IV every 8 hours was
prescribed for post abdominal pain. Which will
be your priority nursing action?
a. Check abdominal dressing for possible
swelling
b. Explain the proper use of PCA to
28
alleviate anxiety
c. Avoid overdosing to prevent
dependence/tolerance
d. Monitor VS, more importantly RR
28. The client complained of abdominal distention
and pain. Your nursing intervention that can
alleviate pain is:
a. Instruct client to go to sleep and relax
b. Advice the client to close the lips and
avoid deep breathing and talking
c. Offer hot and clear soup
d. Turn to sides frequently and avoid too
much talking
29. Surgical pain might be minimized by which
nursing action in the O.R.
a. Skill of surgical team and lesser
manipulation
b. Appropriate preparation for the
scheduled procedure
c. Use of modern technology in closing the
wound
d. Proper positioning and draping of clients
30. Inadequate anesthesia is said to be one of the
common cause of pain both in intra and post op
patients. If General anesthesia is desired, it will
involve loss of consciousness. Which of the
following are the 2 general types of GA?
a. Epidural and Spinal
b. Subarachnoid block and Intravenous
c. Inhalation and Regional
d. Intravenous and Inhalation
Situation: Nurse’s attitudes toward the pain influence
the way they perceive and interact with clients in pain.
31. Nurses should be aware that older adults are at
risk of underrated pain. Nursing assessment and
management of pain should address the
following beliefs EXCEPT:
a. Older patients seldom tend to report
pain than the younger ones
b. Pain is a sign of weakness
c. Older patients do not believe in
analgesics, they are tolerant
d. Complaining of pain will lead to being
labeled a ‘bad’ patient
32. Nurses should understand that when a client
responds favorably to a placebo, it is known as
the ‘placebo effect’. Placebos do not indicate

whether or not a client has:
a. Conscience
b. Disease
c. Real pain
d. Drug tolerance
33. You are the nurse in the pain clinic where you
have client who has difficulty specifying the
location of pain. How can you assist such client?
a. The pain is vague
b. By charting-it hurts all over
c. Identify the absence and presence of
pain
d. As the client to point to the painful are
by just one finger
34. What symptom, more distressing than pain,
should the nurse monitor when giving opioids
especially among elderly clients who are in pain?
a. Forgetfulness
b. Drowsiness
c. Constipation
d. Allergic reactions like pruritis
35. Physical dependence occurs in anyone who
takes opiods over a period of time. What do you
tell a mother of a ‘dependent’ when asked for
advice?
a. Start another drug and slowly lessen the
opioid dosage
b. Indulge in recreational outdoor activities
c. Isolate opioid dependent to a restful
resort
d. Instruct slow tapering of the drug
dosage and alleviate physical
withdrawal symptoms
Situation: The nurse is performing health education
activities for Janevi Segovia, a 30 year old Dentist with
Insulin dependent diabetes Miletus.
36. Janevi is preparing a mixed dose of insulin. The
nurse is satisfied with her performance when
she:
a. Draw insulin from the vial of clear
insulin first
b. Draw insulin from the vial of the
intermediate acting insulin first
c. Fill both syringes with the prescribed
insulin dosage then shake the bottle
vigorously
d. Withdraw the intermediate acting
insulin first before withdrawing the short
29
acting insulin first
37. Janevi complains of nausea, vomiting,
diaphoresis and headache. Which of the
following nursing intervention are you going to
carry out first?
a. Withhold the client’s next insulin
injection
b. Test the client’s blood glucose level
c. Administer Tylenol as ordered
d. Offer fruit juice, gelatine and chicken
bouillon
38. Janevi administered regular insulin at 7 A.M and
the nurse should instruct Jane to avoid
exercising at around:
a. 9 to 11 A.M
b. Between 8 A.M to 9 A.M
c. After 8 hours
d. In the afternoon, after taking lunch
39. Janevi was brought at the emergency room after
four month because she fainted in her clinic. The
nurse should monitor which of the following test
to evaluate the overall therapeutic compliance
of a diabetic patient?
a. Glycosylated hemoglobin
b. Ketone levels
c. Fasting blood glucose
d. Urine glucose level
40. Upon the assessment of Hba1c of Mrs. Segovia,
The nurse has been informed of a 9% Hba1c
result. In this case, she will teach the patient to:
a. Avoid infection
b. Prevent and recognize hyperglycaemia
c. Take adequate food and nutrition
d. Prevent and recognize hypoglycaemia
41. The nurse is teaching plan of care for Jane with
regards to proper foot care. Which of the
following should be included in the plan?
a. Soak feet in hot water
b. Avoid using mild soap on the feet
c. Apply a moisturizing lotion to dry feet
but not between the toes
d. Always have a podiatrist to cut your toe
nails; never cut them yourself
42. Another patient was brought to the emergency
room in an unresponsive state and a diagnosis of
hyperglycaemic hyperosmolar nonketotic
syndrome is made. The nurse immediately
 prepares to initiate which of the following
anticipated physician’s order?
a. Endotracheal intubation
b. 100 unites of NPH insulin
c. Intravenous infusion of normal saline
d. Intravenous infusion of sodium
bicarbonate
43. Jane eventually developed DKA and is being 47.
treated in the emergency room. Which finding
would the nurse expect to note as confirming
this diagnosis?
a. Comatose state
b. Decreased urine output
c. Increased respiration and an increase in
pH 48.
d. Elevated blood glucose level and low
plasma bicarbonate level
44. The nurse teaches Jane to know the difference
between hypoglycaemia and ketoacidosis. Jane
demonstrates understanding of the teaching by
stating that glucose will be taken if which of the 49.
following symptoms develops?
a. Polyuria
b. Shakiness
c. Blurred Vision
d. Fruity breath odour
45. Jane has been scheduled to have a FBS taken in 50.
the morning. The nurse tells Jane not to eat or
drink after midnight. Prior to taking the blood
specimen, the nurse noticed that Jane is holding
a bottle of distilled water. The nurse asked Jane
if she drink any, and she said “yes.” Which of the
following is the best nursing action?
a. Administer syrup of ipecac to remove Situation – In the OR, there are safety protocols that
the distilled water from the stomach should be followed. The OR nurse should be well versed
b. Suction the stomach content using NGT with all these to safeguard the safety and quality of
prior to specimen collection patient delivery outcome.
c. Advice to physician to reschedule to
diagnostic examination next day 51.
d. Continue as usual and have the FBS
analysis performed and specimen be
taken
Situation: Elderly clients usually produce unusual signs
when it comes to different diseases. The ageing process
is a complicated process and the nurse should
understand that it is an inevitable fact and she must be
prepared to care for the growing elderly population. 52.
46. Hypoxia may occur in the older patients because
30
of which of the following physiologic changes
associated with aging.
a. Ineffective airway clearance
b. Decreased alveolar surfaced area
c. Decreased anterior-posterior chest
diameter
d. Hyperventilation
The older patient is at higher risk for
incontinence because of:
a. Dilated urethra
b. Increased glomerular filtration rate
c. Diuretic use
d. Decreased bladder capacity
Merle, age 86, is complaining of dizziness when
she stands up. This may indicate:
a. Dementia
b. Functional decline
c. A visual problem
d. Drug toxicity
Cardiac ischemia in an older patient usually
produces:
a. ST-T wave changes
b. Chest pain radiating to the left arm
c. Very high creatinine kinase level
d. Acute confusion
The most dependable sign of infection in the
older patient is:
a. Change in mental status
b. Fever
c. Pain
d. Decreased breath sounds with crackles
Which of the following should be given highest
priority when receiving patient in the OR?
a. Assess level of consciousness
b. Verify patient identification and
informed consent
c. Assess vital signs
d. Check for jewelry, gown, manicure, and
dentures
Surgeries like I and D (incision and drainage) and
debridement are relatively short procedures but
considered ‘dirty cases’. When are these

procedures best scheduled?
a. Last case
b. In between cases
c. According to availability of
anaesthesiologist
d. According to the surgeon’s preference
53. OR nurses should be aware that maintaining the
client’s safety is the overall goal of nursing care
during the intraoperative phase. As the
circulating nurse, you make certain that
throughout the procedure…
a. the surgeon greets his client before
induction of anesthesia
b. the surgeon and anesthesiologist are in
tandem
c. strap made of strong non-abrasive
materials are fastened securely around
the joints of the knees and ankles and
around the 2 hands around an arm
board.
d. Client is monitored throughout the
surgery by the assistant anesthesiologist
54. Another nursing check that should not be missed
before the induction of general anesthesia is:
a. check for presence underwear
b. check for presence dentures
c. check patient’s ID
d. check baseline vital signs
55. Some lifetime habits and hobbies affect
postoperative respiratory function. If your client
smokes 3 packs of cigarettes a day for the past
10 years, you will anticipate increased risk for:
a. perioperative anxiety and stress
b. delayed coagulation time
c. delayed wound healing
d. postoperative respiratory infection
Situation: Sterilization is the process of removing ALL
living microorganism. To be free of ALL living
microorganism is sterility.
56. There are 3 general types of sterilization use in
the hospital, which one is not included?
a. Steam sterilization
b. Physical sterilization
c. Chemical sterilization
d. Sterilization by boiling
57. Autoclave or steam under pressure is the most
common method of sterilization in the hospital.
31
The nurse knows that the temperature and time
is set to the optimum level to destroy not only
the microorganism, but also the spores. Which
of the following is the ideal setting of the
autoclave machine?
a. 10,000 degree Celsius for 1 hour
b. 5,000 degree Celsius for 30 minutes
c. 37 degree Celsius for 15 minutes
d. 121 degree Celsius for 15 minutes
58. It is important that before a nurse prepares the
material to be sterilized, a chemical indicator
strip should be placed above the package,
preferably, Muslin sheet. What is the color of
the striped produced after autoclaving?
a. Black
b. Blue
c. Gray
d. Purple
59. Chemical indicators communicate that:
a. The items are sterile
b. That the items had undergone
sterilization process but not necessarily
sterile
c. The items are disinfected
d. That the items had undergone
disinfection process but not necessarily
disinfected
60. If a nurse will sterilize a heat and moisture labile
instruments, It is according to AORN
recommendation to use which of the following
method of sterilization?
a. Ethylene oxide gas
b. Autoclaving
c. Flash sterilizer
d. Alcohol immersion
Situation 5 – Nurses hold a variety of roles when
providing care to a perioperative patient.
61. Which of the following role would be the
responsibility of the scrub nurse?
a. Assess the readiness of the client prior
to surgery
b. Ensure that the airway is adequate
c. Account for the number of sponges,
needles, supplies, used during the
surgical procedure.
d. Evaluate the type of anesthesia
appropriate for the surgical client
62. As a perioperative nurse, how can you best meet
the safety need of the client after administering
preoperative narcotic?
a. Put side rails up and ask the client not
to get out of bed
b. Send the client to OR with the family
c. Allow client to get up to go to the
comfort room
d. Obtain consent form
63. It is the responsibility of the pre-op nurse to do
skin prep for patients undergoing surgery. If hair
at the operative site is not shaved, what should
be done to make suturing easy and lessen
chance of incision infection?
a. Draped
b. Pulled
c. Clipped
d. Shampooed
64. It is also the nurse’s function to determine when
infection is developing in the surgical incision.
The perioperative nurse should observe for what
signs of impending infection?
a. Localized heat and redness
b. Serosanguinous exudates and skin
blanching
c. Separation of the incision
d. Blood clots and scar tissue are visible
65. Which of the following nursing interventions is
done when examining the incision wound and
changing the dressing?
a. Observe the dressing and type and odor
of drainage if any
b. Get patient’s consent
c. Wash hands
d. Request the client to expose the incision
wound
Situation – The preoperative nurse collaborates with the
client significant others, and healthcare providers.
66. To control environmental hazards in the OR, the
nurse collaborates with the following
departments EXCEPT:
a. Biomedical division
b. Infection control committee
c. Chaplaincy services
d. Pathology department
67. An air crash occurred near the hospital leading
to a surge of trauma patient. One of the last
32
patients will need surgical amputation but there
are no sterile surgical equipments. In this case,
which of the following will the nurse expect?
a. Equipments needed for surgery need not
be sterilized if this is an emergency
necessitating life saving measures
b. Forwarding the trauma client to the
nearest hospital that has available sterile
equipments is appropriate
c. The nurse will need to sterilize the item
before using it to the client using the
regular sterilization setting at 121
degree Celsius in 15 minutes
d. In such cases, flash sterlizer will be use
at 132 degree Celsius in 3 minutes
68. Tess, the PACU nurse, discovered that Malou,
who weighs 110 lbs prior to surgery, is in severe
pain 3 hrs after cholecystectomy. Upon checking
the chart, Malou found out that she has an order
of Demerol 100 mg I.M. prn for pain. Tess should
verify the order with:
a. Nurse Supervisor
b. Surgeon
c. Anesthesiologist
d. Intern on duty
69. Rosie, 57, who is diabetic is for debridement if
incision wound. When the circulating nurse
checked the present IV fluid, she found out that
there is no insulin incorporated as ordered.
What should the circulating nurse do?
a. Double check the doctor’s order and
call the attending MD
b. Communicate with the ward nurse to
verify if insulin was incorporated or not
c. Communicate with the client to verify if
insulin was incorporated
d. Incorporate insulin as ordered.
70. The documentation of all nursing activities
performed is legally and professionally vital.
Which of the following should NOT be included
in the patient’s chart?
a. Presence of prosthetoid devices such as
dentures, artificial limbs hearing aid, etc.
b. Baseline physical, emotional, and
psychosocial data
c. Arguments between nurses and
residents regarding treatments
d. Observed untoward signs and symptoms
and interventions including contaminant
intervening factors

Situation – Team efforts is best demonstrated in the OR.
71. If you are the nurse in charge for scheduling
surgical cases, what important information do
you need to ask the surgeon?
a. Who is your internist
b. Who is your assistant and
anaesthesiologist, and what is your
preferred time and type of surgery?
c. Who are your anaesthesiologist,
internist, and assistant
d. Who is your anaesthesiologist
72. In the OR, the nursing tandem for every surgery
is:
a. Instrument technician and circulating
nurse
b. Nurse anaesthetist, nurse assistant, and
instrument technician
c. Scrub nurse and nurse anaesthetist
d. Scrub and circulating nurses
73. While team effort is needed in the OR for
efficient and quality patient care delivery, we
should limit the number of people in the room
for infection control. Who comprise this team?
a. Surgeon, anaesthesiologist, scrub nurse,
radiologist, orderly
b. Surgeon, assistants, scrub nurse,
circulating nurse, anaesthesiologist
c. Surgeon, assistant surgeon,
anaesthesiologist, scrub nurse,
pathologist
d. Surgeon, assistant surgeon,
anaesthesiologist, intern, scrub nurse
74. Who usually act as an important part of the OR
personnel by getting the wheelchair or stretcher,
and pushing/pulling them towards the operating
room?
a. Orderly/clerk
b. Nurse Supervisor
c. Circulating Nurse
d. Anaesthesiologist
75. The breakdown in teamwork is often times a
failure in:
a. Electricity
b. Inadequate supply
c. Leg work
d. Communication
33
Situation: Basic knowledge on Intravenous solutions is
necessary for care of clients with problems with fluids
and electrolytes.
76. A client involved in a motor vehicle crash
presents to the emergency department with
severe internal bleeding. The client is severely
hypotensive and unresponsive. The nurse
anticipates which of the following intravenous
solutions will most likely be prescribed to
increase intravascular volume, replace
immediate blood loss and increase blood
pressure?
a. 0.45% sodium chloride
b. 0.33% sodium chloride
c. Normal saline solution
d. Lactated ringer’s solution
77. The physician orders the nurse to prepare an
isotonic solution. Which of the following IV
solution would the nurse expect the intern to
prescribe?
a. 5% dextrose in water
b. 0.45% sodium chloride
c. 10% dextrose in water
d. 5% dextrose in 0.9% sodium chloride
78. The nurse is making initial rounds on the nursing
unit to assess the condition of assigned clients.
The nurse notes that the client’s IV Site is cool,
pale and swollen and the solution is not infusing.
The nurse concludes that which of the following
complications has been experienced by the
client?
a. Infection
b. Phlebitis
c. Infiltration
d. Thrombophelibitis
79. A nurse reviews the client’s electrolyte
laboratory report and notes that the potassium
level is 3.2 mEq/L. Which of the following would
the nurse note on the electrocardiogram as a
result of the laboratory value?
a. U waves
b. Absend P waves
c. Elevated T waves
d. Elevated ST segment
80. One patient had a ‘runaway’ IV of 50% dextrose.
To prevent temporary excess of insulin or
transient hyperinsulin reaction what solution
you prepare in anticipation of the doctor’s
 order?
a. Any IV solution available to KVO
b. Isotonic solution
c. Hypertonic solution
d. Hypotonic solution
81. An informed consent is required for:
a. closed reduction of a fracture
b. irrigation of the external ear canal
c. insertion of intravenous catheter
d. urethral catheterization
82. Which of the following is not true with regards
to the informed consent?
a. It should describe different treatment
alternatives
b. It should contain a thorough and
detailed explanation of the procedure
to be done
c. It should describe the client’s diagnosis
d. It should give an explanation of the
client’s prognosis
83. You know that the hallmark of nursing
accountability is the:
a. accurate documentation and reporting
b. admitting your mistakes
c. filing an incidence report
d. reporting a medication error
84. A nurse is assigned to care for a group of clients.
On review of the client’s medical records, the
nurse determines that which client is at risk for
excess fluid volume?
a. The client taking diuretics
b. The client with renal failure
c. The client with an ileostomy
d. The client who requires gastrointestinal
suctioning
85. A nurse is assigned to care for a group of clients.
On review of the client’s medical records, the
nurse determines that which client is at risk for
deficient fluid volume?
a. A client with colostomy
b. A client with congestive heart failure
c. A client with decreased kidney function
d. A client receiving frequent wound
irrigation
Situation: As a perioperative nurse, you are aware of the
correct processing methods for preparing instruments
and other devices for patient use to prevent infection.
34
86. As an OR nurse, what are your foremost
considerations for selecting chemical agents for
disinfection?
a. Material compatibility and efficiency
b. Odor and availability
c. Cost and duration of disinfection process
d. Duration of disinfection and efficiency
87. Before you use a disinfected instrument it is
essential that you:
a. Rinse with tap water followed by alcohol
b. Wrap the instrument with sterile water
c. Dry the instrument thoroughly
d. Rinse with sterile water
88. You have a critical heat labile instrument to
sterilize and are considering to use high level
disinfectant. What should you do?
a. Cover the soaking vessel to contain the
vapor
b. Double the amount of high level
disinfectant
c. Test the potency of the high level
disinfectant
d. Prolong the exposure time according to
manufacturer’s direction
89. To achieve sterilization using disinfectants,
which of the following is used?
a. Low level disinfectants immersion in 24
hours
b. Intermediate level disinfectants
immersion in 12 hours
c. High level disinfectants immersion in 1
hour
d. High level disinfectant immersion in 10
hours
90. Bronchoscope, Thermometer, Endoscope, ET
tube, Cytoscope are all BEST sterilized using
which of the following?
a. Autoclaving at 121 degree Celsius in 15
minutes
b. Flash sterilizer at 132 degree Celsius in 3
minutes
c. Ethylene Oxide gas aeration for 20 hours
d. 2% Glutaraldehyde immersion for 10
hours
Situation: The OR is divided into three zones to control
traffic flow and contamination

91. What OR attires are worn in the restricted area?
a. Scrub suit, OR shoes, head cap
b. Head cap, scrub suit, mask, OR shoes
c. Mask, OR shoes, scrub suit
d. Cap, mask, gloves, shoes
92. Nursing intervention for a patient on low dose IV
insulin therapy includes the following, EXCEPT:
a. Elevation of serum ketones to monitor
ketosis
b. Vital signs including BP
c. Estimate serum potassium
d. Elevation of blood glucose levels
93. The doctor ordered to incorporate 1000”u”
insulin to the remaining on-going IV. The
strength is 500 /ml. How much should you
incorporate into the IV solution?
a. 10 ml
b. 0.5 ml
c. 2 ml
d. 5 ml
94. Multiple vial-dose-insulin when in use should be
a. Kept at room temperature
b. Kept in narcotic cabinet
c. Kept in the refrigerator
d. Store in the freezer
95. Insulins using insulin syringe are given using how
many degrees of needle insertion?
a. 45
b. 180
c. 90
d. 15
Situation: Maintenance of sterility is an important
function a nurse should perform in any OR setting.
96. Which of the following is true with regards to
sterility?
a. Sterility is time related, items are not
considered sterile after a period of 30
days of being not use.
b. for 9 months, sterile items are
considered sterile as long as they are
covered with sterile muslin cover and
stored in a dust proof covers.
c. Sterility is event related, not time
related
d. For 3 weeks, items double covered with
muslin are considered sterile as long as
they have undergone the sterilization
35
process
97. 2 organizations endorsed that sterility are
affected by factors other than the time itself,
these are:
a. The PNA and the PRC
b. AORN and JCAHO
c. ORNAP and MCNAP
d. MMDA and DILG
98. All of these factors affect the sterility of the OR
equipments, these are the following except:
a. The material used for packaging
b. The handling of the materials as well as
its transport
c. Storage
d. The chemical or process used in
sterililzing the material
99. When you say sterile, it means:
a. The material is clean
b. The material as well as the equipments
are sterilized and had undergone a
rigorous sterilization process
c. There is a black stripe on the paper
indicator
d. The material has no microorganism nor
spores present that might cause an
infection
100. In using liquid sterilizer versus autoclave
machine, which of the following is true?
a. Autoclave is better in sterilizing OR
supplies versus liquid sterilizer
b. They are both capable of sterilizing the
equipments, however, it is necessary to
soak supplies in the liquid sterilizer for
a longer period of time
c. Sharps are sterilized using autoclave and
not cidex
d. If liquid sterilizer is used, rinsing it
before using is not necessary
 d. CT Scan and Incidence report

NURSING PRACTICE IV Situation: An entry level nurse should be able to apply

theoretical knowledge in the performance of the basic
Situation: After an abdominal surgery, the circulating nursing skills.
and scrub nurses have critical responsibility about
sponge and instrument count. 6. A client has an indwelling urinary catheter and
she is suspected of having urinary infection. How
1. Counting is performed thrice: During the should you collect a urine specimen for culture
preincision phase, the operative phase and and sensitivity?
closing phase. Who counts the sponges, needles a. clamp tubing for 60 minutes and insert a
and instruments? sterile needle into the tubing above the
a. The scrub nurse only clamp to aspirate urine
b. The circulating nurse only b. drain urine from the drainage bag into
c. The surgeon and the assistant surgeon the sterile container
d. The scrub nurse and the circulating c. disconnect the tubing from the urinary
nurse catheter and let urine flow into a sterile
container
2. The layer of the abdomen is divided into 5. d. wipe the self-sealing aspiration port
Arrange the following from the first layer going with antiseptic solution and insert a
to the deepest layer: sterile needle into the self-sealing port
1. Fascia
2. Muscle 7. To obtain specimen for sputum culture and
3. Peritoneum sensitivity, which of the following instruction is
4. Subcutaneous/Fat best?
5. Skin a. Upon waking up, cough deeply and
a. 5,4,3,2,1 expectorate into container
b. 5,4,1,3,2 b. Cough after pursed lip breathing
c. 5,4,2,1,3 c. Save sputum for two days in covered
d. 5,4,1,2,3 container
d. After respiratory treatment, expectorate
3. When is the first sponge/instrument count into a container
reported?
a. Before closing the subcutaneous layer 8. The best time for collecting the sputum
b. Before peritoneum is closed specimen for culture and sensitivity is:
c. Before closing the skin a. Before retiring at night
d. Before the fascia is sutured b. Anytime of the day
c. Upon waking up in the morning
4. Like any nursing interventions, counts should be d. Before meals
documented. To whom does the scrub nurse
report any discrepancy of counts so that 9. When suctioning the endotracheal tube, the
immediate and appropriate action is instituted? nurse should:
a. Anaesthesiologists a. Explain procedure to patient; insert
b. Surgeon catheter gently applying suction.
c. OR nurse supervisor Withdrawn using twisting motion
d. Circulating nurse b. Insert catheter until resistance is met,
and then withdraw slightly, applying
5. Which of the following are 2 interventions of the suction intermittently as catheter is
surgical team when an instrument was withdrawn
confirmed missing? c. Hyperoxygenate client insert catheter
a. MRI and Incidence report using back and forth motion
b. CT Scan, MRI, Incidence report d. Insert suction catheter four inches into
c. X-RAY and Incidence report the tube, suction 30 seconds using

36
 37

twirling motion as catheter is withdrawn Nursing intervention includes:

a. Bed rest
10. The purpose of NGT IMMEDIATELY after an b. Warm moist soak A transurethral resection
operation is: c. Early ambulation of the prostate (TURP) is
a surgical procedure that
a. For feeding or gavage d. Hot sitz bath involves cutting away a
b. For gastric decompression section of the prostate

c. For lavage, or the cleansing of the
stomach content
d. For the rapid return of peristalsis
Situation - Mr. Santos, 50, is to undergo cystoscopy due
to multiple problems like scantly urination, hematuria
and dysuria. A cystoscopy is a procedure to look inside the
bladder using a thin camera called a cystoscope.
11. You are the nurse in charge in Mr. Santos. When
asked what are the organs to be examined
during cystoscopy, you will enumerate as
follows:
a. Urethra, kidney, bladder, urethra
b. Urethra, bladder wall, trigone, ureteral
opening
c. Bladder wall, uterine wall, and urethral
opening
d. Urethral opening, ureteral opening
bladder
12. In the OR, you will position Mr. Santos who is
cystoscopy in:
a. Supine
b. Lithotomy
c. Semi-fowler
d. Trendelenburg
13. After cystoscopy, Mr. Santos asked you to
explain why there is no incision of any kind.
What do you tell him?
a. “Cystoscopy is direct visualization and
examination by urologist”.
b. “Cystoscopy is done by x-ray
visualization of the urinary tract”.
c. “Cystoscopy is done by using lasers on
the urinary tract”.
d. “Cystoscopy is an endoscopic procedure
of the urinary tract”.
14. Within 24-48 hours post cystoscopy, it is normal
to observe one the following:
a. Pink-tinged urine
b. Distended bladder
c. Signs of infection
d. Prolonged hematuria
Situation – Mang Felix, a 79 year old man who is brought
to the Surgical Unit from PACU after a transurethral
resection. You are assigned to receive him. You noted
that he has a 3-way indwelling urinary catheter for
continuous fast drip bladder irrigation which is
connected to a straight drainage.
16. Immediately after surgery, what would you
expect his urine to be?
a. Light yellow
b. Bright red
c. Amber
d. Pinkish to red
17. The purpose of the continuous bladder irrigation
is to:
a. Allow continuous monitoring of the fluid
output status
b. Provide continuous flushing of clots and
debris from the bladder
c. Allow for proper exchange of
electrolytes and fluid
d. Ensure accurate monitoring of intake
and output
18. Mang Felix informs you that he feels some
discomfort on the hypogastric area and he has to
void. What will be your most appropriate action?
a. Remove his catheter then allow him to
void on his own
b. Irrigate his catheter
c. Tell him to “Go ahead and void. You
have an indwelling catheter.”
d. Assess color and rate of outflow, if
there is changes refer to urologist for
possible irrigation.
19. You decided to check on Mang Felix’s IV fluid
infusion. You noted a change in flow rate, pallor
and coldness around the insertion site. What is
your assessment finding?
a. Phlebitis
b. Infiltration to subcutaneous tissue
c. Pyrogenic reaction
d. Air embolism

15. Leg cramps are NOT uncommon post cystoscopy. 20. Knowing that proper documentation of
 assessment findings and interventions are d. Fever, Irritability and a large output of
important responsibilities of the nurse during diluted urine
first post-operative day, which of the following is
the LEAST relevant to document in the case of 25. What kind of renal failure will melamine
Mang Felix? poisoning cause?
a. Chest pain and vital signs a. Chronic, Prerenal
b. Intravenous infusion rate b. Chronic, Intrarenal
c. Amount, color, and consistency of c. Acute, Postrenal
bladder irrigation drainage d. Acute, Prerenal
d. Activities of daily living started
Situation: Leukemia is the most common type of
Situation: Melamine contamination in milk has brought childhood cancer. Acute Lymphoid Leukemia is the cause
worldwide crisis both in the milk production sector as of almost 1/3 of all cancer that occurs in children under
well as the health and economy. Being aware of the age 15.
current events is one quality that a nurse should possess
to prove that nursing is a dynamic profession that will 26. The survival rate for Acute Lymphoid Leukemia is
adapt depending on the patient’s needs. approximately:
a. 25%
21. Melamine is a synthetic resin used for b. 40%
whiteboards, hard plastics and jewellery box c. 75%
covers due to its fire retardant properties. Milk d. 95%
and food manufacturers add melamine in order
to: 27. Whereas acute nonlymphoid leukemia has a
a. It has a bacteriostatic property leading survival rate of:
to increase food and milk life as a way of a. 25%
preserving the foods b. 40%
b. Gives a glazy and more edible look on c. 75%
foods d. 95%
c. Make milks more tasty and creamy
d. Create an illusion of a high protein 28. The three main consequence of leukemia that
content on their products cause the most danger is:
a. Neutropenia causing infection, anemia
22. Most of the milks contaminated by Melamine causing impaired oxygenation and
came from which country? thrombocytopenia leading to bleeding
a. India tendencies
b. China b. Central nervous system infiltration,
c. Philippines anemia causing impaired oxygenation
d. Korea and thrombocytopenia leading to
bleeding tendencies
23. Which government agency is responsible for c. Splenomegaly, hepatomegaly, fractures
testing the melamine content of foods and food d. Invasion by the leukemic cells to the
products? bone causing severe bone pain
a. DOH
b. MMDA 29. Gold standard in the diagnosis of leukemia is by
c. NBI which of the following?
d. BFAD a. Blood culture and sensitivity
b. Bone marrow biopsy
24. Infants are the most vulnerable to melamine c. Blood biopsy
poisoning. Which of the following is NOT a sign d. CSF aspiration and examination
of melamine poisoning?
a. Irritability, Back ache, Urolithiasis 30. Adriamycin,Vincristine,Prednisone and L
b. High blood pressure, fever asparaginase are given to the client for long
c. Anuria, Oliguria or Hematuria term therapy. One common side effect,

38

especially of adriamycin is alopecia. The child
asks: “Will I get my hair back once again?” The
nurse best respond is by saying:
a. “Don’t be silly, ofcourse you will get your
hair back”
b. “We are not sure, let’s hope it’ll grow”
c. “This side effect is usually permanent,
But I will get the doctor to discuss it for
you”
d. “Your hair will regrow in 3 to 6 months
but of different color, usually darker
and of different texture”
Situation: Breast Cancer is the 2nd most common type of
cancer after lung cancer and 99% of which, occurs in
woman. Survival rate is 98% if this is detected early and
treated promptly. Carmen is a 53 year old patient in the
high risk group for breast cancer was recently diagnosed
with Breast cancer.
31. All of the following are factors that said to
contribute to the development of breast cancer
except:
a. Prolonged exposure to estrogen such as
an early menarche or late menopause,
nulliparity and childbirth after age 30
b. Genetics
c. Increasing Age
d. Prolonged intake of Tamoxifen
(Nolvadex)
32. Protective factors for the development of breast
cancer includes which of the following except:
a. Exercise
b. Breast feeding
c. Prophylactic Tamoxifen
d. Alcohol intake
33. A patient diagnosed with breast cancer has been
offered the treatment choices of breast
conservation surgery with radiation or a
modified radical mastectomy. When questioned
by the patient about these options, the nurse
informs the patient that the lumpectomy with
radiation:
a. reduces the fear and anxiety that
accompany the diagnosis and treatment
of cancer
b. has about the same 10-year survival rate
as the modified radical mastectomy
c. provides a shorter treatment period with
a fewer long term complications
d. preserves the normal appearance and
39
sensitivity of the breast.
34. Carmen, who is asking the nurse the most
appropriate time of the month to do her self-
examination of the breast. The MOST
appropriate reply by the nurse would be:
a. the 26th day of the menstrual cycle
b. 7 to 8 days after conclusion of the
menstrual period
c. during her menstruation
d. the same day each month
35. Carmen being treated with radiation therapy.
What should be included in the plan of care to
minimize skin damage from the radiation
therapy?
a. Cover the areas with thick clothing
materials
b. Apply a heating pad to the site
c. Wash skin with water after the therapy
d. Avoid applying creams and powders to
the area
36. Based on the DOH and World Health
Organization (WHO) guidelines, the mainstay for
early detection method for breast cancer that is
recommended for developing countries is:
a. a monthly breast self-examination (BSE)
and an annual health worker breast
examination (HWBE)
b. an annual hormone receptor assay
c. an annual mammogram
d. a physician conduct a breast clinical
examination every 2 years
37. The purpose of performing the breast self-
examination (BSE) regularly is to discover:
a. fibrocystic masses
b. areas of thickness or fullness
c. cancerous lumps
d. changes from previous BSE
38. If you are to instruct a postmenopausal woman
about BSE, when would you tell her to do BSE:
a. on the same day of each month
b. on the first day of her menstruation
c. right after the menstrual period
d. on the last day of her menstruation
39. During breast self-examination, the purpose of
standing in front of the mirror it to observe the
breast for:
a. thickening of the tissue
 b. lumps in the breast tissue
c. axillary lymphnodes
d. change in size and contour
40. When preparing to examine the left breast in a
reclining position, the purpose of placing a small
folded towel under the client’s left shoulder is
to:
a. bring the breast closer to the examiner’s
right hand
b. tense the pectoral muscle
c. balance the breast tissue more evenly
on the chest wall
d. facilitate lateral positioning of the breast
Situation – Radiation therapy is another modality of
cancer management. With emphasis on multidisciplinary
management you have important responsibilities as
nurse.
41. Albert is receiving external radiation therapy and
he complains of fatigue and malaise. Which of
the following nursing interventions would be
most helpful for Albert?
a. Tell him that sometimes these feelings
can be psychogenic
b. Refer him to the physician
c. Reassure him that these feelings are
normal
d. Help him plan his activities
42. Immediately following the radiation teletherapy,
Albert is
a. Considered radioactive for 24 hrs
b. Given a complete bath
c. Placed on isolation for 6 hours
d. Free from radiation
43. Albert is admitted with a radiation induced
thrombocytopenia. As a nurse you should
observe the following symptoms:
a. Petechiae, ecchymosis, epistaxis
b. Weakness, easy fatigability, pallor
c. Headache, dizziness, blurred vision
d. Severe sore throat, bacteremia,
hepatomegaly
44. What nursing diagnosis should be of highest
priority?
a. Knowledge deficit regarding
thrombocytopenia precautions
b. Activity intolerance
c. Impaired tissue integrity
40
d. Ineffective tissue perfusion, peripheral,
cerebral, cardiovascular,
gastrointestinal, renal
45. What intervention should you include in your
care plan?
a. Inspect his skin for petechiae, bruising,
GI bleeding regularly
b. Place Albert on strict isolation
precaution
c. Provide rest in between activities
d. Administer antipyretics if his
temperature exceeds 38C
Situation: Burn are cause by transfer of heat source to
the body. It can be thermal, electrical, radiation or
chemical.
46. A burn characterized by Pale white appearance,
charred or with fat exposed and painlessness is:
a. Superficial partial thickness burn
b. Deep partial thickness burn
c. Full thickness burn
d. Deep full thickness burn
47. Which of the following BEST describes superficial
partial thickness burn or first degree burn?
a. Structures beneath the skin are damage
b. Dermis is partially damaged
c. Epidermis and dermis are both damaged
d. Epidermis is damaged
48. A burn that is said to be “WEEPING” is classified
as:
a. Superficial partial thickness burn
b. Deep partial thickness burn
c. Full thickness burn
d. Deep full thickness burn
49. During the Acute phase of the burn injury, which
of the following is a priority?
a. wound healing
b. emotional support
c. reconstructive surgery
d. fluid resuscitation
50. While in the emergent phase, the nurse knows
that the priority is to:
a. Prevent infection
b. Prevent deformities and contractures
c. Control pain
d. Return the hemodynamic stability via
fluid resuscitation

51. The MOST effective method of delivering pain
medication during the emergent phase is:
a. intramuscularly
b. orally
c. subcutaneously
d. intravenously
52. When a client accidentally splashes chemicals to
his eyes, The initial priority care following the
chemical burn is to:
a. irrigate with normal saline for 1 to 15
minutes
b. transport to a physician immediately
c. irrigate with water for 15 minutes or
longer
d. cover the eyes with a sterile gauze
53. Which of the following can be a fatal
complication of upper airway burns?
a. stress ulcers
b. shock
c. hemorrhage
d. laryngeal spasms and swelling
54. When a client will rush towards you and he has a
burning clothes on, It is your priority to do which
of the following first?
a. log roll on the grass/ground
b. slap the flames with his hands
c. Try to remove the burning clothes
d. Splash the client with 1 bucket of cool
water
55. Once the flames are extinguished, it is most
important to:
a. cover clientwith a warm blanket
b. give him sips of water
c. calculate the extent of his burns
d. assess the Sergio’s breathing
56. During the first 24 hours after the thermal injury,
you should asses Sergio for:
a. hypokalemia and hypernatremia
b. hypokalemia and hyponatremia
c. hyperkalemia and hyponatremia
d. hyperkalemia and hypernatremia
57. A client who sustained deep partial thickness
and full thickness burns of the face, whole
anterior chest and both upper extremities two
days ago begins to exhibit extreme restlessness.
You recognize that this most likely indicates that
41
the client is developing:
a. Cerebral hypoxia
b. metabolic acidosis
c. Hypervolemia
d. Renal failure
58. A 165 lbs trauma client was rushed to the
emergency room with full thickness burns on the
whole face, right and left arm, and at the
anterior upper chest sparing the abdominal area.
He also has superficial partial thickness burn at
the posterior trunk and at the half upper portion
of the left leg. He is at the emergent phase of
burn. Using the parkland’s formula, you know
that during the first 8 hours of burn, the amount
of fluid will be given is:
a. 5,400 ml
b. 9, 450 ml
c. 10,800 ml
d. 6,750 ml
59. The doctor incorporated insulin on the client’s
fluid during the emergent phase. The nurse
knows that insulin is given because:
a. Clients with burn also develops
Metabolic acidosis
b. Clients with burn also develops
hyperglycemia
c. Insulin is needed for additional energy
and glucose burning after the stressful
incidence to hasten wound healing,
regain of consciousness and rapid return
of hemodynamic stability
d. For hyperkalemia
60. The IV fluid of choice for burn as well as
dehydration is:
a. 0.45% NaCl
b. Sterile water
c. NSS
d. D5LR
Situation: ENTEROSTOMAL THERAPY is now considered a
specialty in nursing. You are participating in the OSTOMY
CARE CLASS.
61. You plan to teach Fermin how to irrigate the
colostomy when:
a. The perineal wound heals And Fermin
can sit comfortably on the commode
b. Fermin can lie on the side comfortably,
about the 3rd postoperative day
c. The abdominal incision is closed and
 contamination is no longer a danger
d. The stools starts to become formed,
around the 7th postoperative day
62. When preparing to teach Fermin how to irrigate
colostomy, you should plan to do the procedure:
a. When Fermin would have normal bowel
movement
b. At least 2 hours before visiting hours
c. Prior to breakfast and morning care
d. After Fermin accepts alteration in body
image
63. When observing a return demonstration of a
colostomy irrigation, you know that more
teaching is required if Fermin:
a. Lubricates the tip of the catheter prior to
inserting into the stoma
b. Hangs the irrigating bag on the
bathroom door cloth hook during fluid
insertion
c. Discontinues the insertion of fluid after
500 ml of fluid has been instilled
d. Clamps of the flow of fluid when felling
uncomfortable
64. You are aware that teaching about colostomy
care is understood when Fermin states, “I will
contact my physician and report:
a. If I have any difficulty inserting the
irrigating tub into the stoma.”
b. If I noticed a loss of sensation to touch in
the stoma tissue.”
c. The expulsion of flatus while the
irrigating fluid is running out.”
d. When mucus is passed from the stoma
between the irrigations.”
65. You would know after teaching Fermin that
dietary instruction for him is effective when he
states, “It is important that I eat:
a. Soft food that is easily digested and
absorbed by my large intestines.”
b. Bland food so that my intestines do not
become irritated.”
c. Food low in fiber so that there are fewer
stools.”
d. Everything that I ate before the
operation, while avoiding foods that
cause gas”.
Situation: Based on studies of nurses working in special
units like the intensive care unit and coronary care unit,
42
it is important for nurses to gather as much information
to be able to address their needs for nursing care.
66. Critically ill patients frequently complain about
which of the following when hospitalized?
a. Hospital food
b. Lack of privacy
c. Lack of blankets
d. Inadequate nursing staff
67. Who of the following is at greatest risk of
developing sensory problem?
a. Female patient
b. Transplant patient
c. Adoloscent
d. Unresponsive patient
68. Which of the following factors may inhibit
learning in critically ill patients?
a. Gender
b. Educational level
c. Medication
d. Previous knowledge of illness
69. Which of the following statements does not
apply to critically ill patients?
a. Majority need extensive rehabilitation
b. All have been hospitalized previously
c. Are physically unstable
d. Most have chronic illness
70. Families of critically ill patients desire which of
the following needs to be met first by the nurse?
a. Provision of comfortable space
b. Emotional support
c. Updated information on client’s status
d. Spiritual counselling
Situation: Johnny, sought consultation to the hospital
because of fatigability, irritability, jittery and he has been
experiencing this sign and symptoms for the past 5
months.
71. His diagnosis was hyperthyroidism, the following
are expected symptoms except:
a. Anorexia
b. Fine tremors of the hand
c. Palpitation
d. Hyper alertness
72. She has to take drugs to treat her
hyperthyroidism. Which of the following will you
NOT expect that the doctor will prescribe?
 43

a. Colace (Docusate) to:

b. Tapazole (Methimazole) a. Decrease the vascularity and size of the
c. Cytomel (Liothyronine) thyroid gland
d. Synthroid (Levothyroxine) b. Decrease the size of the thyroid gland
only
73. The nurse knows that Tapazole has which of the c. Increase the vascularity and size of the
following side effect that will warrant immediate thyroid gland
withholding of the medication? d. Increase the size of the thyroid gland
a. Death only
b. Hyperthermia
c. Sore throat 79. Which of the following is a side effect of Lugol’s
d. Thrombocytosis solution?
a. Hypokalemia
74. You asked questions as soon as she regained b. Enlargement of the Thryoid gland
consciousness from thyroidectomy primarily to c. Nystagmus
assess the evidence of: d. Excessive salivation
a. Thyroid storm
b. Damage to the laryngeal nerve 80. In administering Lugol’s solution, the
c. Mediastinal shift precautionary measure should include:
d. Hypocalcaemia tetany a. Administer with glass only
b. Dilute with juice and administer with a
75. Should you check for haemorrhage, you will: straw
a. Slip your hand under the nape of her c. Administer it with milk and drink it
neck d. Follow it with milk of magnesia
b. Check for hypotension
c. Apply neck collar to prevent Situation: Pharmacological treatment was not effective
haemorrhage for Johnny’s hyperthyroidism and now, he is scheduled
d. Observe the dressing if it is soaked with for Thyroidectomy.
blood
81. Instruments in the surgical suite for surgery is
76. Basal Metabolic rate is assessed on Johnny to classified as either CRITICAL, SEMI CRITICAL and
determine his metabolic rate. In assessing the NON CRITICAL. If the instrument are introduced
BMR using the standard procedure, you need to directly into the blood stream or into any
tell Johnny that: normally sterile cavity or area of the body it is
a. Obstructing his vision classified as:
b. Restraining his upper and lower a. Critical
extremities b. Non Critical
c. Obstructing his hearing c. Semi Critical
d. Obstructing his nostrils with a clamp d. Ultra Critical

77. The BMR is based on the measurement that: 82. Instruments that do not touch the patient or
a. Rate of respiration under different have contact only to intact skin is classified as:
condition of activities and rest a. Critical
b. Amount of oxygen consumption under b. Non Critical
resting condition over a measured c. Semi Critical
period of time d. Ultra Critical
c. Amount of oxygen consumption under
stressed condition over a measured 83. If an instrument is classified as Semi Critical, an
period of time acceptable method of making the instrument
d. Ratio of respiration to pulse rate over a ready for surgery is through:
measured period of time a. Sterilization
b. Disinfection
78. Her physician ordered lugol’s solution in order c. Decontamination
 d. Cleaning
84. While critical items and should be:
a. Clean
b. Sterilized
c. Decontaminated
d. Disinfected
85. As a nurse, you know that intact skin acts as an
effective barrier to most microorganisms.
Therefore, items that come in contact with the
intact skin or mucus membranes should be:
a. Disinfected
b. Clean
c. Sterile
d. Alcoholized
86. You are caring for Johnny who is scheduled to
undergo total thyroidectomy because of a
diagnosis of thyroid cancer. Prior to total
thyroidectomy, you should instruct Johnny to:
a. Perform range and motion exercise on
the head and neck
b. Apply gentle pressure against the
incision when swallowing
c. Cough and deep breathe every 2 hours
d. Support head with the hands when
changing position
87. As Johnny’s nurse, you plan to set up emergency
equipment at her bedside following
thyroidectomy. You should include:
a. An airway and rebreathing tube
b. A tracheostomy set and oxygen
c. A crush cart with bed board
d. Two ampules of sodium bicarbonate
88. Which of the following nursing interventions is
appropriate after a total thyroidectomy?
a. Place pillows under your patient’s
shoulders.
b. Raise the knee-gatch to 30 degrees
c. Keep you patient in a high-fowler’s
position.
d. Support the patient’s head and neck
with pillows and sandbags.
89. If there is an accidental injury to the parathyroid
gland during a thyroidectomy which of the
following might Leda develops postoperatively?
a. Cardiac arrest
b. Respiratory failure
c. Dyspnea
44
d. Tetany
90. After surgery Johnny develops peripheral
numbness, tingling and muscle twitching and
spasm. What would you anticipate to
administer?
a. Magnesium sulfate
b. Potassium iodide
c. Calcium gluconate
d. Potassium chloride
Situation: Budgeting is an important part of a nurse
managerial activity. The correct allocation and
distribution of resources is vital in the harmonious
operation of the financial balance of the agency.
91. Which of the following best defines Budget?
a. Plan for the allocation of resources for
future use
b. The process of allocating resources for
future use
c. Estimate cost of expenses
d. Continuous process in seeing that the
goals and objective of the agency is met
92. Which of the following best defines Capital
Budget?
a. Budget to estimate the cost of direct
labour, number of staff to be hired and
necessary number of workers to meet
the general patient needs
b. Includes the monthly and daily expenses
and expected revenue and expenses
c. These are related to long term planning
and includes major replacement or
expansion of the plant, major
equipment and inventories.
d. These are expenses that are not
dependent on the level of production or
sales. They tend to be time-related, such
as salaries or rents being paid per month
93. Which of the following best described
Operational Budget?
a. Budget to estimate the cost of direct
labour, number of staff to be hired and
necessary number of workers to meet
the general patient needs
b. Includes the monthly and daily
expenses and expected revenue and
expenses
c. These are related to long term planning
and includes major replacement or

expansion of the plant, major
equipments and inventories.
d. These are expenses that are not
dependent on the level of production or
sales. They tend to be time-related, such
as rent
94. Which of the following accurately describes a
Fixed Cost in budgeting?
a. These are usually the raw materials and
labour salaries that depend on the
production or sales
b. These are expenses that change in
proportion to the activity of a business
c. These are expenses that are not
dependent on the level of production or
sales. They tend to be time-related,
such as rent
d. This is the summation of the Variable
Cost and the Fixed Cost
95. Which of the following accurately describes
Variable Cost in budgeting?
a. These are related to long term planning
and include major replacement or
expansion of the plant, major
equipments and inventories.
b. These are expenses that change in
proportion to the activity of a business
c. These are expenses that are not
dependent on the level of production or
sales. They tend to be time-related, such
as rent
d. This is the summation of the Variable
Cost and the Fixed Cost
Situation – Andrea is admitted to the ER following an
assault where she was hit in the face and head. She was
brought to the ER by a police woman. Emergency
measures were started.
96. Andrea’s respiration is described as waxing and
waning. You know that this rhythm of respiration
is defined as:
a. Biot’s
b. Cheyne stokes
c. Kussmaul’s
d. Eupnea
97. What do you call the triad of sign and symptoms
seen in a client with increasing ICP?
a. Virchow’s Triad
b. Cushing’s Triad
45
c. The Chinese Triad
d. Charcot’s Triad
98. Which of the following is true with the Triad
seen in head injuries?
a. Narrowing of Pulse pressure, Cheyne
stokes respiration, Tachycardia
b. Widening Pulse pressure, Irregular
respiration, Bradycardia
c. Hypertension, Kussmaul’s respiration,
Tachycardia
d. Hypotension, Irregular respiration,
Bradycardia
99. In a client with a Cheyne stokes respiration,
which of the following is the most appropriate
nursing diagnosis?
a. Ineffective airway clearance
b. Impaired gas exchange
c. Ineffective breathing pattern
d. Activity intolerance
100. You know the apnea is seen in client’s with
cheyne stokes respiration, APNEA is defined as:
a. Inability to breathe in a supine position
so the patient sits up in bed to breathe
b. The patient is dead, the breathing stops
c. There is an absence of breathing for a
period of time, usually 15 seconds or
more
d. A period of hypercapnea and hypoxia
due to the cessation of respiratory effort
inspite of normal respiratory functioning

NURSING PRACTICE V
Situation: Understanding different models of care is a
necessary part of the nurse patient relationship.
1. The focus of this therapy is to have a positive
environmental manipulation, physical and social
to effect a positive change.
A. Milieu
B. Psychotherapy
C. Behaviour
D. Group
2. The client asks the nurse about Milieu therapy.
The nurse responds knowing that the primary
focus of milieu therapy can be best described by
which of the following?
A. A form of behavior modification therapy
B. A cognitive approach of changing the
behaviour
C. A living, learning or working
environment
D. A behavioural approach to changing
behaviour
3. A nurse is caring for a client with phobia who is
being treated for the condition. The client is
introduced to short periods of exposure to the
phobic object while in relaxed state. The nurse
understands that this form of behaviour
modification can be best described as:
A. Systematic desensitization
B. Self-control therapy
C. Aversion Therapy
D. Operant conditioning
4. A client with major depression is considering
cognitive therapy. The client say to the nurse,
“How does this treatment works?” The nurse
responds by telling the client that:
A. “This type of treatment helps you
examine how your thoughts and
feelings contribute to your difficulties”
B. “This type of treatment helps you
examine how your past life has
contributed to your problems.”
C. “This type of treatment helps you to
confront your fears by exposing you to
the feared object abruptly.
D. “This type of treatment will help you
relax and develop new coping skills.”
46
5. A Client state, “I get down on myself when I
make mistake.” Using Cognitive therapy
approach, the nurse should:
A. Teach the client relaxation exercise to
diminish stress
B. Provide the client with Mastery
experience to boost self esteem
C. Explore the client’s past experiences that
causes the illness
D. Help client modify the belief that
anything less than perfect is horrible
6. The most advantageous therapy for a preschool
age child with a history of physical and sexual
abuse would be:
A. Play
B. Psychoanalysis
C. Group
D. Family
7. An 18 year old client is admitted with the
diagnosis of anorexia nervosa. A cognitive
behavioural approach is used as part of her
treatment plan. The nurse understands that the
purpose of this approach is to:
A. Help the client identify and examine
dysfunctional thoughts and beliefs
B. Emphasize social interaction with clients
who withdraw
C. Provide a supportive environment and a
therapeutic community
D. Examine intrapsychic conflicts and past
events in life
8. The nurse is preparing to provide reminiscence
therapy for a group of clients. Which of the
following clients will the nurse select for this
group?
A. A client who experiences profound
depression with moderate cognitive
impairment
B. A catatonic, immobile client with
moderate cognitive impairment
C. An undifferentiated schizophrenic client
with moderate cognitive impairment
D. A client with mild depression who
exhibits who demonstrates normal
cognition
9. Which intervention would be typical of a nurse
using cognitive-behavioral approach to a client
experiencing low self-esteem?
 47

A. Use of unconditional positive regard C. refer the client to the psychiatrist

B. Analysis of free association D. refer the matter to the police
C. Classical conditioning
D. Examination of negative thought Situation: Rose seeks psychiatric consultation because of
patterns intense fear of flying in an airplane which has greatly
affected her chances of success in her job.
10. Which of the following therapies has been
strongly advocated for the treatment of post- 16. The most common defense mechanism used by
traumatic stress disorders? phobic clients is:
A. ECT A. Supression
B. Group Therapy B. Denial
C. Hypnotherapy C. Rationalization
D. Psychoanalysis D. Displacement

11. The nurse knows that in group therapy, the
maximum number of members to include is:
A. 4
B. 8
C. 10
D. 16
12. The nurse is providing information to a client
with the use of disulfiram (antabuse) for the
treatment of alcohol abuse. The nurse
understands that this form of therapy works on
what principle?
A. Negative Reinforcement
B. Operant Conditioning
C. Aversion Therapy
D. Gestalt therapy
13. A biological or medical approach in treating
psychiatric patient is:
A. Million therapy
B. Behavioral therapy
C. Somatic therapy
D. Psychotherapy
14. Which of these nursing actions belong to the
secondary level of preventive intervention?
A. Providing mental health consultation to
health care providers
B. Providing emergency psychiatric
services
C. Being politically active in relation to
mental health issues
D. Providing mental health education to
members of the community
15. When the nurse identifies a client who has
attempted to commit suicide the nurse should:
A. call a priest
B. counsel the client
17. The goal of the therapy in phobia is:
A. Change her lifestyle
B. Ignore tension producing situation
C. Change her reaction towards anxiety
D. Eliminate fear producing situations
18. The therapy most effective for client’s with
phobia is:
A. Hypnotherapy
B. Cognitive therapy
C. Group therapy
D. Behavior therapy
19. The fear and anxiety related to phobia is said to
be abruptly decreased when the patient is
exposed to what is feared through:
A. Guided Imagery
B. Systematic desensitization
C. Flooding
D. Hypotherapy
20. Based on the presence of symptom, the
appropriate nursing diagnosis is:
A. Self-esteem disturbance
B. Activity intolerance
C. Impaired adjustment
D. Ineffective individual coping
Situation: Mang Jose, 39 year old farmer, unmarried, had
been confined in the National center for mental health
for three years with a diagnosis of schizophrenia.
21. The most common defense mechanism used by
a paranoid client is:
A. Displacement
B. Rationalization
C. Suppression
D. Projection
 22. When Mang Jose says to you: “The voices are
telling me bad things again!” The best response
is:
A. “Whose voices are those?”
B. “I doubt what the voices are telling you”
C. “I do not hear the voice you say you
hear”
D. “Are you sure you hear these voices?”
23. A relevant nursing diagnosis for clients with
auditory hallucination is:
A. Sensory perceptual alteration
B. Altered thought process
C. Impaired social interaction
D. Impaired verbal communication
24. During mealtime, Jose refused to eat telling that
the food was poisoned. The nurse should:
A. Ignore his remark
B. Offer him food in his own container
C. Show him how irrational his thinking is
D. Respect his refusal to eat
25. When communicating with Jose, The nurse
considers the following except:
A. Be warm and enthusiastic
B. Refrain from touching Jose
C. Do not argue regarding his hallucination
and delusion
D. Use simple, clear language
Situation: Gringo seeks psychiatric counselling for his
ritualistic behavior of counting his money as many as 10
times before leaving home.
26. An initial appropriate nursing diagnosis is:
A. Impaired social interaction
B. Ineffective individual coping
C. Impaired adjustment
D. Anxiety Moderate
27. Obsessive compulsive disorder is BEST described
by:
A. Uncontrollable impulse to perform an
act or ritual repeatedly
B. Persistent thoughts
C. Recurring unwanted and disturbing
thought alternating with a behavior
D. Pathological persistence of unwilled
thought, feeling or impulse
28. The defense mechanism used by persons with
obsessive compulsive disorder is undoing and it
48
is best described in one of the following
statements:
A. Unacceptable feelings or behavior are
kept out of awareness by developing the
opposite behavior or emotion
B. Consciously unacceptable instinctual
drives are diverted into personally and
socially acceptable channels
C. Something unacceptable already done
is symbolically acted out in reverse
D. Transfer of emotions associated with a
particular person, object or situation to
another less threatening person, object
or situation
29. To be more effective, the nurse who cares for
persons with obsessive compulsive disorder
must possess one of the following qualities:
A. Compassion
B. Patience
C. Consistency
D. Friendliness
30. Persons with OCD usually manifest:
A. Fear
B. Apathy
C. Suspiciousness
D. Anxiety
Situation: The patient who is depressed will undergo
electroconvulsive therapy.
31. Studies on biological depression support
electroconvulsive therapy as a mode of
treatment. The rationale is:
A. ECT produces massive brain damage
which destroys the specific area
containing memories related to the
events surrounding the development of
psychotic condition
B. The treatment serves as a symbolic
punishment for the client who feels
guilty and worthless
C. ECT relieves depression psychologically
by increasing the norepinephrine level
D. ECT is seen as a life-threatening
experience and depressed patients
mobilize all their bodily defences to deal
with this attack.
32. The preparation of a patient for ECT ideally is
MOST similar to preparation for a patient for:
A. electroencephalogram

B. general anesthesia
C. X-ray
D. electrocardiogram
33. Which of the following is a possible side effect
which you will discuss with the patient?
A. hemorrhage within the brain
B. encephalitis
C. robot-like body stiffness
D. confusion, disorientation and short
term memory loss
34. Informed consent is necessary for the treatment
for involuntary clients. When this cannot be
obtained, permission may be taken from the:
A. social worker
B. next of kin or guardian
C. doctor
D. chief nurse
35. After ECT, the nurse should do this action before
giving the client fluids, food or medication:
A. assess the gag reflex
B. next of kin or guardian
C. assess the sensorium
D. check O2 Sat with a pulse oximeter
Situation: Mrs Ethel Agustin 50 y/o, teacher is afflicted
with myasthenia gravis. myasthenia gravis is chronic autoimmune,
neuromuscular disease that causes
weakness in the skeletal muscles
36. Looking at Mrs Agustin, your assessment would
include the following except;
A. Nystagmus
B. Difficulty of hearing
C. Weakness of the levator palpebrae
D. Weakness of the ocular muscle
37. In an effort to combat complications which
might occur relatives should he taught;
A. Checking cardiac rate
B. Taking blood pressure reading
C. Techniques of oxygen inhalation
D. Administration of oxygen inhalation
38. The drug of choice for her condition is;
A. Prostigmine
B. Morphine
C. Codeine
D. Prednisone
39. As her nurse, you have to be cautious about
administration of medication, if she is under
medicated this can cause;
49
Myasthenic crisis is a life-
A. Emotional crisis threatening condition that
B. Cholinergic crisis occurs when the muscles
C. Menopausal crisis that control breathing
D. Myasthenia crisis become too weak to work.
40. If you are not extra careful and by chance you
give over medication, this would lead to;
A. Cholinergic crisis A cholinergic
crisis develops as a result
B. Menopausal crisis of overstimulation of
C. Emotional crisis nicotinic and muscarinic
receptors at the
D. Myasthenia crisis neuromuscular junctions.
Situation: Rosanna 20 y/o unmarried patient believes
that the toilet for the female patient in contaminated
with AIDS virus and refuses to use it unless she flushes it
three times and wipes the seat same number of times
with antiseptic solution.
41. The fear of using “contaminated” toilet seat can
be attributed to Rosanna’s inability to;
A. Adjust to a strange environment
B. Express her anxiety
C. Develop the sense of trust in other
person
D. Control unacceptable impulses or
feelings
42. Assessment data upon admission help the nurse
to identify this appropriate nursing diagnosis
A. Ineffective denial
B. Impaired adjustment
C. Ineffective individual coping
D. Impaired social interaction
43. An effective nursing intervention to help Rosana
is;
A. Convincing her to use the toilet after the
nurse has used it first
B. Explaining to her that AIDS cannot be
transmitted by using the toilet
C. Allowing her to flush and clear the
toilet seat until she can manage her
anxiety
D. Explaining to her how AIDS is
transmitted
44. The goal for treatment for Rosana must be
directed toward helping her to;
A. Walk freely about her past experience
B. Develop trusting relationship with others
C. Gain insight that her behaviour is due
to feeling of anxiety
D. Accept the environment unconditionally

45. Psychotherapy which is prescribed for Rosana is
described as;
A. Establishing an environment adapted to
an individual patient needs
B. Sustained interaction between the
therapist and client to help her develop
more functional behaviour
C. Using dramatic techniques to portray
interpersonal conflicts
D. Biologic treatment for mental disorder
Situation: Dennis 40 y/o married man, an electrical
engineer was admitted with the diagnosis of paranoid
disorders. He has become suspicious and distrustful 2
months before admission. Upon admission, he kept on
saying, “my wife has been planning to kill me.”
46. A paranoid individual who cannot accept the
guilt demonstrate one of the following defense
mechanism;
A. Denial
B. Projection
C. Rationalization
D. Displacement
47. One morning, Dennis was seen tilting his head as
if he was listening to someone. An appropriate
nursing intervention would be;
A. Tell him to socialize with other patient to
divert his attention
B. Involve him in group activities
C. Address him by name to ask if he is
hearing voices again
D. Request for an order of antipsychotic
medicine
48. When he says, “these voices are telling me my
wife is going to kill me.” A therapeutic
communication of the nurse is which one of the
following;
A. “i do not hear the voices you say you
hear”
B. “are you really sure you heard those
voices?”
C. “I do not think you heard those
voices?”
D. “Whose voices are those?”
49. The nurse confirms that Dennis is manifesting
auditory hallucination. The appropriate nursing
diagnosis she identifiesis;
A. Sensory perceptual alteration
50
B. Self-esteem disturbance
C. Ineffective individual coping
D. Defensive coping
50. Most appropriate nursing intervention for a
client with suspicious behavior is one of the
following;
A. Talk to the client constantly to reinforce
reality
B. Involve him in competitive activities
C. Use Non Judgmental and Consistent
approach
D. Project cheerfulness in interacting with
the patient
Situation: Clients with Bipolar disorder receives a very
high nursing attention due to the increasing rate of
suicide related to the illness.
51. The nurse is assigned to care for a recently
admitted client who has attempted suicide.
What should the nurse do?
A. Search the client's belongings and room
carefully for items that could be used to
attempt suicide.
B. Express trust that the client won't cause
self-harm while in the facility.
C. Respect the client's privacy by not
searching any belongings.
D. Remind all staff members to check on
the client frequently.
52. In planning activities for the depressed client,
especially during the early stages of
hospitalization, which of the following plan is
best?
A. Provide an activity that is quiet and
solitary to avoid increased fatigue such
as working on a puzzle and reading a
book.
B. Plan nothing until the client asks to
participate in the milieu
C. Offer the client a menu of daily activities
and ask the client to participate in all of
them
D. Provide a structured daily program of
activities and encourage the client to
participate
53. A client with a diagnosis of major depression,
recurrent with psychotic features is admitted to
the mental health unit. To create a safe
environment for the client, the nurse most

importantly devises a plan of care that deals
specifically with the clients:
A. Disturbed thought process
B. Imbalanced nutrition
C. Self-Care Deficit
D. Deficient Knowledge
54. The client is taking a Tricyclic anti-depressant,
which of the following is an example of TCA?
A. Paxil
B. Nardil
C. Zoloft
D. Pamelor
55. A client visits the physician's office to seek
treatment for depression, feelings of
hopelessness, poor appetite, insomnia, fatigue,
low self-esteem, poor concentration, and
difficulty making decisions. The client states that
these symptoms began at least 2 years ago.
Based on this report, the nurse suspects:
A. cyclothymic disorder.
B. Bipolar disorder
C. major depression.
D. dysthymic disorder.
56. The nurse is planning activities for a client who
has bipolar disorder, which aggressive social
behaviour. Which of the following activities
would be most appropriate for this client?
A. Ping Pong
B. Linen delivery
C. Chess
D. Basketball
57. The nurse assesses a client with admitted
diagnosis of bipolar affective disorder, mania.
The symptom presented by the client that
requires the nurse’s immediate intervention is
the client’s:
A. Outlandish behaviour and inappropriate
dress
B. Grandiose delusion of being a royal
descendant of king arthut
C. Nonstop physical activity and poor
nutritional intake
D. Constant incessant talking that includes
sexual topics and teasing the staff
58. A nurse is conducting a group therapy session
and during the session, A client with mania
consistently talks and dominates the group. The
behaviour is disrupting the group interaction.
51
The nurse would initially:
A. Ask the client to leave the group session
B. Tell the client that she will not be
allowed to attend any more group
sessions
C. Tell the client that she needs to allow
other client in a group time to talk
D. Ask another nurse to escort the client
out of the group session
59. A professional artist is admitted to the
psychiatric unit for treatment of bipolar
disorder. During the last 2 weeks, the client has
created 154 paintings, slept only 2 to 3 hours
every 2 days, and lost 18 lb (8.2 kg). Based on
Maslow's hierarchy of needs, what should the
nurse provide this client with first?
A. The opportunity to explore family
dynamics
B. Help with re-establishing a normal
sleep pattern
C. Experiences that build self-esteem
D. Art materials and equipment
60. The physician orders lithium carbonate
(Lithonate) for a client who's in the manic phase
of bipolar disorder. During lithium therapy, the
nurse should watch for which adverse reactions?
A. Anxiety, restlessness, and sleep
disturbance
B. Nausea, diarrhea, tremor, and lethargy
C. Constipation, lethargy, and ataxia
D. Weakness, tremor, and urine retention
Situation – Annie has a morbid fear of heights. She asks
the nurse what desensitization therapy is:
61. The accurate information of the nurse of the
goal of desensitization is:
A. To help the clients relax and
progressively work up a list of anxiety
provoking situations through imagery.
B. To provide corrective emotional
experiences through a one-to-one
intensive relationship.
C. To help clients in a group therapy setting
to take on specific roles and reenact in
front of an audience, situations in which
interpersonal conflict is involved.
D. To help clients cope with their problems
by learning behaviors that are more
functional and be better equipped to
face reality and make decisions.
 problem. After the identification of the research
62. It is essential in desensitization for the patient problem, which of the following should be done?
to: A. Methodology
A. Have rapport with the therapist B. Acknowledgement
B. Use deep breathing or another C. Review of related literature
relaxation technique D. Formulate hypothesis
C. Assess one’s self for the need of an
anxiolytic drug 68. Which of the following communicate the results
D. Work through unresolved unconscious of the research to the readers. They facilitate the
conflicts description of the data.
A. Hypothesis
63. In this level of anxiety, cognitive capacity B. Research problem
diminishes. Focus becomes limited and client C. Statistics
experiences tunnel vision. Physical signs of D. Tables and Graphs
anxiety become more pronounced.
A. Severe anxiety 69. In Quantitative date, which of the following is
B. Mild anxiety described as the distance in the scoring unites of
C. Panic the variable from the highest to the lower?
D. Moderate anxiety A. Frequency
B. Median
64. Antianxiety medications should be used with C. Mean
extreme caution because long term use can lead D. Range
to:
A. Parkinsonian like syndrome 70. This expresses the variability of the data in
B. Hepatic failure reference to the mean. It provides as with a
C. Hypertensive crisis numerical estimate of how far, on the average
D. Risk of addiction the separate observation are from the mean:
A. Mode
65. The nursing management of anxiety related with B. Median
post-traumatic stress disorder includes all of the C. Standard deviation
following EXCEPT: D. Frequency
A. Encourage participation in recreation or
sports activities Situation: Survey and Statistics are important part of
B. Reassure client’s safety while touching research that is necessary to explain the characteristics
client of the population.
C. Speak in a calm soothing voice
D. Remain with the client while fear level is 71. According to the WHO statistics on the Homeless
high population around the world, which of the
following groups of people in the world
SITUATION: You are fortunate to be chosen as part of disproportionately represents the homeless
the research team in the hospital. A review of the population?
following IMPORTANT nursing concepts was made. A. Hispanics
B. Asians
66. As a professional, a nurse can do research for C. African Americans
varied reason except: D. Caucasians
A. Professional advancement through
research participation 72. All but one of the following is not a measure of
B. To validate results of new nursing Central Tendency:
modalities A. Mode
C. For financial gains B. Standard Deviation
D. To improve nursing care C. Variance
D. Range
67. Each nurse participants was asked to identify a

52
 53

73. In the value: 87, 85, 88, 92, 90; what is the A. There is a control group
mean? B. There is an experimental group
A. 88.2 C. Selection of subjects in the control group
B. 88.4 is randomized
C. 87 D. There is a careful selection of subjects
D. 90 in the experimental group

74. In the value: 80, 80, 80, 82, 82, 90, 90, 100; what 80. The researcher implemented a medication
is the mode? regimen using a new type of combination drugs
A. 80 to manic patients while another group of manic
B. 82 patient receives the routine drugs. The
C. 90 researcher however handpicked the
D. 85.5 experimental group for they are the clients with
75. In the value: 80, 80, 10, 10, 25, 65, 100, 200; multiple episodes of bipolar disorder. The
what is the median? researcher utilized which research design?
A. 71.25 A. Quasi-experimental
B. 22.5 B. Phenomenological
C. 10 and 25 C. Pure experimental
D. 72.5 D. Longitudinal

76. Draw Lots, Lottery, Table of random numbers or
a sampling that ensures that each element of the
population has an equal and independent
chance of being chosen is called:
A. Cluster
B. Stratified
C. Simple
D. Systematic
77. An investigator wants to determine some of the
problems that are experienced by diabetic
clients when using an insulin pump. The
investigator went into a clinic where he
personally knows several diabetic clients having
problem with insulin pump. The type of sampling
done by the investigator is called:
A. Probability
B. Snowball
C. Purposive
D. Incidental
78. If the researcher implemented a new structured
counselling program with a randomized group of
subject and a routine counselling program with
another randomized group of subject, the
research is utilizing which design?
A. Quasi experimental
B. Comparative
C. Experimental
D. Methodological
79. Which of the following is not true about a Pure
Experimental research?
Situation 19: As a nurse, you are expected to participate
in initiating or participating in the conduct of research
studies to improve nursing practice. You to be updated
on the latest trends and issues affected the profession
and the best practices arrived at by the profession.
81. You are interested to study the effects of
mediation and relaxation on the pain
experienced by cancer patients. What type of
variable is pain?
A. Dependent
B. Independent
C. Correlational
D. Demographic
82. You would like to compare the support system
of patient with chronic illness to those with
acute illness. How will you best state your
problem?
A. A descriptive study to compare the
support system of patients with chronic
illness and those with acute illness in
terms of demographic data and
knowledge about intervention.
B. The effects of the types of support
system of patients with chronic illness
and those with acute illness.
C. A comparative analysis of the support
system of patients with chronic illness
and those with acute illness.
D. A study to compare the support system
of patients with chronic illness and those
with acute illness.
 E. What are the differences of the support
system being received by patient with
chronic illness and patients with acute
illness?
83. You would like to compare the support system
of patients with chronic illness to those with
acute illness. Considering that the hypothesis
was: “Client’s with chronic illness have lesser
support system than client’s with acute illness.”
What type of research is this?
A. Descriptive
B. Correlational, Non experimental
C. Experimental
D. Quasi Experimental
84. 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
you should disclose to the prospective subjects
except:
A. Consent to incomplete disclosure
B. Description of benefits, risks and
discomforts
C. Explanation of procedure
D. Assurance of anonymity and
confidentiality
85. In the Hypothesis: “The utilization of technology
in teaching improves the retention and attention
of the nursing students.” Which is the
dependent variable?
A. Utilization of technology
B. Improvement in the retention and
attention
C. Nursing students
D. Teaching
Situation: You are actively practicing nurse who has just
finished you graduate studies. You learned the value of
research and would like to utilize the knowledge and
skills gained in the application of research to the nursing
service. The following questions apply to research.
86. Which type of research inquiry investigates the
issues of human complexity (e.g understanding
the human expertise)?
A. Logical position
B. Positivism
C. Naturalistic inquiry
D. Quantitative research
54
87. Which of the following studies is based on
quantitative research?
A. A study examining the bereavement
process in spouse of clients with
terminal cancer
B. A study exploring the factors influencing
weight control behaviour
C. A Study measuring the effects of sleep
deprivation on wound healing
D. A study examining client’s feelings
before, during and after bone marrow
aspiration.
88. Which of the following studies is based on the
qualitative research?
A. A study examining clients’ reaction to
stress after open heart surgery
B. A study measuring nutrition and weight
loss/gain in clients with cancer
C. A study examining oxygen levels after
endotracheal suctioning
D. A study measuring differences in blood
pressure before, during and after
procedure
89. An 85 year old client in a nursing home tells a
nurse, “I signed the papers of that research
study because the doctor was so insistent and I
want him to continue taking care for me” Which
client right is being violated?
A. Right of self determination
B. Right to full disclosure
C. Right to privacy and confidentiality
D. Right not to be harmed
90. A supposition or system of ideas that is
proposed to explain a given phenomenon best
defines:
A. A paradigm
B. A theory
C. A Concept
D. A conceptual framework
Situation: Mastery of research design determination is
essential in passing the NLE.
91. Ana wants to know if the length of time she will
study for the board examination is proportional
to her board rating. During the June 2008 board
examination, she studied for 6 months and
gained 68%, On the next board exam, she
studied for 6 months again for a total of 1 year
and gained 74%, On the third board exam, She
studied for 6 months for a total of 1 and a half
 55

year and gained 82%. The research design she collected 100 random individuals and determine
used is: who is their favourite comedian actor. 50% said
A. Comparative Dolphy, 20% said Vic Sotto, while some
B. Experimental answered Joey de Leon, Allan K, Michael V.
C. Correlational Tonyo conducted what type of research study?
D. Qualitative A. Phenomenological
B. Non experimental
92. Anton was always eating high fat diet. You want C. Case Study
to determine if what will be the effect of high D. Survey
cholesterol food to Anton in the next 10 years.
You will use: 98. Jane visited a tribe located somewhere in China,
A. Comparative it is called the Shin Jea tribe. She studied the way
B. Historical of life, tradition and the societal structure of
C. Correlational these people. Jane will best use which research
D. Longitudinal design?
A. Historical
93. Community A was selected randomly as well as B. Phenomenological
community B, nurse Edna conducted teaching to C. Case Study
community A and assess if community A will D. Ethnographic
have a better status than community B. This is
an example of: 99. Anjoe researched on TB. Its transmission,
A. Comparative Causative agent and factors, treatment sign and
B. Experimental symptoms as well as medication and all other in
C. Correlational depth information about tuberculosis. This study
D. Qualitative is best suited for which research design?
A. Historical
94. Ana researched on the development of a new B. Phenomenological
way to measure intelligence by creating a 100 C. Case Study
item questionnaire that will assess the cognitive D. Ethnographic
skills of an individual. The design best suited for
this study is: 100. Diana is to conduct a study about the
A. Historical relationship of the number of family members in
B. Survey the household and the electricity bill. Which of
C. Methodological the following is the best research design suited
D. Case study for this study?
1. Descriptive
95. Gen is conducting a research study on how mark, 2. Exploratory
an AIDS client lives his life. A design suited for 3. Explanatory
this is: 4. Correlational
A. Historical 5. Comparative
B. Phenomenological 6. Experimental
C. Case Study A. 1,4
D. Ethnographic B. 2,5
C. 3,6
96. Marco is to perform a study about how nurses D. 1,5
perform surgical asepsis during World War II. A E. 2,4
design best for this study is:
A. Historical
B. Phenomenological
C. Case Study
D. Ethnographic

97. Tonyo conducts sampling at barangay 412. He