ILOILO DOCTORS’ COLLEGE

COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

COLLEGE OF NURSING
MIDTERM EXAMINATION
ENHANCEMENT
(CARDIO, NEURO, PHARMA, CHN & PSYCHIATRIC NURSING)

DIRECTION:
1. PLEASE USE THE PRESCRIBED ASNSWER SHEET FOR ANSWERING. USE PENCIL
FOR SHADING.

Part I: Medical Surgical Nursing – Cardio

1. A client with a bundle branch block is on a cardiac monitor. The nurse should expect
to observe

a. Sagging ST segments
b. Absence of P wave configurations
c. Inverted T waves following each QRS complex
d. Widening of QRS complexes to 0.12 sec or greater

2. The cardioversion is a procedure used to convert certain dysrhythmias to normal

rhythm. I addition to atrial fibrillation, cardioversion is most affective when the client
demonstrates ventricular:

a. Standstill
b. Fibrillation
c. Tachycardia
d. Premature complexes

3. A client who has a myocardial infarction is in the coronary care on cardiac monitor.
The nurse observes ventricular irritability on the screen. The nurse should preapere to
administer

a. Digoxin ( lanoxin)
b. Furosemide ( lasix)
c,. Lidocaine ( xylocaine)
d. Levarterenol bitartrate ( levophed)

4. When performing external cardiac compression, the nurse should exert downward
vertical pressure on the lower sternum by placing:

a. The fleshy part of a clenched list on the lower sternum

b. The heels of each hand side by side extending the fingers over the chest
c. The fingers of one hand on the sternum and the fingers of the other hand on top of
them
d. The heel of one hand on the sternum and the heel of the other on top of it,
interlocking the fingers

5. When assessing the lower extremeties of a client with right ventricular heart failure
the nurse expects pitting edema because of the

a. Increase in the tissue hydrostatic pressure

b. Increase in tissue colloid osmotic pressure
c. elevation in the plasma hydrostatic pressure
d. Decrease in the plasma colloid osmotic pressure

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

6. When taking an admission history of a client with right ventricular heart failure the
nurse would expect the client to complain of:

a. Dyspnea, edema, fatigue

b. Fatigue, vertigo, headache
c. weakness, palpitations nausea
d. a feeling of distress when breathing

7. A client is admitted to the hospital and has edematous ankles. To best limit edema of
the feet the nurse should prepare to:

a. Restrict fluids
b. elevate the legs
c. Apply elastic bandages
d. Do ROM exercise

8. A client has edema in the lower extremities during the day which disappears at night,
The nurse should suspect:

a. lung disease
b. Pulmonary edema
c. Myocardial infarction
d. Right ventricular heart failure

9. A client is scheduled for cardiac catheterization using a radiopaque dye. Which of the
following assessments is most critical before the procedure?

a. Intake and output

b. Baseline peripheral pulses
c. Height and weight
d. Allergy to shellfish or iodine

10. A client with myocardial infarction has been transferred from a coronary care unit to
a general medical unit with a cardiac monitoring via telemetry. A nurse plans to allow for
which of the following client activities?

a. Strict bedrest for 24 hours after transfer

b. Bathroom privileges and self-care activities
c. Unsupervised hallway ambulation with distances under 200 feet
d. Ad lib activities because the client is monitored.

11. A client with no history of cardiovascular disease comes in to the ambulatory clinic
with flu-like symptoms. The client suddently complains of chest pain. Which of the
following questions would best help the nurse to discriminate the pain caused by a non-
cardiac problem?

a. “Have you ever had this pain before?”

b. “Can you describe the pain to me?”
c. “Does the pain gets worse when you breathe in?”
d. “Can you rate the pain scale from 1-10 with 10 being the worst?”

12. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A
nurse sees no electrocardiogram complexes on the screen. The first action of the nurse
is to:

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

a. Check the client’s status and lead placement

b. Press the recorder button in the electrocardiogram console.
c. Call the physician.
d. Call a code blue.

13. A client who has been receiving heparin therapy also started with warfarin. The
client asks the nurse why both medications are being administered. In formulating the
response, the nurse incorporates the understanding that warfarin:

a. Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3days
for this to exert an anticoagulant effect.
b. Inhibits synthesis of specific clotting factors in the liver and it takes 3-4 days for this
medication to exert an anticoagulant effect.
c. Stimulates production of the body’s own thrombolytic substances, but it takes 2-4
days for this to begin.
d. Has the same mechanism of action as Heparin, and the crossover time is needed for
the serum level of warfarin to be therapeutic.

14. When interpreting an ECG, the nurse would keep in mind the following about the P
wave. Select all that apply:

1. Reflects electrical impulse beginning at the SA Node

2. Indicated electrical impulse beginning at the AV Node
3. Reflects atrial muscle depolarization
4. Identifies ventricular muscle depolarization
5. Has a duration of normally 0.11 seconds or less.

a. 1,2,3
b. 1,3,5
c. 2,3,4
d. All of the above

15. The nurse receives emergency laboratory results for a client with chest pain and
immediately informs the physician. An increased myoglobin level suggests which of the
following:

a. Cancer
b. Hypertension
c. Liver Disease
d. Myocardial Infarction

16. The most important long-term goal for a hypertensive client would be:

a. Learn how to avoid stress

b. Explore a job change or early retirement
c. Make a commitment for long-term therapy
d. Control high blood pressure

17. Which of the following symptoms should the nurse teach the client with unstable
angina to report immediately to her physician?

a. A change in the pattern of her pain

b. Pain during sex

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

c. Pain during an argument with her husband

d. Pain during or after an activity such as lawn mowning

18. Which of the following arteries primarly feeds the anterior walls of the heart?

a. Circumflex artery
b. Internal mammary artery
c. Left anterior descending artery
d. Right coronary artery

19. Following a treadmill test and cardiac catheterization, the client is found to have
CAD which is inappropriate. He is referred to the cardiac rehabilitation unit. During his
first visit to the unit he says that he doesn’t understand why he needs to be there
because there is nothing that can be done to make him better. The best nursing
response is:

a. “Cardiac rehabilitation is not a cure but can help restore you to many of your former
activites.”
b. “Here we teach you to gradually change your lifestyle to accommodate your heart
disease.”
c. “You are probably right but we can gradually increase your activities so that you can
live a more active life”
d. “Do you feel that you will have to make some changes in your life now?”

20. A client enters the ER complaining of chest pressure and severe epigastric distress.
His vital signs are 160/90, 94, 24 and 99 degrees Fahrenheit. The doctor orders cardiac
enzymes. If the client were diagnosed with an MI, the nurse would expect which cardiac
enzyme to rise within the next 3 to 8 hours?

a. Creatinine kinase
b. LDH
c. LDH – 1
d. LDH – 2

Part I: Medical Surgical Nursing – Neuro

21. An 18-year-old client was hit in the head with a baseball during practice. When
discharging him to the care of his mother, the nurse gives which of the following
instructions?

a. “Watch him for a keyhole pupil the next 24 hours.”

b. “Expect profuse vomiting for 24 hours after the injury.”
c. “Wake him every hour and assess his orientation to person, time, and place.”
d. “Notify the physician immediately if he has a headache.”

22. Which neurotransmitter is responsible for many of the functions of the frontal lobe?

a. Dopamine
b. GABA
c. Histamine
d. Norepinephrine

23. The nurse is discussing the purpose of an electroencephalogram (EEG) with the
family of a client with massive cerebral hemorrhage and loss of consciousness. It would

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

be most accurate for the nurse to tell family members that the test measures which of
the following conditions?

a. Extent of intracranial bleeding.

b. Sites of brain injury.
c. Activity of the brain.
d. Percent of functional brain tissue.

24. A client arrives at the ER after slipping on a patch of ice and hitting her head. A CT
scan of the head shows a collection of blood between the skull and dura mater. Which
type of head injury does this finding suggest?

a. Subdural hematoma
b. Subarachnoid hemorrhage
c. Epidural hematoma
d. Contusion

25. After falling 20’, a 36-year-old man sustains a C6 fracture with spinal cord
transaction. Which other findings should the nurse expect?

a. Quadriplegia with gross arm movement and diaphragmatic breathing.

b. Quadriplegia and loss of respiratory function.
c. Paraplegia with intercostal muscle loss.
d. Loss of bowel and bladder control.

26. A 20-year-old client who fell approximately 30’ is unresponsive and breathless. A
cervical spine injury is suspected. How should the first-responder open the client’s
airway for rescue breathing?

a. By inserting a nasopharyngeal airway.

b. By inserting an oropharyngeal airway.
c. By performing a jaw thrust maneuver.
d. By performing the head-tilt, chin-lift maneuver.

27. The nurse is caring for a client with a T5 complete spinal cord injury. Upon
assessment, the nurse notes flushed skin, diaphoresis above the T5, and a blood
pressure of 162/96. The client reports a severe, pounding headache. Which of the
following nursing interventions would be appropriate for this client? Select all that apply.

1. Elevate HOB to 90 degrees

2. Loosen constrictive clothing
3. Use a fan to reduce diaphoresis
4. Assess for the bladder distention and bowel impaction
5. Administer antihypertensive medication
6. Place the client in a supine position with legs elevated

a. 1,2,3,4 and 6
b. 2, 3 and 4
c. 2, 4 and 5
d. All of the above

28. The nurse is caring for the client in the ER following a head injury. The client
momentarily lost consciousness at the time of the injury and then regained it. The client

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

now has lost consciousness again. The nurse takes quick action, knowing this is
compatible with:

a. Skull fracture
b. Concussion
c. Subdural hematoma
d. Epidural hematoma

29. The nurse is caring for a client who suffered a spinal cord injury 48 hours ago. The
nurse monitors for GI complications by assessing for:

a. A flattened abdomen.
b. Hematest positive nasogastric tube drainage.
c. Hyperactive bowel sounds.
d. A history of diarrhea.

30. A client with a spinal cord injury is prone to experiencing autonomic dysreflexia. The
nurse would avoid which of the following measures to minimize the risk of recurrence?

a. Strict adherence to a bowel retraining program.

b. Limiting bladder catheterization to once every 12 hours.
c. Keeping the linen wrinkle-free under the client.
d. Preventing unnecessary pressure on the lower limbs.

31. The nurse is planning care for the client in spinal shock. Which of the following
actions would be least helpful in minimizing the effects of vasodilation below the level of
the injury?

a. Monitoring vital signs before and during position changes.

b. Using vasopressor medications as prescribed.
c. Moving the client quickly as one unit.
d. Applying Teds or compression stockings.

32. The nurse is caring for a client admitted with spinal cord injury. The nurse minimizes
the risk of compounding the injury most effectively by:

a. Keeping the client on a stretcher.

b. Logrolling the client on a firm mattress.
c. Logrolling the client on a soft mattress.
d. Placing the client on a Stryker frame.

33. The nurse is evaluating neurological signs of the male client in spinal shock
following spinal cord injury. Which of the following observations by the nurse indicates
that spinal shock persists?

a. Positive reflexes
b. Hyperreflexia
c. Inability to elicit a Babinski’s reflex.
d. Reflex emptying of the bladder.

34. A client is at risk for increased ICP. Which of the following would be a priority for the
nurse to monitor?

a. Unequal pupil size

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

b. Decreasing systolic blood pressure

c. Tachycardia
d. Decreasing body temperature

35. Which of the following respiratory patterns indicate increasing ICP in the brain
stem?

a. Slow, irregular respirations

b. Rapid, shallow respirations
c. Asymmetric chest expansion
d. Nasal flaring

36. Which of the following nursing interventions is appropriate for a client with an ICP of
20 mm Hg?

a. Give the client a warming blanket.

b. Administer low-dose barbiturate.
c. Encourage the client to hyperventilate.
d. Restrict fluids.

37. A client has signs of increased ICP. Which of the following is an early indicator of
deterioration in the client’s condition?

a. Widening pulse pressure

b. Decrease in the pulse rate
c. Dilated, fixed pupil
d. Decrease in LOC

38. A client who is regaining consciousness after a craniotomy becomes restless and
attempts to pull out her IV line. Which nursing intervention protects the client without
increasing her ICP?

a. Place her in a jacket restraint.

b. Wrap her hands in soft “mitten” restraints.
c. Tuck her arms and hands under the draw sheet.
d. Apply a wrist restraint to each arm.

39. Which of the following describes decerebrate posturing?

a. Internal rotation and adduction of arms with flexion of elbows, wrists, and fingers.
b. Back hunched over, rigid flexion of all four extremities with supination of arms and
plantar flexion of the feet.
c. Supination of arms, dorsiflexion of feet.
d. Back arched; rigid extension of all four extremities.

40. A client receiving vent-assisted mode ventilation begins to experience cluster

breathing after recent intracranial occipital bleeding. Which action would
be most appropriate?

a. Count the rate to be sure the ventilations are deep enough to be sufficient.
b. Call the physician while another nurse checks the vital signs and ascertains the
patient’s Glasgow Coma score.
c. Call the physician to adjust the ventilator settings.
d. Check deep tendon reflexes to determine the best motor response.

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

Part III: Pharmacology

41. A 67-year-old client is discharged from the hospital with a prescription for digoxin
(Lanoxin) 0.25 mg daily. Which instruction should the nurse include in this client's
discharge teaching plan?

a. Take the medication in the morning before rising.

b. Take and record radial pulse rate daily.
c. Expect some vision changes due to the medication.
d. Increase intake of foods rich in Vitamin K.

42. Which symptoms are serious adverse effects of beta-adrenergic blockers such as
propranolol (Inderal)?

a. Headache, hypertension, and blurred vision.

b. Wheezing, hypotension, and AV block.
c. Vomiting, dilated pupils, and papilledema.
d. Tinnitus, muscle weakness, and tachypnea.

43. What medication is useful in treating digoxin (Lanoxin) toxicity?

a.Atropine sulfate (Atropine).

b. Isoproterenol (Isuprel)
c. Xylocaine (Lidocaine).
d. Digoxin immune fab (Digibind).

44. When caring for a client on digoxin (Lanoxin) therapy the nurse knows to be alert for
digoxin (Lanoxin) toxicity. Which finding would predispose this client to developing
digoxin toxicity?

a. Low serum sodium.

b. High serum sodium.
c. Low serum potassium.
d. High serum potassium.

45. A 78-year-old client with congestive heart failure receives a cardiac glycoside,
digoxin (Lanoxin) 0.25mg po daily. Which observation by the nurse indicates that the
medication has been effective?

a. Systolic blood pressure readings ranges from 120 to 130.

b. Clear breath sounds anteriorly and posteriorly
c. Jugular venous distention present with supine positioning.
d. Radial pulse volume of +4 bilaterally.

46. The physician prescribes digitalis (Digoxin) for a client diagnosed with congestive
heart failure. Which intervention should the nurse implement prior to administering the
digoxin?

a. Observe respiratory rate and depth.

b. Assess the serum potassium level.
c. Obtain the client's blood pressure.
d. Monitor the serum glucose level.

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

47. A 59-year-old client with congestive heart failure is taking furosemide (Lasix) 40 mg
twice daily. The nurse plans to monitor this client for development of which
complication?

a. Hyponatremia.
b. Hyperchloremia.
c. Hypercalcemia.
d. Hyponatremia.

48. A male client being discharged with a prescription for theophylline, a bronchodilator,
tells the nurse that he understands he is to take three doses of the medication each
day. Since, at the time of discharge, timed-release capsules are not available, which
dosing schedule should the nurse advise the client to follow?

a. 9 a.m., 1 p.m., and 5 p.m.

b. 8 a.m., 4 p.m., and midnight.
c. Before breakfast, before lunch and before dinner.
d. With breakfast, with lunch, and with dinner.

49. A 75-year-old male client taking hydrochlorothiazide (HCTZ) is admitted to the

hospital having "palpitations" and "skipped heart beats." What is the most likely cause
of these symptoms given the client's medication history?

a. Hypokalemia.
b. Hypermagnesemia.
c. Hyperchloremia.
d. Hyponatremia.

50. Vancomycin (Vancocin) is prescribed for a client who has a history of endocarditis
and is to undergo minor dental surgery. The nurse knows that this drug

a. should be administered IM.

b. may be administered sub-q.
c. should always be administered IV.
d. may be administered po.

51. Alteration of which laboratory finding represents achievement of a therapeutic goal

for heparin administration?

a. Prothrombin time.
b. Fibrin split products.
d. Platelet count.
c. Partial thromboplastin time.

52. A client receiving a continuous infusion of heparin intravenously starts to

hemorrhage from an arterial access site. What medication should the nurse anticipate
administering to prevent further heparin-induced hemorrhaging?

a. Vitamin K (Aquamephyton).
b. Protamine sulfate.
c. Warfarin sodium (Coumadin).
d. Prothrombin.

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

53. A client taking furosemide (Lasix), reports difficulty sleeping. What question is
important for the nurse to ask the client?

a. What dose of medication are you taking?

b. Are you eating foods rich in potassium?
c. Have you lost weight recently?
d. At what time do you take your medication?

54. A female client who has started taking long-term corticosteroid therapy tells the
nurse that she is careful to take her daily dose at bedtime with a snack of crackers and
milk. What is the best response by the nurse?

a. Advise the client to take the medication in the morning, rather than at bedtime.
b. Teach the client that dairy products should not be taken with her medication.
c. Tell the client that absorption is improved when taken on an empty stomach.
d. Affirm that the client has a safe and effective routine for taking the medication.

55. The nurse has completed diabetic teaching for a client who has been newly
diagnosed with diabetes mellitus. Which statement by this client would indicate to the
nurse that further teaching is needed?

a. "Regular insulin can be stored at room temperature for 30 days."

b. "My legs, arms, and abdomen are all good sites to inject my insulin."
c. "I will always carry hard candies to treat hypoglycemic reactions."
d. "When I exercise, I should plan to increase my insulin dosage."

56. A client asks the nurse if glipizide (Glucotrol) is an oral insulin. What is the correct
answer for the nurse to provide?
a. "Yes, it is an oral insulin and has the same actions and properties as intermediate
insulin."
b. "Yes, it is an oral insulin and is distributed, metabolized, and excreted in the same
manner as insulin."
c. “No, it is not an oral insulin and can be used only when some beta cell function is
present."
d. “No, it is not an oral insulin, but it is effective for those who are resistant to injectable
insulins."

57. The nurse gives a client NPH insulin 15 units subcutaneously before breakfast (7:30
a.m.). At what time should the nurse be particularly alert for signs or symptoms of a
potential hypoglycemic reaction?

a. 8:30 to 11:30 a.m.

b. 1:30 to 3:30 p.m.
c. 7:30 to 9:30 p.m.
d. 12:00 midnight.

58. The nurse is preparing a teaching plan for a client who is newly diagnosed with type
1 diabetes mellitus. Which signs and symptoms should the nurse describe when
teaching the client about hypoglycemia?

a. Sweating, trembling, tachycardia.

b. Polyuria, polydipsia, polyphagia.
c. Nausea, vomiting, anorexia.
d. Fruity breath, tachypnea, chest pain.

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

59. A 43-year-old female client is receiving thyroid replacement hormone following a

thyroidectomy. What adverse effects associated with thyroid hormone toxicity should
the nurse instruct the client to report promptly to the physician?

a. Tinnitus and dizziness.

b. Tachycardia and chest pain.
c. Dry skin and intolerance to cold.
d. Weight gain and increased appetite.

60. The nurse is preparing a teaching plan for a client who has received a new
prescription for levothyroxine sodium (Synthroid). Which instruction should be
included?

a. "Take this medication with a high protein snack at bedtime."

b. "You may change at anytime to a less expensive generic brand."
c. "Take your pulse daily, and if it exceeds 100, contact the physician."
d. "Return to the clinic weekly for serum blood glucose testing."

Part IV: Community Health Nursing

61. Community Health Nursing is a service that is provided to an environment that is

constantly changing. This implies that the community health nurse to be able to provide
relevant service must:

a. involve other disciplines in carrying out health services in various settings

b. provide a service that is community based
c. provide a service that is integrated and comprehensive
d. update her knowledge on the current and evolving characteristics of the health
care system

62 .The concept of community health nursing as a population-based service means that

it should be provided to be:

a. home only
b. nursing community
c. individuals only
d. individual and families

63. The goal of community health nursing is to:

a. lessen caseload of public health nurse

b. provide clinic-nursing services to the populace
c. assist families to be self-reliant and be able to identify and solve own problem
d. spread information about facilities of rural health units or centers

64. A phase of the nursing process where the needs of the patient or family are being
observed

a. nursing diagnosis
b. assessment
c. evaluation
d. intervention

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

65. Health services were devolved to local government units (LGU’s) for the following
reasons EXCEPT

a. to transform LGU’s into self-reliant communities

b. to involve people in the development and progress of their communities
c. to empower local officials
d. to provide people better access to decision-making

66. Which of the following public health program are devolved and are made more
accessible to the people?

a. Environmental health and communicable disease control

b. Maternal and Child Health Program
c. Control of non-communicable diseases
d. All these programs

67. The Department of Health adopts measures to augment basic health services and
facilities provided by LGU’s. Which of the following is NOT a priority area for the
provision of assistance by the DOH?
a. Areas where studies/research on health are conducted
b. Selected areas in the city
c. Areas recommended by governors and other local officials
d. Deserving but less developed local government units

68. Which law mandates devolution of health services to LGU’s?

a. R.A. 7610
b. R.A. 7160
c. R.A. 6170
d. R.A. 6710

69. According to C.E. Winslow, public health is directed towards assisting every citizen
to

a. Be free from illness

b. Realize his birth rights of health and longevity
c. Get social services and welfare support
d. Have medicine at an affordable

70. Which best demonstrate the concept that community health nursing is population-
focused?

a. The performance of community diagnosis

b. The provision of services at an affordable cost
c. The provision of nursing care in the natural environment of people
d. The coordination of services by different members of the health team

71. Which is the primary goal of community health nursing?

a. To support and supplement the efforts of the medical profession in the promotion
of health and prevention of illness
b. To enhance the capacity of individuals, families and communities to cope with
their health needs
c. To increase the productivity of the people

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

d. To contribute to national development

72. Which DOES NOT describe primary health care?

a. It emphasizes partnership between health care providers and the people

b. It is a total approach to community development
c. It aims to provide free health services to the people.
d. It stresses the use of appropriate technology

73. When we determines whether the objectives of a program were attained or not, we
are determining

a. Effectiveness
b. Efficiency
c. Adequacy
d. Appropriateness

74. Which is a mark of success in Primary Health Care?

a. The people utilize health services according to their needs

b. Health workers are able to provide efficient and acceptable services
c. The people are able to attain the highest level of health through their own efforts
d. Barangay officials participate actively in health related activities

75. Accessibility of health services means all of the following EXCEPT

a. Health service providers are within 5 kilometers from most of their catchment
population
b. Health services and the manner of delivery of these services are acceptable to
the people.
c. The people and the government can afford the health services provided
d. Government and non-government agencies participate in providing

76. In the present health care delivery system, the public health nurse is a

a. Manager of the Rural Health Unit

b. Primary health worker
c. Grassroots health worker
d. Secondary health worker

77. In a conference with midwives and the rural sanitary inspector, you reviewed the
functions of the Rural Health Unit. You agreed that the RHU should function as a

a. Health are of the LGU

b. Resource of the community
c. All of these
d. Municipal Clinic

78. Which herbal preparation may be recommended for fever, cough and abdominal
pain?

a. Sambong
b. Tsaang Gubat
c. Yerba Buena

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

d. Bayabas

79. Which herbal preparation may be used to relieve pain due to arthritis?
a. Lagundi
b. Herba Buena
c. Both of these
d. None of these

80. The Public Health Nurse in the Rural Health Unit is expected to participate in the
planning of the total public health program for the municipality. Her main contribution is
to
a. Collect and collate community data
b. Prepare the nursing component of the plan
c. Implement the community health plan
d. Assess the total health needs of the community

Part V: Psychiatric Nursing

81. Mrs. Reyes remarked, “I am worried about people visiting- with all the media news
about child kidnapping and robberies.” The nurse BEST response would be:

a. “Would you rather wish that I don’t come and visit you? You regard me as a
stranger?”
b. “I get that.” The nurse diverts the attention to talk about non-threatening topics
c. “It must be distressing to think and feel the way that you do.”
d. “I acknowledge what you are saying. My concern is the health care of your family
and information are strictly confidential.”

82. Mrs. Reyes expressed that her socializing with neighbors is limited because her
husband thinks she is getting overly friendly with a guy next door. Which of the following
would the nurse emphasize as basic?

a. Keeping trust in the relationship

b. Avoid relating with neighbors to minimize conflict
c. Be assertive to express her individuality
d. Ignore the husband and just be supportive

83. A client has just begun to discuss important feelings when the time of the interview
is up. The next day, when the nurse meets with the client at the agreed upon time, the
initial intervention would be to say:

a. “Good morning, how are you today?”

b. “Yesterday you were talking about some very important feelings. Let’s continue.”
c. “What would you like to talk about today?”
d. Nothing and wait for the client to introduce a topic.

84. A new staff nurse is on orientation tour with the head nurse. A client approaches her
and says, “I don’t belong here. Please try to get me out.” The staff nurse’s best
response would be:

a. “What would you do if you were out of the hospital?”

b. “I am new staff member, and I’m on tour. I’ll come back and talk with you later.”
c. “I think you should talk with the head nurse about that.”
d. “I can’t do anything about that.”

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

85. The nurse is in the day room with a group of clients when a client who has been
quietly watching TV suddenly jumps up screaming and runs out of the room. The
nurse’s priority intervention would be to:

a. Turn off the TV, and ask the group what they think about the client’s behavior
b. Follow after the client to see what has happened.
c. Ignore the incident because these outbreaks are frequent.
d. Send another client out of the room to check on the agitated client.

86. A nurse observes a client sitting alone in her room crying. As the nurse approaches
her, the client states, “I’m feeling sad. I don’t want to talk now.” The nurse’s best
response would be:

a. “It will help you feel better if you talk about it.”
b. “I’ll come back when you feel like talking.”
c. “I’ll stay with you a few minutes.”
d. “Sometimes it helps to talk.”

87. A student failed her Statistics Final Exam and spent the entire evening berating the
teacher and the course. This behavior would be an example of which defense
mechanism?

a. Reaction-Formation
b. Compensation
c. Projection
d. Displacement

88. The pre-morbid personality of a person with a non-psychotic maladaptive response

to anxiety may most accurately be described as:

a. unpredictable, impulsive, aggressive

b. rigid, insecure and conforming
c. dependent, pessimistic, moody
d. anxious, insensitive and self-absorbed

89. The most effective nursing intervention for a severely anxious client who is pacing
vigorously would be to:

a. Instruct her to sit down and quit pacing

b. Place her in bed to reduce stimuli and allow rest.
c. Allow her to talk until she becomes physically tired.
d. Give her PRN medication and walk with her at a gradual slowing pace.

90. It is in this level of anxiety where cognitive capacity diminishes. Focus becomes
limited and client experiences tunnel of vision. Physical signs of anxiety become more
pronounced.

a. Severe
b. Panic
c. Mild
d. Moderate

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

91. Antianxiety medications should be used with extreme caution because long term
use can lead to:

a. Parkinsonian like syndrome

b. Hypertensive crisis
c. Hepatic failure
d. Addiction

92. It is essential in desensitization for the patient to:

a. have rapport with the therapist

b. assess one’s self for the need of an anxiolytic drug
c. use deep breathing or another relaxation technique
d. work through unresolved unconscious conflicts

93. A client with a diagnosis of obsessive-compulsive disorder constantly does repetitive

cleaning. The nurse knows that this behavior is probably most basically an attempt to:

a. decrease the anxiety to a tolerable level

b. focus attention on non threatening tasks
c. control others
d. decrease the time available for interaction with people

94. A client is suffering from Post-traumatic stress disorder following a rape by an

unknown assailant. One of the primary goals of nursing care for this client would be to:

a. establish a safe, supportive environment

b. control aggressive behavior
c. deal with the client’s anxiety
d. discuss the client’s nightmares and reactions

95. The nursing management of anxiety related with post traumatic stress disorder
includes all of the following EXCEPT:

a. encourage participation in recreation or sports activities

b. reassure client’s safety while touching the client
c. speak in calm soothing voice
d. remain with the client while fear level is high

96. A client’s deafness has been diagnosed as Conversion disorder. Nursing

interventions should be guided by which one of the following?

a. The client will probably express much anxiety about her deafness and require
much reassurance
b. The client will have little or no awareness of the psychogenic cause of her
deafness
c. The client’s need for the symptom should be respected; thus, secondary gains
should be allowed
d. The defense mechanisms of suppression and rationalization are involved in
creating the symptom.

97. A female client has just received the diagnosis of Hypochondriasis. This client
continually focuses on GI problems and constantly rings for a nurse to meet her every
demand. The best nursing approach is to:

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 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
Philippines 5000
Tel. No. (033)338-2830

a. Ignore the demands because the nurse knows it is not necessary to respond
b. Assign various staff members to work with the client so no staff member will
become negative
c. Anticipate the client’s demands and spend time with her even though she does
not demand it
d. Provide for the client’s basic needs, but do not respond to every demand, which
reinforces secondary gains

98. Persons with Personality disorders tend to be manipulative. In planning the care of a
person with this diagnosis, the nurse would:

a. Allow manipulation so as to not raise the client’s anxiety

b. Appeal to the client’s sense of loyalty in adhering to rules of the community
c. Know that when the client’s manipulation are not successful, anxiety will
increase
d. Establish a nurse-client relationship to decrease the client’s manipulations

99. A male client in the Psychiatric unit becomes upset and breaks a chair when a
visitor does not show up. The first nursing intervention should be to:

a. Stay with the client during the stressful time

b. Ask direct questions about the client’s behavior
c. Set limits and restrict the client’s behavior
d. Plan with the client for how can he better handle the situation

100. The nurse has been interviewing a client who has not been able to discuss any
feelings. 5 minutes before the time is over, the client begins to talk about important
feelings. The intervention is to:

a. Go over the agreed upon time, as the client is finally able to discuss his feelings
with him
b. Tell the client that it is time to end the session now, but another nurse will discuss
his feelings with him
c. Set an extra meeting time a little later to discuss these feelings
d. End just as agreed, but tell the client that these are very important feelings and
he can continue tomorrow

Prepared by:

JOHN FRANCIS B. HANKINS, RN/ MARK TUBURAN, RN

Instructors

Noted by:

RUBY A. PADERES, RN, MN

Academic Coordinator

Approved by:

CYGNETTE S. LUMBO, RN, MN, PhD

Acting Dean

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