RECALLS 4 EXAM
Total points
86/100
NURSING PRACTICE NPII
Email *
nursanaani1@gmail.com
0 of 0 points
LAST NAME, FIRST NAME, MI *
SANAANI, Nur-hathi M.
SCHOOL *
Ateneo de Zamboanga University
Weekend Class B2
Weekend Class B3
Evening Class B1
Evening Class B2
Crash Course
SPLE
QUESTIONS
86 of 100 points
Situation – This is the first postoperative day for patient Emma who delivered by
cesarean section (CS). Nurse Ivy a newly hired staff was assigned to her.
1. Emma asks the nurse why she has to get up and walk the day after
surgery. Which of the following is the BEST response of the nurse?
Walking hastens _________.
A. Hastens lactation
B. Relieves pain
C. Heals wounds
D. Fast recovery from anesthesia
*1/1
2. Which laboratory finding should the nurse assess on the patient 24
*0/1
hours after caesarian section delivery upon doctor’s request?
A. Trace 1+ proteinuria
B. Hematocrit 35%
C. White blood cell count 20,000/cu.mm
D. Hemoglobin 7.0 g/dL
3. Emma complains of “afterpains”. What should be the nurse
*1/1
IMMEDIATE action?
A. Advise her to stop breast-feeding for a day
B. Encourage her to drink more water
C. Assess vital signs and pain level
D. Administer an analgesic STAT
4. Emma is to be discharge 3 days after CS delivery. Which of the
following observations of the nurse would cause the delay of her
discharge and would warrant notification to the physician?
A. Moderate amount of lochia rubra
B. Fundus is firm at umbilicus
C. Pulse rate of 61 beats/minute taken in 24 hours
D. Five voidings totaling 240 cc in 12 hours
*1/1
5. On the third postpartum day, Emma reports that she has voided five
*0/1
times that morning. What should the nurse INITIALLY do?
A. Insert a Foley catheter
B. Collect the next voiding and measure the urine amount
C. Catheterize the client to check for residual urine
D. Call the physician
Situation – Nurses Fatima and Imelda are doing research on, “The common errors
regarding Standard of Nursing Documentation in the Obstetrics Ward of Medical
Center.”
6. Which could be the MAJOR Purpose of the study? To __________. *
A. Improve the clarity of documentation
B. Duplicate the study in other hospitals
C. Reduce, if not eliminate, errors in documentation
D. Protect the hospital and staff from being sued
1/1
7. Which of the following could be the BEST Method to gather the
*1/1
research data?
A. Nursing Audit
B. Focus Group Discussion
C. Phenomenological
D. Survey
8. What is the term used to describe the arrangement of statistical data
*1/1
that exhibits the number of times the values of a variable occurs?
A. Frequency distribution
B. Frequency
C. Skewness
D. Survey
9. In statistics, what is the definition of percentage? It is __________. *
A. Whole population
B. A value on a scale of 100
C. A share of profits
D. Part of a whole expressed in hundredths
1/1
10.
Based from the study’s findings, to whom are the study’s
*0/1
recommendations generally addressed?
Using the situation a forecited, the recommendation should be addressed
to _________.
I.Nursing educators
II.Staff nurses
III. Nursing Service Administrators
IV. Hospital Administrators
A. I, II, III
B. I, III, IV
C. I, II, III, IV
D. II, III, IV
Situation – Patient Carlita, 19 years old, is in her first trimester of pregnancy.
Because it is her first pregnancy, she went for her prenatal check-up with her
mother. She asked a lot of questions which she expects the nurse to answer her.
11. The nurse asked for the personal data of the patient which, to some,
*1/1
Carlita did not like to answer. And so she asked: “Why do you need to
know if I am married?” what should be a good response of the nurse? “I
asked your marital status because _________.
A. If you do not have a husband, then that can pose a big problem for you.”
B. If you are married then your husband will also suffer from discomforts like you.”
C. You need your husband to accompany you every prenatal check-up.”
D. Your husband is your best support system during your pregnancy.”
12. The patient asked what is the term for signs such as breast changes, *1/1
urinary frequency, fatigue, morning sickness and amenorrhea?
A. Probable signs
B. Presumptive signs
C. Possible signs
D. Positive signs
13. The patient asked what causes newborn babies with total absence of *1/1
extremities. The nurse answered that the cause for Amelia is intake of
which of the following medications during pregnancy ___________.
A. Anti-emetics
B. Antibiotics
C. analgesics
D. anti-bacterials
14. The patient complained that every morning, she becomes nauseated
and oftentimes, she would vomit excessively. “What could be the cause
of this,” she asked? The nurse’s answer is: “It is due to increase level of
________.”
A. Heart burn
B. Estrogen
C. heart rate
D. Progesterone
*1/1
15. The nurse advised patient Carlita to report to her physician which of
*1/1
the following MOST important sign, if ever she will suffer from it?
A. Cough
B. Vaginal bleeding
C. Headache
D. strong fetal movement
Situation – As a newly-hired staff nurse of the hospital, Erlyn learned that the
hospitals have an in-service training for its staff. The in-service trainings conducted
are based on hospital and staff’s needs. One of the identified needs was on
knowledge deficit of Mother and Baby Friendly Hospital Initiative (MBFHI).
16. What is the FIRST step among the ten steps for successful
*0/1
breastfeeding?
A. Have a written breastfeeding policy that is routinely communicated to all staff.
B. Inform all pregnant women about the benefits and management of
breastfeeding.
C. Foster the establishment of breastfeeding support groups.
D. Train all health care staff in skills necessary to implement the policy.
17. When practicing rooming-in, how long should the baby stay with the
*1/1
mother? ______ hours.
A. 8
B. 24
C. 12
D. 10
18. What is the CORRECT time for which the mother should initiate
*1/1
breastfeeding? It should be _______ hours after birth.
A. ½
B. 1
C. 3
D. 2
19. Erlyn learned that newborn infants should ONLY be given, which of the *1/1
following?
A. Fruit juice
B. Breastmilk
C. water
D. cow’s milk
20. Which is the LAST part of the initiative, as recommended by WHO and *0/1
UNICEF, for the MBFHI external team to do before its final designation as
MBFHI Hospital?
A. Assess business facilities if they follow the 10 steps for successful
breastfeeding.
B. Develop a research on the benefits of breastfeeding within the institution.
C. Disseminate the benefits of breastfeeding to communities.
D. Follow up mothers if they are exclusively breastfeeding.
Situation – Jade is 23 years old. She and her boyfriend, Kevin, are planning to get
married in a couple of months. Thereafter, they plan to have three babies. For this
reason they sought reproductive health counseling for their benefit and the proper
growth and development of their future children. Nurse Nilda was there to help
them.
21.
Jade asks what she must do in order to be healthy in case
she becomes pregnant. Which among the answers of Nurse Nilda should
NOT be followed by Jade?
A. Get support from husband and family.
B. May have a massage from a lay midwife.
C. To readily accept her pregnancy.
D. Early prenatal check-up
*1/1
22.
Kevin asks what possible contribution he could give for the *1/1
normal development of the baby. Nurse Jade agreed that his BEST
contribution would be the following EXCEPT __________.
A. Stroke Jade’s abdomen and talk to baby
B. Provide Jade nutritious food and drinks
C. Join wife during prenatal check-up
D. May smoke once in a while
23.
For the normal developmental of the fetus, Nurse Nilda
taught the couple that Jade should prevent Folic Acid Deficiency anemia
by good diet, correct way of cooking vegetables and taking Folic Acid
supplements. Which of the following is NOT included among the
outcomes of folic acid deficiency to the baby?
A. Cleft lip
B. Cleft palate
C. Neural tube defect
D. Fractures of all types
*1/1
24.
Jade asks the nurse what possible diseases should she
*1/1
avoid that would guarantee health for the baby? These are:
1. Rubella
2. Rheumatic fever
3. Anemia
4. Chronic hypertension
A. 1, 2, 3
B. 1, 2, 3, 4
C. 1, 2, 4
D. 2, 3, 4
25.
Nurse Nilda advised the couple that the BEST way to check *1/1
the condition of the mother and the baby is to have _________.
A. Regular well-selected exercise
B. Regular prenatal check-up
C. Music therapy
D. Good food
Situation – A hospitalized adolescent Robbie suddenly has a seizure while his
family is visiting. Nurse Karen notes whole body rigidity followed by general jerking
movements. Robbie vomits immediately after seizure.
26.
Which of the following would be the PRIORITY nursing
*1/1
diagnosis for Robbie?
A. Fluid volume deficit related to vomiting.
B. Altered family processes related to chronic illness.
C. High risk for infection related to vomiting.
D. Risk for aspiration related to loss of consciousness.
27.
Which of the following would be the LEAST PRIORITY
*1/1
nursing care for a child with seizure disorder?
A. Observation and recording all seizures.
B. Ensuring safety and protection from injury.
C. Teaching the family about anticonvulsant drug therapy: indication, dosage, route
and effects.
D. Assessing for signs and symptoms of Increased Intracranial Pressure.
28.
Robbie will be taking phenytoin (Dilantin) regularly for
seizure control. Which of the following will be the MOST important
teaching to Robbie’s family?
A. Administer acetaminophen to promote sleep.
B. Serve a diet that is high in iron
C. Maintain good oral hygiene and dental care
D. Omit medication if the child is seizure free.
*1/1
29.
After teaching the parents about their child’s unique
*0/1
psychological needs related to a seizures disorder and possible
stressors, which of the following concerns voiced by them would indicate
the need for additional teaching? The child’s ___________.
A. Feeling different from peers
B. Cognitive delays
C. Poor self-image
D. Dependency
30.
Which of the following is NOT a focus for teaching plan for *1/1
an adolescent with a seizure disorder?
A. Obtaining a driver’s license
B. Increase risk for infections
C. Peer pressure
D. Drug and alcohol use
Situation – Any pregnancy may pose a risk. A pregnant woman must therefore
submit herself for regular pre-natal consultation in any health facility near her place
of abode. A nurse can play an important role in making these pregnant women
aware of these risks in all stages of pregnancy.
31.
What CHIEF ingredient of the prenatal vitamin for
*1/1
pregnancy nutrition that the patient should look for?
A. Vitamin B12
B. Potassium
C. Vitamin C
D. Folic Acid.
32.
A woman in labor is at risk for abruptio placenta. Which of
the following assessments would MOST convince you and the pregnant
woman to believe that this has happened?
A. Painless vaginal bleeding and downward trend of BP.
B. And increased blood pressure and scanty urination.
C. Pain at the lower quadrant and increased pulse rate.
D. Sharp fundal pain and discomfort between contractions.
*1/1
33.
A woman 2 ½ months pregnant calls you by telephone
*1/1
because she passed out some “berry-like” blood clots and now has
continued dark brown vaginal bleeding. Which of the following is the
BEST instruction you should give her?
A. “Continue normal activity but take your pulse and respiratory rate every 4 hours.”
B. “Come to the health facility if uterine contractions start.”
C. “Come to the health facility with any vaginal material passed out.”
D. “Maintain bedrest and count the number of perineal pads used every hour.”
34.
A woman, 33 weeks pregnant, with preterm rupture of
membranes had blood work ordered daily. Which laboratory report would
be MOST important to read daily?
A. Serum creatinine
B. Red blood cell count
C. Sodium and potassium levels
D. White blood cell count
*1/1
35.
An 18 –year –old delivers to an 8 –pound – baby after 10
*1/1
hours of labor. In the post-partal period, which of the following would be a
PRIORITY concern to assess for by the nurse?
A. Endometritis
B. Thrombophlebitis
C. Bleeding
D. Amniotic embolus
Situation – Patient Fe, 15 years old, G0P1, AOG 39 weeks, has been admitted at
6:30 in the morning for lumbo-sacral pains and strong uterine contractions every
10 minutes. Nurse Jocele was there to admit her. She uses Focus, Data, Action and
Response (FDAR) as the form of charting.
36.
In any type of charting or documentation, which of the
following should the nurse refer to and use to generate and describe the
status of patient Fe? Nursing __________.
A. Assessment
B. Process
C. actions
D. diagnosis
*1/1
37.
Which of the following are the purposes of documentation? *0/1
To ________.
I.Ensure the development of organized comprehensive care plan
II.Have a clear and accurate record of what was done to the patient.
III.Have an evidence of the health care member’s accountability in giving
care
IV.Detect patients who are clinically deteriorating
A. II, III, IV
B. I, II, III, IV
C. I, II, III
D. I, III, IV
38.
Which of the following is the CORRECT definition of focus
*1/1
charting?
A. It is an electronically form of documentation of nursing care done to a patient by
a registered nurse.
B. It is a note, written or electronically generated, to provide documentation
related to a specific focus.
C. It is a nurse-centered way of documentation that describes the patient status
and nursing care rendered.
D. It is a nurse-centered approach to documentation.
39.
In the given situation, which is the FOCUS? *
1/1
A. Jocele as the admitting nurse
B. Lumbo-sacral pains and strong uterine contractions
C. 15 years old, G0P1, AOG of 36 weeks
D. Admission at 6:30 in the morning
40.
What is the term used to describe the patient’s data or
*1/1
assessment, the action done based on the assessment and response
based on the action made:
A. Progress Note
B. Flow sheets
C. Standard of Care
D. Focus Format
Situation – Head nurse Carmen supervises Nurse Donna who is assigned to take
care of a newborn baby boy named Henrich with a cleft palate.
41.
The mother asks the head nurse why the pediatrician
*1/1
recommended that closure of the palate should be done before he is 6
months old. She asked Nurse Donna to answer her. Which of the
following is Nurse Donna’s APPROPRIATE response?
A. “After age 2, surgery is very frightening and should be avoided if possible.”
B. “The eruption of the 2-year molars often complicates the surgical procedure.”
C. “Surgery should be performed before the child starts to use faulty speech
patterns.”
D. “As he gets older the palate gets wider and more difficult to repair.”
42.
The head nurse continued to ask Nurse Donna, “A cleft lip
predispose an infant to infections PRIMARILY because of which of the
following reasons?”
A. Waste products that accumulate along the defect.
B. Inadequate circulation in the defective area.
C. Deficient nutrition from ineffective feeding.
D. Mouth breathing that dries the oropharyngeal mucous membranes.
*1/1
43.
Which SIGNIFICANT statement of the mother predisposes
*1/1
her son to cleft lip or palate?
A. “On my 6 months of pregnancy, I saw a rabbit with the same case of my son.”
B. “I am asthmatic and I usually take steroids.”
C. “My mother- in- law doesn’t like me, that’s why she cursed me.”
D. “I believe my enemy did some forms of witchcraft on me.”
44.
For an infant born with a unilateral cleft lip and palate,
*1/1
which of the following type of feeding will be BEST to use?
A. Rubber-tipped syringe or medicine dropper.
B. Full breast feeding.
C. IV fluids on limited number of ounces.
D. Cross-cut rubber nipple.
45.
Which of the following is the number ONE consideration in
the care of an infant after the surgical repair of a cleft lip?
A. Preventing the infant from crying
B. Feeding the infant with a spoon for 2 days after surgery
C. Placing the infant in a semi-sitting position
D. Keeping the infant NPO for 1 say after surgery.
*0/1
Situation – Miel, on her 35 weeks of gestation, is admitted because of
hypertension, BP of 185/110, severe headache and blurred vision. She was placed
on imposed bedrest without toilet privileges. The physician orders MgSo4. Erika is
the nurse assigned to her.
46.
Which of the following would Nurse Erika anticipate in then *1/1
patient’s maternal history?
A. On and off vaginal spotting
B. Esophageal discomfort is experienced after a heavy meal.
C. Weight gain of 20lbs in the 1st and 2nd Trimester
D. Fetus moves very frequently
47.
When a patient is on an imposed bedrest, which of the
following can help the patient cope? These are the following, EXCEPT
__________.
A. Let the patient lie on her side to allow more blood to the uterus.
B. Increase fluid intake to 8 glasses a day to prevent constipation.
C. Discourage participation of family in patient care to prevent further anxiety.
D. Use relaxation techniques to help cope with stress such as music and books.
*1/1
48.
MgSo4 injections are painful to the patient. Which of the
*0/1
following is the BEST route for injection to prevent such negative
experience for patient Miel?
A. Intravenous injection at the main IV line.
B. Intravenous injection given through “piggy back”.
C. Intramuscular on each of the deltoid muscle.
D. Deep intramuscular using z-track technique on buttocks.
49.
The nurse must be alert to MgSo4 toxicity. Which of the
*0/1
following in NOT included?
A. Fetal bradycardia
B. Urine output of <30 ml per hour
C. Respiration of <12 per min
D. Increase in maternal pulse rate
50.
Which of the following hospital environment will be MOST
conducive to Miel’s condition? A room that is / with ____________.
A. Bright and well-ventilated
B. 2 or three other patients
C. Quiet and non-stimulating
D. A call button for watcher’s use.
*1/1
Situation - a 13-year-old- girl named Zelda tells the nurse at the pediatric clinic that
she took a pregnancy test and it was positive. She tells the nurse that her
grandfather, with whom she, her younger siblings, and her mother live, has
repeatedly molested her for the past 3 years. When the nurse asks the girl if she
has told this to anyone, she replies: “Yes, my mother.”
51. As the nurse’s legal responsibility, which is the APPROPRIATE agency *0/1
should she notify FIRST?
a) City Health Office to do a vaginal examination to confirm the pregnancy
b) DSWD for notifying the girl’s mother about the pregnancy test positive result.
c) Board members of Child Protective Services for proper intervention
d) Philippine National Police concerning a possible sex crime
52. If Zelda is really a victim of incest and the agency opts that she be
admitted in the hospital, where should she be placed?
a) With an older friendly child
b) In a room near the nurse’s station
c) With another 5 year old
d) In a private room
*1/1
53. The abusive parent usually manifests one of the following
*1/1
characteristics EXCEPT________
a) History of severe mental illness
b) History of drug abuse
c) Belongs to low-income group
d) Low tolerance for frustration
54. When a patient, who allegedly has been sexually abused, the nurse
*1/1
should be aware that legal proceedings may be necessary. Because of
this possibility, which of the following actions is MOST important to be
done by the nurse?
a) Determining if there are other injuries such as bruises and hematomas.
b) Asking the parents for their approval for diagnostic examinations for the child.
c) Assessing the child’s physical, intellectual and emotional developmental levels.
d) Documenting physical findings and interactions during admission.
55. What typical assessment findings are observed to a patient who is a
victim of sexual abuse
a) Recurrent UTI
b) Fracture and bruises
c) Enuresis
d) Failure to thrive syndrome
*1/1
Situation - Nurse Von is assigned at the Under Five Clinic. Mostly of her patients
are infants, so she took the opportunity to have a mother’s class on the care of
infants.
56. Which of the following will Nurse Von EMPHASIZE regarding the
*1/1
importance of play during infancy? Play enhances _______ development.
a) Cognitive
b) Emotional
c) Physical
d) Social
57. Which among the infants would show signs that he/she is
experiencing maternal deprivation?
a) Hyperactive
b) Overweight
c) prone to illness
d) responsive to stimuli
*1/1
58. What should Nurse Von include in the accident prevention teaching
*1/1
plan for a mother with 4-month-old infant?
a) Keep crib rails up to the highest position.
b) Cover electric outlets with safety plugs.
c) Remove poisonous substances from low areas.
d) Remove small objects from the floor.
59. When teaching a mother how to prevent accidents while caring for
*1/1
her 6-month-old infant, Nurse Von should emphasize that at this age, the
infant can already do which of the following developmental milestone?
a) Stand while holding on to furniture.
b) Crawl short distances.
c) Roll over from back to abdomen.
d) Sit up without assistance.
60. Nurse Von assesses the oral cavity of a 6-month-old child and finds
out that the tooth that buds first is the __________.
a) Upper molars
b) Lower central incisor
c) Canines
d) Lower molars
*1/1
Situation - Nurse Karl is caring for a mother- infant dyad. The mother has just given
birth to a baby boy two days ago. Today, the charge nurse us doing a chart audit to
determine whether the nursing process was properly done from prenatal to
postnatal periods. The laboratory results of the mother and baby boy are shown
below.
61. Using the chart data, which nursing intervention was CORRECTLY
done by Nurse Karl for Mrs. Gloria Lim?
a. Rubella vaccination
b. Rhogam injection
c. Neonatal 50% glucose infusion
d. Maternal blood transfusion
*1/1
62. Nurse Karl charted an IMPORTANT plan of care for Mrs. Lim. He
*1/1
indicated in her charting that the patient should report immediately signs
and symptoms of a virus-causing- disease which may affect the
cardiovascular system of the fetus during which of the period of
pregnancy?
a) First month
b) Third month
c) Second Month
d) Fourth Month
63. Looking at the medication sheet, the charge nurse noted that Nurse
Karl used the CORRECT ROUTE in the administration of the vaccine,
which was_______________.
a) Rectal
b) Intradermal
c) Subcutaneous
d) Intramuscular
*1/1
64. After administration of the vaccine, health teaching was also charted *1/1
by the staff nurse. Which of the following is the CORRECT one?
a) Immediate follow-up check up
b) Nothing Per Orem
c) No pregnancy for 3 months
d) Avoid exposure to Rubella
65. Nurse Karl should also include in his charting an additional health
education to Mrs. Lim that is: rubella virus can be transmitted via the
placenta by the process of ______________.
a) Simple diffusion
b) Pinocytosis
c) Active Transport
d) Facilitated Diffusion
Situation- Breastfeeding is one of the major responsibilities of OPD Nurse Pau.
Along this line, she gathers pregnant women to provide them health education
about the topic.
*1/1
66. Nurse Pau explains that exclusive breastfeeding is giving the
*1/1
baby_______.
a) Breast milk and introducing solids at one month
b) Breast milk with drops of syrup
c) Breast milk alternating with sips of boiled water
d) Only breast milk for 6 months
67. She further explains that the specific objectives of exclusive and
extended breastfeeding from 2005 to 2010 are the following
EXCEPT_________.
a) 50% of infants are exclusively breastfeeding up to 6 months
b) 90% of infants are started on complementary feeding by 6 months of age.
c) 70% of newborns are initiated to breastfeeding within an hour after birth.
d) Twelve (12) months is the median duration of breastfeeding.
*1/1
68. A mother questioned Nurse Pau in the event that she does not
*1/1
produce milk, what should she do? The BEST answer of Nurse Pau would
be___________.
a) “If it is difficult on your part, then you can use local herbs said to help the
production of the breast milk.”
b) “That’s a big problem ma’am, but you can still try again.”
c) “Just continue breastfeeding. This will stimulate the hypothalamus in the
production of breast milk.”
d) I empathize with you. I too, do not have breast milk.”
69. Malou, one of the pregnant women, asked Nurse Pau to teach her
the proper positioning of the baby while breastfeeding. Among Nurse
Pau’s answers, which one is NOT CORRECT?
a) The baby can lie down perpendicularly with the mother to promote better
bonding.
b) The baby’s face should be towards the mother’s breast to have an eye to eye
contact.
c) The baby’s head and body should be aligned to promote better swallowing.
d) The baby’s tummy should be close to the mother’s tummy for better support.
*0/1
70. To convince the pregnant mothers to breastfeed their newborns
*1/1
upon delivery, the BEST thing that Nurse Pau must do is to ______________
a) Explain the hospital policy on “No breastfeeding; No admission”
b) Relate her own experience on breastfeeding
c) Prepare the mothers physically, emotionally and psychologically
d) Ask other mothers to convince them to breastfeed
Situation - Geneva is now 15 years old. She goes to an exclusive school but she
seldom interacts with her classmates nor is interested to join school activities. Her
mother brought her to an adolescent specialist and was diagnosed of malnutrition.
71. Which of the following is NOT a CORRECT statement about
malnutrition? Malnutrition is for ____________.
a) Both the urban and rural areas
b) Both the poor and the rich
c) The underweight as family income increases
d) The overweight as family income increases
*1/1
72. Advertisement (ads) on television is said to be a contributory factor
*1/1
for obesity. What could be a GOOD advice to adolescents like Geneva
regarding these ads that can be contributory to malnutrition?
a) “Check nutritional contents before buying foods.”
b) “Follow your desire for food and drinks.”
c) “What you see is what you get.”
d) “There is no truth in advertisements.”
73. Geneva went to see a nutritionist. She is overweight for her height.
*1/1
What is the normal weight, in POUNDS, for Geneva who is 5 feet tall?
a) 90
b) 75
c) 85
d) 80
74. How can Geneva be helped to reduce her weight? She can be
advised to cut intake of which of the following?
a) Salt, protein and fats
b) Carbohydrates, vitamins and salts
c) Carbohydrates, fats and salts
d) Fats, protein and sweets
*1/1
75. Which of the following can Geneva do to help her with her obesity
*1/1
problem?
a) Skip one full meal a day.
b) Drink 6 glasses of water every day.
c) Take weight reducing pills.
d) Exercise 30 minutes three times a week.
Situation - Baby Boy Christian, 6 months old, was diagnosed as having
communicating hydrocephalus. Nurse Peninah is planning nursing care for this
baby who is a candidate for ventriculo- peritoneal shunting.
76. When helping the parents understand the baby’s problem, which of
*1/1
the following should be Nurse Peninah’s ACCURATE explanation?
a) “The CSF is prevented from adequate absorption by a blockage in the ventricles
of the brain.”
b) “Too much Cerebro Spinal Fluid (CSF) is produced within the ventricles of the
brains.”
c) “The flow of CSF through the brain cells does not empty effectively into the
spinal cord.”
d) “There is a part of the brain surface that usually absorbs CSF after its
production that is not functioning adequately.
77. Nurse Peninah understands that hydrocephalus, if left untreated, can *1/1
cause mental retardation because of which of the following rationales?
a) Hypertonic CSF disturbs normal plasma concentration, depriving nerve cells of
vital nutrients.
b) Gradually increasing size of the ventricles presses the brain against the bony
cranium; anoxia and decreased blood supply result.
c) Increasing head size necessitates more oxygen and nutrients than normal blood
flow can supply.
d) CSF dilutes blood supply, causing cells to atrophy.
78. What is the IMPORTANT nursing care of an infant with increased
intracranial pressure?
a) Check the infant’s reflexes at regular intervals.
b) Monitor the infant’s level of consciousness by stimulating frequently.
c) Weight the infant daily before feeding.
d) Elevate the infant’s head higher than the hips.
*1/1
79. Baby Boy Christian just had a ventriculoperitoneal shunt. His parents *1/1
were worried about the prognosis. What information should Nurse
Peninah give to the parents to allay their worry?
a) The shunt may need to be revised as the child grows older.
b) If any brain damage has occurred, it is reversible during the first year of life.
c) Hydrocephalus usually is self- limiting by 2 years of age and then the shunt is
removed.
d) The prognosis is excellent and the valve is permanent.
80. What is the drug that will lessen CSF production that Nurse Peninah *1/1
will anticipate the doctor to order?
a) Spironolactone
b) Lasix
c) Mannitol
d) Diamox
Situation - Nurse Vincent assists in the in-service training of nurses in St. James
Hospital. Based from the needs assessment, the nurses need to be trained on
patient’s safety. The first lecture was on medication administration. Nurse Vincent
gave the following problems for the nurse to solve.
81. An eight-year-old- patient is to receive Aminophylline 3 mg/kg TID. If *1/1
the girl weights 25 kg, how much Aminophylline should she receive daily?
a) 125 mg
b) 225 mg
c) 200 mg
d) 100 mg
82. Mrs. Delos Santos is to receive Digoxin 0.325 mg p.o. because of her *1/1
heart ailment. The stock is 0.250 mg per tablet. How many TABLETS
should the nurse request for 7 days supply for the patient?
a) 9
b) 7
c) 10
d) 8
83. In giving insulin to an OB diabetic patient, the nurse must use an
APPROPRIATE needle size and length, which among the following will
this be?
a) 23 G, 3/8
b) 22 G, 2/8
c) 24 G, 4/8
d) 25 G, 5/8
*1/1
84. Nurse Vincent emphasized that patient safety is___________. *
0/1
a) Preventing errors and adverse reactions to patients associated with health care
b) Being careful in caring for patients at all times
c) Providing treatment and care to patients and documenting the same
d) Being mindful of the needs of others at all times
85. Nurse Vincent has provided instructions that all care provided by
*1/1
nurses must be documented, as one of their legal responsibilities. In case
errors occur, which is the correct way of documenting it?
a) Wrong medicine given to wrong patient. Physician notified. Patient observed
b) Medication inadvertently omitted. Supervisor notified.
c) Medication given to patient A instead to patient B. Patient advised.
d) Wrong dose of medicine administered to patient. Sorry.
Situation - one of the responsibilities of a nurse in fertility specialist’s office is to
provide health teaching to the patient in relation to timing of intercourse to achieve
pregnancy.
86. Which instruction to patient addresses the BEST time to achieve a
*1/1
pregnancy?
a) 14 days before the next period is expected
b) Immediately after menses end
c) Midway between periods
d) 14 days after the beginning of the last period
87. With regards to sexual functioning, the nurse explained the ovulation *1/1
occurs on which of the following conditions?
a) Chorionic gonadotropin level is high
b) Luteinizing hormone level is high
c) Oxytocin level is high
d) Progesterone level is high
88. After ovulation has occurred, the nurse teaches women in the
fertility clinic that the ovum is through to remain viable for many HOURS?
a) 24 to 36
b) 12 to 18
c) 48 to 72
d) 1 to 6
*1/1
89. When teaching clients to determine the time of ovulation by taking
*1/1
the basal temperature, the nurse explains that the change in the basal
temperature during ovulation is shown in which of the following
observations? The temperature_____________.
a) Drops markedly and remains lower
b) Rises markedly and remains high
c) Drops slightly and then rises again
d) Rises suddenly and then falls down
90. In response to a client’s question on the chief function of
*1/1
progesterone, which of the following would be the CORRECT answer? It
_________________.
a) Stimulates the follicles for ovulation to occur
b) Establishes the secondary male sex characteristics
c) Prepares the uterus to receive a fertilized ovum
d) Develops the female reproductive organs
Situation- Janna, 3 years old, was admitted to Pediatrics Ward because of watery
stools four times in 30 minutes accompanied by vomiting, abdominal pain and
temperature of 38.1 degrees centigrade. Nurse Gel was the one who was the
admitting nurse.
91. Which of the following should be the PRIMARY consideration by the *1/1
nurse when charting the Chief Complaint? The ___________.
a) Number of significant accompanying symptoms
b) Objective symptom presented
c) Subjective symptom presented
d) Significant reason for the child’s hospitalization
92. Using the FDAR (Focus Data Action and Response) Charting, which
*1/1
of the following presenting data would be PRIMARY “Focus”
a) Vomiting in small amount
b) Watery stools 4x in 30 minutes
c) Generalized abdominal pain
d) Temperature of 38.1 centigrade
93. When getting the data on the subjective symptom of the abdominal
pain, which of the following should the nurse RELY on?
a) Mother’s verbal complaint
b) Result of the abdominal percussion
c) Patient’s verbal complaint
d) Result of auscultation of the abdomen
*1/1
94. The “response” should be based from which of the following
*0/1
categories of the FDAR?
a) Intervention made
b) Laboratory Findings
c) Focus
d) Assessment
95. Which of the following can be the LEAST source of data for this
*1/1
case?
a) Vital signs
b) Laboratory Findings
c) Intake and output
d) Immunization record
Situation - Nurses are guided by bio-ethical principles as they practice their chosen
profession.
96. What bio- ethical principle guides the nurses when taking care and
*1/1
being responsible for patients?
a) Solidarity
b) Fidelity
c) Totality
d) Stewardship
97. Each person has a responsibility to take care of his/her body. In case *1/1
a part is defective, it can be removed for the benefit of the remaining
parts. What bio- ethical principle is this?
a) Totality
b) Stewardship
c) Solidarity
d) Fidelity
98. As member of the health team, nurses are expected to collaborate
with other health care professionals for unity and cooperation. What bioethical principle is this?
a) Fidelity
b) Stewardship
c) Solidarity
d) Totality
*1/1
99. When another person or entity intrudes in the affairs of the patient to *1/1
promote justice and welfare, what bio- ethical principle does he/she
promotes
a) Welfare
b) Stewardship
c) Justice
d) Paternalism
100. As a means to solve any crisis or scarcity in any health care
systems, providing an equitable distribution of resources is based on
what bio- ethical principle?
a) Paternalism
b) Justice
c) Fidelity
d) Stewardship
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