Ratio, Formative Examination 6 1. A. Total quality management – process. Goes beyond standard. Always interested in… QI – continuous. Focus on ways to make int better. Always focus on the improvement. QA – focuses on structure. Follows on the standards. Focuses on the problems or burden of the structure that hinders in delivering quality service. 2. B. Asking for the definition or example of QI program. 3. C. Structure standard – type of evaluation. 3 elements of quality (SPO) Structure – any facilities. Environment. Equipment. Manpower. Finances. (rotation of duty; personnel kasi manpower) Process – performance. Any type of action or intervention made by the nurse. (record of daily weight) Outcome – result. Evaluation feedback. (evaluation form); verbalize satisfaction. 4. D. Performance appraisal – type of evaluation that is being done by the manager to his/her employee. Not a form of punishment. Assess the improvement. Basis for promotion and raise. Basis to job description. Focuses on the improvement of the employee. -individual performance. -using standards as a guide. -determine strengths and weaknesses. 5. B. Incident report – objective; factual. Document accurate information. In timely manner, as soon as possible. Serves as legal document. Do not put in nurses’ notes. 6. A. Justice – being fair. Beneficence – doing good. Fidelity – being faithful. Nonmaleficence – do no harm. Apply by ensuring that pt won’t acquired nosocomial infection. Should not put anymore injury. Put harm to pt. pt failed to open oxygen tank. 7. C. Veracity – telling the truth. Has the right to do the truth; trust. Confidentiality – privacy. Sanctity of life – highest good. Life threatening condition. Issue of trust. 8. D. Put in mind the age. Just honor the pt’s request. Information confidentiality. Give him the autonomy; right to self-determination. As an advocate. 9. C. Section 12, Article 4 of Code of ethics and Article 3 of RA 9173 – membership to PNA is voluntary. 10. D. Core responsibilities of nurses – alleviating of suffering; prevention of illness; health promotion; restoration of health. Can be seen in the preamble of code of ethics. Pre - preamble (Art 1) Pe -rn and the people (2) Pra – rn and the practices (3) Co – rn and the coworkers (4) So – rn and the society and environment (5) Pro – rn and the profession (6) A – administrative penalties, repealing clause and effectivity. (7) 11. C. Most experienced – most amount of data. Mean – average Median – middlemost Mode – most frequent data Range – identifying the highest value and the lowest value. Measure of variability 12. A. Level of measurement Ratio – 0 is fix Interval – has a mathematical value. Temperature. Ordinal – ranks; order. 1st honor, 2nd honors; siblings Nominal – categories. Gender; marital status; religious affiliation. 13. D. ANOVA – diff two or more variables. T-test – identify the diff between two variables. Pearson’s R – correlation; identify relationships of two variables. Chi-square – identify the significance of two categories to another categories. Determine the academic performance between male and female. 14. B. Implication – how important is the research? How is it beneficial? Interpretation – make an inference; add source or RRL. The translation of findings in practice, concept, and theory. Does it confirm or oppose your theory? Analysis - breakdown Conclusion – summary; not merely the summary but the synthesize of the research. Take aways in the study. 15. C. Following the review and evaluation of the data, the nurses should: Extrapolate – generalize or conclude. Decide the level of evidence - Determine the quality of the research. 16. D. 15 yrs old male. BMI of 31 (class 1 obesity) Wha’s the goal? -increase in exercise and reduction of calorie intake. 17.B . Assessment parameters included when assessing a pt’s nutritional status. BMI Clinical examination findings (LDL; HDL) Mid-upperarm circumference Dietary data – at least a week Ethnic mores – social mores; culture. 18. C. Instruction when the tube has already reached the oropharynx? - Can be instructed to tilt head forward. Take a sip of water and swallow facilitates closure of airway. Coughing indicates wrong placement. It allows coughing. It signifies airway placement. Hyperextend the head (sniffing position)– nasa nasopharynx, first instruction. Tilt the head forward or press the chin – nasa oropharynx. 19. B. Action should be taken to prevent aspiration? - Be an advocate – refer the pt to a swallow evaluation Removal can be done when nutritional needs are already met – remove the feeding tube as it interferes with the ability to swallow. 20. B. Nagkaroon daw ng resistance. - Turn on his left side. In irrigation – you should never continue or force it if may resistance (baka na-trap lang sa abdominal wall). It can cause trauma. Also, replacing an NGT tube to a larger one. 21. A. Types of fatty acid that need to be reduced? Fat is good. Important; a macronutrient. Monounsaturated fat – neutral effect; olive oil. Polyunsaturated fat – decreases the cholesterol in the blood. Omega 3,6; good for immune system; infla. Saturated fats – CVD; bad; butter; milk; meat. 22. A. Rich in fiber – carrot, raisin salad. Fresh kasi. If canned – the heat will decrease the fiber Potato is rich in starch and not fiber Sesame seed is good pero on the hamburger. Konti lang nasa fatty. Still, low. 23. D. Pesco-vegetarian – pesco (piscis – fish) consumes seafood and vegies. Consumes dairy and egg. 24. C. TPN-related infection after a massive burn injury. - Adding insulin to the bag of TPN fluid after it arrives in the client care area. (can harbor microorganism) use mask to avoid transfer of airborne bacteria. 25. D. TPN – assess most frequently? Serum sodium kasi TPN adm is at risk of having hypervolemia 26. A. 85 yrs old. Intestinal obstruction. Most likely the reason to his urinary incontinence. Frequency due to normal aging changes. Not a part of normal process pero due to Musculo or neuro problem. Stress incontinence occurs due to physical exertion. 27. A. Recording the times at which johnny is incontinent. Incontinence log – patterns. For bladder retraining. 28. C. Enema – painful cramping (rapid irrigation) - Clamping the tube for 1 minute and then starting the enema at a slower rate. 29. A. Normal for the stoma to swell after pt brought back to postop. If walang swell sa stoma – blockage 30. A. 31. A. Community organizing approach Issue-based – moves around certain problem. Dengue outbreak. Faith-based – religious affiliation Socioeconomic (micro-project) 32. B. Correct sequence of community organizing -community analysis -design and initiation -implementation -program maintenance -dissemination reassessment No such thing as program evaluation 33. D. Community analysis has five components: Health wellness outcomes; survey of current health promotion program; studies conducted in certain groups; demographic social and economic profile; health risk profile: social, behavior and environmental risks. 34. D. Initial step of comm analysis Steps in community analysis 1. Defining the community 2. Collect data 3. Assess the capacity of the community 4. Assessment of communication barriers 5. Assessment or readiness for change. 6. Synthesize data and priorities. 35. A. Health promotion program. Most likely to influence…management of chronic condition and disability. 36. C. Initial step in the preparatory phase (pre-entry phase): - area selection Community profiling – windshield or ocular survey. Identifying the needs of the community. Criteria for site selection – poor health situation; inaccessibility to health services; exploited; relative peace and order; an oppressed community (PIERA) 37. C. Patient observation – integrating with them na. Windshield survey – drove 38. C. 39. C. 40. C. Nurse as a developer – nurture the community Advocate – represent the community Enabler – guide or facilitator Builder – support system 41. C. COPAR -Self-reliant as a goal. -Establishment awareness -Direction is internal rather than external 42. B. Assemble the core group – entry phase (social preparation phase) 43. C. Criteria in selecting a leader: Belong to poor sector; respected; open and willing to learn; with good comm (good communicator); no political position. (BROWN) potential management skills; willing to serve; basic education. 44. B. Community study phase – sino ite-train? Phases of COPAR Pre-entry – involves community leaders Entry - Brgy captain; core group Community study - Train researchers (members of the community); Assess ka here and prioritize problems. Organizing phase - Officers ang need i-train. Community action phase – community health workers. Sustenance – identify secondary leaders. 45. D. Entry phase – conducting community assembly, spotting potential leaders and core group members, integrating with the community residents regarding COPAR. Developing Management system – organizing phase Finalizing na -sustenance phase na 46. A. 3 phases of puerperium: Taking in – 1-3 days upon delivery; passive; dependent; little interest in taking their child; rest. - Encourage mother to verbalize her experience - Encourage her to nap when her infant is napping - Question about presence of pain. Taking hold Letting go 47. B. Regain pre-pregnancy tone with exercise. Still-pregnant appearance due to relaxation of the abdomen. Balik within 6 weeks upon exercise. 48. A. 24 hours postop vaginal delivery but not occur 2-3 days – no bowel movement 49. B. 50. A. Highest risk of developing postpartum hemorrhage -placenta previa -triplets -delivered sixth baby -precipitous delivery (rapid delivery) VEAL CHOP 51. D. 52. A. Anti-depressant – postpartum depression 53. C. Limit fluid and apply ice – suppress lactation. 54. D. Mastitis – infla in the breast. Presence of infection. Staphylococcus aureus. At 2nd or 3rd postpartum and common in primigravida. Petroleum jelly – moist – high risk for infection. Soap and water - Drying – cracking – impaired skin integrity – increased infection. 55.B . DMPA – depot medroxyprogesterone acetate (Depo provera) – progestin-only. IM, q3months. If may inclusion na hormones, bawal smokes. 56. A. Acute asthma – expiratory wheezing with dry cough. 57. D. Incorporate intervention to play – if child ang pt. high chance of compliance. 58. C. 59. D. Pneumococcal pneumonia -intermittent, productive cough -high pulse rate -rapid, shallow respirations Clubbing of finger – only in chronic conditions 60. D. Test before adm antibiotic? – sputum culture (identify causative agent) 61. A. Altered urinary elimination; what outcome? Urinares 6 to 8 times per day. Problem addresses by ambulation - immobility Enuresis is not normal to the pt kasi 10 years old na siya. 62. C. Nocturnal enuresis – bed wetting; considered abnormal after age of 6. 63. B. UTI; factor should the nurse assesses first? Toileting habits. q2h ang urination; handwashing 64. C. Nephrotic syndrome – damage in glomeruli. Proteinuria – massive Anasarca (monitor their weight) – normally manifested by ascites. BUN and crea to monitor fxn of the kidney. 65. B. Risk for interrupted family processes related to chronically ill family member – parents participate in the care of their ill child. 66. D. 0.9 NSS – consider danger? Requires large volume; increased risk of PE. Hypertonic solution – hypernatremia Interfere platelet aggregation – dextrose Requires large volume infusion and can cause heart failure – albumin 67. D. Systemic infection – septic shock Allergic reaction – anaphylactic shock Cardio in origin - Cardiogenic shock Blood or water loss – hypovolemic shock (dissecting aortic aneurysm – impending sign of rupture) 68. C. Shock – which feature is not present in all types of shock? – vasoconstriction Hypo, tachy, tachy – vasodilation dapat. (pooling of blood in the peripheral vessels) 69. A. Highest priority sa septic shock 1. Address the underlying cause. 2. Manage the s/sx. 70. A. 165 lbs. Order is at 5 mcg/kg/min Stock is at 400 mg in 250 ml. 165/2.2 = 75 kg 400/250 = 1.6 x 1000 = 1600 mcg/ml 5 mcg / 75 kg = 375 mcg/kg x 60 min = 22,500/1,600 = 14ml/hr 71. C. Parkland formula – lactated ringer’s solution – crystalloid solutions. 4ml/kg/% of total BSA – first half – 48hrs; 2nd half – 16hrs. 72. D. 73. A. Third degree burns over 50% of his body – high in CHON and calories. – peanut butter sandwich and milkshake Low calories – orange juice 74. C. Highest priority of 2nd or 3rd degree burns, which psychosocial nsg dx should have the highest priority? -disturbed body image 75. D. P - PULL A - AIM S – SQUEEZE S - SWEEP 76. D. Hip fracture - Can’t cross their knees for at least 2 months - Not yet allowed to put weight - Adduction should not be performed for 2 months. 77. A. Elderly pt with osteoporosis who has fractures her mid-shaft clavicle - Don’t encourage weight-bearing exercises (only implemented to low extremities fracture). - Increase fluid to 1,900ml per day. - Immobilize the affected shoulder with sling. 78. B. Buck’s traction (skin traction) - Weight should be between 5-7 lbs. (mabigat kapag sa skeletal traction). - Weights should hang freely and be checked regularly - Diligent pin site care – only for skeletal traction. 79. D. Ostreoporosis – highest/greatest risk of developing this disorder? - Women; sedentary lifestyle; smokes cigarettes (lessen number of productions of osteoblast (generates osteocytes)). 80. B. Osteoporosis – avoid - No evidence ‘yung caffeinated drinks - Carbonated beverage – interfere bone density due to its phosphoric content. - Tobacco smoking. 81. D. SLE – least likely indicate she has SLE? - Involves musculoskeletal disorders; arthralgia - Butterfly rash - Pericardial friction rub – pericarditis - Also affects kidney; urine output and BUN and Crea are abnormal. 82. A. Major complication associated with SLE? - Nephritis. (end-stage renal dse) 83. B. ESR – significantly elevated with RA C4 complement; RBC - low 84. A. Cold pack – exacerbation and not to morning stiffness. Warm bath relieves stiffness. 85. D. 86. D. Severe anxiety - Use close-ended - Speak first kasi need ng reassurance of his safety, huwag silent. - Use simple sentences - Use, low soothing voice (non-stimulating interventation) 87. B. Panic level anxiety Priority nsg action? – provide a non-stimulating environment (safety of the pt). 88. D. Generalized anxiety disorder - Lorazepam, discontinue, can cause withdrawal syndrome (original symptoms of the problem). It can cause physical dependence. 89. D. PRN anxiolytic medication, would question? Busperone (Buspar) 10-14 hours delay ang effect 90. C. PTSD – difficulty handling the hallucinations, rather flashbacks, experienced by a trauma. Avoid emotional attachment to people to protect themselves to the trauma they are experiencing. 91. A. Best evaluate for the pt at risk for suicide? Ask the client if she has had any suicidal thoughts or plans (ask question directly) 92. B. Danger is greatest of committing suicide (kapag may sudden increase of energy) - April (sun during the energy) - Monday - Morning - When the pt’s mood improves and the energy level increases. 93. C. 94. B. Purpose of ECT to pt with depression? Biochemical theory – increases neurotransmitters. Mainly biologic. 95. D. Grand-mal – completion of ECT. 96. A. ADHD – inattentiveness, hyperactivity, impulsiveness (IHI); restlessness; distractibility. 97. C. Ritalin – methylphenidate – CNS stimulant for ADHD. Take it before meals because it can cause loss of appetite. 98. A. Planning interventions for a child with ADHD - Provide as much structure as possible for the child. - Activities that are non-destructive. - Calm, non-confrontational. - Set limits; time is limited dapat. 99. C. Autism – my son rarely speaks to anyone. Social interaction of the child. Most common than boys than girls. Little eye contact. Pt also has few facial expressions. Limited gestures. 100. A. Flap their hands; twist their body; bang head – autism disorder. Lack of social interaction.
