Republic of the Philippines

PROFESSIONAL REGULATION COMMISSION

Manila

BOARD OF NURSING

Philippine Nurse Licensure Examination

NURSING PRACTICE III – Care of Clients with Physiologic Alterations A

INSTRUCTION: Select the correct answer for each of the following

questions. Mark only one answer for each item by shading the box
corresponding to the letter of your choice on the answer sheet provided.
STRICTLY NO ERASURES ALLOWED.

✓ NO OPEN OF NOTES
✓ EVALUATE YOUR RETENTION
✓ EVALUATE YOUR UNDERSTANDING/COMPREHENSION
✓ EVALUATE YOUR CRITICAL THINKING SKILLS & APPLICATION

TAKE THE EXAM AS SIMULATED BOARD EXAM!!!

Situation 1: Rob, a 20 year old college student was rushed to the emergency room
due to a sharp and sudden chest pain. He was diagnosed to have
Pneumothorax.

1. Sharp and sudden chest pain is categorized according to what patterns of pain?
A. Somatic pain C. Acute pain
B. Chronic pain D. Cutaneous pain

2. In assessing for pain, the nurse considers the following goals EXCEPT:
A. To identify the cause of pain
B. To implement pain management techniques
C. To understand the nurse’s perception of pain
D. To measure the characteristics of pain

3. Rob suddenly experiences pleuritic pain from a short onset. Which of the
following measures would most likely be successful in reducing his chest pain?
A. Encourage the client to breathe shallowly
B. Have the client practice abdominal breathing
C. Offer the client incentive spirometry
D. Teach the client to splint the rib cage when coughing

4. Pneumothorax is an emergency condition that needs immediate intervention.

Chest tube is inserted at what intercostal space?
A. 1st or 2nd C. 3rd or 4th
B. 2nd or 3rd D. 5th or 6th
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5. What is the best way to assess Rob’s pain?
A. Ask Rob to rate his pain on a scale of 1 to 10
B. Use the Wong & Baker Pain Rating Scale
C. Refer to Rob’s chart
D. Measure Rob’s complete vital signs

Situation 2: Ryan, an adolescent client is admitted to the emergency room due to

a sharp abdominal pain. After further examination he was diagnosed to
have Appendicitis.

6. Ryan’s pain in the abdominal area is located at which of the following?

A. Right upper quadrant C. Left upper quadrant
B. Right lower quadrant D. Left lower quadrant

7. What is the best nursing diagnosis for Ryan’s condition?

A. Acute pain related to inflammation
B. Chronic pain related to inflammation
C. Acute pain related to ruptured appendix
D. Chronic pain related to ruptured appendix

8. Which of the following is the best way to manage pain in Appendicitis?

A. Give appropriate pain medication as prescribed
B. Apply hot compress over the abdominal region
C. Allow Ryan to lie still and draw the legs up
D. Give the laxative if Ryan asks for it

9. Which of the following signs is elicited by palpating the left lower quadrant,
which paradoxically causes pain to be felt by the patient in the right lower
quadrant?
A. Positive psoas sign C. Blumberg’s sign
B. Rousing’s sign D. McBurney’s sign

10. When appendicitis is not managed and has ruptured, you expect the client to
experience which of the following?
A. Persistent vomiting
B. Intense and severe pain radiating to the back, lower legs and toes
C. Board like abdomen
D. Decreasing body temperature

Situation 3: The goal of peri-operative nursing practice is to assist client,

their families and significant others to achieve a level of wellness
equal to or greater than that which they had before any surgical
procedure.

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11. The nurse is preparing a client for surgery. What is the most effective
method for obtaining an accurate blood pressure reading from a client?
A. Position the cuff approximately 4 inches above the antecubital arm
B. Use a cuff that is wide enough to cover the upper two thirds of the
client’s arm
C. Identify the Korotkoff sounds and take a systolic reading at 10mmHg after
the first sound
D. Obtain a cuff that covers the upper one third of the client’s arm

12. Which of the following drugs is administered to minimize respiratory

secretions preoperatively?
A. Diazepam (Valium) C. Promethazine (Phenergan
B. Atropine Sulfate D. Meperidine (Demerol)

13. Arrange the stages of anesthesia in their proper order:

1. Delirium stage
2. Induction stage
3. Danger stage
4. Surgical stage

A. 2, 1, 3, 4
B. 1, 2, 4, 3
C. 4, 2, 1, 3
D. 2, 1, 4, 3

14. Which of the following is the most dangerous complication during the
induction of spinal anesthesia?
A. Cardiac arrest C. Hyperthermia
B. Hypotension D. Respiratory Paralysis

15. The nurse is admitting a patient to the operating room. Which of the
following nursing actions should be given the highest priority by the nurse?
A. Checking the patient’s vital signs
B. Positioning and performing skin preparation to the patient
C. Assessing the patient’s level of consciousness
D. Checking the patient’s identification and correct operative permit

Situation 4: The post-operative phase extends from the time the client is
admitted to the recovery room up to the time he is transported back to
the surgical unit, discharged from the hospital, until the follow-up
care.

16. The patient had undergone spinal anesthesia for Appendectomy. To prevent
post spinal headache the nurse should place the patient in which of the
following positions?
A. Semi-Fowler’s C. Prone position

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 B. Flat on bed for 6 to 8 hours D. Modified trendelenburg position

17. This patient had undergone Thyriodectomy. Which of the following are the
earliest signs of poor tissue perfusion and poor respiratory function?
A. Fast, thready pulse, bradypnea C. Cyanosis, lethargy
B. Faintness, pallor D. Apprehension and restlessness

18. In the Recovery Room, the postoperative client suddenly becomes cyanotic.
What is the most appropriate nursing action?
A. Start O2 administration through nasal cannula
B. Call for assistance
C. Reposition the head and determine patency of airway
D. Insert an oral airway and suction the nasopharynx

19. Which of the following is the best position for kidney, chest or hip
surgery?
A. Trendelenburg C. Lateral
B. Supine D. Lithotomy

20. Which of the following would you expect to be the type of incision for a
case of mastectomy?
A. Halstead incision C. Pfannenstiel incision
B. Limbal incision D. Lumbotomy incision

Situation 5: Nurses are significantly involved both in providing care for

clients with respiratory conditions and in preventing such problems. In
acute care settings, nursing interventions focus on relieving existing
respiratory problems and preventing possible respiratory complications.
The following questions refer to care of client with alteration in
oxygenation.

21. Andal, 64 years old, had been diagnosed to have Hydrothorax secondary to
Viral Pneumonia. The physician performs thoracentesis. The following are
appropriate nursing intervention EXCEPT:
A. Instruct the client to remain still and to hold his breath as the
physician inserts the needle
B. Place the client in sitting position at the edge of the bed, arms
supported on an over bed table, feet on a foot stool
C. Inform client that he will need to turn towards affected side after the
procedure
D. Inform the client that pressure sensation will be experienced as the
needle is inserted.

22. The physician ordered a Mantoux test for Andal. The client has a positive
reaction to the test. The nurse correctly interprets this reaction to mean
that the client:

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 A. Has active tuberculosis
B. Has develop a resistance to tubercle bacilli
C. Has had exposure to mycobacterium tuberculosis
D. Has developed passive immunity to tuberculosis

23. A client with anxiety attack comes to the emergency department complaining
of dizziness and light-headedness. Arterial Blood Gas (ABG) analysis reveasl a
pH of 7.62, PaCO2 of 22 mmHg, PaO2 of 96 mmHg and HCO3 of 24 mEq/L. Which of
the following actions should the nurse take?
A. Do nothing; these ABG values are normal
B. Encourage the client to breathe into a paper bag
C. Notify the physician and prepare to give sodium bicarbonate
D. Notify the physician and prepare to give supplemental oxygen.
24. A client was given Morphine Sulfate for pain. He is sleeping and his
respiratory rate is 4 breaths/minute. If no action was taken immediately.
Which of the following would have occurred?
A. Seizures C. Cardiac arrest
B. Asthma attack D. Respiratory arrest

25. A client receives Midazolam (Versed), 2 mg IV as sedation before

Bronchoscopy. Five minutes after, his RR drops to 5 breaths/min. Which of the
following drug is given to reverse its effect?
A. Flumazenil (Romazicon)
B. Naloxone (Narcon)
C. Protamine Sulfate
D. Phetolamine (Regitine)

Situation 6: COPD is a disease condition characterized by airflow limitation

that is not fully reversible. This disease is one of the leading causes
of morbidity and mortality in the Philippines. The following questions
are related to COPD.

26. Which of the following physical assessment findings would the nurse expect
to find in a client with advanced COPD?
A. Barrel chest
B. Collapse a Neck vein
C. Increasing chest excursions with respiration
D. Non productive hacking cough

27. A client’s ABG analysis reveals a PH of 7.18 PaCO2 of 73 mmHg, PaO2 of 77

mmHg and HCO3 of 24 mEq/L. What do these values indicate?
A. Respiratory acidosis C. Metabolic acidosis
B. Respiratory alkalosis D. Metabolic alkalosis

28. The following are proper nursing management for clients with COPD EXCEPT:
A. Teach the client pursed-lip breathing

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 B. Administer bronchodilators as prescribed before chest physiotherapy
C. Give supplemental oxygen at a rate of 6L/min
D. Encourage high caloric and high protein diet

29. A client diagnosed with Pulmonary Emphysema, asked his nurse about his
disease. The nurse is correct if she tells her client that Pulmonary Emphysema
is:
A. A chronic dilatation of the bronchi and bronchioles causing pulmonary
infection of the bronchus.
B. A complex and destructive lung disease characterized by destruction of
the alveoli, enlargement of air spaces and loss of airway support by the
lung parenchyma
C. An intermittent, reversible, obstructive airway disease characterized by
increased responsiveness of the trachea and bronchi to various stimuli
D. A collection of pus in the pleural cavity that frequently progresses to a
fibropurulent stage where it encloses the lung within a thick exudative
membrane.

30. What is the best position for this client experiencing dyspnea or difficulty
in breathing?
A. Supine C. Orthopneic
B. Prone D. Reverse trendenburg

Situation 7: Hormones help to regulate organ function in concert with the

nervous system. The following questions refer to different metabolic
and hormonal imbalances.

31. The following hormones are secreted by the anterior lobe of the pituitary
gland. Select all that apply:
1. Follicle Stimulating Hormone 4. Oxytocin
2. Growth Hormone 5. Epinephrine
3. Luteinizing Hormone 6. Prolactin

A. 2, 3, 5, 6 C. 1, 2, 3, 6
B. 3, 4, 5, 6 D. 1, 2, 3, 4

32. Which of the following findings would be typical of Addison’s disease?

A. Hypokalemia C. Hypoglycemia
B. Hypernatremia D. Decreased BUN level

33. Which of the following is the primary feature of Pheochromocytona on blood

pressure?
A. Widening pulse pressure
B. Hypertension that is resistant to treatment with drugs
C. Systolic Hypertension
D. Diastolic Hypertension

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34. Propylthiouracil (PTU) is prescribed for a client with Grave’s disease to
decrease circulating thyroid hormone. The nurse should teach the client to
immediately report which of the following signs and symptoms?
A. Save throat
B. Painful, excessive menstruation
C. Constipation
D. Increase urine output

35. Which of the following conditions is caused by excessive secretion of

vasopressin?
A. Thyrotoxic crisis
B. Diabetes insipidus
C. Primary adrenocortical insufficiency
D. SIADH

Situation 8: Kenny, a 27 year old who had a recurrent respiratory infection is

complaining of weakness, constipation and cold intolerance. He was sent
to the hospital for confinement and the doctor ordered a laboratory exam
to check his T3 and T4 level.

36. Kenny, is most likely experiencing, what hormonal imbalance?

A. Hyperthyroidism C. Hyperparathyroidism
B. Hyporthyrodism D. Hypoparathyroidism

37. The following signs and symptoms can be felt by Kenny as his condition
progresses. Select all that apply.
1. Bradycardia 4. Anorexia
2. Obesity or weight gain 5. Diaphoresis
3. Exophthalmos 6. Mask-like face

A. 1, 3, 4, 6 C. 1, 2, 3, 4
B. 2, 4, 5, 6 D. 1, 2, 4, 6

38. A client with enlarged goiter is scheduled for a subtotal tyroidectomy to

treat Thyrotoxicosis. Saturated solution of Potassium Iodine (SSKI) is
prescribed preoperatively for the client. The primary reason for using this
drug is that it helps:
A. Slow the progression of exophthalmos
B. Reduce the vascularity of the thyroid gland
C. Decrease the body’s ability to store thyroxine
D. Increase the body’s ability to excrete thyroxine

39. During Transphenoidal Hypophysectomy, the incision is made beneath the:

A. Upper lip C. Nasal cavity

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 B. Lower lip D. Sphenoidal sinus

40. Which of the following statements should the nurse make when teaching the
client about taking oral corticosteroids?
A. “Take your medication with a full glass of water”
B. “Take your medication on an empty stomach”
C. “Take your medication with meals or with an antacid”
D. “Take your medication at bedtime to increase absorption”

Situation 9: Any condition that interferes with ingestion, digestion and

elimination can negatively influence a person’s self perception and
overall sense of well being. The following questions refer to care of
clients with alteration in nutrition and metabolic functions.

41. A client who has been diagnosed with Gastroesophageal Reflux Disease (GERD)
complains of heartburns. To decrease the heartburns, the nurse should instruct
the client to eliminate which of the following items from the diet?
A. Raw vegetables C. Air-popped popcorn
B. Hot chocolate D. Lean beef

42. The nurse is preparing to teach a client with peptic ulcer disease about the
diet that should be followed after discharge. The nurse should explain that
the client will most likely consist of the following:
A. Bland foods C. Any foods that are tolerated
B. High protein foods D. Large amounts of milk

43. After ingestion of nasoenteric tube, the nurse should place the client in
which of the following position?
A. Semi-Fowlers C. Supine
B. Upright D. Right-side lying

44. Crohn’s Disease can be described as a chronic relapsing disease. Which of

the following areas of the GI system may be involved in this condition?
A. The entire length of the large colon
B. Only the sigmoid area
C. The entire large colon through the layers of mucosa and submucosa
D. The small intestine and colon, affecting the entire thickness of the
bowel

45. Which of the following factors associates chronic gastritis with pernicious
anemia?
A. Chronic blood loss
B. Immobility to absorb vitamin B12
C. Overproduction of stomach acid
D. Overproduction of vitamin B12

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Situation 10: Diabetes Mellitus is a group of metabolic diseases characterized
by increased levels of glucose in the blood (hyperglycemia) resulting
from defects in insulin secretion, Insulin action, or both.

46. The client with type 1 DM is taught to take NPH (Humulin N) at 5 pm each
day. The client should be instructed that the greatest risk for hypoglycemia
will occur at what time?
A. 11:00AM, shortly before lunch
B. 1:00PM, shortly after lunch
C. 6:00PM, shortly after dinner
D. 7:00AM, while sleeping

47. The diabetic client who is taking Insulin Lispro (Humalog) injections would
be advised to eat:
A. Within 10 to 15 minutes after injection
B. 1 hour after injection
C. At anytime
D. 2 hours before the injection

48. Your diabetic client suddenly feels weak. You assessed the client and
observed that he is sweating, tachycardic, and has palpitations. He is also
complaining of double vision and drowsiness. Which of the following would be
your immediate action in this case?
A. Notify the physician immediately
B. Give 6 to 10 hard candies
C. Check the patient blood glucose level
D. Run 50 ml of 50% dextrose in water (D50W)

49. What causes Diabetic Ketoacidosis (DKA)?

A. Overproduction of glucose
B. Underproduction of glucose
C. Insulin deficiency
D. Over production of insulin

50. The following are correct nursing interventions for Insulin Therapy EXCEPT:
A. Do not massage the injection site after administering insulin
subcutaneously
B. Shake the vial to suspend and redistribute insulin particles
C. Prefilled insulin syringes should be kept in the refrigerator. If used,
store the vial at room temperature
D. Rotate the site of insulin injections to prevent lipohyperthrophy

Situation 11: Any nurse who wishes to be an effective caregiver must first learn
to communicate. Good communication skills enable nurses to get to know
their patients and ultimately to diagnose and to meet their needs for

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 nursing care. The following questions refer to good communication
skills.

51. The nurse enters the patient’s room and examines the patient’s IV fluids and
cardiac monitoring. The patient states “Well, I haven’t seen you before. Who
are you?” The nurse’s best response is:
A. “I’m just the IV therapist checking your IV”
B. “I’ve been transferred to this division and will be caring for you.”
C. “I’m sorry, my name is John Smith. I’m responsible for your IV.”
D. “My name is John Smith. I’ll be caring for you till 11 pm.”

52. A nursing student is preparing to administer morning care to the patient.

The most important question that the nursing student should ask the patient is:
A. “Would you prefer a bath or a shower?”
B. “May I help you with a bed bath now or later this morning?”
C. “I will be giving you your bath. Do you use soap or shower gel?”
D. “I prefer a shower in the evening. When would you like your bath?”

53. During an interaction with a critically ill patient’s family, the nurse uses
the communication technique of silence. This technique assists the family to:
A. Communicate with the patient C. Organize thoughts
B. Plan for discharge D. Decrease anxiety

54. The nurse enters the room of a patient with Diabetes. He is crying and
states, “I feel so alone.” Of the following statements, which is the most
therapeutic?
A. The nurse stands at the patient’s bedside and states, “I understand how
you feel. My mother said the same thing when she was ill.”
B. The nurse places a hand on the patient’s arm and states, “You feel so
alone.”
C. The nurse stands in the patient’s room and asks, “Why do you feel so
alone? Your wife has been here everyday.”
D. The nurse holds the patient’s hand and asks, “What makes you feel so
alone?”

55. A 76-year old patient states, “Do you take two injections of insulin to
decrease the complications of Diabetes?” The nurse needs to direct the patient
to gain more information. What is the most appropriate comment or question to
elicit additional information?
A. “Do you take two injections of insulin to decrease the complications?”
B. “Most physicians recommend diet and exercise to regulate blood sugar”
C. “Most complication of Diabetes are related to neuropathy”
D. “What specific complications have you experienced?”

Situation 12: Collaboration and team work are essential tool for optimum service
of health to the client. These allow the nurse to grow professionally
and communicate effectively for skills and technical empowerment.
56. A nurse is asked to act as a mentor. The nurse interprets this position as:
A. A formal process for professional growth
B. A paid responsibility of all nurses
C. Limited to those with professional titles and rank
D. A means for participation in a professional organization

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57. During a nursing staff meeting, the nurses determine that they will make
sure all vital signs are reported and charted within 15 minutes following
assessment. This is an example of:
A. Group decision making C. Group identity
B. Group leadership D. Group patterns of interaction

58. The RN on a surgical unit is behind schedule administering her medication.

Which of her other tasks can she safely delegate to an LPN?
A. The assessment of a patient who has just arrived on the unit
B. Documentation of patient’s I & O on the flow chart
C. Teaching a patient with newly diagnosed Diabetes about foot care
D. Helping a patient who has recently undergone surgery out of bed for the
first time.

59. The nurse will provide pre-op teaching to a client scheduled for surgery.
When is the best time to provide the pre-operative reaching?
A. Before administration of pre-operative medications
B. The afternoon or evening prior to surgery
C. Several days prior to surgery
D. Upon admission of the client in the RR

60. Which among the following is/are not members of the sterile team in the
O.R.? Select all that apply:
1. Surgeon 4. Scrub nurse
2. Anesthesiologist 5. Circulating nurse
3. Radiology Technician

A. 2, 3, 5 C. 2, 3
B. 2 only D. 2, 5

Situation 13: Nurses assume the role of teacher and patients assume the role of
learner when patients have identifiable learning needs. This teacher-
learner relationship is enhanced by the helping relationship in which
mutual respect and trust are established. The following questions refer
to teaching-learning process application.

61. Which of the following instructions should the nurse give a client about his
active Tuberculosis (TB)?
A. “It’s ok to miss a dose every day or two”
B. “If side effects occur, stop taking the medication”
C. “Only take the medication until you feel better”
D. “You must comply with the medication regimen to treat TB”

62. After receiving radiation treatment for Lung Cancer, a client complains that
he has lost his appetite. The nurse should provide which of the following
instructions?
A. Drink plenty of fluids
B. Eat hot meats with spices to improve the taste
C. Limit activities immediately before and after meals
D. Consume food high in calories

63. A client with newly diagnosed Diabetes Mellitus is ready for discharge.
Discharge teaching must include which of the following?

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 A. Foot care and the need for a high-calorie diet
B. How to balance diet, exercise, and medication
C. Fasting before health care maintenance visits
D. Avoiding all carbohydrates and drinking 2 L of water daily

64. A patient with Colon Cancer asks you what diet might have mostly contributed
to his condition. The nurse correctly responds if she answers which of the
following diets?
A. Low fiber, high fat C. Low protein, high carbohydrate
B. Low fat, high fiber D. Low carbohydrate, high protein

65. The nurse teaches the client who has had rectal surgery the proper timing
for sitz-bath. The nurse knows that the client has understood the teachings
when the client states that it is most important take sitz-bath:
A. First thing each morning C. After a bowel movement
B. As needed for discomfort D. At bedtime

Situation 14: Scarlet, a fresh board exam passer wanted to become a Nurse
Researcher. She wanted to recall important concepts in Nursing Research
to enable her to effectively function as such.

66. Scarlet understands that the most objective means of obtaining nursing
knowledge is through:
A. Trial and error C. Scientific Research
B. Tradition D. Authority
67. Taylor, OR Nurse asks Scarlet the major reason for conducting nursing
research. She is correct if she answers that the major reason for conducting
nursing research is to:
A. Improve nursing care for clients
B. Promote the growth of nursing profession
C. Document the cost effectiveness of nursing care
D. Ensure accountability for nursing practice

68. Which of the following is present in every experimental study?

A. Manipulation of the independent variable
B. A control group
C. Random assignment of subjects to groups
D. Random selection of subjects from the population

69. Which of the following is a probability sampling method?

A. Convenience C. Quota
B. Cluster D. Purposive

70. Scarlet, together with Taylor, in their research, used the clients in the
hypertension clinics of two local hospital as their sample. What type of
sampling method did they use?
A. Simple random sampling C. Convenience sampling
B. Purposive sampling D. Quota sampling

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71. A staff nurse on a busy Pediatric Unit is an excellent role model for her
colleagues. She encourages them to participate in the unit’s decision making
process and helps them improve their clinical skills. In which of the
following roles is the nurse functioning effectively?
A. Manager C. Leader
B. Autocrat D. Authority

72. Nancy and the team needed a continuous quality improvement for their
department as one of the hospital protocol. She understands that all of the
following EXCEPT one are steps for continuous quality improvement:
A. Establish criteria C. Collects and analyzes data
B. Identifies relevant information D. Terminating employees

73. A nurse gives a client the wrong medication. After assessing the client,
the nurse completes an incident report. Which statement describes what will
occur next?
A. The incident will be reported to the state Board of Nursing for
disciplinary action
B. The incident will be documented in the nurse’s personnel file
C. The medication error will result in the nurse being suspended and
possibly terminated
D. The incident report is method of promoting quality care and risk
management

74. Performance improvement is an important component of continuous quality

improvement. Which action should an effective nurse-manager do when conducting
performance evaluation?
A. Conduct performance evaluations in a group setting so input from peers
and subordinates is considered when evaluating a staff member’s
effectiveness
B. Provide feedback on strengths as well as areas for improvement and
clarify what the staff member is expected to accomplish before the next
performance evaluation.
C. Document areas for improvement in writing. Areas of strength don’t need
to be documented because these areas are complementary and don’t describe
actions the staff member must take to improve
D. Delegate responsibility for conducting performance evaluations to primary
nurse whenever possible to help them grow professionally

75. Which is the role of the nurse in a domestic abuse situation?

A. Document situation and provide support for the victim
B. Protect the client’s privacy by not documenting the abuse
C. Provide counseling to the person committing the abuse
D. Provide counseling for the victim

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Situation 15: Tobby a staff nurse, is the newly assigned Manager as appointed by
the Chief Nurse because of his excellence and dedication to his work,
long-term service and loyalty and his good relationship with his co-
workers. As soon as he got the good news, he started to review the
different concepts of nursing leadership and management.

76. Tobby had received about the different theories of leadership. He correctly
states that the Theory X and Y was introduced by:
A. David McClelland C. Frederick Herzberg
B. Douglas McGregor D. B.F. Skinner

77. Blake and Mouton developed the managerial Grid in 1978. A low concern for
the production and high concern for people (1.9) is categorized as:
A. Impoverished management C. Team management
B. Country club management D. Authority-obedience

78. As a nurse-manager, which of the following is part of the personnel budget?

A. Anticipated overtime payment for staff
B. Computers for staff use
C. Office supplies for secretariat use
D. Videos for staff education

79. Tobby can appropriately behave as an Autocrat in which of the following

situations?
A. Planning vacation time for staff
B. Directing staff activities if a client has a cardiac arrest
C. Evaluating a new medication administration process
D. Identifying the strengths and weakness of a client education videos

80. Delegation is the process of transferring work to subordinates. Tobby can

appropriately delegate which of the following tasks?
A. Scheduling staff assignments for the next month
B. Terminating a nursing assistants for insubornation
C. Deciding on salary increase for PLN after they can complete orientation
D. Telling a staff nurse to initiate disciplinary action against one of her
peers.

Situation 15: Incident Reporting is an effective technique of a good risk

management program.

81. The selection of a nursing care delivery system (NCDC) is critical to the
success of a nursing area. Which factor is essential to the evaluation of a
NCDC?
A. Determining how planned absences, such as vacation time, will be
scheduled so that all staff are treated fairly
B. Identifying who will be responsible for making client care decisions

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 C. Deciding what type of dress code will be implemented
D. Identifying salary ranges for various types of staff

82. The following are characteristics of a correctly written incident report

EXCEPT:
A. It must be complete and factual
B. It should not be altered or rewritten
C. It must be sent directly from prepare to attorney to ensure
confidentiality
D. It must be written on the patient’s chart to ensure proper documentation

83. Lyndon, a newly registered nurse had her first exposure in the hospital as a
treatment nurse in the medical-surgical ward. On that day, she was unlucky to
be surprised that her patient fell from his bed because she failed to raise the
side rails. She was reprimanded by the nurse-manager and was asked to complete
an incident report for her negligent act. She correctly writes an incident
report if she includes ALL BUT one
A. Name, address and age of the client
B. Reason for the negligent act
C. Condition of the involved individual
D. Names of the witnesses

84. The following are DO’s of incident reports. Select all that apply:
1. Report to nurse manager
2. Keep the report confidential
3. Be complete
4. Follow establishing policy and procedure
5. Confirm all telephone orders in writing

A. All except 1 C. All except 1 and 5

B. 1, 2, 3 D. 1, 2, 3, 4, and 5

85. A CHN nurse is working with the Disaster Relief Team following a flood.
Finding safe housing for survivors, providing support for families, organizing
counseling, and security, physical care are examples of which type of
prevention?
A. Aggregate care prevention C. Secondary prevention
B. Primary prevention D. Tertiary prevention

Situation 16: The fields of law, jurisprudence and ethics have a special place
in the practice of every progression, whether related to health or not.
However, understanding nursing law, jurisprudence and professional
ethics requires basic knowledge of law, jurisprudence and ethics.

86. The Philippine Nursing Act of 2002 is also known as:

A. RA 9173 C. RA 9673

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 B. RA 9713 D. RA 9273

87. According to the Philippine Nursing Act of 2002 the Board of Nursing shall
be composed of:
A. 5 members and 1 chairperson
B. 6 members and 1 chairperson
C. 7 members and 1 chairperson
D. 7 members

88. In order to pass the examination, one must have:

A. A general average of 75%
B. A general average of 75% or higher
C. A general average of 75% or higher with a rating of not below 60% in any
subject
D. A general average of 75% or higher with a rating of not below 50% in any
subject.

89. The Philippine Nursing Act of 1991 is known as:

A. RA 8371 C. RA 9173
B. RA 7164 D. RA 7160

90. PD 856 is the:

A. Code of Sanitation
B. Family Planning Act
C. Garbage Disposal Act
D. Clean Air Act

Situation 17: There are ethico-legal obligation, rights and pledges that nurses
in the Philippines must abide by and conform to in the performance of
their duties. Some legal and traditional duties are not simply
persuasive or directive in nature, but mandatory in character.

91. This is the division of ethics which treats of the moral principles, duties
or behavior of the members of the nursing profession toward their co-nurse, to
their profession, to other health care workers, to the patients and to the
public in general.
A. Health Ethics C. Professional Ethics
B. Nursing Professional Ethics D. Bioethics

92. A client in a long-term care facility refuses to take his oral medications.
The nurse threatens the client and tells him that, if the medication isn’t
taken, restraints will be applied and the medication will be given by
injection. The nurse’s act constitutes which legal tort?
A. Assault C. Negligence
B. Battery D. Dual defamation

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93. In which of the following circumstances may the nurse legally and ethically
disclose confidential information about a client?
A. The HIV status of a single male client to his family members
B. The diagnosis of Pancreatic Cancer to the client’s significant other
C. The diagnosis of an uncontrolled seizure disorder of a taxi driver to a
state agency
D. The client is 32 weeks pregnant with twins and legally separated

94. Which of the following concepts, refers to the role of the professional
nurse in client advocacy?
A. The nurse makes decisions for clients who can’t make decisions for
themselves
B. The nurse follows the basic standards of care and hospital policies and
procedures for providing care for clients
C. The nurse promotes and protects the client ‘s interest and rights
D. The nurse adapts a paternalistic approach to the care of clients

95. A client who is a member of the Jehovah’s witnesses refuses a blood

transfusion based on his religious beliefs and practices. His decision must be
followed based on which ethical principle?
A. Right to die C. Advance direction
B. Right to refuse treatment D. Substituted judgment

Situation 18: Nursing is a clinical practice discipline. Professional nurses want

autonomy and control of their practice. They want to apply their nursing
knowledge and skills without interference from nurse managers,
physicians or persons in other disciplines.

96. The following are nursing responsibilities for informed consent, EXCEPT:
A. Ensure that client understood
B. Explain thoroughly the surgery to be done
C. Sign the consent as a witness
D. Ensure privacy and anonymity of client
97. Brad, a clinical instructor, was asked by his student about informed
consent. He is correct if he says which of the following?
A. “Minors are permitted to give informed consent”
B. “ The professional nurse and physician may both obtain informed consent”
C. “The client must be fully informed regarding treatment, tests, surgery
and the risks and benefits prior to giving informed consent”
D. “Mentally competent and incompetent clients can legally give informed
consent”

98. You have been asked to witness a patient sign an informed consent form for
surgery. You recognize that the document is valid for which one of these
patients:
A. A 92-year old patient who is severally confused

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 B. A 45-year old patient who is oriented and alert
C. A 10-year old patient who is oriented and alert
D. A 36-year old patient who has had a narcotic premedication

99. The nursing student is nervous and concerned about the work she is about to
do at the clinical facility. To allay anxiety and be successful in her
provision of care it is important for her to:
A. Engage in self-talk to plan her day and decrease her fear
B. Speak with her fellow colleagues about how they feel
C. Determine the established goals of the institution
D. Be sure her verbal and non-verbal communication is congruent

100. A home health nurse who performs a careful safety assessment of the home of
a frail elderly patient to prevent harm to the patient is acting in accord
with which of the following principles of bioethics?
A. Beneficence C. Fidelity
B. Non-maleficence D. Autonomy

***** END OF EXAMINATION *****

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