Situation. Jungkook rushed to the ER due to severe Situation. Mr.

Olaf, a 62 year-old male, complains of

abdominal pain radiating to the scapular region. shortness of breath, dyspnea on exertion, palpitation,
Health history revealed that his meals were mostly and expectorating frothy, blood-tinged sputum. He
from KFC. Patient appeared jaundiced with facial was brought to the emergency room of Hospital C.
grimaces. The physician on duty (POD) examined him During the interview, he also complained of easy
and an impression of Cholelithiasis was given by the fatigability and weakness.
POD. Patient was ordered to be admitted for further 6. Given the following assessment cues, Nurse Olaf
work-up and possible surgery. makes a nursing care plan with the priority nursing
1. Which of the following questions should be asked diagnosis of:*
by the nurse to accurately describe biliary colic? A. Anxiety related to actual threat to biological
A. Nararamdaman niyo po ba ang sakit bagomatulog? integrity secondary to heart failure
B. Nararamdaman niyo po bang sakit sa kaliwang B. Ineffective breathing patterns related to decreased
parte ng inyong tiyan? respiratory depth secondary to pulmonary edema
C. Panandalian lamang po ba ang sakit? C. Activity intolerance related to compromised
D. Nararamdaman niyo po ba ang sakit matapos oxygen transport system secondary to heart failure
kumain? D. Activity intolerance related to compromised
2. In a patient with obstructive jaundice, which of oxygen transport system secondary to heart muscle
the following assessment findings would you expect? dysfunction
A. Itchiness of the abdomen 7. Mr. Snowman has been diagnosed with heart
B. Clay-colored stool failure. Nurse Olaf expects this patient to not exhibit
C. Reddish-colored urine and stool the following signs and symptoms EXCEPT:*
D. Presence of urobilinogen in the urine A. Pulse rate of 48 bpm
3. Mr. Jungkook had bile duct exploration with open B. Murmurs
cholecystectomy. A t-tube was connected to drain C. Respiratory rate of 18 cpm
after surgery. After 12 hours, there was a marked D. Strong, bounding pulse
decrease in output from 260 ml to 90 ml. What is the 8. The doctor ordered oxygen administration for the
nurse’s priority action? patient. The nurse knows that the rationale behind
A. Call the physician stat this intervention is that:*
B. Assess the tube for any obstruction A. Oxygen helps to decrease the work of breathing
C. Irrigate the tube with normal saline B. Oxygen is contraindicated in heart failure so the
D. Change the position. order is questionable
4. One of the most common complications post- C. Oxygen is given to reduce anxiety
operatively is:* D. Oxygen is administered through mechanical
A. Pleurisy ventilation only
B. Bronchopneumonia 9. Nurse Olaf prepares to perform the following
C. Pneumonia interventions for the immediate management of Mr.
D. COPD Snowman excluding:
5. Which dietary restriction should be recommended A. Establish an IV line and administer PNSS
by the nurse to help prevent recurrence of stone immediatelY
formation?* B. Monitor heart rate and dysrhythmia by using a
A. Orange juice, pan de sal cardiac monitor
B. Whole milk, dairy crème , fried chicken breast C. Continuously assess level of consciousness
C. Steamed lapu-lapu, nilagang okra, salabat D. Provide reassurance and support to the patient
D. Nilagangsaba, vegetable salad, 10. The nurse knows that the management of a
patient with heart failure requires interprofessional D. 10-12 cm
collaboration. Mr. Snowman asks Nurse Olaf from 15. To prevent urinary tract infection in a female
whom can he ask for assistance and counsel patient with an indwelling catheter,
regarding home care services. Nurse Olaf responds Dengdeng instructs her to decrease intake of which of
that the professional who can help him with his the following fruit juices?*
concern and who assists the continuing care nurse A. Pineapple Juice
with planning the patient's discharge is the: B. Prune Juice
A. Physical therapist C. Apple Juice
B. Social worker D. Cranberry Juice
C. Psychologist Situation. Anna, while going on a date with Kristoff,
D. Head nurse suddenly complains “I can’t breathe”. Kristoff rushed
Situation. Nurse Dengdeng handles various patients her immediately in the ER. She was given
with elimination problems. She always performs her Theophylline and Cromolyn sodium for the attack.
best nursing care to these patients. 16. The following are expected assessment findings
11. Nurse Dengdeng teaches an incontinent patient for Anna except:*
bowel training. Which among the following would A. Decreased tactile fremitus
Nheng not include in her health teaching?* B. Resonant to tympanitic
A. Opioids are avoided to prevent decrease in bowel C. Wheezing sounds
peristalsis. D. Crackles
B. Regular exercise is encouraged. 17. Upon administration of theophylline, you are
C. Leaning backward at the hips while sitting on the monitoring Anna for which drug induced adverse
toilet will help stimulate colon emptying. effect?*
D. A hot tea or fruit juice may be taken before the A. Bradycardia
patient defecates. B. Diarrhea
12. An enema to provide relief from gaseous C. Constipation
distention is prescribed to a patent. Dengdeng knows D. Restlessness
that this is a/an: 18. Upon administration of Theophylline, the
A. Oil retention enema therapeutic effect that you would expect is:*
B. Carminativeenema A. Decrease in breath sounds
C. Soapsuds enema B. Increase in body temperature
D. Fleet enema C. Decrease in wheezing
13. After inserting a nasogastric tube, Dengdeng D. Prurittus
checks its placement by measuring the pH of the 19. Kristoff asks the nurse why Anna needs
aspirate. Dengdeng knows that proper placement has Theophylline. The best response of the nurse is:*
likely been made if the aspirate has a pH of:* A. “Pinaluluwag nito ang daluyan ng hangin.”
A. pH 3.0 B. “Iniiwasan nito na magkaroon pa ng allergic attack
B. pH 7.0 si Athena.”
C. pH 9.0 C. “Iniiwasan nito na atakihin ng epilepsy si Athena”
D. pH 7.4 D. “Binabawasan nito ang pamamaga ng baga”
14. Nurse Dengdeng knows that the approximate 20. Kristoff brought food in Anna’s room. Which of
length of a normal female urethra is: * the following food should be restricted for Anna in
A. 1.5-2.5 cm consideration to her therapeutic regimen?*
B. 4-6.5 cm A. White Chocolate Mocha drin
C. 20-25 cm B. Mango juice
C. One piece chicken with rice C. Elevate extremity above heart level.
D. One peach mango pie D. Increase oral fluid intake.
Situation. Nurse Rosé has newly admitted patients in Situation. Nurse Lisa is a staff nurse in the medical
the Medicine Ward who are for workup. ward. Most of her patients are afflicted with intestinal
21. A patient with suspected pneumonia is ordered and rectal disorders.
to have sputum culture and sensitivity. Nurse Rosé 26. Upon assessment, which of the following
orders the patient to cough up how much sputum differentiates Crohn’s disease from ulcerative colitis?*
into the container? 0/1
A. 15-30mL A. Presence of bleeding: severe in Crohn’s disease
B. 1-5mL while in Ulcerative Colitis bleeding is mild.
C. 4-10mL B. Presence of diarrhea: severe in Crohn’s disease in
250mL ulcerative colitis it is mild
22. Jisoo is a 25-year-old patient suspected to have C. Affected area: Crohn’s disease is the descending
chronic myelogenous leukemia. She is advised to while Ulcerative colitis is the ascending colon.
undergo bone marrow biopsy. The following bones D. Course of the disease: Crohn’s disease is prolonged
may be used for the procedure, except:* and variable, Ulcerative colitis has a remission and
A. Posterior superior iliac crest exacerbation
B. Anterior superior iliac spine 27. In terms of therapeutics, which of the following
C. Sternum medications can be used for inflammatory bowel
D. Triquetrum diseases?
23. Patient Jennie likes to eat melons and A. Corticosteroid
strawberries. On the day of her specimen collection B. Atropine sulfate
for fecal occult blood, she claimed that she has been C. Dulcolax
bingeing on these fruits since 5 days ago. What will D. Maalox
be its implication on the test/results?* 28. Which systemic complication can be expected
A. Results can become falsely positive for occult from a patient with Crohn’s Disease?
blood A. Perforation
B. Results can become falsely negative for occult B. Small bowel obstruction
blood. C. Hemorrhage
C. Increased intake of fruits will confirm presence of D. Megacolon
occult blood in stool. 29. In order to accurately diagnose ulcerative colitis,
D. Stool specimen will become clay-colored. which of the following laboratory studies is needed?*
24. Nurse Rosé knows that 24-hour urine collection A. Proctosigmoidoscopy
is needed in determining the following, except:* B. Albumin study
A. Vanillylmandelic acid (VMA) in pheochromocytoma C. Colonoscopy
B. Uric acid in gouty arthritis D. Ultrasound
C. Culture and sensitivity of causative agent in urinary 30. Which of the following is the MOST appropriate
tract infections nursing diagnoses for a patient in acute exacerbation
D. Creatinine clearance in acute kidney injury (AKI) of ulcerative colitis?*
25. Immediately after obtaining blood for an arterial i. Imbalanced nutrition less than body requirements
blood gas examination, Nurse Rosé instructs the R/T impaired absorption
patient to do which of the following?* ii. Risk for deficient fluid volume R/T abnormal fluid
A. Perform ROM exercise on the proximal joint. loss
B. Apply pressure for 5-10 minutes iii. Risk for ineffective tissue perfusion R/T low
hemoglobin 35. Which nursing action of Nurse Vebs will
iv. Acute Diarrhea R/T inflammation of the bowel promote a dying, elderly patient’s dignity and self-
A. ii & iii esteem?
B. i, ii, & iii A. Providing him regular baths and good hygien
C. i, ii, ii & iv B. Instructing the patient’s family members to decide
D. i & ii for his food choices
Situation. In her 15 years of being a ward nurse, Vebs C. Calling the elderly patient by his first name only
has witnessed and taken cared of several terminally- D. Encouraging his siblings to join during your private
ill patients and their families. conversations with the patient
31. Which among the following is not considered Situation. The nursing director assigned Rendon, RN
palliative care?* in the orthopedic ward to care for patients with
A. Administering anti-emetics to a cancer patient who mobility problems.
underwent chemotherapy 36. Rendon is caring for a patient with an arm cast.
B. Frequently turning the position of a comatose He knows that the functional position of the wrist and
patient post-CVA fingers is which among the following:
C. Removing the tumor in a Stage I breast cancer A. Wrist in extension, fingers and thumb in flexion
D. Providing pain relief to a cancer patient B. Wrist in flexion, fingers in flexion, thumb in
32. What is the immediate focus of nurses in caring extension
for a grieving family who just lost their father from C. Wrist in flexion, fingers and thumb in flexion
cancer?* D. Wrist in extension, fingers in flexion, thumb in
A. Post-mortem care extension
B. Return patient’s belongings (watch, clothes, etc) to 37. Rendon is teaching a patient with crutches how
the family to go up the stairs. Which among the following should
C. Obtaining consent for autopsy he instruct the patient with?*
D. Provide and facilitate time for mourning A. When moving the affected leg up, the body weight
33. Which among the following is not true regarding should be on the crutches.
grief in the older population?* B. The unaffected leg goes up the step after the
A. Many older adults exhibit resilience in facing affected leg.
losses. C. Patient should keep his feet together at the bottom
B. They are not at risk for complicated grieving. of the stairs.
C. Their increased age increases their likelihood of D. The crutches and the affected leg go up the step
having faced multiple losses. together.
D. Positive reappraisal helps older adults adapt to 38. Rendon is assisted by another staff nurse in
significant losses. lifting a patient. Which among the following actions
34. Which among the following statements from will prevent injury to Xydo?*
Nurse Vebs assesses the social support systems of a A. Keeping the feet wide apart and knees extended
person experiencing grief from the death of his B. Positioning himself close to the patient
sister?* C. Using the muscles of the back in lifting
A. “What does this loss mean to you?” D. Rotating at the waist in lifting
B. “Tell me how you are feeling.” 39. Nurse Rendon asks two more nurses to help him
C. “Which friends or family members do you wish logroll a patient. Where should Xydo place the
were here with you?” patient’s arms prior to logrolling?*
A. Along the sides
D. “Tell me about your relationship with your sister. B. Crossed on the chest
C. Overhead, extended 45. Amoxicillin 250 mg oral suspension is prescribed
D. Behind the hips to a patient q8h. Nurse Joan checked the stock dose
40. In applying restraints, Rendon should employ and saw that the bottle reads Erythromycin Oral
which type of tie?* Suspension 125mg/5mL. How much will Nurse Ariana
A. Half-bow administer to the patient in a day?*
B. Surgical tie A. 6mL
C. Double knot B. 12mL
D. Two-throw knot C. 10mL
Situation. Because it is already her board exams in a D. 30mL
few days, Rihanna practices computing medications Situation. Nurse Neytiri is reviewing concepts and
dosages with the following scenarios. practicing skills on intravenous transfusions.
41. Nurse Rihanna administered 2 tablets of 46. Nurse Neytiri is selecting a vein for an
Losartan to Patient Grande within the past 24 hours. intravenous transfusion in a 62-year-old patient. He
According to the doctor’s orders, Patient Grande is to wants to dilate and distend the veins for easier
receive 100mg of valsartan a day. With this insertion. He does the following methods, except:
information, Taylor Swift knows that the stock dose A. Tapping the selected vein multiple times
Nurse Ariana has on hand is:* B. Placing extremity in a dependent position if there
A. Losartan 1 mg/tablet are no contraindications
B. Losartan 25 mg/tablet C. Applying warm washcloth on to the extremity for
C. Losartan 20mg/tablet several minutes
D. Losartan 50 mg/tablet D. Stroking the extremity from distal to proximal
42. Phenytoin (Dilantin) 200mg PO BID was below his desired site
prescribed to a patient. The medication label reads 47. Which among the following catheters is used for
0.1 g/capsule. For each dose, the nurse prepares how less than 24 hours?*
many capsules to give to the patient?* A. Butterfly needle
A. 500 B. Midline catheter
B. 2 C. Plastic indwelling cannula
C. 3 D. Angiocath
D. 4 48. How often should Nurse Neytiri observe a
43. Mannitol 0.25g/kg/day was prescribed to a 7- patient with intravenous infusions?
year-old patient with meningitis. The patient weighs A. Every 2 hour
28.6 lbs. How much mannitol should the nurse give?* B. Every 6 hours
A. 32.5 g C. Every 8 hours
B. 3.25 mg D. Every 12 hours
C. 3.25 g 49. Six hours after initiating an IV line in a patient,
D. 0.325 g Nurse Neytiri noticed that the IV site was red and
44. Nurse Rihanna received an order of enalapril 10 warm. The patient complained that it was painful.
mg OD for a hypertensive patient. How many tablets Nurse Ravi would suspect which of the following?
will she give to the patient if they have a stock dose A. Phlebitis
of 20mg/tablet? B. Extravasation
A. 1/2 tablet C. Infiltration
B. 1 tablet D. Clot formation
C. 1 1/2 tablets 50. What should be the size/gauge of the needle
D. 2 tablets Nurse Neytiri would use in administering IV infusions
for trauma patients? room reading the chart which was inadvertently left
A. 18 by a medical intern. What PRIORITY Nursing actions
B. 22 should you do in this situation?
C. 20 A. Get the chart from the husband so he will not be
D. 24 able to read the diagnosis of his wife
Situation. There are extensive legal aspects that guide B. Explain to the husband as per policy, relatives are
the Filipino nurses in terms of regulation in practice not allowed to read the chart
of her profession. C. Report immediately to the supervisor on duty and
51. The Professional Regulation Commission, Board submit an incident report
of Nursing (PRC– BoN) as a regulatory board has the D. Ask the husband what information he would like to
legal functions and responsibilities EXCEPT in ONE of ask from the health care professional regarding
the following ___________.* medical plan and diagnosis
A. Ensure the quality nursing education by jointly 54. Nurse Celin, is assisting Mr. Robert who just
monitoring with the Commission on Higher Education came from the Recovery unit for a thoracic surgery.
(CHED) adherence to its guidelines, policies and She noted that the dressings are saturated with
standards blood, but the Surgeon just reassured the Nurse to
B. Monitor and enforce quality standards and nursing reinforce the dressings and monitor him closely. After
practice in the Philippines to ensure efficient, ethical, an hour, Mr. Robert went into shock and died. The
moral, technical professional standards family filed charges against the Doctor and the Nurse.
C. Issue, suspend or revoke certificates of registration What is the lawsuit involved in this case?
for the practice of nursing A. Murder
D. Recognize specialty organizations in coordination B. Battery
with the accredited professional organization and C. Assault
collect fees to upgrade the conditions of Nurses D. Malpractice
52. You are a nurse in Batangas Medical Hospital 55. What is the MOST important Nursing measure
and have just completed a 2 year experience in the that Nurse Celin should have done to avoid this
surgical unit. One day, your supervisor ordered you to situation?*
go on a float to the Intensive Care Unit (ICU) as two of 1. Monitor and record closely the vital signs until
the nurses called “on sick” in the said unit. What is stable
the MOST important action you should do in this 2. Report to the surgeon the vital signs and degree of
situation?* bleeding from operative site
A. Explain to your supervisor that you might not be 3. Call the supervisor on duty to assist you in referring
able to perform safely your duty as a nurse in the unit the patient to the surgeon
B. File a leave instead and call your husband to fetch 4. Ask the family members to call the surgeon to see
you in the hospital the patient
C. Refuse the order and tell your supervisor you don’t A. 2 & 3
want to put your license in jeopardy B. 1 & 2
D. Report to the surgical ward of your assignment and C. 1, 2, & 3
request one of your nurses to replace you instead as D. 1 & 3
floater in the ICU. Situation. Chatty, 40 years old, came to the hospital
53. Janina, a 35-year old, married to an insurance for a diagnostic work-up for a cholelithiasis prior to
agent, was diagnosed with colon cancer only a month surgery.
ago. The couple have very limited information about 56. Which of the following clinical manifestations
this condition. One day, you saw the husband in the would you MOST likely to observe when a patient is
suffering from Cholelithiasis?* assessment, noted the presence of a foot ulcer which
A. Indigestion, pain on the right upper quadrant Blanch was trying to hide.
radiating pain to the shoulder 61. Nurse Charm holds the hands of Blanch while
B. Vague left upper quadrant pain radiating to the doing her assessment. Her hands were cold and
scapula clammy, she suspected that the patient was having
C. Feeling of abdominal tenderness after waking-up in hypoglycemia. To relieve her condition, an immediate
the morning action is to offer her _________.*
D. Feeling of abdominal fullness after taking meals A. Candy
57. Which ONE of the following vitamins is B. Sandwich
interfered when there is obstruction of the bile flow C. Full mea
in cholecystitis?* D. Fruits
A. Vitamin C 62. Nurse Charm watches Ms. Blanch while
B. Vitamin B sleeping. An EXCELLENT guideline to differentiate if a
C. Vitamin B12 patient is just sleeping or experiencing hypoglycemic
D. Vitamin K reaction is when one is observed to be _______.*
58. The patient was ordered Endoscopic Retrograde A. With dyspnea
Cholangiopancreatography (ERCP). She was put on a B. With diaphoresis
mild sedation. As a Nurse, what should you check as a C. Snoring
PRIORITY action when he returns to the ward?* D. Grunting his teeth
A. Irritation of orropharynx 63. Nurse Charm practiced surgical asepsis during
B. Nausea and vomiting foot care. Which of the following techniques has to
C. Cough and gag reflex be observed?
D. Signs of bleeding A. Opening container of sterile water after putting
59. Which of the following conditions is NOT a side gloves on.
effect of anticholinergic drugs?* B. Changing the sterile field after sterile water spilled
A. Constipation on it
B. Blurred Vision C. Placing sterile dressing 2 cm from the edge of the
C. Dryness of the mouth sterile field.
D. Increased blood pressure D. Cleaning the wound in circular motion from outer
60. When a client has a nasogastric tube (NGT) due towards the ulcer site
to abdominal distention post surgery. Which of the 64. Nurse Charm after foot care encourages Patient
following nursing responsibilities should you do?* Blanch to do which of the following APPROPRIATE
1) Measure gastric secretion every shift measures
2) Observe and record color, viscosity of secretions A. Apply lanolin generously between the toes
3) Ensure that the gastric tube is patent B. Cut toenails rounded at the edges and close to the
4) Assist patient to assume a comfortable position skin
A. 1, 2, 3, & 4 C. Apply alcohol after cleansing feet to improve
B. 1, 2, & 3 infection
C. 1 & 2 D. Wear a shoe-type slipper at home
D. 2, 3, & 4 65. Ms. Blanch was administered NPH insulin at 8
Situation. Nurse Charm admitted Blanch, 38 years old, am. At what time would Nurse Charm expect the
who was diagnosed by her physician with Type I patient to be at risk for hypoglycemic reaction.*
Diabetes Mellitus. She complains of easy fatigability A. 11am
and increased tiredness. Nurse Charm, during the B. 6pm
C. Noon 70. Nurse Jess assesses the pain intensity of Mr.
D. 4pm Ramos. The pain assessment tool APPROPRIATE to be
Situation. Nurse Jess admits Mr. Ramos, 45 year-old, used for Mr. Ramos is _____________.
who was brought to the Emergency room by his co- A. Face Pain Rating Scale
worker because of severe abdominal pain. He was B. World Rating Scale
observed to be very anxious; holding his abdomen C. Visual Rating Scale
with his right hand while bending towards his right D. Numeric Rating Scale
side. The Emergency Room doctor made his initial Situation. Lu, a retired Barangay Health Worker, came
assessment and referred the patient to the Surgical to the OPD for her check-up for her diabetes mellitus.
doctor on duty for further assessment. She had been diabetic since she was 37 years old. She
66. To describe a sensation of severe pain felt for has been taking her maintenance medications which
ruptured appendicitis, Nurse Jess applies deep she sometimes does not comply with.
pressure of her finger into the abdomen at a point 71. There are metabolic abnormalities in the
away from the pain and then releases. This maneuver development of type 2 Diabetes. Which of the
is termed as __________.* following is NOT included in these abnormalities?*
A. Perforation A. Inappropriate production of the liver
B. Rovsing's sign B. Increased ability of the pancreas to produce insulin
C. McBurney's point C. Insulin resistance
D. Rebound tenderness D. Altered production of hormones by adipose tissues
67. Mr. Ramos was diagnosed with ruptured 72. Ms. Lu was admitted to the hospital for further
appendicitis. When the appendix is suspected check-up. Which of the following diagnostic tests do
ruptured, a generalized abdominal pain is felt and you expect to be ordered by the diabetologist as an
becomes ____________.* indicator that the patient is compliant to her
A. Merely a discomfort and steady rather that prescribed diet?*
intermittent A. Oral glucose tolerance test
B. Intense and the patient guards the area by living B. Glycosylated hemoglobin level (hgb, Alc)
room C. Finger glucose findings for one day
C. Rigid, stiff and board like feeling D. Fasting blood glucose level
D. Tender and focused on the umbilical cord region 73. While Nurse Dianne was completing her
68. Immediate surgery was done on Mr. Ramos. assessment, she discovered the following findings.
Which of the following measures for pain control is Which of the following should she refer immediately
NOT advisable to be done by Nurse Jess while patient to the physician?*
Ramos is having post-op pain?* A. Tingling sensation of the hands and feet
A. Coughing exercises neuropathy
B. High-fowler's position B. Changes in the peripheral vision retinopathy
C. Deep breathing C. Beginning ulceration of the left big toe
D. Semi-fowler's position D. Fruity odor breath
69. After operation, a nasogastric tube (NGT) was 74. Nurse Dianne, the nurse in charge of patient Lu,
inserted to Patient Ramos. The rationale for this informed her physician that her serum glucose level is
surgical measure is to _________. 38mmol/L and quite unresponsive to verbal
A. Prevent use of antibiotics questioning. The nurse suspects that she is starting to
B. Decrease hospitalization to two days develop Diabetes Ketoacidosis (DKA). Which of the
C. Decrease pain after the operation following manifestations is UNIQUE to this condition?
D. Avoid the use of analgesics A. Shallow slow respirations
B. Increased serum potassium the procedure
C. Rapid deep respirations 78. Nurse Hanna must be alert that certain
D. Decreased serum albumin complications may arise after the procedure. What
75. Nurse Dianne’s counseling role includes lifestyle PRIORITY nursing assessment should she observe?*
changes as well as pharmacologic regimen. Lu’s family A. Tingling sensation
were interested to know information regarding B. Signs of bleeding at the puncture site
insulin. She differentiated an intermediate acting C. Blurring vision
insulin from that of short-acting which is __.* D. Disorientation
A. Regular onset is 2 hrs. Peak is 3 ½ hr., duration -7 79. When teaching patient Lia about self-
hrs., administered 20-30 min. before meal management following cardiac catheterization, Nurse
B. Regular onset is 2-4 hr., peak is 4-12 hr., duration is Hanna should emphasize to AVOID which ONE of the
8 hr., administered 20-30 min. after meal following?*
C. Regular, onset is 1 ½ hr, peak is 3-4 hrs, duration is A. Diet high in Protein and Carbohydrates to low
6 hrs. administered 20-30 min after meal cholesterol and fats
D. Regular onset is 1 ½ - 1hr, peak is 2-3 hr., 4-6hr B. Lifting objects heavier than five (5) lbs
duration administered 20-30 min. before C. Taking shower with the site covered after 24 hours
Situation. Lia, 23 year old, a dental student has been D. Light exercise program within 48 hours when
having frequent bouts of tonsillitis in the past. One tolerated
day, she developed low grade fever, dyspnea, 80. The POD established Lia’s diagnosis that she is
dizziness, syncope, and fainting spells while preparing suffering from acquired valvular heart disease. This
for her final examination. She was rushed to the condition is brought about by _______.*
hospital by her parents and was seen in the A. Rheumatic fever
Emergency room by the physician on duty (POD), Ms. B. Alcohol consumption
Hanna was the nurse-on-duty. The POD ordered a 12 C. Drug abuse
lead Electro-cardiogram (EKG) and other laboratory D. Heredity
tests. Situation. You are the nurse on night duty in the
76. What specific information is essential for the medical ward. You were assigned by Ms. Heart, the
Health professionals to know when this EKG is Charge Nurse of the unit to monitor the status of a 8
ordered for patient Lia?* year old boy with bronchial asthma.
A. Rate, rhythm and pressure within the blood vessels 81. Which of the following manifestations of the
B. Rate, rhythm, axis and circulation child would cause you to be alarmed?*
C. Rate, rhythm, axis, hypertrophy, and infarction A. Excessive sweating
D. Rate, hypertrophy and blockage to the chambers of B. Choking sensation
the heart C. Cough with phlegm
77. Aside from the EKG and laboratory studies, the D. Generalized chest tightness
POD ordered patient Lia to undergo cardiac 82. You would like the child to be comfortable in
catheterization to establish further the medical bed. Which position should you put the child to ease
diagnosis of Valvular heart disease. Which of the his discomfort?
following is NOT true as part of Nurse Hanna A. Lying on his side
instructions to the patient regarding this procedure?* B. High-fowler's position
A. Signing of consent is optional C. Prone position
B. Normal procedure is less than 2 hours D. Supine position
C. Fasting should be 8 to 12 hours
D. Presence of pounding sensation in the chest during 83. The Pediatrician ordered theophylline by IV route.
The effect(s) of this drug is __________.* C. Serum gamma glutamyltranspeptidase
A. Decrease gastric acid secretion D. Alkaline phosphatase
B. Causes coronary vasoconstriction 88. Nurse Carl provides important instructions to
C. Relaxes the smooth muscle of the bronchial tree Ms. Rhods on the prevention of Cholelithiasis. Select
D. Stimulation of the peripheral nervous system all that apply.
84. What APPROPRIATE activity should you advise 1. Maintain ideal weight
the child while in the hospital?* 2. Adapt low fat diet
A. Talk on the phone with his classmates adolescent 3. Regular exercise
B. Finish his assignments in school promote rest 4. Prevent pregnancy
C. Watch cartoon movies on TV A. 2, 3, 4
D. Play with his teddy bear promote rest, reserve B. 1, 2, 3
energy C. 1, 3, 4
85. The patient is ready to go home. What health D. 1, 2, 4
teachings can you give to him and to his mother?* 89. Ms. Rhods is prepared for surgery. Nurse Carl
1. Prevent the child from exposure to dust and provides comfort measures to relieve pain with the
pollutants following nursing intervention, EXCEPT _______.
2. Avoid exposure to extreme hot or cold weather A. Quiet environment
3. Increase fluid intake B. Administering analgesic
4. Avoid hyper-allergenic food C. Positioning
A. 1 & 2 Back rub
B. 1, 2, 3, & 4 90. Immediate postoperative care of Nurse Carl
C. 2, 3, 4 includes providing careful instructions to Ms. Rhods.
D. 1 only Which of the following interventions should be
Situation. Rhods, 65 year-old cook, restless and delegated to the caregiver?A. Administration of
obese was brought to the Emergency Room due to intravenous therapy
right abdominal pain, nausea and vomiting for a B. Reinforce information on exercise
week. She frequently changes her position to a more C. T-tube care and changing
comfortable one due to intense pain. You are the D. Instructions for the reduction of pain
nurse in charge who admitted the patient after the Situation. A 6-year old boy is suffering from pain on
attending doctor diagnosed her with Acute his right inguinal region. His mother brought him to
Cholelithiasis. the hospital and was diagnosed to have incarcerated
86. Patient Rhods’s vomiting can be treated with a hernia. He had a scheduled herniotomy.
nasogastric tube insertion with a suction attachment. 91. What will be your FIRST pre-operative nursing
This measure will remove the gastric juice stimulating measure?
painful contractions of the gallbladder which is A. Get informed consent from the mother.
A. Cholecystokinin B. Change the boy’s street clothes to surgical gown
B. Lithotripsy C. Shave the operative site
C. Ecchymosis D. Call the OR nurse for scheduling
D. Acalculus 92. The boy is transferred to the operating room.
87. Patient Rhods, was ordered by the physician to What is the BEST mode to be used in transferring the
undergo several diagnostic tests. You expect that patient?
patient will have an elevation of ________. A. Nurse's carry
A. Bromsulphalein excretion B. Mother's carry
B. Lactate dehydrogenase C. Stretcher
D. Wheelchair B. Obtain majority agreements when issues are
93. The nurse must prepare the OR environment to presented
be safe and comfortable for the child by reducing the C. Include obsessed people as part of your Task force
air conditioning temperature so as to prevent for change
_______ D. Ignore organizational conflict as possible
A. Hypoventilation 98. Decision-making in an organizational structure
B. Hypothermia comes at many levels. The level which is considered
C. Hyperventilation empowering to staff-member is when the unit
D. Hyperthermia manager does which one of the following?
94. The scrub nurse has to prepare for a pediatric A. Makes a decision when she reads the reported
herniotomy. Which of the following should be ready? concerns
A. Subcuticular 3/0 round, absorbable B. Ask direct report from personnel to decide on a
B. Subcuticular 3/0 cutting, absorbable solution
C. Monofilament 3/0 cutting, absorbable C. Makes a decision after convening a core group to
D. Monofilament 3/0 round, absorbable analyze the concerned issues
95. The mother was afraid to submit the child for D. Makes a decision by herself and assumes
surgery. What is the BEST response to the Nurse in responsibility for her action
this situation?A. “It is alright to feel that way but you 99. The nurse manager is receiving some feedback
cannot do anything now.” that one of her staff-nurses has been observed to be
B. “It is the doctor's order; you’ll have to accept the always irritated, “bossy”, and indifferent to her
situation.” patients and some co-workers. Which of the following
C. “Your child’s condition is an emergency case. If he PRIORITY nursing actions should the manager
is not operated on, he will die.” implement?*
D. “I understand your feelings, but your child needs to A. Conduct a joint meeting of both parties involved
be operated on.” B. Request the concerned patients and co-workers to
Situation. The hospital director of a tertiary hospital submit an Incident report
is alarmed with the recent report of the head Human C. Call the nurse concerned and talk to her privately
Resource Department Office (HRDO) that there is so about the observations
much conflict going on among the health care D. Give a memo to the nurse involved
professionals which is affecting quality patient care. 100. A team building session was conducted by the
96. Which of the following is a form of dispute HRDO task force to come up with strategies for
resolution and considered a legal technique which is conflict resolution. Which of the following is a WIN-
outside the court? WIN approach in conflict management?*
A. Suppresion A. Each party involved agree to respond to majority
B. Bribe vote
C. Arbitration B. Each participants agree to resolve conflicts by
D. Negotiation adhering to the Institutional Vision and Mission
97. Change is defined “as making something C. Each participants will give way to 60-40% of their
different from what it was”. If you become a unit agreements
manager in the future, which of the following is your D. Disagreements are settled with respective
FIRST step as an agent in promoting successful compromises on issues presented
change in your health care setting?*
A. Revisit Institutional Vision-Mission and adhere to
its commitment