Situation As you begin to work in the hospital where you are on probation, you are tasked to take care

of a few patients. The clients have varied needs and you are expected to provide care for them. 1. An ambulatory client. Mr. osimo, is being prepared for bed. !hich of the following nursing actions promote safety for the client" A. Turning off the lights to promote rest and sleep #. $nstructing the client about the use of call system %. &aising the side rails '. (lacing the bed in high position ). Mikka, a )* year old female client, is admitted with right lower +uadrant abdominal pain. Thephysician diagnosed the client with acute appendicitis and an emergency appendectomy wasperformed. Twelve hours following surgery, the patient complained of pain. !hich of thefollowing is the most appropriate nursing diagnosis" A. $mpaired mobility related to pain secondary to an abdominal incision #. $mpaired movements related to pain due to surgery %. $mpaired mobility related to surgery '. Severe pain related to surgery ,. -ou are preparing a plan of care for a client who is experiencing pain related to incisional swelling following laminectomy. !hich of the following should be included in the nursing care plan" A. .ncourage the client to log roll when turning #. .ncourage the client to do self/care %. $nstruct the client to do deep breathing exercises '. Ambulate the client in ward premises every twenty minutes 0. Mr. 1o2ano, *3 year old executive, is recovering from severe myocardial

infarction. 4or the past , days, Mr. 1o2ano5s hygiene and grooming needs have been met by the nursing staff. !hich of the following activities should be implemented to achieve the goal of independence for Mr. 1o2ano" A. $nvolving family members in meeting client5s personal needs #. Meeting his needs till he is ready to perform self/care %. (reparing a day to day activity list to be followed by client '. $nvolving Mr. 1o2ano in his care *. Mr. .rnest 1ope2 is terminally ill and he choose to be at home with his family. !hat nursing action are best initiated to prepare the family of Mr. 1ope2" A. Talk with the family members about the advantage of staying in the hospital for proper care #. (rovide support to the family members by teaching ways to care for their loved one %. %onvince the client to stay in the hospital for professional care '. Tell the client to be with his family Situation 6 7 Myrna, a researcher, proposes a study on the relationship between health values and the health promotion activities of staff nurses in a selected college of nursing. 6. $n both +uantitative and +ualitative research, the used of a frame of reference is re+uired. !hich of the following items serves as the purpose of a framework" A. $ncorporates theories into nursing5s body of knowledge #. 8rgani2es the development of study and links the findings to nursing5s body of knowledge %. (rovides logical structure of the research findings

'. $dentifies concepts and relationships between concepts 9. Myrna need to review relevant literature and studies. The following processes are undertaken in reviewing literature .:%.(T; A. locating and identifying resources %. clarifying a research topic #. reading and recording notes '. using the library <. The primary purpose for reviewing literature is to; A. organi2e materials related to the problem of interest #. generate broad background and understanding of information related to the research problem of interest %. select topics related to the problem of interest '. gather current knowledge of the problem of interest <. $n formulating the research hypotheses, researcher Myrna should state the research +uestion as; A. !hat is the response of the staff nurses to the health values" #. =ow is variable >health value? perceived in a population" %. $s there a significant relationship between health values and health promotion activities of the staff nurses" '. =ow do health values affect health promotion activities of the staff nurses" @. The proposed study shows the relationship between the variables. !hich of the following is the independent variable" A. Staff nurses in a selected college of nursing #. =ealth values %. =ealth promotion activities '. &elationship between health values and health promotion activities

Situation 9 7 !hile working in a tertiary hospital, you are assigned to the medical ward. 13. -our client, Mr. 'ia2, is concerned that he can not pay his hospital bills and professional fees. -ou refer him to a; A. Aurse supervisor %. bookkeeping department #. Social worker '. physician 11. Mr. Magno has lung cancer and is going through chemotherapy. =e is referred by the oncology nurse to a self/help group of clients with cancer to; A. receive emotional support %. provide financial assistance #. to be a part of a research study '. assist with chemotherapy 1). A diabetic hypertensive client, Mrs. 1inao, needs a change in diet to improve her health status.She should be referred to a; A. nutritionist %. physician #. dietitian '. medical pathologist 1,. !hen collaborating with other health team members, the best description of Aurse &ita5s role is; A. encourages the client5s involvement in his care #. shares and implements orders of the health team to ensure +uality care %. she listens to the individual views of the team members '. helps client set goals of care and discharge 10. Aurse &ita is successful in collaborating with health team members about the care of Mr. 1inao. This is because she has the following competencies; A. %ommunication, trust, and decision making #. %onflict management, trust, negotiation %. Aegotiation, decision making '. Mutual respect, negotiation and trust

Situation < 7 The practice of nursing goes with responsibilities and accountability whether you work in a hospital or in the community setting you main obBective is to provide safe nursing to your clients" 1*. To provide safe, +uality nursing care to various clients in any setting, the most important tool of the nurse is; A. critical thinking to decide appropriate nursing actions #. understanding of various nursing diagnoses %. observation skills for data collection '. possession of in scientific knowledge about client needs 16. -ou ensure the appropriateness and safety of your nursing interventions while caring for various client groups by; A. creating plans of care for particular clientele #. identifying the correct nursing diagnoses for clients %. making a thorough assessment of client needs and problems '. using standards of nursing care as your criteria for evaluation 19. The effectiveness of your nursing care plan for your clients is determined by A. the number of nursing procedures performed to comfort the client #. the amount of medications administered to the client as ordered %. the number of times the client calls the nurse '. the outcome of nursing interventions based on plan of care 1<. -ou are assigned to Mrs. Amado, age 0@, who was admitted for possible surgey. She complained of recurrent pain at the right upper +uadrant of the abdomen 1/) hours after ingestion of fatty food. She also had fre+uent bouts of di22iness, blood pressure of 193C133,

hot flashes. !hich of the above symptoms would be an obBective cue" A. #lood pressure measurement of 193C133 #. %omplaint of hot flashes %. &eport of pain after ingestion of fatty food '. %omplaint of fre+uent bouts of di22iness 1@. !hile talking with Mrs. Amado, it is most important for the nurse to; A. schedule the laboratory exams ordered for her #. do an assessment of the client to determine priority needs %. tell the client that your shift ends after eight hours '. have the client sign an informed consent Situation @ 7 8ral care is an important part of hygienic practices and promoting client comfort. )3. An elderly client, <0 years old, is unconscious. Assessment of the mouth reveals excessive dryness and presence of sores. !hich of the following is #.ST to use for oral care" A. lemon glycerine %. Mineral oil #. hydrogen peroxide '. Aormal saline solution )1. !hen performing oral care to an unconscious client, which of the following is a special consideration to prevent aspiration of fluids into the lungs" A. (ut the client on a sidelying position with head of bed lowered #. Deep the client dry by placing towel under the chin %. !ash hands and observe appropriate infection control '. %lean mouth with oral swabs in a careful and an orderly progression )). The advantages of oral care for a client include all of the following, .:%.(T; A. decreases bacteria in the mouth and teeth #. reduces need to use commercial mouthwash which irritate the buccal mucosa

%. improves client5s appearance and self/ confidence '. improves appetite and taste of food ),. A possible problem while providing oral care to unconscious clients is the risk of fluid aspiration to lungs. This can be avoided by; A. %leaning teeth and mouth with cotton swabs soaked with mouthwash to avoid rinsing the buccal cavity #. swabbing the inside of the cheeks and lips, tongue and gums with dry cotton swabs %. use fingers wrapped with wet cotton washcloth to rub inside the cheeks, tongue, lips and ums '. suctioning as needed while cleaning the buccal cavity )0. -our client has difficulty of breathing and is mouth breathing most of the time. This causes dryness of the mouth with unpleasant odor. 8ral hygiene is recommended for the client and in addition, you will keep the mouth moistened by using; A. salt solution %. petroleum Belly #. water '. mentholated ointment Situation 13 7 .rrors while providing nursing care to patients must be avoided and minimi2ed at all time. .ffective management of available resources enables the nurse to provide safe, +uality patient care. )*. $n the hospital where you work, increased incidence of medication error was identified as the number one problem in the unit. 'uring the brainstorming session of the nursing service department, probable causes were identified. !hich of the following is process related" A. interruptions %. lack of knowledge #. use of unofficial abbreviations '. failure to identify client

)6. Miscommunication of drug orders was identified as a probable cause of medication errors. !hich of the following is safe medication practice related to this" A. Maintain medication in its unit dose package until point of actual administration #. Aote both generic and brand name of the medication in the Medication Administration Method %. 8nly officially approved abbreviations maybe used in prescription orders '. .ncourage clients to ask +uestion about their medications. )9. The hospital has an ongoing +uality assurance program. !hich of the following indicates implementation of process standards" A. The nurses check client5s identification band before giving medications #. The nurse reports adverse reaction to drugs %. Average waiting time for medication administration is measured '. The unit has well ventilated medication room )<. !hich of the following actions indicate that Aurse Eerome is performing outcome evaluation of +uality care" A. $nterviews nurses for comments regarding staffing #. Measures waiting time for client5s per nurse5s call %. %hecks e+uipment for its calibration schedule '. 'etermines whether nurses perform skin assessment every shift )@. An order for a client was given and the nurse in charge of the client reports that she has no experience of doing the procedure before. !hich of the following is the most appropriate action of the nurse supervisor" A. Assign another nurse to perform the procedure #. Ask the nurse to find way to learn the procedure

%. Tell the nurse to read the procedure manual '. 'o the procedure with the nurse Situation 11 7 Mr. Eose5s chart is the permanent legal recording of all information that relates to his health care management. As such, the entries in the chart must have accurate data. ,3. Mr. Eose5s chart contains all information about his health care. The functions of records include all except; A. means of communication that health team members use to communicate their contributions to the client5s health care #. the client5s record also shows a document of how much health care agencies will be reimbursed for their services %. educational resource for student of nursing and medicine '. recording of actions in advance to save time ,1. An advantage of automated or computeri2ed client care system is; A. The nursing diagnoses for a client5s data can be accurately determined #. %ost of confinement will be reduced %. $nformation concerning the client can b easily updated '. The number of people to take care of the client will be reduced ,). $nformation in the patient5s chart is inadmissible in court as evidence when; A. The client5s family refuses to have it used #. The client obBects to its use %. The handwriting is not legible '. $t has too many abbreviations that are >unofficial? ,,. Aursing audit aims to; A. provide research data to hospital personnel #. study client5s illness and treatment regimen closely %. compare actual nursing done to established standards

'. provide information to health/care providers ,0. A telephone order is given for a client in your ward. !hat is your most appropriate action" A. %opy the order on to the chart and sign the physician5s name as close to his original signature as possible #. &epeat the order back to the physician, copy onto the order sheet and indicate that it is a telephone order %. !rite the order in the client5s chart and have the head nurse co/sign it '. Tell the physician that you can not take the order but you will call the nurse supervisor Situation 1) 7 Aurse &o+ue, a newly hired nurse, is asked to take over an absent nurse in another unit. She will take care of clients with various conditions. ,*. !hich of the following client conditions should be Miss &o+ue5s priority in the pediatric unit" A. The baby whose fantanelle is bulging and firm while asleep #. The infant who is brought in for upper respiratory tract infection whose temperature is slightly elevated %. A baby who is wailing after being awakened by the banging door '. A baby boy whose circumcision has yellowish exudate ,6. !hen suctioning the endotracheal tube, the nurse should; A. .xplain procedure to patientF insert catheter gently applying suction. !ithdrawn using twisting motion #. $nsert catheter until resistance is met, then withdraw slightly, applying suction intermittently as catheter is withdrawn %. =yperoxygenate client insert catheter using back and forth motion '. $nsert suction catheter four inches into the tube, suction ,3 seconds using twirling motion as catheter is withdrawn

,9. Aurse &o+ue is giving instructions to 'oris, the daughter of a comatose patient, to give a sponge bath. !hile 'oris is doing spone bath, what action of 'oris needs correction" A. Answering the phone while wearing gloves used for sponge bath #. &olling the patient like a log to do back rub %. 1ining the rubber mat with bed sheet as incontinence pad for the patient '. Turning the patient on the left side with head slightly elevated ,<. 'ina sustained a fracture of the ulna and a cast will be applied. !hat nursing action before cast application is most important for Aurse &o+ue to do" A. Gse baby powder to reduce irritation under the cast #. Assess sensation of each arm %. .valuate skin temperature in the area '. %heck radial pulses bilaterally and compare ,@. To obtain specimen for sputum culture and sensitivity, which of the following instruction is best" A. Gpon waking up, cough deeply and expectorate into container #. %ough after pursed lip breathing %. Save sputum for two days in covered container '. After respiratory treatment, expectorate into a container Situation 1, 7 $nfections are +uite commonly the reasons for a client5s hospitali2ation. Appropriate interpretation of diagnostic tests and measures for infection control are helpful in the management of patient care. 03. 'orothy underwent diagnostic test and the result of the blood examination are back. 8n reviewing the result the nurse notices which of the following as abnormal finding"

A. Aeutrophils 63H #. !hite blood cells I!#%J @333Cmm %. .rythrocyte sedimentation rate I.S&J is ,@ mmChr '. $ron 9* mgC133 ml *3. Surgical sepsis is observed when; A. inserting an intravenous catheter #. disposing of syringes and needles in puncture proof containers %. washing hands before changing wound dressing '. placing dirty soiled linen in moisture resistant bags *1. A client with viral infection will most likely manifest which of the following during the illness stage of the infection" A. %lient was exposed to the infection ) days ago but without any symptoms #. 8ral temperature shows fever %. Acute symptoms are no longer visible '. %lient >feels sick? but can do normal activities *). !hich of the following laboratory test result indicate presence of an infectious process" A. .rythrocyte sedimentation rate I.S&J 1) mmChr #. !hite blood cells I!#%J 1<,333Cmm, %. $ron @3 gC133ml '. Aeutrophils 69H *,. Among the clients you are assigned to take care of, who is the most susceptible to infection" A. 'iabetic client %. client with pulmonary emphysema #. %lient with burns '. client with myocardial infarction Situation 10 7 -ou are a newly hired nurse in a tertiary hospital. -ou have finished your orientation program recently and you are beginning to assimilate the culture of the profession.

*0. Gsing #enner5s stages of nursing expertise, you are a beginning nurse practitioner. -ou will rank yourself as aCan; A. competent nurse %. proficient nurse #. novice nurse '. advanced beginner

Situation 1.Community Health Nursing is a unique blend of nursing and public health practice woven into a human service that properly developed and applied has a tremendous impact on human well being.

of empowering people in the community" a. %ommunity development may allow women to discover and strengthen their innate capabilities to enBoy and utili2e e+ual opportunities in all aspects of development work b. Sustainability aspects of development strategies can be taken into consideration c. %ommunity development is solely confined to the meeting of the day to day survival of the people d. %ommunity development is a learning process where both women and men participate to improve their lives 0. $f a particular health service fails, the most basic +uestion is; a. $s this what the people demanded" b. !hat went wrong" c. $s this what the people need" d. !ho is responsible for the failure" *. !hich of the following statement is correct" a. $f people are not attending to the services offered by the health staff, the team must reassess the needs of the people b. $n participatory approach, the nurse must devotedly adhere to what the people want c. $n a peasant community where people are fighting for land ownership, the nurse must not participate as this is not a health concern d. Aurses must not Boin protest actions as nurses should always be neutral at all times Situation 2. Nurse Sid, a public health nurse, prepares a community health nursing care plan utili ing the nursing process,

1. The primary goal of %ommunity =ealth Aursing is to; a. Support and supplement the efforts of the medical professions in the promotion of health and prevention of illness b. .nhance the capacity of individuals, families and communities to cope with their heath needs c. $ncrease the productivity of the people d. &aise the level of health of the citi2enry ). The context of %ommunity =ealth Aursing is based on the nurseKs evaluation about the; a. .xisting health problems and needs of the people b. %urrent health status of the people c. 'epartment of =ealth I'8=J goals d. 'evolution of health ,. %ommunity =ealth Aursing is a speciali2ed field of nursing that follows the basic principles in %ommunity 'evelopment work. !hich of the following statements best described %ommunity 'evelopment as a process

which is responsive to the health promotion needs of the community.

6. To obtain a 133H population count of the community, Aurse Sid should need to do a; a. Survey b. 8ne to one interview c. %ensus d. Sampling of the population 9. !hich of the following is a well/stated obBective in a community health nursing care plan" a. To increase the number of mothers coming for prenatal check/up by )*H in 6 months time b. To increase the number of home visits by *3H c. To increase the coverage for immuni2ation in 1 year time d. To increase the number of children receiving food assistance <. $dentification of health risks in the community is a step in formulating a community health diagnosis. !hich of the following methods Aurse Sid should do to best facilitate the identification of health risks threatening the community" a. Assess community resources and industries available b. 4amiliari2e with the prevalent lifestyle of the people within the community c. Study health center records and reports d. &eview of vital statistics available @. The community health diagnosis is an important input to the formulation of a community health nursing care plan. $n order to assure a successful implementation of the care plan, the diagnosis must be carried out in a manner where;

a. An outside consultant determines what data to collect b. The community is directly involved in data collection and analysis c. The nurse delegates the collection of data to the barangay health workers d. All the members of the rural health unit participates in data collection 13. !hich criterion in priority setting of health problems is used only in community health care" a. Magnitude of the health problem b. (reventive potential of the health problem c. Aature of the problem presented d. Modifiability of the problem Situation !."he application of the nursing process is rational method of planning and providing nursing care. #s basic tool in professional nursing practice, its utili ation ensures competent and safe practice. $t is a scientific tool that is utili ed also in Community Health Nursing.

11. !hich of the following is %ommunity =ealth Aursing Assessment" a. Auditing Aursing &ecord b. Monitoring health services c. (rioriti2ing needs d. $ntensive fact/finding 1). !hen the nurse invites other members of the nursing team to develop evaluation parameters, this process is called; a. $nterpreting data b. Tabulating data c. (lanning nursing action d. (utting plan of action 1,. !hen the nurse performs

appraisals, this process is called; A. Assessment %..valuation #. (lanning '. 'iagnosing

A. Gpon admission of the client in the health care system #. Gpon discharge of the client from the health care system %. After the clientKs condition stabili2es physical

10. 8nce the nurse initiates contact with a client, asking +uestions to gather data, this process is called; A. $mplementation %. (lanning #. .valuation '.Assessment

'. Soon after the client had re+uested for rehabilitation services

1*. !hen the &=G nurse provides health teaching to individuals or families, this process is called; A. $ntervention %.Assessment #. (lanning '. .valuation

1<. The factor in the ecosystem affecting the individuals health that is involved in the provision of essential health services whether community/based, accessible, sustainable and affordable is the; A. Socio/economic influences #. =ealth %are 'elivery System %. #ehavioral '. (olitical

Situation %. "here are several factors in the ecosystem which affect the optimum level of functioning &'(')* of individuals, families and communities. "he nurse must be +nowledgeable on this.

16. The modern concept of health refers to; A. =ow individuals maintain a maximum level of wellness #. =ow individuals can be called disease/free %. =ow individuals avoid diseases '. =ow individuals can avail of their immune system

1@. The factor in the ecosystem affecting the individualKs health that is involved in the menace of pollution, basically man/made, is; A. #ehavioral #. Socio/economic %. .nvironmental influences '. =ealth %are 'elivery System

19. $n the =ealth %are 'elivery System, ideally, rehabilitation services begin;

)3. !hich is not an example of behavioral influences in 8184 on health status" A. %igarette smoking and alcohol drinking

#. .xposure to toxic substances in the workplace %. worker '. A grandmother with an adult/ onset diabetes )1. According to 'r. %... !inslow, which of the following is the goal of (ublic =ealth" A. 4or promotion of health and prevention and diseases #. 4or people to be organi2ed in their health efforts %. 4or people to have access to basic health services '. 4or people to attain birthrights and longevity their Sedentary lifestyle of an office

#. (ublic health nursing focuses on preventive, not curative services %. The public health nurse functions as part of a team providing a public health nursing service '. Services are provided free of charge to people within the catchment area

)0. The public health nurse is the supervisor of rural health midwives. !hich of the following is a supervisory function of the public health nurse" A. &eferring cases or patients to the midwife #. (roviding technical guidance to the midwife %. (roving nursing care to cases referred by the midwife '. 4ormulating and implementing training programs for midwive

)). According to 'r. Margaret Shetland, the philosophy of public health nursing is based on which of the following" A. The worth and dignity of man #. The mandate of the state to protect the birthrights of its citi2ens %. =ealth and longevity as birthrights '. (ublic health nursing speciali2ed field of nursing as a

)*. Lualifications to be a public health nurse includes which of the following; 1. Mood physical and mental health ). #SA graduate ,. &egistered nurse

),. !hich of the following is the most prominent feature of public health nursing" A. $t involves providing home care to sick people who are not confined in the hospital

0. Masters degree in Aursing *. , years experience as a %linical $nstructor

A. 1, ) and ,

%. 1, 0 and *

#. 1, , and 0

'. ), , and 0

=ealth %are in the (hilippines is; A. &.A. 9163 %. &.A. <0), #. 18$ @0@ '. &.A. @)**

Situation ,. -rimary Health Care as an approach to delivery of health care services )6. !hich one is the goal of (rimary =ealth %are in the (hilippines" A. &eorientation and reorgani2ation of the national health care system with the establishment of functional support mechanism #. .ssential health care made universally accessible, acceptable, available, and affordable to all %. =ealth for all 4ilipinos and health in the hands of the people by the year )3)3 '. To strengthen the health care system, let the people manage their own health care

)@. !hich of the following is not a corner stone of (rimary =ealth %are" A. Support mechanisms made available #. Active community participation %. $ntra and intersectoral solicitation linkages '. Gse of appropriate technology

,3. !hich does not describe (rimary =ealth %are" A. $t emphasi2es partnership between health care providers and the people #. $t is a total approach community development to

)9. The mission of (rimary =ealth %are refers to which of the following" A. To strengthen the health care system, let the people manage their own health care #. Muarantee e+uitable, sustainable and +uality health for all 4ilipinos, especially the poor, and shall lead the +uest for excellence in health %. =ealth for all by the year )3)3 '. =ealth for all 4ilipinos and health in the hands of the people by the year )3)3

%. $t stresses the importance of linkages '. $t aims to provide free health services to the people

)<. The law that provided mandate for the implementation of (rimary