2. How should the nurse position the patient who is in a somnolent status and still under the

    Effect of anesthesia?

3. When a patient has bleeding after surgery , the PACU nurse expects which color is coming

    from the arterial source?

4. During the immediate post-operative phase , the PRIMARY goal of the healthcare team is to

    maintain ventilation. Which of the following situations should be observed as a result of

    Hypoxemia.

5. When a patient develops a temperature of 39.8 degree centigrade after an abdominal surgery  

    With with an ongoing blood transfusion, the PACU nurse should notify the surgeon as this

    may indicate____

Situation 2- Nurse Sandy is a member of the research team in a cardiovascular health facility. One of the research priority problems in her unit is on the “ effect of personalized care management strategies on stress after an acute myocardial infarction (MI)

6. Nurse Sandy selected a framework which focuses” that humans are in constant relationship with stressors in the environment and that nursing is keeping the patient’s system adjust to

   wellness which is BEST reflected in ______

7. What type sampling will nurse Sandy adopt if every third (3rd) patients with MI are selected

    after a random start?

8. Nurse Sandy distributed the coded questionnaires to the respondents of the study without

    their names on it. What ethical safeguard is being employed in this practice

9. When the findings of the study can be applied to all patients with MI under stress patients in

    the whole philippines , it satisfies which of the following criteria in research?

10. Nurse Sandy has completed the study and started to make a report to the research

  department . A written brief summary is submitted which is known as______.

Situation 3- Communication is a basic competency needed by the nurse in the health care delivery system as a means of building relationships with patients and significant others.

11. Mrs Lim , 52 year old, has been in the hospital for almost a week. She approached nurse

     Alma who was doing her rounds and said” I wish that my children will visit me today” Your BEST response to the patient is ______.

12. Nurse Linda observe that her patient who was just admitted for abdominal pain, looks tense and quite restless. The patient tells the nurse “ I am afraid to undergo the physical examination”. The best response of nurse Linda is_____.

13. Ms Cynthia, a college student is being admitted on and off in the hospital for bronchial

     asthma verbalizes to the nurse” Do you think I should stop attending my classes ? What is

     the BEST response of the nurse?

14. An elderly patient looks depressed, tells the nurse while her blood pressure is being

     taken,”Go away , leave me alone , I don’t want to talk to you anymore “. that, Nurse BEST

    Response is______

15. Patient Alma is receiving insulin injection for her diabetes. She tells the nurse “ I don't want

      to have that insulin injection anymore.” the MOST therapeutic response of the nurse is

      ______.

Situation 4- Nurse Lina is assigned in the Medical ward and has admitted patient Sonia , a 52 year old accountant, who was suspected to have Crohn's disease by her family physician.

16. Nurse Lina should assess the patient for the presence of____

I. Left lower quadrant abdominal pain

II. Diarrhea, relieved by defecation

III. Abdominal tenderness and spasm

IV. Increase in weight

V. Excessive fat in the feces

17. The physician in charge of the patient ordered laboratory and diagnostic studies in order to

     confirm its diagnosis . which of the following examinations is conclusive of the presence of

     Crohn's disease ?

18. During Ms. Sonia hospitalization, she had fever , loose bowel movement with foul smelling

     odor with abdominal pain. Considering these manifestations, Nurse Lina should monitor the

     patient on what specific condition?

19. Ms. Sonia was ordered by her physician to have total parenteral nutrition (TPN) to improve

      her hydration, skin turgor and improve the overall well being of the patient . Which of the

      following nursing measures should nurse Lina implement to facilitate positive patients outcome?

I. Weighing the patient daily

II. Measure intake and output

III. Provide relief of pain & discomforts

IV. Monitor IV infusion rate daily

20. The patient is preparing to go home in a few days. What specific health teachique on HOME

      PARENTERAL NUTRITION (PN) should be given considering the level of education of the

      patient. These include the following EXCEPT _____

Situation 5- In today's nursing practice role has been expanded to include legal responsibilities and accountability in the workplace.

21. Nurse Lina is on duty  at the ER and has been very busy that morning resulting to the

     administration of a penicillin injection which is ordered to another patient. With this error, the

    nurse can be charged of______

22. Transcription of a doctor's order is a nurse’s responsibility to put the order into action. Which

of the following principles of medication safety is NOT considered to belong to transcription error.

23. In order for nurse not to encounter legal problems in drug administration which of the

     following 7 rights of drug administration should be implemented under the category of “Right

     Drug:? Read the label of the drug ______

I.  three (3) times.

II. Before removing from the shelf

III. Before measuring actual dose.

IV. Before opening a unit dose-container.

24. Nurse Edna admits a patient from the ER to the medical unit. The patient is very restless

      with IV lines and a urinary catheter . she was put to bed and the nurse applied a body

      restraint without the doctor’s order. Nurse Edna’s action can be liable for______

25. Ms. Cruz is the supervisor of a hospital on night shift. Several nurses did not report due to

      jeepney strike. When the supervisor is executing proper allocation of nurses to the

     PRIORITY wards to address this concern she is observing that type of principle?

Situation 6- Mr JC 50- year old is having an episode of bronchial asthma and was examined in the ER by a physician and ordered to be admitted.

26. Nurse Tita admitted the patient and was observed to be dyspneic.

      Breath sounds are diminished upon auscultation. Which INITIAL nursing action should she

      implement first?

27. Based on the health history, the patient is working in a cement factory. This occupational hazard can bring about asthmatic trigger as an _____

28. The physician ordered theophylline 300 mg. Per day to relieve a patient's asthmatic attack.

      Which of the following is NOT a mechanism of action of this drug ?

29. Select from the following potential ADVERSE effects of theophylline , the nurse should

      observe when he drug is taken orally ____

30. The patient is preparing to go home with his bronchodilator drugs. He asked the nurse , how

      will I know if the drugs are effective ? her APPROPRIATE response is, there will be in initial

     decreased in ______

Situation 7- Noel, a 67 year old, male , anxious and restless with his condition, was admitted by Nurse Chona is the medical ward due to chronic back pain , general weakness and difficulty of breathing . He was attended by the physician and was tentatively diagnosed with impending respiratory insufficiency secondary to hypoxia.

31. It is important that Nurse Chona records accurately the restlessness caused by pain and that of hypoxia. Which of the following should be recorded as the restlessness caused by pain?

32. Nurse Chona read in one nurse’s notes chart this documentation: “Refused to eat and fell from Bed” which of the following is lacking in this documentation?

33. Charting are important documents that are used in court proceedings, Nurse chona should

      take note that the following entry recorded would be MOST defensible in court?

34. Which of the following charting rules will keep the nurse legally safe ?

I. Documenting worries and all concerns as verbalized by the patient.

II. Charting at the end of the shift only

III. Discussing recorded cases and diagnosis of the patient.

IV. Recording all information verbalized by patient and family

35. Nurse Chona saw patient Noel reading his own chart and question the nurse why (-)

      Smoking and liquor was recorded when he does not smoke and drink alcohol ?

      What is the INITIAL explanation of Nurse chona on the record?

Situation 8- Ethical dilemma is becoming a common scenario in the health care delivery system brought about by the advanced technological changes on health care.

36. Which of the following is an example of an ethical dilemma?

37. A 70- year-old has been rushed to the hospital due to bradycardia and palpitation. The

     The physician suggested that a pacemaker be inserted to correct the symptoms. The patient

     Voluntarily decides not to have the pacemaker inserted. This is respected by the family . this

     is an example of the ethical principle.

38. The ER nurse clarifies the doctor’s prescription on the dose of the pain medication based on

      the pain scale assessment and patient's age. Which ethical principle is applied?

39. Nurse Pat promised to a post - surgical patient , that she would come back to assist in his

      ambulation after carrying out the physician’s order. This follows the principle of_____

40. When a nurse supports the welfare of the patients in relation to health, safety and personal

      Rights, the ethical principle followed is ____

Situation 9- Nurse Dina is caring for several patients in the medical unit mostly suffering from endocrine disorders. Evelyn is a 45 year old government employee who has been diagnosed by their doctor to be suffering from Grave’s disease. Based on her health history she has been having insomnia , palpitation and heat intolerance.

41. A classic finding that Nurse Dina would expect to find in addition to the above complaints which is SPECIFIC to her condition is _____

42. Select the two (2) primary laboratory tests findings ordered by his physician that will confirm

      That patient Evelyn has grave’s disease.

I. Decreased TSH levels

II. Elevated free thyroxine levels

III. Increased TSH levels

IV. Decreased free thyroxine levels

43. Choose from the listed drug therapy that should be administered to Ms. Evelyn in order to

       Inhibit the synthesis of thyroid hormones and block the conversion of T3 and T4

44. While Ms. Evelyn is being prepared physically and psychologically for possible thyroid surgery , her nutritional needs was also being met with a diet that is ____

45. Ms. Evelyn underwent thyroidectomy , six hours after surgery , she complained of numbness of the fingers, toe and twitching of the mouth, this is MOST likely caused by ____

Situation 10 - Mr. Santi, a salesman was admitted because of severe abdominal pain. Based on the data gathered , he smokes and drinks 3-4 bottles of beer every day. He appeared jaundiced, dyspneic with enlarged abdomen. The physician suspected that he has a liver disorder and beginning esophageal varices.

46. Which of the following clinical manifestations is not included in client with hepatic disorder?

47. Liver function test was ordered. In a damaged liver the following tests will reveal-

I. Prothrombin time is prolonged

II. Albumin level is increased

III. Globulin level is decreased

IV. Ammonia level is decreased

48. Mr. Santos esophageal varices bleed. His doctor ordered Sengstaken-Blakemore tube to stop bleeding Two hours after the client developed difficulty breathing. What  PRIORITY action should the nurse undertake?

49. In clients with esophageal varices , which of the following doctor order do you anticipate?

50. Which of the following medications is likely be given to quickly stop bleeding from esophageal varices_____

Situation 11: Mr. Leo, an insurance agent was ordered by his physician to be admitted to the hospital for Coronary Artery Bypass Graft (CABG) due to three vessels blockage.

51. As a nurse, you are aware that cardiac surgery is a source of stress to the patient and family. Which of the following strategies should the nurse implement FIRST to overcome this stress?

52. Mr. Leo, underwent an invasive diagnostic test to determine the location of the blockage which is needed for his CABG. This procedure is _____

53. The nurse is teaching breathing  exercises to Mr .Leo at what phase of the perioperative care is this BEST performed?

54. Which of the following is a blood  thinning drug and temporarily stopped by the physician prior to CABG due to possible bleeding?

55. The nurse formulates a nursing diagnosis “ decreased cardiac output R/T blood loss” which of the following is the HIGHEST priority nursing action?

Situation 12- Venus, 32 year old, a government employee has been having abdominal pain which was on and off for almost 6 months. She has been having flatulence , and recently lost weight because of vomiting. She consulted their office physician and she was suspected to be suffering from chronic pancreatitis. She was advised to be hospitalized for further work-up

56. You were the admitting Nurse when Ms. Venus arrived in the hospital. When doing a comprehensive pain assessment , you should conduct the procedure during the ___

57. When a patient is having pain due to pancreatitis, you expect that the pain is located in the ___

58. You are aware of several manifestations when a patient is in pain. Which of the following is

      behavioral response to pain?

59. When a patient is ordered corticosteroids, which of the following drugs will produce

      therapeutic effects of reducing pain ?

60. When severe vomiting occurs in this patient, it results to what particular condition?

Situation 13- Collaboration and teamwork are critical to the success of health care operations.

61. Which of the following statements is INCORRECT of collaboration in a health care setting?

62. Nurse Lyn received on order from the attending physician of patient Pilar who was having a

      severe abdominal pain of almost a double dose of morphine SO4. The nurse consulted her

      unit manager and the pharmacist regarding the order which was also questioned. The nurse

      called the attention of the physician regarding the dose of the drug and changed the order to

      at an acceptable level, what relevant principle of collaboration is applied in this case?

I. Shared vision

II. Respect and trust

III. Communication

IV. Interpersonal relationship

63. In a tertiary hospital where Gie works as unit manager , an interdisciplinary team model is

      adapted on collaboration of care. With this type of model , how is DECISION making made ?

64. Nurse Ime, is a member of the Quality Assurance team of the hospital and has been always

     rated as very assertive. Which of the following is NOT a characteristic of an assertive

     person?

65. A patient is going for a coronary arterial bypass graft (CABG) due to a 4 blocked arterial

     blood vessels. A surgical team has been formed with the cardiac surgeon as the head . Who

     is the member of the health team that prepares the pre-operative orders for the patient?

Situation 14- Roy , 65 years old, came to the outpatient clinic due to dyspnea fever and on and off productive cough. He has smoked one pack of cigarettes per day for the last 30 years. The doctor ordered a sputum examination , chest xray and blood culture.

66. In collecting sputum specimen, the nurse should instruct Roy to ____

67. When a patient is diagnosed to have pneumonia, the breath sounds detected by the nurse

      on auscultation of the affected area would be _____

68. When there respiratory depression resulting from drug overdose, the nurse have to watch for which  of the following?

Situation 15- Ms. Bel 66 year old consulted the OPD due changes in energy level , fatigue and not able to tolerate performance of activities of daily living . The physician suspected that she has hypothyroid disorder and advised admission for further work-up

69. When the patient is with hypothyroidism, the assessment findings of the nurse that is NOT

      present is _____

70. In assessing the thyroid gland for size, shape, symmetry, consistency and presence of

      tenderness, the MOST appropriate examination modality is _____

71. After several thyroid diagnostic tests , Ms Bel was ordered to take , thyroids hormone

    ( levothyroxine) . which of the following nursing actions is not ADVISABLE in administering

     this drug? The nurse should give ____

72. In monitoring the effectiveness of the drug therapy, which of the following is NOT  expected

      as a POSITIVE patient’s outcome ?

73. The nurse is developing a nursing care plan for Ms. Bel . If the Nursing diagnosis is “ Activity

      intolerance R/T fatigue and depressed cognitive process”. Which of the following is an

      APPROPRIATE intervention?

Situation 17- Resources in the healthcare delivery system are one of the challenging concerns in the country today. Nurse Gayle is a unit manager in a tertiary hospital and conducts meetings regularly every two weeks to her staff to address PRIORITY affecting their services.

74. Which of the following statement indicate an effective communication technique used by the

      unit manager to her staff?

75. For the past 6 months, several nurses have been resigning . some have verbalized in th exit

      interview that they are not happy anymore. Which of the following descriptions manifest

      BEST , a nurse who has job satisfaction

76. Delegation is a critical component of leadership and governance . which of the following

      empowering activities should the unit manager apply in delegation?

77. Nurse Gyle is guided that the initial step of delegation is ____

78. The unit manager is planning to take her regular official business leave for the year. She has

      written a letter of recommendation to her immediate supervisor for her assistant manager to assume her position while she is on leave. This is an

     example of delegation by ______

Situation 17- Nurse adela is on duty in the medical unit and has two patients for discharge. Eliza, 38 years old diagnosed with diabetes mellitus and on insulin therapy for the first time and eileen, 42 years old who had myocardial infarction (MI)

79. When preparing a teaching plan for patient Eliza, the following are the instructions provided

      to patients with diabetes mellitus. Which ONE of the teaching plan is considered NOT a

      PRIORITY concern when discussing the list with the patient

80. Eliza was taught by nurse Adela on how to administer self- injection insulin and rotation sites

      with the use of the chart every day till her discharge. The following is the procedure for the self injection of insulin. Which of the following are the CORRECT Sequence in self administration of the drug.

I. Inject the insulin, push the plunger all the way in

II. With one hand stabilize the skin by spreading a large area

III. Pull the needle straight out of the skin & press cotton ball over injection site

IV. Pick- up syringe with the other hand, hold and insert needle to the skin

V. Dispose syringe in a hard plastic container.

81. The doctor ordered a low- saturated fat ,low-cholesterol diet to patient Eileen who was also

      going home. From the following list of foods, which meals has to be included in the

      instructional plan of Nurse adela to her patient?

82. Considering that patient Eilen is a post MI patient, she was taught by the nurse on home

      Exercises on leg movements while resting on bed. The expected goal of his intervention is

      To______.

83. The resumption of sexual activity is an important activity that has to be included in the home

      instructions to be given to patient Eileen together with her husband .which of the following is

      the SAFE period for an uncomplicated MI to resume sexual activity ?

Situation 18- MO, a 22 years old nurse graduate, passed the November 2018 Philippine Nurse Licensure examination before her birthday which is November 16 . The scheduled oath-taking ceremony was set on January 6, 2019.

84. To obtain her license to practice , she must do the following , EXCEPT:

85. Nurse Marle has to renew her license on or before______

86. For Merle to continually practice nursing, she must satisfy the requirements set by the PRC

      and comply with how many units of CPD upon renewal?

87. After 3 years being assigned in the operating Room, Merle in interested to activity join which

     appropriate professional organization?

88. What would Merle do to keep abreast with the latest trends in perioperative nursing ?

Situation 19 - A computer analyst of a company , was rushed to the emergency room due to abdominal pain, nausea and vomiting, ascites and shallow breathing due to enlarged abdomen. The physician suspected that the patient was suffering from peritonitis and was advised to be admitted for further workout .

89. In assessing a patient suffering from peritonitis , which of the following manifestations is

     NOT likely to be present?

90. The overall goals set by the members of the health team once the patient is admitted includes which of the following?

I. Relief of the abdominal pain

II. Resolution of inflammation

III. Provision of normal nutritional status

IV. Prevention from complications

91. Diagnostic tests were ordered to the patient which included: complete blood count (CBC)

      and abdominal CT scan. The primary purpose for ordering CT scan is to determine

      PRESENCE of ________

92. Which of the following drugs do you expect to be ordered by the physician for severe acute

      Pain?

93. The physician ordered the patient for paracentesis. Which of the following pre- procedure

      nursing actions should the nurse perform EXCEPT ________

Situation 20- Jen is an active member of the quality Assurance (QA) team in a health facility where the major role is setting quality standards .

94. Which of the following statements is TRUE of Quality improvement?

95. As a QA nurse , which of the following can Nurse  adopt as a concurrent evaluation of a

      patient's outcome in the unit?

I. Direct observation of patient’s condition

II. Patient’s interview in the unit

III. Face to face interview with nursing staff.

IV. Nursing audit from the patient’s chart

96. Nurse Jen , distributed the patient satisfaction form to the admitted patients in the hospital,

     this tool is in compliance to the _______quality standards

97. The QA team was alerted by the administration, that they have to anticipate for a possible

      Earthquake in the forthcoming days. As part of safe practice environment (SPE) standards,

      which of the following are to be given PRIORITY attention by the team?

I. Electrical wires

II. Combustible materials of the building

III. Entry , exit of the building

IV. Infected waste materials

98. The QA team has been bombarded by complaints of patients on their long waiting period in the OPD before the health care professionals are examining them. In response to this

        cencern , which type of quality assessment should the team implement?