NURSING PRACTICE V - CARE OF CLIENTS (PART C)

Situation 1 - You are a staff nurse in the Ear Unit of a

government hospital. As such, you are taking care of patients with different ear conditions.

1. Mariel, a 25 year-old radio announcer came in for consult with the chief complaints of not being able to hear well and inability to discriminate sounds he is hearing. An otoscopic examination was done to her, which revealed that there is sensorineural loss. This condition is due to damage to what part

of the ear?

A. Cochlea and auditory ne

A. Cochlea and auditory nerve

2. Which of the following is a predisposing factor for sensory hearing loss?

A. Serous otitis media

B. Ototoxic agents

C. Otosclerosis

D. Perforation of the eardrum

B. Ototoxic agents

3. Which of the following is useful in correcting a sensorineural hearing loss?

A. Nothing, the damage is irreversible

B. Myringotomy

C. Stapedectomy

D. Tympanoplasty

A. Nothing, the damage is irreversible

4. One of your patients underwent tympanoplasty. Which of the following interventions is the MOST APPROPRIATE after a tympanoplasty?

A. Applying ear drops as ordered by the physician

B. Teaching the patient to avoid heavy physical activity for at least three weeks.

C. Rinsing ear three times a day using hydrogen peroxide as ordered

D. Avoiding the use of cotton in cleaning the ears

A. Applying ear drops as ordered by the physician

5. A patient came in with the chief complaints of ringing in the ears and a feeling of whirling around. The attending physician suspects Meneire's Syndrome. To arrive at a correct diagnosis,

the patient must be manifesting these three symptoms: paroxysmal whirling vertigo; tinnitus; and _____________.

A. conductive hearing loss

B. bilateral symptoms

C. vomiting

D. sensorineural hearing loss

D. sensorineural hearing loss

6. What would be your MOST therapeutic response to a manic patient demanding that you call his attending physician to make an order for a pass to go out at the middle of the night?

A. "You go to the recreation hall now while I call your attending physician"

B. "You must really be upset to want a pass immediately. I will give you a medication to make you calm."

C. "I can't call your physician now but you can talk to me about your request to pass."

D. "Don't be unreasonable. I can't call your

C. "I can't call your physician now but you can talk to me about your request to pass."

7. One of your patients lacks food and fluid intake due to poor appetite. What foods would BEST meet the patient's nutritional needs?

A. Steak and spaghetti

B. Peanut butter, sandwich and milk

C. Carrots, celery, raisins, apple

D. Beef and non-diet soda

B. Peanut butter, sandwich and milk

8. During lunchtime you have observed that a patient with mania taking food from other patient. What principle would guide you in determining the appropriate intervention in this situation?

A. the patient needs foods and fluids any way possible

B. The patient will calm down as soon as lunchtime is over.

C. the intrusive behavior of a manic patient is not a threat to other patients.

D. other patients need to be protected from the intrusive behavior of other patients

D. other patients need to be protected from the intrusive behavior of other patients

9. A patient is manifesting some manic depression. Which of the following activities would you provide to distract such patient? *

A. you let the patient go for a walk

B. give him a book to read.

C. let him watch the final game of the UAAP

D. let him play checkers with another patient

A. you let the patient go for a walk

10. What therapeutic activity would you provide a patient with mania?

A. doing ceramics and whittling

B. playing cards and checkers

C. playing bingo and knitting

D. drawing and folding towels

D. drawing and folding towels

Situation 3 - You are a staff nurse in a Rehabilitation Center for Substance Abuse.

11. You admitted an intoxicated patient for alcohol withdrawal. Which of the following interventions should you implement to help the client become sober?

A. have the patient take a cold shower

B. walk the patient around the unit

C. Provide the patient a quiet room to sleep in

D. Give patient a black coffee to drink

C. Provide the patient a quiet room to sleep in

12. While obtaining the history of a patient with several cases of driving under the influence of alcohol, you asked about the amount of alcohol the patient consumes daily. He answered "I just have a few drinks with the guys after work". Which of the following would be your MOST therapeutic response?

A. "That's all the patients here say at first".

B. "You say you have a few drinks, but you have a multiple arrests".

C. "I think you cannot handle a few drinks".

D. "Then you should have somebo

B. "You say you have a few drinks, but you have a multiple arrests".

13. Which of the following assessment data provides the best information on the patient's physiologic response and the effectiveness of the medication prescribed for alcohol withdrawal?

a. sleep pattern

b. evidence of tremors

c. vital signs

d. nutritional signs

A. B and C

B. C and D

C. B, C and D

D. A, B and C

D. A, B and C

14. One of your patients is manifesting signs and symptoms of alcohol withdrawal such as: tremors, diaphoresis, and hyperactivity. Blood pressure is 190/92 mm.Hg and pulse rate of 92 beats/min. which of the following medications should you

expect to be ordered for this patient?

A. Lorazepam (Ativan)

B. Naloxone (Narcan)

C. Haloperidol (Haldol)

D. Benztropin(Cogentin)

A. Lorazepam (Ativan)

15. A patient discharged from an alcohol rehabilitation

program was on Clonazepam (Klonopin) 0.5 mg. three times a day. Several months later he reported having insomnia, shakiness, sweating, and one seizure. Which of the following questions should you ask FIRST? Ask if he _____________.

A. has stopped taking the Klonopin suddenly

B. has been drinking alcohol with the Klonopin

C. has developed tolerance to the Klonopin and needs to increase the dose.

D. is having a panic attack and needs to

A. has stopped taking the Klonopin suddenly

Situation 4 - You are a staff nurse in the Eye Unit of the hospital. In the regular Quality Circle meeting one of the matters discussed was the increasing complaints of patients who underwent eye surgery in relation to instillation of eye drops. The case of Claudia who has cataract surgery was presented as a frame of reference in the reviewing the procedure on eye drops instillation.

16. Which of the following is the rationale for instilling eye drops to patients who has eye surgery?

A. to he

D. to constrict the patient's pupil

17. You have observed presence of drainage in Claudia's eyes. Which of the following eye solutions would you use in cleaning her eyes?

A. hydrochloric acid

B. Normal saline solution

C. Mineral water

D. Soapsuds solutions

B. Normal saline solution

18. In instilling the eye drops you have to tilt the back slightly Claudia's head. Which of the following is the rationale for this nursing action?

A. to prevent any spill from the eye during the procedure

B. to keep any debris away from the lacrimal duct.

C. to facilitate the procedure.

D. to reach the conjunctival sac easily

D. to reach the conjunctival sac easily

19. You accidentally touch Claudia's eyelid during eye drop instillation causing her to blink. What should have you done to prevent this from occurring?

A. Touch the inner side of the medicine cap

B. Tilt back Claudia's head slightly

C. Hold the dropper close to the eye but do not allow the medication to fall into the cornea.

D. Have Claudia look up and focus on something

D. Have Claudia look up and focus on something

20. You cannot open Claudia's eyes due to dried crust. Which of the following actions would you do?

A. Apply the eye drops the next day

B. Apply eye ointment to soften the crust.

C. Instill eye drops

D. Place a warm wet wash cloth over her eyes for at least three minutes

D. Place a warm wet wash cloth over her eyes for at least three minutes

Situation 5 - Nurse Fatima who is on-duty in a psychiatric unit is assigned to care for patients at-risk for suicide.

21. Nurse Fatima should pursue assessment of suicide risk for individuals who display tendencies to be _____________.

A. Compulsive, obsessive, or weak

B. risk-taking, aggressive, or controlling

C. hostile, impulsive, or depressed

D. blaming, abusive, or confused

C. hostile, impulsive, or depressed

22. On admission, the nursing diagnosis for Gringo, who is depressed and suicidal is, "Risk for suicide." An appropriate outcome for this diagnosis at discharge from the hospital is, "The patient will _____________.

A. not harm self while hospitalized

B. be able to problem-solve effectively

C. increase feelings of self-worth

D. develop a trusting relationship with the nursing staff

B. be able to problem-solve effectively

23. Which of the following statements would BEST represent Nurse Fatima's attempt to assess a patient's current ability to organize and enact a suicide wish?

A. "What is your educational background?"

B. "What plan do you have for committing suicide?"

C. "Have you ever thought about hurting yourself?"

D. "Are your self-destructive thoughts frequent?"

B. "What plan do you have for committing suicide?"

24. A male suicidal patient is found by Nurse Fatima as he tries to hang himself in the bathroom. What nursing intervention would address the patient's need for safety while maintaining his self-esteem?

A. Advise him to use the bathroom only with staff supervision.

B. Tell him that the police is coming to rescue him.

C. Place him in the seclusion room with 15-minute checks.

D. Assign a nursing staff to remain with him all times

C. Place him in the seclusion room with 15-minute checks.

25. In evaluating the effectiveness of the care provided for a self-destructive patient, the BEST approach is to __________.

A. modify the plan as little as possible to avoid confusing the patient.

B. make sure the staff has followed the original care plan.

C. involve the patient in the process of evaluation.

D. identify maladaptive coping behaviors

C. involve the patient in the process of evaluation.

Situation 6 - The nurse's work environment plays a vital role in her ability to provide quality patient care. Inadequate resources in health care and unhealthy conditions in the workplace result to nurse's work stress.

26. Burnout is a phenomenon that is BEST characterized by

_____________.

A. emotional exhaustion: depersonalization: and reduced personal accomplishment

B. growing dissatisfaction among nurses due to changing career expectations.

C. increased absenteeism and fast turnover o

A. emotional exhaustion: depersonalization: and reduced personal accomplishment

27. A common response to unhealthy work environment is physical tension. This can be overcome by progressive muscle

relaxation which basically involves __________.

A. focusing on an image to relax

B. active physical exercise like aerobics

C. releasing muscles from tension.

D. listening to a relaxation audio program

C. releasing muscles from tension

28. Bio-behavioral interventions are being used increasingly by both nurses and patients in stress management. The following are examples of such intervention except ___________.

A. progressive muscle relaxation

B. pharmacotherapy

C. guided imagery

D. mindful meditation

B. pharmacotherapy

29. Ace, a young overweight nurse, is making five to ten sticks

of cigarettes a day. He claimed that he learned to smoke to

relieve his stress caused by toxic assignments in the ward.

Along with the smoking he became a stress-eater. He decided

to undergo a lifestyle modification which begins with

____________.

A. eating the right kind of foods

B. a recognition of the impact of unhealthy habits

C. doing a regular daily exercise.

D. a constructive and positive attitude in life

B. a recognition of the impact of unhealthy habits

30. Ace is a well-informed nurse on the smoking cessation program of the Department of Health. As a next step to his decision to stop smoking, Ace needs ___________.

A. commitment

B. motivation

C. information

D. skills to implement change

B. motivation

Situation 7 - Mrs. Andrea Santos, a 43-year old female came in for consult with the chief complaint of severe pain of both eyes. She claimed she sometimes sees rainbow halos around light. She also experiences nausea and vomiting, the attending

physician gave an impression of Acute Angle-Closure

Glaucoma.

31. In assessing Mrs. Santos, what demographic data is/are RELEVANT to ocular movement?

A. gender

B. age at menarche

C. age and gender

D. Race

C. age and gender

32. An ophthalmoscopic examination was done to Mrs. Santos. The following results are expected EXCEPT ____________.

A. nonreactive pupil

B. corneal cloudiness

C. erythematous conjunctiva

D. decreased intraocular pressure

D. decreased intraocular pressure

33. Vision loss for Mrs. Santos may progress as days go by and this is irreparable. An appropriate nursing diagnosis would be ___________.

A. disturbed sensory perception related to severe pain

B. risk for ineffective therapeutic regimen

C. disturbed sensory perception related to recent loss of vision.

D. grieving related to loss of vision

D. grieving related to loss of vision

34. Select the medication that should be discussed by the nurse with the attending physician before administering it to Mrs. Santos.

A. Isoptocarpine eyedrops

B. Corticosporin ophthalmic

C. Mannitol

D. Atropine

D. Atropine

35. In a medically-managed patient with glaucoma,

independent self-care is the area for evaluation. Which of the following is a short-term outcome for Mrs. Santos?

A. ability to recognize clinical manifestations of complications

B. Mrs. Santos' self-care ability

C. Compliance with the medical management

D. Mrs. Santos ability to instill eye drops

D. Mrs. Santos ability to instill eye drops

Situation 8 - Marites is a beginning nurse in a government hospital. She still needs enhancement of her competencies in charting.

36. Marites should know that in narrative charting,

documentation of patient care should be ____________.

A. Extensive

B. Formatted

C. Chronologic

D. Descriptive

C. Chronologic

37. Which statement is NOT true about medical record that Marites must understand. Charts _____________.

A. Contents must be kept confidential

B. Can be borrowed by any nursing student

C. Can be accessed by a researcher.

D. Can be given out only with patient's consent

B. Can be borrowed by any nursing student

38. The following are methods of charting, EXCEPT

__________.

A. Sequential

B. Narrative

C. POMR

D. Focus

A. Sequential

39. In a PIE method of charting, P is for needs, EXCEPT

___________.

A. Admission

B. Problem

C. Teaching

D. Discharge

A. Admission

40. In charting neurologic assessment, Marites must

understand that the following should be indicated. SELECT all that apply.

1. Orientation

2. Pupil movement

3. Sensation

4. Quality of speech

A. 3 and 4

B. 1 and 2

C. 1, 2, 3, and 4

D. 1, 3, and 4

D. 1, 3, and 4

Situation 9 - One of your programs as a community health nurse is related to substance abuse addiction. You spearheaded an educational collaborative activity to address the increasing drug and alcohol problems in the community. A multi-sectoral

committee was formed, and an initial organizational committee meeting was held. The following questions apply to this situation.

41. To motivate and spark the interest of prospective

participants in the proposed program, which of the following activit

A. Lecture-forum on alarming dangers of drug and alcohol use

42. To assess the prevalence and incidence of substance abuse, a community survey was done by the barangay health workers. Using purposive sampling, what age group is at MOST risk to

be considered as the survey respondents?

A. Pre-schoolers

B. Older adults

C. Older Children

D. Adolescents

D. Adolescents

43. A self-help support group for educational and caring approach for alcoholics is:

A. Halfway homes

B. Psychiatric treatment and rehabilitation centers

C. Alcoholic Anonymous

D. Detoxification treatment programs

C. Alcoholic Anonymous

44. The LEAST effective education and preventive measure for drug abuse is:

A. Activity workshops for out of school youths

B. Family enrichment programs

C. Regular advocacy meetings to include families, store, restaurant, bar owners

D. Leaflets and brochures for mass distribution

D. Leaflets and brochures for mass distribution

45. The committee organized parent education classes. A representative from the local police department was invited to discuss:

A. Stress management

B. Parent effectiveness training

C. The legal implications of illicit drug use

D. Recognition of deviant child and adolescent behavior

C. The legal implications of illicit drug use

Situation 10 - As a beginning professional nurse one of the competencies expected of you is to engage in research. Basic knowledge in research, therefore, is very important. The following questions related to these statements.

46. What element distinguishes a true experimental research from a quasi-experimental research?

A. The use of non-probability sampling

B. Lack of random assignment of subject to group

C. Size of the sample

D. The introduction of experimental treatment

B. Lack of random assignment of subject to group

47. You want to determine the effect of a planned exercise on low-back pain. Which of the following research designs would be MOST APPROPRIATE to use in this study?

A. Posttest only control group design

B. One-shot case study

C. Pretest-posttest control group design

D. One group pretest-posttest design

C. Pretest-posttest control group design

48. Which of the following is a type of probability sampling?

A. Cluster

B. Purposive

C. Quota

D. Convenience

A. Cluster

49. You want all people who are currently institutionalized for psychiatric problems to participate in your study. This is an example of ____________.

A. Universal population

B. Target population

C. Element

D. Sample

B. Target population

50. You want to determine the difference of the anxiety level between male and female patients scheduled for abdominal

surgery. The first 30 males and the first 30 females who are admitted to the hospital at the time of the study would be asked as study participants. This is an example of what sampling technique?

A. Fish ball technique

B. Simple random

C. Quota sampling

D. Purposive sampling

C. Quota sampling