Pre-Boards 2: Nursing Practice 1 PDF

PRE-BOARDS 2: NURSING PRACTICE I 1. In designing a care plan, which modifiable risk factors have to be emphasized to the patient to prevent another heart attack from happening? 1. Smoking 2. High blood pressure 3. High cholesterol 4. Overweight A. 1,2, & 3 B. 3 & 4 C. 1 & 2 D. 1,2,3, 4 Rationale: Smoking, high blood pressure, high cholesterol, and being overweight are all modifiable risk factors that the patient can work on in order to prevent another heart attack. Situation: Ms. Nilda is a new graduate with a Bachelor of Science degree which she acquired from a university. She is determined to pass the National Licensure Examination (NLE) to be administered by the Board of Nursing. 2. The licensure examination which is administered by the Professional Regulation Commission, Board of Nursing is given to _______. A. apply the theory learned from classroom to practice settings B. protect the public from incompetent practitioners C. apply the scope of nursing practice D. demonstrate expected competency standards 3. The PRC-Board of Nursing (PR-BON) has the power to regulate Nursing Practice in the Philippines. The regulatory functions include the following EXCEPT ______. A. enforce and monitor quality standards of nursing practice in the country B. issue, suspend, revoke or reissue certification of registered nurses C. ensure proper conduct of nurses licensure in the country D. issue permit for the opening of nursing programs in the country - CHED Rationale: This is a function of the Commission on Higher Education (CHED) upon the written recommendation of the Board. According to RA 9173, the BON has regulatory functions of A, B, and C. REFERENCE: Republic Act No. 9173 Official Gazette of the Republic of the Philippines 4. Ms. Sanchez is a new nursing graduate and in dire need for the hospitalization of her ailing mother. She is being offered to endorse a detergent product on TV Commercial wearing a mini skirt and plunging neckline shirt. In doing this performance Ms. Sanchez is violating the neckline shirt. In doing this performance Ms. Sanchez is violating the ____. A. Oath of professional for new nurses B. Nursing practice act 7164 C. Code of ethics for nurses D. Core competency standards Rationale: Under Article III Section 11, registered nurses must not allow themselves to be used in advertisement that should demean the image of the profession (i.e. indecent exposure, violation of the dress code, seductive behavior, etc). 5. Nurse Rey with the members of the team from a tertiary hospital is going for their annual outreach program “Operation Tuli”. There were 300 patients who came in the morning with only 4 doctors, 3 nurses and 1 pharmacist. Due to the volume of patients, Nurse Rey was asked to participate in performing circumcision with the rest of the doctors. Nurse Rey can be liable for committing ______. A. Assault - oral threat B. Invasion of privacy C. Tort - legal wrong D. Malpractice performing tasks that are not within his scope are considered malpractice. → Negligence - non-professional 6. Which of the following actions is likely to constitute GROSS Negligence? A. Complied with the request of a bedridden patient not to be turned because of pain. B. A nasogastric feeding is not given on time because the patient is feeling nauseated. C. A patient suffering from bleeding due to a postoperative wound and the Nurse failed to report to the attending physician. D. Urine output that has not been measured because of an emergency admission. Rationale: Elements of negligence: 1. Duty: an individual has a duty to behave in a responsible manner. 2. Breach: a plaintiff must prove that the defendant breached his duty to behave in a responsible or professional manner. 3. Proximate cause: the plaintiff must prove that there were injuries or damages which arose from the breach of duty by the defendant. 4. Harm: the ability to prove you suffered injuries, loss, or other expenses because of the defendant's negligence. REFERENCE: The Four Elements of Negligence Nurse Paralegal USA Situation: Documentation is a basic competency expected of a graduate nurse when performing her role in the clinical setting. 7. Mr. Rey had his insulin therapy on the day of his admission. On the second day he developed allergic reactions after 2 hours of the administration. What clinical manifestations do you expect the nurse to write in her documentation as a reaction to this drug? 1. Redness 2. Swelling 3. Tenderness 4. Induration - pantal A. 1, 2, & 3 B. 2 & 4 C. 1, 2, 3, & 4 D. 1 & 2 Rationale: Complication of insulin therapy include: local allergic reaction (redness, swelling, tenderness, and induration or a 2- to 4-сm wheal) may appear at the injection site 1 to 2 hours after the insulin administration. These reactions, which usually occur during the beginning stages of therapy and disappear with continued use of insulin, are becoming rare because of the increased use of human insulin. The physician may prescribe an antihistamine to be taken 1 hour before the injection if such a local reaction occurs. REFERENCE: Brunner & Suddarth's Textbook of Medical Surgical Nursing 12th edition, p. 1210. 8. Mr. Rey has been anxious regarding his diagnosis as well as the reaction to the insulin therapy. As a nurse, the PRIORITY nursing actions to overcome this anxiety behavior is to _____. A. conduct a family conference for the concern of the patient B. refer to the physician for an order of tranquilizer C. express your empathy and respect for his feelings D. take time to explain his disease process and effects of insulin Rationale: Providing the client with information will help the client in overcoming his anxiety in regards to his diagnosis and insulin therapy. Rationale: Malpractice is also called professional negligence. Since Rey is already a nurse, or a professional, here, PRE-BOARDS 2: NURSING PRACTICE I PRE-BOARDS 2: NURSING PRACTICE I 9. When a patient is suffering from Ketoacidosis, you expect that the entry of Nurse assessment findings in the chart will include the following clinical manifestations EXCEPT ________. A. kussmaul respiration B. cheyne stokes breathing - aka death rattle, present in increased ICP; not r/t ketoacidosis C. lethargy. D. acetone breath odor Rationale: Letters A, C, and D are clinical manifestations of ketoacidosis. Kussmaul respirations represent the body's attempt to decrease the acidosis, counteracting the effect of ketone buildup. In addition, mental status varies widely. The patient may be alert, lethargic, or comatose. Acetone breath odor occurs due to elevated ketone levels. REFERENCE: Brunner & Suddarth's Textbook of MedicalSurgical Nursing 12th edition, p. 1226. Rationale: Appendicitis is when the appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fecalith (ie, hardened mass of stool), tumor, or foreign body. Rovsing's sign may be elicited by palpating the left lower quadrant; this paradoxically causes pain to be felt in the right lower quadrant. Obturator sign is a clinical sign of acute appendicitis, it is defined as discomfort felt by the subject/patient on the slow internal movement of the hip joint, while the right knee is flexed. Psoas sign is elicited by having the patient lie on his or her left side while the right thigh is flexed backward. Blumberg sign, also called rebound tenderness (ie, production or intensification of pain when pressure is released) may be present. REFERENCE: Brunner & Suddarth's Textbook of MedicalSurgical Nursing 12th edition, p. 1076. 10. Nurse Gladys, who is on morning shift, was making her rounds when observed Mr. Joe, who is suffering from Congestive heart failure, complaining of heaviness of his legs. She observed the patient with an edema of his lower extremities. If the edema is 3+, what do expect the nurse to write in her assessment findings? a. Deeper pit, rebounds in 30 seconds. b. Barely the pit is not perceptible. - +1 c. Deeper pit, rebounds in only a few seconds. - +1 d. Deep pit, rebounds in 10-20 seconds. - +2 Rationale: Pitting edema occurs when excess fluid builds up in the body, causing swelling; when pressure is applied to the swollen area, a "pit" or indention, will remain. Usually in the legs, feet, and ankles. GRADING SCALE: → +1 - up to 2mm of depression, rebounding immediately → +2 - 3 to 4mm of depression, rebounding in 15 seconds or less → +3 - 5-6mm of depression, rebounding in 60 seconds → +4 - 8mm of depression, rebounding in 2-3 mins REFERENCE: Pitting Edema: What Is It, Causes, Grading, Diagnosis, Treatment, and More Osmosis 13. After a thorough physical examination, laboratory and diagnostic test the physician ordered an emergency open appendectomy due to suspected ruptured appendicitis. This is done to prevent which of the following MAJOR complications? A. A Thrombosis B. Sepsis C. Perforation D. Bleeding Rationale: ruptured appendicitis → peritonitis → septic shock The major complication of appendicitis is perforation of the appendix, which can lead to peritonitis, abscess formation (collection of purulent material), or portal pylephlebitis, which is septic thrombosis of the portal vein caused by vegetative emboli that arise from septic intestines. REFERENCE: Brunner & Suddarth's Textbook of MedicalSurgical Nursing 12th edition, p. 1076. 11. When auscultating the breadth sounds of patients with respiratory disorders they are instructed to breathe through their mouth. A possible complaint the nurse has to watch and be written in her documentation when performing this procedure is which of the following? A. Palpitation B. Dizziness C. Tachycardia D. Bradycardia Rationale: tachycardia is present to compensate the transient decreased of proper oxygenation ↓oxygen, ↑HR as a compensatory mechanism Situation: Mary, a hairstylist is experiencing periumbilical pain, feeling feverish and nauseated while at work. She was rushed to the hospital as the pain is becoming intense at the right lower quadrant of the abdomen. She was advised by the ER physician to be admitted for further work-up. 12. Nurse Ella admitted the patient and started to do her assessment. What sign is elicited by the nurse when a deep palpation of the left iliac fossa is done and causes pain on the right iliac fossa of the patient? A. Obturator sign - RLQ pain when the right knee is flexed B. Blumberg sign - rebound tenderness C. Psoas sign - RLQ pain upon knee flexed backwards D. Rovsing sign - radiating pain 14. The nurse prepares the patient for surgery. The overall goals by the surgical team for the patient going for operation include which of the following? I. Relief of pain II. Preventing fluid volume deficit III. Reducing anxiety reaction IV. Eliminating infection A. I, II, III, & IV B. I, II, & III C. II & IV D. I &II Rationale: Goals include relieving pain, preventing fluid volume deficit, reducing anxiety, eliminating infection due to the potential or actual disruption of the GI tract, maintaining skin integrity, and attaining optimal nutrition. Brunner & Suddarth's Textbook of Medical-Surgical Nursing 12th edition, p. 1077. 15. As a safety alert, which of the following nursing measures should be AVOIDED by the nurse prior to appendectomy? A. Observe nothing by mouth B. Administration of enema. - increased abdominal pressure → increased risk for rupture C. Removal of nail polish D. Instruct to urinate. Rationale: If you have symptoms of appendicitis, it is important that you do not take laxatives or enemas to relieve constipation. These medications could cause your PRE-BOARDS 2: NURSING PRACTICE I PRE-BOARDS 2: NURSING PRACTICE I appendix to burst. You should also avoid taking pain medications that could mask the symptoms the doctor would need to know about to diagnose the condition. REFERENCE: Appendicitis: Causes & Diagnosis (clevelandclinicabudhabi.ae) 16. In wound care management, the nurse is aware NOT to perform which of the following interventions? A. Allow the wound to drain freely. B. Maintenance of an acidic or neutral PH C. Application of cold pack solutions. - vasoconstriction → decreased blood flow → poor wound healing D. Maintenance for a moist wound environment. Rationale: Done incorrectly, placing cold packs may cause frostbite and damage the skin's tissues. While exposure to cold can ease pain and swelling, ice packs can also stop blood flow if left on the skin for too long. If there is decreased blood flow, there is decreased wound healing. Situation: You are the nurse in the emergency room. A 22year-old male is brought with an apparent head injury after being involved in a serious car accident. He is unconscious and exhibits signs of increasing intracranial pressure 17. When the client arrives at the ER, which of the following should you consider a priority care? a. Replace blood loss. b. Determine if he has a fracture in the neck. c. Establish an airway. d. Stop bleeding from the open head wound. Rationale: The ABCDs of basic CPR include airway, breathing, circulation, and defibrillation (AHA, 2006): 1. Airway: opening and maintaining an airway 2. Breathing: providing artificial ventilation by rescue breathing if spontaneous respirations are absent or inadequate 3. Circulation: promoting artificial circulation by external cardiac compression when there is no pulse; administering medications (eg, epinephrine for asystole) 4. Defibrillation with standard defibrillator or automatic external defibrillator (AED) for ventricular tachycardia and ventricular fibrillation. REFERENCE: Brunner & Suddarth's Textbook of MedicalSurgical Nursing 12th edition, p. 844. 18. You position the client. Which position would be MOST appropriate? A. Elevate the head to 30 to 45 degrees. - prevent increasing ICP B. Elevate the head to two pillows. C. Place the client in a Trendelenburg position. D. Place the client in Sim's position. Rationale: Head elevation above 45 degrees should be avoided in all cases. In most patients with intracranial hypertension, head and trunk elevation up to 30 degrees is useful in helping to decrease ICP, providing that a safe CPP of at least 70 mmHg or even 80 mmHg is maintained. REFERENCE: The effect of position on intracranial pressure) - PubMed (nih.gov) 19. You assess the client frequently for signs of increasing intracranial pressure which is ______. A. Decreasing symbolic pressure. - increased systolic pressure B. Decreasing body temperature. - hyperthermia C. Tachycardia - cushing’s triad - bradycardia D. Unequal pupil size. - aka anisocoria - brainstem compression; late sign in increased ICP Rationale: This is also called anisocoria. In the management and prognosis of severe traumatic brain injury (TBI), abnormalities of pupillary response or anisocoria (pupil size asymmetries) are often associated with neurological deterioration, and they are correlated with poor neurological outcome. Letter A should be increasing systolic pressure, increased respiration rate, and Letter C should be bradycardia. Letter B should be increasing temperature. These manifestations are called your Cushing's Triad plus increased temperature. REFERENCE: Pupillary reactivity as an early indicator of increased intracranial pressure: The Introduction of the Neurological Pupil index - PMC (nih.gov) 20. You continue to assess the client. Which of the following respiratory signs would indicate increasing intracranial pressure in the brain stem? a. Rapid, shallow respiration. b. Asymmetric chest excursion. c. Nasal flaring. d. Slow, irregular respiration. Rationale: as part of the cushing’s triad, option A exhibits signs of bradypnea or decreased respiration rate 21. You are aware that early indication of deterioration in the neurologic status of the client is a _________. A. Dilated, fixed pupil. B. Widening or pulse pressure. C. Decrease in the level of consciousness - early sign of cerebral hypoxia; increased ICP D. Decrease in the pulse rate. Rationale: A change in the person's sensorium is an early indication of the deterioration in the neurologic status of the client. REFERENCE: Brunner & Suddarth's Textbook of MedicalSurgical Nursing 12th edition. Situation: The nurse on the oncology unit cares for a 35-yearold female client with colon cancer. The following questions are related to educating the client. 22. The client tells the nurse that their family has a history of colon cancer. Which of the following has an appropriate action by the nurse? a. Ask the client to get a stool specimen to test for occult blood. b. Instruct the client to ask her physician for a sigmoidoscopy, a procedure that may provide baseline data c. Teach the client that she needs to have a colonoscopy when she reaches the age of 50 years. d. Instruct the client to ask her physician about a specific test for colon cancer. Rationale: Colonoscopy is done every 10 years, starting at the age of 50 years old for both men and women. Letter C is more centered on the nurse providing information about the screening and diagnostic options for colon cancer. REFERENCE: Brunner & Suddarth's Textbook of MedicalSurgical Nursing 12th edition, p 344. → Options B and D are pass the buck; kaya mo naman gawin, pinasa mo pa sa doctor → inaccuracy of understanding 23. The client is scheduled for external radiation therapy to the abdomen. Which of the following information provided by the client indicates a need for further teaching by the nurse? The client _______. a. has a history of dental carries. b. eats small amount of food five to six times during the day. c. showers with a moisturizing soap every day. d. swims in chlorinated pools five days in a week. Rationale: external radiation therapy/teletherapy - patient is not radioactive; focus is skin If you are going through radiation treatment, you should avoid chlorinated pools. The chlorine can be irritation of the skin REFERENCE: Pool Safety for Cancer Survivors | PealPoint Nutrition Services PRE-BOARDS 2: NURSING PRACTICE I PRE-BOARDS 2: NURSING PRACTICE I 24. The patient has been told by the physician that the cells in the bowel tumor are poorly differentiated. The client asks the nurse what it means. The BEST response of the nurse would be ______: a. “The cells on your tumor have mutated from normal bowel cells. b. “Your tumor cells look more like immature fetal cells than normal bowel cells.” c. “The tumor cells have DNA that is different from your normal bowel cells.” d. “The cells in your body tumor do not look very different from normal bowel cells. Rationale: Tumors that do not clearly resemble the tissue of origin in structure or function are described as poorly differentiated or undifferentiated and are assigned grade IV. These tumors tend to be more aggressive and less responsive to treatment than well-differentiated tumors. REFERENCE: Brunner & Suddarth's Textbook of MedicalSurgical Nursing 12th edition.p 346 25. The client appears anxious and angry because of the diagnosis of Anxiety Related to Fear of the Unknown as manifested by anger. The BEST approach for the nurse to take in relation to the needs of the client for more information is to _______: A. Discuss specific scientific facts related to colon cancer. B. Provide a simple explanation of proposed treatments to the client. C. Provide a detailed plan for future interventions to the client. D. Offer suggestions to modify the client’s expression or anger. Rationale: The client may be experiencing anxiety because they may not fully understand the situation or condition they are experiencing. Providing information may help ease the client's anxiety. 26. Nurse Margie is aware that the legal terminology used in child abuse is battery. This means: A. Maligning the character of a person while threatening to do bodily harm. - assault B. A legal wrong committed by one person against the property of another. - tort C. Doing something that a reasonable person with the same education or experience would not do. - negligence D. Application of force to another person without lawful justification. Rationale: Battery is the intentional offensive or harmful touching of another person without their consent. Under this general definition, a battery offense requires all of the following: → intentional touching → the touching must be harmful or offensive → without the consent from the victim. 27. Nurse Margie admits a young woman who claimed to have been beaten and sexually assaulted by her boyfriend. What is the MOST appropriate? A. Stay with the client during the physical examination. B. Refer the client to a psychiatrist for evaluation of her mental state. C. Encourage the client to call a lawyer to press charges against her boyfriend. D. Wash and dress the wounds of the client before the physician conducts a physical examination. Rationale: Maintaining the client's safety is the priority focus of nursing interventions. Staying with the client helps reassure them. REFERENCE: Psychiatric-Mental Health Nursing 5th edition by Sheila Videbeck C. D. A legal wrong committed by one person against the property of another. - tort The application of force to another person without lawful justification. - battery Rationale: Assault involves any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority. Examples include making threats to restrain the client to give him or her an injection for failure to cooperate. REFERENCE: Psychiatric-Mental Health Nursing 5th edition by Sheila Videbeck 29. Nurse Margie admits a 10-year-old female child. When assessing the child, she observes several bruises on the child and asks the mother about it. The mother says that the child often falls down and hurts herself. The nurse should ________: a. Refer the child to the psychiatrist. b. Continue evaluating circumstances. c. Not probe as this is a family matter. d. Talk with the mother privately. Rationale: As with all types of family violence, detection and accurate identification are the first steps. The key is to recognize when the child's behavior is outside what is normally expected for his or her age and developmental stage. Seemingly unexplained behavior, from refusal to eat to aggressive behavior with peers, may indicate abuse. The nurse alone or in consultation with other health team members (e.g., physicians or social workers) may report suspected abuse to appropriate local governmental authorities. REFERENCE: Psychiatric-Mental Health Nursing 5th edition by Sheila Videbeck Situation: The nurse assists in the care of a client admitted for hypokalemia. 30. The assessment by the nurse should focus on which of the following _______ : a. Heart rhythm b. Presence of edema - r/t sodium c. Presence of Chvostek’s sign - r/t calcium d. Blood pressure - r/t sodium, CA, MG Rationale: Decreased potassium levels due to administration of potassium-excreting diuretics can cause many forms of dysrhythmias, including life-threatening ventricular tachycardia or ventricular fibrillation, and predispose patients taking digitalis preparations to digitalis toxicity. REFERENCE: Brunner & Suddarth's Textbook of MedicalSurgical Nursing 12th edition, p. 706. 31. The nurse reads the order of the physician which is to infuse a bolus of 30 mEq of the potassium in 100 ml of normal saline over 30 minutes. The most appropriate action of the nurse is to __________: a. Order an infusion pump to administer the potassium. b. Request the pharmacy to 250 ml of saline instead of 100 ml. c. Clarify the order with the physician. d. Administer the potassium as ordered. Rationale: Potassium is never administered by IV push or intramuscularly to avoid replacing potassium too quickly. IV potassium must be administered using an infusion pump. Concentrations of potassium greater than 20 mEq/100 mL should be administered through a central IV catheter using an infusion pump with the patient monitored by ECG. LIMIT: 40MEQ PER DOSE. DOESN'T EXCEED 200MEQS IN 24HR PERIOD REFERENCE: Brunner & Suddarth's Textbook of MedicalSurgical Nursing 12th edition, p. 282 and 283. 28. Nurse Margie understands that assault means: A. A legal wrong committed against the public and punishable by law through the state and courts. - felony/crime B. Threats to do bodily harm to the person. PRE-BOARDS 2: NURSING PRACTICE I PRE-BOARDS 2: NURSING PRACTICE I 32. The physician prescribes a thrombolytic agent for the client. This understands that the expected outcome of this drug therapy is to ______: A. Decrease vascular permeability and improve cerebral perfusion. B. Dissolve emboli and therefore minimize damage to the DNA. C. Prevent further hemorrhage within the cerebral vascularity. D. Increase vascular permeability and improve cerebral perfusion. Rationale: Thrombolytic therapy resolves the thrombi or emboli quickly and restores more normal hemodynamic functioning of the pulmonary circulation, thereby reducing pulmonary hypertension and improving perfusion, oxygenation, and cardiac output. However, bleeding is a significant side effect. REFERENCE: Brunner & Suddarth's Textbook of MedicalSurgical Nursing 12th edition, p. 585. Rationale: All statements are true. JRA is the most prevalent chronic disease in children below 16 years (Wong's Nursing Care of Infants and Children). The onset of JRA is between 1 and 3 and between 8 and 10 years of age (Puberty starts at around 8-10 years of age) Wong's Nursing Care of Infants and Children). Most common symptom to be reported first in JRA is pain (Wong's Nursing Care of Infants and Children). Children do respond better to MTX than adults because recent studies suggested that the drug is more completely distributed in the tissues of children than adults at the same infused dosage. REFERENCE: Wong's Nursing Care of Infants and Children 10th edition, p. 1602. Situation: The nurse reviews a recent finding of a study which revealed that while depressed clients may have higher risk for heart failure, clients suffering from cardiovascular disease are more prone to depressive symptoms. 33. The nurse writes a nursing diagnosis. Which is an appropriate nursing diagnosis for the young child with JRA? a. Ineffective Airway Clearance b. Impaired swallowing c. Total Incontinence d. Impaired Physical Mobility 36. The study further reveals that the major depression is most prevalent to which of the following __________: a. persons younger than 60 years of age. b. male c. female d. persons older than 60 years of age Rationale: Juvenile idiopathic arthritis (JIA) is a form of arthritis in children. Arthritis causes joint swelling (inflammation) and joint stiffness. JIA is arthritis that affects one or more joints for at least 6 weeks in a child age 16 or younger. Unlike adult rheumatoid arthritis, which is ongoing (chronic) and lasts a lifetime, children often outgrow JIA. But the disease can affect bone development in a growing child. Symptoms may appear during episodes (flare-ups). Or they may be ongoing (chronic). Each child's symptoms can vary. Symptoms may include: → Swollen, stiff, and painful joints in the knees, hands, feet, ankles, shoulders, elbows, or other joints, often in the morning or after a nap → Eye inflammation → Warmth and redness in a joint → Less ability to use one or more joints → Fatigue → Decreased appetite, poor weight gain, and slow growth → High fever and rash (in systemic JIA) → Swollen lymph nodes (in systemic JIA) REFERENCE: https://www.hopkinsmedicine.org/health/conditionsanddiseases/arthritis/juvenile-idiopathic-arthritis Rationale: Depression is a common illness worldwide, with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years (1). Approximately 280 million people in the world have depression. During a depressive episode, the person experiences a depressed mood (feeling sad, irritable, empty) or a loss of pleasure or interest in activities, for most of the day, nearly every day, for at least two weeks. REFERENCE: https://www.who.int/news-room/factsheets/detail/depression 34. The mother asks the nurse what she should do after observing that her child appears withdrawn. The nurse would suggest the mother to ______: A. Try to be supportive and understanding to her child. B. Introduce the child to other children with JRA. C. Spend extra time with the child and less time for her other children. Rationale: As the child is withdrawn, introducing them to other children with JRA will help them identify with others with the same disease as them. This will help them adjust and accept their condition better, knowing that they are not alone. 35. Which of the following statements are TRUE about juvenile rheumatoid arthritis? 1. JRA is the most prevalent chronic disease in children under 16 years of age 2. The onset of the disease occurs around 8 years of age and letr peak during puberty - peak at 1-3 years old and between 8-10 years old 3. Initial symptoms are frequently called growing pains 4. Children with JRA respond better to the drug Methotrexate (MTX) than adults a. 1 & 3 b. 1 , 2, 3 & 4 c. 1 & 2 d. 1, 3 & 4 37. The nurse reads that mood disturbance among clients with chronic heart failure is greatest among those who ____: A. also had other cardiovascular disorders. B. were most uncertain about how the disease would progress. C. were unable to continue working. D. had previously led extremely active lives. Rationale: Getting diagnosed with heart failure can cause a strain on your emotional health. You may feel depressed and be anxious and worried about your symptoms, the future and how your condition impacts your family. REFERENCE: https://my.clevelandclinic.org/health/diseases/17074-heartfailure-emotional-aspects 38. A term described in the study of chronic depressive states in which the client experiences fewer than five symptoms of depression that last for two years is called _____. a. depression psychosis - hallucination and delusional thinking b. major depression - lasts >2 weeks c. minor depression d. dysthymia Rationale: Dysthymic disorder is characterized by at least 2 years of depressed mood for more days than not with some additional, less severe symptoms that do not meet the criteria for a major depressive episode. 39. According to the research report, the risk for dying within a year of diagnosis among clients with heart failure and with major depression is __________: A. Twice that of clients with heart failure without major depression. B. About the same as that of clients with heart failure without major depression. C. Three times that of clients with heart failure without major depression. Rationale: A recent study presented at the American College PRE-BOARDS 2: NURSING PRACTICE I PRE-BOARDS 2: NURSING PRACTICE I of Cardiology's 66th Annual Scientific Session shows that patients are twice as likely to die if they develop depression after being diagnosed with heart disease. In fact, depression is the strongest predictor of death in the first decade after a heart disease diagnosis. REFERENCE: Heart disease and depression: A two-way relationship NHLBI, NIH 40. The study compared the variables: pharmacologic intervention in clients with both heart failure and depression and psychosocial and psychotherapeutic interventions. It was found out that psychosocial and psychotherapeutic intervention _______: a. Are undesirable for most clients. b. Take longer to be effective. c. Are considerably less effective. d. Tend to increase dyspnea. Rationale: Selective serotonin reuptake inhibitors appear to be safe in patients with cardiac disease and to have beneficial effects on depression (and some suggestion of cardiac benefit) in patients with coronary artery disease, with less evidence of their efficacy in heart failure. In contrast, psychotherapy appears to be effective for depression in coronary artery disease and heart failure, but with less evidence of cardiac benefit. REFERENCE: Psychiatric and Psychological Interventions for Depression in Patients with Heart Disease: A Scoping Review Journal of the American Heart Association (ahajournals.org) Situation: The nurse manager of the medical and surgical units re-orients and staff nurses and other members of the health care team on reporting and recording of incidents that may occur in the units. 41. The nurse manager informs the staff that the purpose of writing incident reports are the following EXCEPT _____: a. For improvement of nursing services. b. For objective reporting of unplanned occurrences. c. For disciplinary action. d. For documentation and follow-up. Rationale: An incident report (also called an unusual occurrence report) is an agency record of an accident or unusual occurrence. Incident reports are used to make all facts available to agency personnel, to contribute to statistical data about accidents or incidents, and to help health personnel prevent future incidents or accidents. All accidents are usually reported on incident forms.Incident reports are not part of the client's medical record; the facts of the incident should also be noted in the medical record. REFERENCE: Kozier and Erb's Fundamentals of Nursing 11th edition 42. The nurse manager cites an example of incorrect reporting which resulted in a medication error. A 10-year-old child was admitted to the emergency department. A nurse took the weight of the child but transcribed it incorrectly in the chart. Another nurse calculated the medication dose based on the incorrect data. The child was given a dose double than what was required. The error was discovered after the child took the medicine. Which of the following actions is the MOST appropriate? The medication nurse should ________. A. Call the attention of the nurse who transcribed the weight incorrectly. B. Omit the second dose. C. Write an incident report. D. Observe closely for signs of side effects of the drug and report to the physician immediately. Rationale: When a medication error is made, report it immediately to the nurse in charge, the primary care provider, or both. REFERENCE: Kozier and Erb's Fundamentals of Nursing 11th edition, p 858. 43. The nurse manager emphasizes that reported incidents are investigated ______: a. Within 24 hours after the occurrence of the incident. b. After consultation with the attending physician of the patient. c. Immediately after the occurrence of the incident. d. After the patient is discharged from the hospital. Rationale: Incident reports are often reviewed by an agency risk management committee, which decides whether to investigate the incident further. Nurses may be required to answer such questions as what they believe precipitated the accident, how it could have been prevented, and whether any equipment should be adjusted. REFERENCE: Kozier and Erb's Fundamentals of Nursing 11th edition 44. The nurse manager describes the filing of records of a client, including incident reports, follow-up and action (s) taken as _____: a. recording b. consulting c. implementation d. investigation Rationale: In the typical day of a nurse providing direct client care, as much as one third of the time may be spent recording in the client's chart (Weaver & O'Brien, 2016). Additional time is spent trying to access data about the client that may be somewhere in the medical record or elsewhere in the healthcare agency. Nurses access standardized forms, policies, and procedures. 45. The nurse manager explains that a reportable incident that should be recorded included the following EXCEPT ______: A. Any client refusal for treatment. B. Any unexplained or unplanned occurrence that affects or may potentially affect a client, a family member or a staff. C. Complaints of a client or family member on nursing care received. D. Complaints or staff nurse towards a client who is unruly and uncooperative. Rationale: Letters A, B, and C are patient or client-centered and should be under reportable incidents. 46. While the nurse is doing an assessment, the child says, the pain is gone and his abdomen doesn’t hurt anymore. The nurse would suspect that the ________: a. Appendix has ruptured. b. Child is afraid to have an operation. c. Child wants more attention. d. Child is having difficulty expressing the pain adequately. Rationale: If the appendix has ruptured, the pain becomes more diffuse; the pain may go away for a few hours because the rupture releases pressure, but serious infection can set in quickly. A rupture can happen within two to three days after the pain starts. REFERENCE:https://www.verywellhealth.com/rupturedappendix-5225827 47. The client’s diagnosis is confirmed. The client is scheduled for appendectomy. Preoperative nursing care include which of the following: a. Apply warm packs on the child’s abdomen to help relieve discomfort. b. Administer a laxative as ordered. c. Assess bowel activity by evaluating abdominal distention and auscultating bowel sounds. d. Place the child in a left side lying position to help localize and prevent the spread of infection. Rationale: Assess the patient for signs of ruptured appendix or manifestations of complications from a ruptured appendicitis such as peritonitis. Warm packs and laxatives are avoided. Patients are put on High Folwers to reduce the tension on the incision and abdominal organs, helping to reduce pain. PRE-BOARDS 2: NURSING PRACTICE I PRE-BOARDS 2: NURSING PRACTICE I REFERENCE: Brunner & Suddarth's Textbook of Medical Surgical Nursing, 12th edition 48. The nurse prepares the child for surgery. Which of the following nursing interventions should the nurse perform? a. Administer an enema as ordered. b. Give clear liquids. - NPO c. Maintain complete bed rest. d. Apply heat to the abdomen. Rationale: In appendicitis, enemas, heat application, and clear liquids should be avoided. Applying heat to the abdomen will cause vasodilation, increasing the risk for rupture. Patients with appendicitis are put on NPO as well. Enemas will cause cecum movement. REFERENCE: Brunner & Suddarth's Textbook of Medical Surgical Nursing, 12th edition Situation: Tommy, a 50-year-old chain smoker, is suspected to have lung cancer after he was seen and examined by his physician. He and his wife got very worried about his diagnosis. 49. Which procedure has to be done to the patient to establish a definitive diagnosis of lung cancer? A. Chest x-ray followed by a CT scan B. Cytological study of the sputum C. Bronchoscopy D. Magnetic resonance imaging - test for metastasis Rationale: → C: Fiberoptic bronchoscopy is more commonly used for the diagnosis of lung cancer; it provides a detailed study of the tracheobronchial tree and allows for brushings, washings, and biopsies of suspicious areas. The biopsy from this procedure can help detect cancerous formation of cells → B: Sputum cytology is rarely used to make a diagnosis of lung cancer. This is because there is decreased risk for cancer detection in the given sputum sample. It may also cause coughing jags for the patient. Aside from that, when the results are positive for cancer, sputum cytology does not provide enough information for doctors to be able to determine exactly what type of lung cancer a patient has. → A: A chest x-ray is performed to search for pulmonary density, a solitary pulmonary nodule (coin lesion),atelectasis, and infection. CT scans of the chest are used to identify small nodules not easily visualized on the chest x-ray and also to serially examine areas for lymphadenopathy. However, these are only imaging studies which cannot determine the presence of cancerous cells. → D: This can be used for detection of metastasis of the cancer, but not as a definitive diagnostic procedure for the lung cancer 50. The MOST significant contributory factor to the development of lung cancer is ______. A. being a cigarette smoker B. belonging to the male sex C. Being extremely obese D. age over 40years. Rationale: Tobacco use is responsible for more than one of every six deaths in the United States from pulmonary and cardiovascular diseases. Smoking is the most important single preventable cause of death and disease. Lung cancer is 10 times more common in cigarette smokers than nonsmokers. 51. The patient while in the hospital is complaining of chest pain. When the nurse is assessing the degree of pain of the patient, the MOST APPROPRIATE basis is ______. A. watcher's description of patient's pain B. patient's own rating of his pain C. Non-verbal cues observed in the patient D. Nurse's own rating of the patient's pain Rationale: Pain is a subjective data or symptom. The best source of the presence and characteristic of pain is the patient → Adult - subjective → Pedia - objective 52. Health teaching on chemotherapy includes informing Tommy on the adverse effect of bleeding related to bone marrow depression. Which verbalization of the patient indicates further teaching? A. I should watch out for discolorations in my skin. B. I am going to take two tablets of Aspirin for my headache C. I may need platelet transfusion in the future D. I should not blow my nose Rationale: Avoid aspirin and aspirin-containing medications or other medications known to inhibit platelet function, if possible. This is because it thins the blood and lowers its ability to clot. Aside from that, aspirin also inhibits helpful substances that protect the stomach's delicate lining, creating a "double whammy" effect. As a result, stomach upset or bleeding in the stomach and intestines can occur. → A: Discolorations in my skin may indicate bruising and hematomas. The decrease in the clotting ability of the patient may make the mild bruises as complicated hemorrhage and bleeding. With that, constant monitoring for these discolorations is needed → C: Due to decrease in platelet count from the bone marrow suppression, platelet transfusion may be needed → D: Blowing through the nose can increase the pressure at that area and break the rich blood vessel system in it. This can precipitate continuous bleeding of the nose. Situation: Nurse Lunario makes several home visits to patients who were discharged from a district hospital. 53. As Nurse Lunario prepares for the day's visits, which of the following patients should be seen FIRST? A client with A. Parkinson' s disease with imbalance gait - expected B. A history of congestive heart failure with dyspnea unexpected C. A thoracostomy six months ago - stable D. A stroke with nasogastric tube (NGT) - expected Rationale: Options A & D are incorrect because imbalanced gait and NGT are to be expected of a client with Parkinson's disease and Stroke. Option C is wrong because the client had thoracostomy six months ago which means the client must be stable already. Option B is the only option which may indicate that the client is having complications/unexpected symptoms. The dyspnea is due to pulmonary congestion resulting from fluid buildup on the lungs due to backup of blood into the pulmonary veins which is ultimately due to left ventricular pumping failure. Also if you use the ABCDE prioritization approach, DYSPNEA is a much higher priority than imbalanced gait and client with NGT. Remember AIRWAY, BREATHING, CIRCULATION, DISABILITY, EXPOSURE (ABCDE). Sources: Brunner & Suddarth's Textbook of Medical-Surgical Nursing 12th Edition. pg. 828.; Thim T, Krarup NH, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Int J Gen Med. 2012;5:117-21. doi: 10.2147/1JGM.S28478. Epub 2012 Jan 31. PMID: 22319249; PMCID: PMC3273374. 54. Mang Bonifacio refuses to take his daily medication for hypertension. Which of the following actions should Nurse Lunario take at this time? A. Tell Mang Bonifacio that he will suffer from a stroke. B. Explore the reason for the client' s refusal to take the medication. C. Administer the medication by injection. D. Obtain help from relatives in administering the medication. Rationale: Ask them WHY they don't want to take it! This is very important because for some individuals, refusal is their way of letting you know that the medication has negative side effects such as nervousness, nausea, drowsiness, bad taste PRE-BOARDS 2: NURSING PRACTICE I PRE-BOARDS 2: NURSING PRACTICE I etc. Source: GUIDELINES: Management of Client Refusal to Take Prescribed Medication. Retrieved from https://hsc.unm.edu/medicine/departments/pediatrics/divisio ns/continuum-ofcare/pdf/mgmt-client-refusal-takeprescribed-meds.pdf 55. Nurse Lunario sees a 65—year—old male, who is recovering from a stroke. He noticed that Mang Jose exhibits signs of unilateral neglect. Which behavior is suggestive of this unilateral neglect? Mang Jose is_____________. A. unable to carry out cognitive and motor activity at the same time - dyspraxia B. observed shaving only one side of his face C. unable to complete a range at vision without turning his neck side to side - head tilt D. unable to distinguish between two tactile stimuli - two-point discrimination test Rationale: neglect syndrome (unilateral neglect) is where the client os unaware of the existence of their paralized side Source: Saunders Comprehensive REview for the NCLEX-RN Examination 7th Edition 56. Nurse Lunario is teaching a client with Parkinson' s disease on ways to prevent curvatures of the spine associated with the disease. To prevent spinal flexion, the nurse should tell the client to. A. rest in supine position with Lis head elevated - promotes spinal flexion- promotes spinal flexion B. sleep only in dorsal recumbent position - promotes spinal flexion- promotes spinal flexion C. periodically lie in prone position without a neck pillow D. sleep on either side, but keep his back straight - unrealistic Rationale: Periodically lying in a prone position without a pillow will help prevent the flexion of the spine that occurs with Parkinson's disease. Sleeping only in dorsal recumbent position and resting in supine position with his head elevated flex the spine; therefore, they are incorrect. Sleeping on either side but keep his back straight is not realistic because of position changes during sleep, therefore, it is incorrect 57. A client with congestive heart failure has been receiving digoxin (Lanoxin), which finding indicates that the medication is having a desired effect? A. Increased weight - decreased weight B. Improved appetite C. Increased urinary output D. increased Pedal edema - decreased Rationale: The increase in myocardial contractility increases cardiac, peripheral, and kidney function by increasing cardiac output, decreasing preload, improving blood flow to the periphery and kidneys, decreasing edema, and increasing fluid excretion; as a result, fluid retention in the lungs and extremities is decreased → Digoxin is a positive inotropic promoting contractility increasing the urine output (more perfusion to the kidneys) Source: Saunders Comprehensive Review for the NCLEX-RN Examination Edition Situation: The goal of ethical reasoning in the context of nursing is to reach a mutual peaceful agreement that is in the best interest of the client. Reaching an agreement may require compromise. 58. When an ethical issue arises, which of the following is the most important nursing responsibility? A. Ensure that a team is responsible for deciding ethical questions. B. Remain neutral and detached when making ethical questions. - neutrality sides the oppressor; neutral u as a nurse?!; dapat may pinapanigan, may moralidad C. Be able to defend the morality of one's own actions D. Follow the client and a family's wishes exactly. Rationale: Option A is wrong because everyone involved should be responsible, you cannot just assign one person or one team. Option B is wrong because we cannot remain neutral and detached when making ethical decisions because we must always come to a conclusion where we choose the best decision for the patient. Option D is wrong because we cannot always follow the client's or family's wishes especially if it's not beneficial and puts the client at risk. 59. Which of the following is a clear violation of the underlying principles associated with professional nursing ethics? A. health care facility policy permits the use of internal fetal monitoring which in the literature evidence points to either support or refute this practice. B. The nurses on the unit agree to sponsor a fundraising event to support a labor strike proposed by fellow nurses at another health care facility, - labor strike is allowed C. A client reports that he didn't quite tell the doctor the truth when asked if he was following his therapeutic diet at home - check before giving D. When asked about the purpose of a medication, a nurse colleague responds, "Oh I never look them up. I just give them what is prescribed." Rationale: The question is looking for the wrong/negative option. Option A is not a violation because the literature evidence doesn't really say that internal fetal monitoring is completely wrong, take note of the words "either support or refute". Option B is not a violation because the nurses are striving for a better condition of their profession, this is included in the Code of Ethics for Registered Nurses (Article VI Sec. 16-17). Option C is not a violation because a client not telling the truth is not the nurse's fault. Option D is a clear violation because this practice does not ensure the safety of the patient which violates the Code of Ethics for Registered Nurses (Article M Sec. 6) where Human life is inviolable which means Human life should be respected and not removed or ignored. 60. Which of the following statements would be most helpful when a nurse is assisting clients in clarifying their values? A. “The most important thing is to follow the plan of care. Did you follow the doctor’s order?" B. "Some people might have a different decision. What led you to make your decision? " C. "If you had asked me, I would have given you, my opinion. Now, how do you feel about your choice? " D. "That was not a good decision. Why did you think it would work?” - “why” is a red flag in therapeutic communication Rationale: Take note of assisting clients in clarifying their values", which means the nurse must assist the clients into understanding why they made their decision. Option A is wrong because you only asked them a closed ended question, you did not clarify. Option C is wrong because this is guilt-tripping the client Option D is wrong because you disagreed with the client and you are questioning them rudely. Only Option B will help with clarifying the client's decision. 61. A Dying patient asks for over dosage of pills from the nurse to end his life for his unbearable pain caused by cancer. If the nurse grants the patient’s request, she is liable for___________ A. euthanasia - act B negligence C. advance directive D. assisted suicide. Rationale: Assisted suicide is the act of deliberately assisting another person to kill themselves. If a relative of a person with a terminal illness obtained strong sedatives, knowing the person intended to use them to kill themselves, the relative may be considered to be assisting suicide. from Source: Euthanasia & assisted suicide. Retrieved https://www.nhs.uk/conditions/euthanasia-and-assisted suicide/ PRE-BOARDS 2: NURSING PRACTICE I PRE-BOARDS 2: NURSING PRACTICE I 62. The midwife is verbally accusing the nurse that the latter caused the medication errors without citing any evidence. The midwife can be sued for A. assault B. slander - sinabi; privately done C. defamation - types are slander & libel D. libel - lapis - written; publicly done Rationale: Defamation is a false communication or a careless disregard for the truth that causes damage to someone's reputation, either in writing (libel) or verbally (slander). An assault occurs when a person puts another person in fear of a harmful or offensive contact. Source: Saunders Comprehensive Review for the NCLEX-RN Examination 7th Edition Situation: Public Health Nurse Melchora is tasked for the day to administer vaccination to pediatric clients in the barangays she covers. She, along with the team of midwives, should be knowledgeable on how to provide the most effective, necessary, and safest vaccination. 63. The foundation of medication administration is the application of the "Rights of Medication Administration. Which of the following is NOT included in these rights? A. Right route B. Right patient C. Right dosage D. Right price Rationale: The 10 Rights of Medication Administration are: (1) Right patient, (2) Right medication, (3) Right dose, (4) Right route, (5) Right time. (6) Right patient education (7) Right documentation, (8) Right to refuse, (9) Right assessment, (10) Right evaluation Source: The 10 Rights of Drug Administration. Retrieved from https://nurseslabs.com/10-rs-rights of drugadministration 64. When conducting Parent Education on immunization, which of the following considerations should Nurse Melchora include? 1. Welcomes and greets child and family 2. Explains the vaccines to be administered 3. Refuse entry to those who come late 4. Informs attendees about the procedures to be done 5. Provide parents time to ask questions 6. Refrain from answering questions from parents A. 2, 4, 5, 6 B. 2, 3, 5, 6 C. 1, 2, 4, 5 D. 1, 3, 4, 6 Rationale: It is obvious that numbers 3 and 6 should not be included. Everyone should be free to attend parent education without scrutiny of their time arrival because it is not a classroom where attendance is graded and it is also not a workplace where late attendance is deducted to the salary. Nurses should always answer inquiries of patients/relatives for them to understand what is happening 65. When handling vaccines, the FIRST step Nurse Melchora should do is to A. select the correct needle size B. reconstitute using the diluent supplied C. check the content prior to drawing up D. check the vial for expiration date Rationale: Determining when a vaccine or diluent expires is an essential step in the vaccine preparation process. The expiration date printed on the vial or box should be checked before preparing the vaccine. Source: Vaccine Administration. Retrieved from https://www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html 66. If more than one vaccine is given, the following guidelines should be observed, EXCEPT. A. do not give more than one dose of the same vaccine in one session. B. do not use the same arm or leg for more than one injection. C. give doses of the same vaccine at the correct intervals. D. use the same syringe and needle in administering two vaccines. Rationale: Use a separate syringe and needle for each injection. Never administer a vaccine from the same syringe to more than one patient, even if the needle is changed. 67. When documenting the procedures done, which of the following should NOT be recorded? A. Date B. Lot number C. Manufacturer D. Needle gauge - standard Rationale: Permanent medical record of the recipient indicates: Date of administration, Vaccine manufacturer, Vaccine lot number Name and title of the person who administered the vaccine and the address of the facility where the permanent record will reside and The edition date of the VIS distributed and the date it was provided to the patient. Source: Vaccine Administration Retrieved https://www.cdc.gov/vaccines/pubs/pinkbook/vecadmin.html from Situation: As nurse supervisor of the health center Nurse Ellen intends to enhance her competencies regarding resource management and care of the environment. 68. Which type of plan should the nurse employ to assess the strengths and weaknesses of the organization? A. Nursing care B. Operational - day to day panning C. Strategic - SWOT analysis D. Program - define problem and developmental plan Rationale: Long-range budgets for long-range planning are often called the organization's strategic plan and are usually projected for 3 to 5 years. Program budgets are part of the strategic plan that focuses on all the benefits and costs associated with a particular program. Source: https://nursing.iugaza.edu.ps/Portals/55/LN_nsg_Idrshp_final. pdf 69. Which BEST describes the planning function of Nurse Ellen in her role as nurse manager? A. Get and develop people to do the work. - intervention B. Distributes and arranges work to ensure smooth operation of the unit. - intervention C. Determines the actual performance compared with the desired output. - evaluation D. Determine how to achieve the mandate of work Rationale: Management is the art of getting things done through people. It is the process of reaching organizational goals by working with and through people and other organizational resources. It is the process of planning, organizing, leading and controlling the work of organization members and of using all available organizational resources to reach stated organizational goals. It is the process of directing, coordinating and influencing the operation of an organization to obtain desired results and enhance total performance. Source: https://nursing.iugaza.edu.ps/Portals/55/LN_nsg_Idrshp_final. pdf PRE-BOARDS 2: NURSING PRACTICE I PRE-BOARDS 2: NURSING PRACTICE I 70. To assist them enhance their performance at work, the nurse manager should review regularly pertaining to the staff's ____. A. Number of submitted incident report B. Academic performance in college C. Job description D. Family dynamics. Rationale: Job Description - termed performance responsibility; spell out the precise job content including duties, activities to be performed, responsibilities and results expected from the various roles of the agency which PREVENTS MALPRACTICE, USE FOR DELEGATION, USE FOR EVALUATION, USE FOR STAFFING Source: https://nursing.jugaza.edu.ps/Portals/55/LN_nsg_Idrshp_final. pdf 71. Doing year end performance evaluation of the staff is an example of A. Planning B. Controlling - evaluation function C. Organizing D. Staffing Rationale: Controlling is the regulation of activities in accordance with the plan. Controlling is a function of all managers at all levels. Its basic objective is to ensure that the task to be accomplished is appropriately executed. Control involves establishing standards of performance, determining the means to be used in measuring performance, evaluating performance, and providing feedback of performance data to the individual. → To improve performance Source: https://nursing.iugaza.edu.ps/Portals/55/LN_nsg_Idrshp_final. pdf 72. Which is the MOST important criterion in budgeting? A. Flexibility B. Standardized C. Consistency D. Cost effectiveness Rationale: The goal of cost containment is to keep costs within acceptable limits for volume, inflation, and other acceptable parameters. It involves cost awareness, monitoring, management, and incentives to prevent, reduce, and control costs and is the most vital part of budgeting, → Should have transparency and used by the unit Source: https://nursing.iugaza.edu.ps/Portals/55/LN_nsg_Idrshp_final. pdf Situation: Nurse Melyconsiders teamwork and collaboration as important components of Community Health Nursing. 73. Which of the following is the PRIMARY goal of collaboration A. Less number of people is needed B. Camaraderie C. Accomplish goals D. Work is faster Rationale: Interprofessional collaboration in healthcare helps to prevent medication errors, improve the patient experience, and deliver better patient outcomes all of which can reduce healthcare costs and accomplish goals. Source: https://nursing.iugaza.edu.ps/Portals/55/LN_nsg_Idrshp_final. pdf 74. Which are KEY ELEMENTS of collaboration 1. Shared vision 2. Partnership 3. Working together 4. Unity A. 1,2,3 B. 3,4 C. 1,2 D. 1,2,3,4 Rationale: Collaboration, the most preferred of the conflict styles, requires both assertiveness and cooperation. It involves attending fully to others' concerns while not sacrificing or suppressing one's own concerns. Although collaboration is the most preferred style, it is the hardest to achieve. Collaboration requires energy and work among participants. To resolve incompatible differences through collaboration, individuals need to take enough time to work together to find mutually satisfying solutions. Source: https://nursing.lugaza.edu.ps/Portals/55/N_nsg_Idrshp_final.p df 75. Which of the following is the MOST important purpose of teamwork 1. Work is faster 2. Promotes trust 3. Sense of security 4. Unity A. 1,2 B. 1,2,3,4 C. 3,4 D. 1,2,3 Rationale: Collaboration, the most preferred of the conflict styles, requires both assertiveness and cooperation. It involves attending fully to others' concerns while not sacrificing or suppressing one's own concerns. Although collaboration is the most preferred style, it is the hardest to achieve. Collaboration requires energy and work among participants. To resolve incompatible differences through collaboration, individuals need to take enough time to work together to find mutually satisfying solutions. Source: https://nursing.lugaza.edu.ps/Portals/55/N_nsg_Idrshp_final.p df 76. Which of the following BEST describe a strong team? A. Cohesive B. Shared goal C. Driven D. Sense of mission. Rationale: A strong team is one where each member knows the role they play. A strong team expects each member to be fully present and ready to go when it is their time to shine. When It's not, they serve the whole. 77. Collaboration and teamwork as essential in public health to improve A. Staff performance. B. Proper use of resources C. Equity in services D. Quality health care Rationale: Interprofessional collaboration in healthcare helps to prevent medication errors, improve the patient experience, and deliver better patient outcomes - all of which can reduce healthcare costs and accomplish goal. Source: https://nursing.iugaza.edu.ps/Portals/55/LN_nsg_Idrshp_final. pdf PRE-BOARDS 2: NURSING PRACTICE I PRE-BOARDS 2: NURSING PRACTICE I Situation: An 18-year-old, female college student was accompanied by her mother for consultation at the Municipal Health Center. According to her mother the patient had been having difficulty concentrating with her lesson, had a tendency to isolate inside her room and was frequently in an angry mood. The physician ordered for psychiatric consultation. 78. In order to determine the patient's ability to concentrate and focus, which would be the PRIORITY nursing action? A. Ask for the academic performance B. Conduct paper and pencil test C. Assess the mental status of the patient. D. Refer the patient to the psychiatrist Rationale: The primary consideration is the health and emotional needs of the patient. Assessment of cognitive function, checking for hallucinations and delusions, evaluating concentration levels, and inquiring into interests and level of activity constitute a mental or emotional health assessment. Asking about how the client feels and their response to those feelings is part of a psychological assessment. Are they agitated, irritable, speaking in loud vocal tones, demanding, depressed, suicidal, unable to talk, have a flat affect, crying, overwhelmed, or are there any signs of substance abuse? The psychological examination may include perceptions, whether justifiable or not, on the part of the patient or client. Religion and cultural beliefs are critical areas to consider. Screening for delirium is essential because symptoms are often subtle and easily overlooked, or explained away as fatigue or depression Source: Nursing Administration Assessment Examination. Retrieved https://www.ncbi.nlm.nih.gov/books/NBK493211/ and from 79. While the nurse was taking her blood pressure, the patient suddenly stated “They are talking about me!". She was referring to other patients who were waiting for their consultation.Which of the following should be the APPROPRIATE nursing action? A. Present the reality of the situation. - if with safety concern B. Distract patient's attention. C. Disagree with the patient. D. Validate the statement. - explore the feelings and emotions; “maaari ninyo po bang ipaliwanag kung ano ang pinag uusapan sa inyo” Rationale: When dealing with the patient with hallucinations: Remain calm, and try to help the person, Approach the person quietly while calling his or her name, Ask the person to tell you what is happening. Tell the person that he or she is having a hallucination and that you do not see or hear what he or she does. Source: Schizophrenia: Hallucinating Helping Someone Who is 80. In taking the patient's history from the mother, the nurse should ask the mother information related to the daughters’ _______________. A. Schooling B. Menarche C. Pregnancy D. Immunization Rationale: The assessment will usually look at the parent's personal history, views and attitudes towards parenting, understanding of child development and a child's needs, the resourcefulness of the parent to seek help and support and who forms their support network as well as immunization administered during infancy. Source: Kozier and Erb's Fundamentals of Nursing - Berman, Audrey, pg. 254. 81. Nurse May is alarmed by the incidence of the number of young adults in the community with mental problems. Which of the following should be her PRIORITY nursing initiative? A. Refer all to tertiary hospital. B. Request for psychiatric drugs. C. Set up a debriefing center. - treatment D. Set up mental health program - promotion and prevention Rationale: Mental health and well-being is a concern of all. Addressing concerns related to MNS contributes to the attainment of the SDGs. Through a comprehensive mental health program that includes a wide range of promotive, preventive, treatment and rehabilitative services; that is for all individuals across the life course especially those at risk of and suffering from MNS disorders, integrated in various treatment settings from community to facility that is implemented from the national to the barangay level; and backed with institutional support mechanisms from different government agencies and CSOs, we hope to attain the highest possible level of health for the nation because there is no Universal Health Care without mental health Source: Mental Health Program. Retrieved https://doh.gov.ph/national mental health program from 82. In giving health teaching to the mother how to manage the patient at home, which of the following should she emphasize? A. Give the patient more time for self B. Impose strict discipline C. Do traditional parenting style. D. Need for emotional support. Rationale: Effective discharge planning is impeded by gaps in communication between the hospital and community interface, such as illegible discharge summaries and delays in sending information to the physician. Focus groups found that they experience their family member's discharge from the hospital as an abrupt and upsetting event because the hospital staff did not prepare them for the technical and emotional challenges ahead of them. Source: Chapter 14 Supporting Family Caregivers in Providing Care. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2665/ Situation: When prioritizing problems in the community, the problems are categorized as health status, health resource or health related. 83. Nurse Maris is correct in identifying which of the following is a health resource problem? A. Increase in number of deaths from Pneumonia B. Feud between the Midwife and Head of the Sanitation Committee C. Absence of Midwife in the community to render health services D. High Maternal Mortality Rate. Rationale: Health resources are available in the community for use of family and includes, man/manpower, money, machine, materials, methods. Source: Family Care Plan. Retrieved from https://www.rnpedia.com/nursing-notes/community healthnursing-notes/family-care-plan/ 84. There are five criteria in prioritizing community health problems. If Nurse Maris is estimating the proportion of the population affected by the problem, she is using what criterion in prioritization? A. Social Concern B. Nature of the Problem. C. Magnitude of the Problem D. Modifiability of the Problem Rationale: Preventive potential refers to the nature and magnitude of the future problems that can be minimized or totally prevented if interventions is done on the condition or PRE-BOARDS 2: NURSING PRACTICE I PRE-BOARDS 2: NURSING PRACTICE I problem under consideration → Awareness is a must to determine problem and to find a solution Source: Family Care Plan. Retrieved https://www.rnpedia.com/nursing-notes/community nursing-notes/family-care-plan/ from health- 85. Nurse Maris oftentimes encounters barriers Select a barrier to goal setting between the nurse and the family. A. Educational attainment B. Nature of employment C. Failure of family to perceive existence of problem. D. Socio economic status Rationale: Barriers to Joint Goal Setting Between the Nurse and the Family: Failure on the part of the family to perceive the existence of the problem. The family may realize the existence of the health condition or problem but is too busy at the moment. Sometimes the family perceives the existence of the problem but does not see it as serious enough to warrant attention. The family may perceive the presence of the problem and the need to take action. It may however refuse to face and do something about the situation. Reasons to this kind of behavior: Fear of consequences of taking actions. Respect for tradition. Failure to perceive the benefits of action. Failure to relate the proposed action to the family's goals. A big barrier to collaborative goal setting between the nurse and the family is the working relationship. potential health conditions or problems of the family are determined and families sought for their own health Source: Family Care Plan https://www.rnpedia.com/nursing-rate nursing note family-care flow Retrieved community from health- Situation: Nurse Jane is the team leader of a group of nurses who plans to utilize Community Organizing Participative Action Research (COPAR). 88. Which of the following BEST describes the PRIMARY goal of COPAR? A. Enhances the skills of the nurse in research. B. Makes the community empowered and self-reliant C. Increases funding of the community programs D. Helps clean up and beautify the community Rationale: COPAR or Community Organizing Participatory Action Research is a vital part of public health nursing, COPAR aims to transform the apathetic, individualistic and voiceless poor into a dynamic, participatory and politically responsive community. Source: Community Organizing Participatory Action Research (COPAR). Retrieved from https://nurseslabs.com/copar-community-organizingparticipatory-action-research/ 86. Which is the MOST appropriate intervention should the nurse do to help the family perform the health tasks? A. Allow family to decide to use health resources B. Help the family recognize the problem C. Leave the family what action take on their problem D. Refer family to barangay officials for guidance 89. At the pre-entry phase, which of the following is the FIRST step in the COPAR-process A. Survey the community B. Train technical working group C. Hold a community assembly D. Create a core group Rationale: Focus on interventions to help the Family Performs Health Tasks: 1. Help the family recognize the problem, increasing the family's knowledge on the nature, magnitude and cause of the problem. Helping the family see the implications of the situation or the consequences of the condition Relating the health needs to the goals of the family. Encouraging positive or wholesome emotional attitude toward the problem by affirming the family's capabilities/qualities/resources and providing information on available actions. 2. Guide the family on how to decide on appropriate health actions to take. Identifying or exploring with the family courses of action available and the resources needed for each. Discussing the consequences of action available. Analyzing with the family of the consequences of inaction 3. Develop the family's ability and commitment to provide nursing care to each member. Contracting is a creative Intervention that can maximize the opportunities to develop the ability and commitment of the family to provide nursing core to its members 4. Enhance the capability of the family to provide a home environment conducive to Health maintenance of personal development. The family can be tough specific competencies to ensure such home environment through environmental manipulation or management to minimize eliminate health threats or risks or to install forms of using care 5. Facilitate the family's capability to utilize community resources for health care. Involves maximum use of available resources through the coordination collaboration and work provided by an effective referral system. Rationale: Pre-Entry Phase is the initial phase of the organizing process where the community organizer looks for communities to serve and help. Activities include: 1. Preparation of the Institution - Train faculty and students in COPAR. Formulate plans for institutionalizing COPAR. Revise/enrich curriculum and immersion program. Coordinate participants of other departments. 2. Site Selection - Initial networking with local government. Conduct preliminary special investigation. Make a long/short list of potential communities. Do ocular survey of listed communities. Criteria for Initial Site Selection: Must have a population of 100200 families. Economically depressed. No strong resistance from the community. No serious peace and order problem. No similar group or organization holding the same program. 3. Identifying Potential Municipalities- Make long/short list of potential municipalities Identifying Potential Community 4. Choosing Final Community - Conduct informal interviews with community residents and key informants. Determine the need of the program in the community. Take note of political development. Develop community profiles for secondary data. Develop survey tools. Pay Courtesy call to community leaders. Choose foster families based on guidelines 5. Identifying Host Family - House is strategically located in the community. Should not belong to the rich segment. Source: Community Organizing Participatory Action Research (COPAR). Retrieved from https://nurseslabs.com/copar-community-organizingparticipatory-action-research/ 87. Choose the step of the nursing process that identifies the family health seeking behavior. A. Assessment B. Implementation C. Planning D. Evaluation. Rationale: Assessment is a process whereby existing and 90. In Participative Action Research [PAR], Which step will empower the community? A. The nurse performs most of the task B. Health team directs all the activities of the place C. Participation and engagement of the community D. Barangay head appoints people in charge Rationale: A process by which a community identifies its needs and objectives, develops confidence to take action in respect to them and in doing so, extends and develops cooperative and collaborative attitudes and practices in the PRE-BOARDS 2: NURSING PRACTICE I PRE-BOARDS 2: NURSING PRACTICE I community (Ross 1967). Source: Community Organizing Participatory Action Research (COPAR). Retrieved from https://nurses/abs.com/copar-community-organizingparticipatory-action-research 91. The nurse, as the community organizer, immerses self by joining local folks in their usual everyday activities in order to ________. A. Gain trust and rapport of people. B. Make self-popular among people C. Identify and spot leaders. D. Become familiar with the place Rationale: Integration - Establishing rapport with the people in continuing effort to imbibe community life: living with the community, seek out to converse with people where they usually congregate, lend a hand in household chores Source: Community Organizing Participatory Action Research (COPAR). Retrieved from https://nurseslabs.com/copar-community-organizingparticipatory-action-research/ 92. In COPAR, which is the MOST important role of the public health nurse? A. Caregiver B. Expert C. Financer D. Adviser Rationale: A continuous and sustained process of educating the people to understand and develop their critical awareness of their existing condition, working with the people collectively iciently on their immediate and long-term problems, and mobilizing the people to develop their capability and readiness to respond and take action on their immediate needs towards solving their long-term problems (CO: A manual of experience, PCPD). Source: Community Organizing Participatory Action Research (COPAR). Retrieved from https://nurseslabs.com/copar-community-organizingparticipatory-action-research/ Situation: Nurse Vince is assigned as the team leader of newly hired community health nurses of the component city in the province. He oriented them about primary health care. 93. Which of the following are some elements of primary health care except? A. Use of appropriate technology - community development B. Safe water supply C. Free medicines - promote dependence D. Maternal and child care Rationale: The eight essential elements of PHC effectively integrates the health and social development aspects of the health system: (a) safe water and sanitation; (b) food and nutrition; (c) maternal and child health; (d) immunization; (e) curative care; T) essential drugs: (a) health education; (h) traditional medicine; and (i) community development. Source: Determinants of Resiliency in Primary Health Care Delivery in the Philippines. Retrieved from https://www.ipc ateneo.org/content/determinants-resiliency-primary-healthcare-delivery 94. Nurse Vince is going to refer a patient to a secondary health facility. Which of the following is an example of a secondary health facility? A. A District Hospital B. Puericulture Center C. Rural health unit D. Barangay Health Station Rationale: The Level II (Secondary Level of Health Care Facilities) is the smaller, non-departmentalized hospitals including emergency and regional hospitals. The services offered to patients with symptomatic stages of disease, which require moderately specialized knowledge and technical resources for adequate treatment. A district hospital typically is the major health care facility in its region, with many beds for intensive care and additional beds for patients who need long-term care → Option BCD are primary health facilities 95. Which of the following herbal medicines is recommended for cough? A. Sambong B. Guava C. Bawang D. Lagundi Rationale: 1. Sambong - Anti-edema, diuretic, anti-urolithiasis 2. Guava - For washing wounds 3. Bawang - hypertension and toothache 4. Lagundi - cough, asthma, fever Source: Research Information Series on Ecosystems. Retrieved from https://erdb.denr.gov.ph/wpcontent/uploads/2015/05/r_v14n2.pdf 96. Guava leaves are recommended by the department of health to A. Dissolve kidney stones B. Lower blood pressure C. Remedy for cough D. Wash wound Rationale: see number 53; bayawash 97. This global program aims to end poverty and protect the planet? A. Center for Disease Control B. Sustainable development goal C. Millennium development goals D. World health organization Rationale: The Sustainable Development Goals (SDGs), also known as the Global Goals, were adopted by the United Nations in 2015 as a universal call to action to end poverty, protect the planet, and ensure that by 2030 all people enjoy peace and prosperity. Source: What are the Sustainable Development Goals?. Retrieved from https://www.undp.org/sustainable development-goals Situation: Ximena a Christian 29-year-old pregnant woman was admitted to the hospital with a complaint of moderate hypogastric pain. She intends to visit the clinic for her first prenatal check-up and informs nurse Parker that she did not realize she's pregnant until a week ago. As a result, she has been on a diet, weightlifting at the health gym. 98. Patient Ximena was seen by the physician and was ordered for a medication that is larger than the standard dose. What should the nurse do? A. Give the drug as prescribed. B. Inform the supervisor. C. Give the average dose of the medication. D. Discuss the prescription with the physician. Rationale: The nurse should always question the primary care provider about any order that is ambiguous, unusual (e.g., an abnormally high dosage of a medication), or contraindicated by the client's condition. PRE-BOARDS 2: NURSING PRACTICE I PRE-BOARDS 2: NURSING PRACTICE I 99. The patient refuses to take the medication because it causes diarrhea. Nurse Parker explains the action of the drug but the patient vehemently refuses the medication. What should be the INITIAL action of the nurse? A. Discuss with a family member the need for the patient to take the medication. B. Document the patient's refusal to take the medication. C. Notify the physician of the patient's refusal to take the medication. D. Explain again to the patient the consequences of refusing to take the medication. Rationale: vehement - intense (ayaw talaga ni px) → Option B - The patient has the right to refuse → Option C - Notifying the practitioner eventually should be done, but it is not the priority at this time. → Option A - Discussing the situation with a family member without the patient's consent is a violation of confidentiality. Option D - The patient has been taught about the medication and adamantly refuses the medication. Further teaching at this time may be viewed by the patient as badgering. 100. As a strong believer of her faith and the need for spiritual guidance, patient Ximena requests that she wants clergy to visit her. How did nurse Parker function when she initiated the visit? A. Dependently - needs doctor’s order; e.g. administering O2 B. Collegially C. Interdependently - collaboration; with RadTech D. Independently - does not need doctor’s order; e.g. taking VS Rationale: clergy - other discipline Interdependent: A nursing intervention that requires a medical team to care for a patient. An example is treatment for an injury where the doctor prescribes medicine, the nurse administers it and a physical therapist helps the patient with rehabilitation. Dependent interventions are activities carried out under the orders or supervision of a licensed physician or other health care provider authorized to write orders to nurses. Independent interventions are those activities that nurses are licensed to initiate on the basis of their knowledge and skills. PRE-BOARDS 2: NURSING PRACTICE I

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