NP5 Nursing Board Exam November Answer Key 'Nursing Care of Client with Physiological and Psychosocial Alteration'

100 Nursing Board Exam test questions of November 2008 Nurse Licensure Examination (NLE)
Nursing Practice V – Nursing Care of Client with Physiological and Psychosocial Alteration
Medical and Surgical Nursing / Psychology

PART 2 Board Exam test questions 51 - 100

Situation 9: Clients with Bipolar disorder receives a very high nursing attention due to the increasing rate of suicide related to illness.

51. The nurse is assigned to care for a recently admitted client  who has attempted suicide. What should the nurse do?

A. Search the client’s belongings and room carefully for items that could be used to attempt suicide.

B. Express trust that the client won’t cause self-harm while in the facility.

C. Respect the client’s privacy by not searching any belongings

D. Remind all staff members to check on the client frequently

52. In planning activities for the depressed client, especially during the early stages of hospitalization, which of the following plan is best?

A. Provide an activity that is quiet and solitary to avoid increased fatigue such as working on a puzzle and reading a book.

B. Plan nothing until the client asks to participate in the milieu

C. Offer the client a menu of daily activities and ask the client to participate in all of them

D. Provide a structured daily program of activities and encourage the client to participate

53. A client with a diagnosis of major depression, recurrent with psychotic features is admitted to the mental health unit. To create a safe environment for the client, the nurse most importantly devises a plan of care that deals specifically with the clients:

A. Disturbed thought process

B. Self Care Deficit

C. Imbalanced Nutrition

D. Deficient Knowledge

54. The client is taking a Tricyclic anti depressant. Which of the following is an example of TCA?

A. Paxil

B. Zoloft

C. Nardil

D. Pamelor

55. A client visits the physician’s office to seek treatment for depression, feeling of hopelessness, poor appetite, insomnia, fatigue, low self-esteem, poor concentration, and difficulty making decisions. The client states that these symptoms began at least 2 years ago. Based on this report, the nurse suspects:

A. cyclothymic disorder

B. Major depression

C. Bipolar disorder

D. Dysthymic disorder

NP5 Nursing Board Exam November Answer Key 'Nursing Care of Client with Physiological and Psychosocial Alteration'

100 Nursing Board Exam test questions of November 2008 Nurse Licensure Examination (NLE)
Nursing Practice V – Nursing Care of Client with Physiological and Psychosocial Alteration
Medical and Surgical Nursing / Psychology

PART 1 Board Exam test questions 1 - 50

Nov. ’08 NP 5

Situation 1: Understanding different models of care is a necessary part of the nurse patient relationship.

1. The focus of this therapy is to have a positive environmental manipulation, physical and social to effect a positive change.

A. Milieu

B. Psychotherapy

C. Behaviour

D. Group

2. The client asks the nurse about the Milieu therapy. The nurse responds knowing that the primary focus of milieu therapy can be best described by which of the following?

A. A form of behaviour modification therapy

B. A cognitive approach of changing the behaviour

C. A living learning or working environment

D. A behavioural approach to changing behaviour

3. A nurse is caring to client with phobia who is being treated for the condition. The client is introduced to short periods of exposure to the phobia object while in relaxed state. The nurse understands that this form of behaviour modification can be best described as:

A. Systematic desensitization

B. Aversion therapy

C. Self-control therapy

D. Operant conditioning

4. A client with major depression is considering cognitive therapy. The client say to the nurse, “how does this treatment works?” The nurse responds by telling the client that:

A. “This type of treatment helps you examine how your thoughts and feelings contribute to your difficulties”

B. “This type of treatment helps you examine how your past life has contributed to your problems.”

C. “This type of treatment helps you confront your fears by exposing you to the feared objects abruptly.”

D. “This type of treatment will help you relax and develop new coping skills.”

5. A client state, “I get down on myself when I make mistake.” Using Cognitive therapy approach, the nurse should:

A. Teach the client relaxation exercise to diminish stress

B. Provide the client with Mastery experience to boost self esteem

C. Explore the client’s past experiences that causes the illness

D. Help client modify the belief that anything less than perfect is horrible.

NP4 Nursing Board Exam November Answer Key 'Nursing Care of Client with Physiological and Psychosocial Alteration'

100 Nursing Board Exam test questions of November 2008 Nurse Licensure Examination (NLE)
Nursing Practice IV – Nursing Care of Client with Physiological and Psychosocial Alteration
Medical and Surgical Nursing / Psychology

PART 2 Board Exam test questions 51 - 100

51. The MOST effective method of delivering pain medication during the emergent phase is:

A. intramuscularly

B. subcutaneously

C. orally

D. intravenously

52. When a client accidentally splashes chemicals to his eyes. The initial priority care of the following the chemical burns is to:

A. irrigate with normal saline for 1 to 15 minutes

B. transport to a physician immediately

C. irrigate with water for 15 minutes or longer

D. cover the eyes with a sterile gauze

53. Which of the following can be fatal complication of upper airway burns?

A. stress ulcers

B. hemorrhage

C. shock

D. laryngeal spasm and swelling

54. When a client will rush towards you and he has burning clothes on, it is your priority to do which of the following first?

A. log roll on the grass/ground

B. slap the flames with his hands

C. Try to remove the burning clothes

D. Splash the client with 1 bucket of cool water

55. Once the flames are extinguished, it is most important:

A. cover client with warm blanket

B. Give him sips of water

C. Calculate the extent of this burns

D. Assess the Sergio’s breathing

NP4 Nursing Board Exam November 2008 Answer Key 'Nursing Care of Client with Physiological and Psychosocial Alteration'

100 Nursing Board Exam test questions of November 2008 Nurse Licensure Examination (NLE)
Nursing Practice IV – Nursing Care of Client with Physiological and Psychosocial Alteration
Medical and Surgical Nursing / Psychology

PART 1 Board Exam test questions 1 - 50

Nov. 08 NP4

Situation 1: After abdominal surgery, the circulating and scrub nurses have critical responsibility about sponge and instrument count.

1. Counting is performed thrice: During the preincision phase, the operative phase and closing phase. Who counts the sponges, needles and instruments?

A. The scrub nurse only

B. The circulating nurse only

C. The surgeon and the assistant surgeon

D. The scrub nurse and circulating nurse.

2. The layer of the abdomen is divided into 5. Arrange the following from the first layer going to the deepest layer:

1. Fascia

2. Muscle

3. Peritoneum

4. Subcutaneous/Fat

5. Skin

A.        5,4,3,2,1

B.        5,4,2,1,3

C.        5,4,1,3,2,

D.        5,4,1,2,3

3. When is the first sponge instrument count reported?

A. Before closing the subcutaneous layer

B. Before peritoneum is closed

C. Before closing the skin

D. Before the fascia is sutured

4. Like any nursing intervention, counts should be documented. To whom does the scrub nurse report any discrepancy of counts so that immediate and appropriate action is instituted?

A. Anaesthesiologist

B. Surgeon

C. OR nurse supervisor

D. Circulating nurse

5. Which of the following are 2 interventions of the surgical team when an instrument was confirmed missing?

A. MRI and Incidence report

B. CT Scan, MRI, Incidence Report

C. X-ray, and Incidence Report

D. CT scan and Incidence Report

NP3 Nursing Board Exam November 2008 Answer Key 'Nursing Care of Client with Physiological and Psychosocial Alteration'

100 Nursing Board Exam test questions of November 2008 Nurse Licensure Examination (NLE)
Nursing Practice III – Nursing Care of Client with Physiological and Psychosocial Alteration
Medical and Surgical Nursing / Psychology

PART 2 Board Exam test questions 51 - 100

Situation 10 – In the OR, there are safety protocols that should be followed. The OR nurseshould be well versed with all these to safeguard the safety and quality of patient delivery outcome.

51. Which of the following should be given highest priority when receiving patient in the OR?

A. Assess level of consciousness

B. Verify patient identification and informed consent

C. Assess vital signs

D. Check for jewelry, gown, manicure, and dentures

52. Surgeries like I and D (incision and drainage) and debridement are relatively short procedures but considered ‘dirty cases’. When are these procedures best scheduled?

A. Last case

B. In between cases

C. According to availability of anaesthesiologist

D. According to the surgeon’s preference

53. OR nurses should be aware that maintaining the client’s safety is the overall goal of nursing care during the intraoperative phase. As the circulating nurse, you make certain that throughout the procedure…

A. the surgeon greets his client before induction of anesthesia

B. the surgeon and anesthesiologist are in tandem

C. strap made of strong non-abrasive materials are fastened securely

around the joints of the knees and ankles and around the 2 hands around

an arm board.

D. Client is monitored throughout the surgery by the assistant anaesthesiologist

54. Another nursing check that should not be missed before the induction of general

anesthesia is:

A. check for presence underwear

B. check for presence dentures

C. check patient’s ID

D. check baseline vital signs

55. Some lifetime habits and hobbies affect postoperative respiratory function. If your client

smokes 3 packs of cigarettes a day for the past 10 years, you will anticipate increased risk

for:

A. perioperative anxiety and stress

B. delayed coagulation time

C. delayed wound healing

D. postoperative respiratory function

NP3 Nursing Board Exam November 2008 Answer Key 'Nursing Care of Client with Physiological and Psychosocial Alteration'

100 Nursing Board Exam test questions of November 2008 Nurse Licensure Examination (NLE)
Nursing Practice III – Nursing Care of Client with Physiological and Psychosocial Alteration
Medical and Surgical Nursing / Psychology

PART 1 Board Exam test questions 1 - 50

Situation 1: Leo lives in the squatter area. He goes to nearby school. He helps his mother gather molasses after school. One day, he was absent because of fever, malaise, anorexia and abdominal discomfort.

1. Upon assessment, Leo was diagnosed to have hepatitis A. Which mode of transmission has the infection agent taken?

A. Fecal oral

B. Droplet

C. Airborne

D. Sexual contact

2. Which of the following is concurrent disinfection in the case of Leo?

A. In

B. Sanitary disposal of feces, urine and blood

C. Quarantine of the sick individual

D.

3. Which of the following must be emphasized during mother’s class to Leo’s mother?

A. Administration of immunoglobulin to families

B. Thorough hand washing before and after eating and toileting

C. Use of attenuated vaccines

D. Boiling of food especially meat

4. Disaster control should be undertaken when there are 3 or more hepatitis A cases. Which of these measures is a priority?

A. Eliminate fecal contamination from foods

B. Mass vaccination of uninfected individuals

C. Health promotion and education to families and communities about the disease it’s cause and transmission.

D. Mass administration of immunoglobulin

5. What is the average incubation period of Hepatitis A?

A. 30 days

B. 60 days

C. 50 days

D. 14 days

NP2 Nursing Board Exam November 2008 Answer Key 'Community Health Nursing and Care of Mother and Child'

100 Nursing Board Exam test questions of November 2008 Nurse Licensure Examination (NLE)
Nursing Practice II – Community Health Nursing and Care of Mother and Child
Community Health Nursing / O.B. (Obstetric)

PART 2 Board Exam test questions 51 - 100

Situation 7: The infant and child mortality rate in the low to middle income countries is ten times higher than industrialized countries. In response to this the WHO and UNICEF launched protocol Integrated Management of Childhood Illness to reduce the morbidity and mortality against childhood illnesses.

51. If a child with diarrhea registers two signs in the yellow row in the IMCCI char, we can classify the patient as:

A. Moderate dehydration

B. Some dehydration

C. Severe dehydration

D. No dehydration

52. Celeste has had diarrhea for 8 days. There is no blood in the stool, he is irritable, his eyes are sunken, the nurse offers fluid to Celeste and he drinks eagerly. When the nurse pinched the abdomen it goes back slowly. How will you classify Celeste’s Illness?

A. Moderate dehydration

B. Some dehydration

C. Severe dehydration

D. No dehydration

53. A child who is 7 weeks has had diarrhea for 14 days but has no sign of dehydration is classified as?

A. Persistent diarrhea

B. Severe dysentery

C. Dysentery

D. Severe Persistent diarrhea

54. The child with no dehydration needs home treatment. Which of the following is not included in the rules for home treatment in this case?

A. Forced fluids

B. When to return

C. Give Vitamin A supplement

D. Feeding more

55. Fever as used in IMCI includes:

A. Axillary temperature of 37.5 or higher

B.  Rectal temperature of 38 or higher

C. Feeling hot to touch

D. All of the above

E. A and C only

NP2 Nursing Board Exam November 2008 Answer Key 'Community Health Nursing and Care of Mother and Child'

100 Nursing Board Exam test questions of November 2008 Nurse Licensure Examination (NLE)
Nursing Practice II – Community Health Nursing and Care of Mother and Child
Community Health Nursing / O.B. (Obstetric)

PART 1 Board Exam test questions 1 - 50

Situation 1: Mariah is a 31 year old lawyer who has been married for 6 moths. She consults you for guidance in relation with her menstrual cycle and her desire to get pregnant.

1. She wants to know the length of her menstrual cycle. Her periodic menstrual period is October 22 to 26. Her LMB is November 21. Which of the following number of days will be your correct response?

A. 29

B. 28

C. 30

D. 31

2. You advised her to observe and record the signs of Ovulation. Which of the following signs will she likely note down?

1.       A 1 degree Farenheit rise in basal body temperature

2.       Cervical mucus becomes copious and clear

3.       One pound increase in weight

4.       Mitteischmerz

A. 1,2,4                    B. 1,2,3                  C. 2,3,4                    D. 1,3,4

3. You instruct Mariah to keep record of her basal temperature everyday, which of the following instructions is incorrect?

A. If coitus has occured, this should be reflected in the chart

B. It is best to have coitus on the evening following a drop in BBT to become pregnant

C. Temperature should be taken immediately after waking and before getting put of bed

D. BBT is lowest during the secretory phase

4. She reports an increase in BBT on December 16. Which hormone brings about this change in her BBT?

A. Estrogen

B. Progesterone

C. Gonadootrophine

D. Follicle Stimulating Hormone

5. The following month, Mariah suspects she is pregnant. Her urine is positive for Human Chorionic Gonadotrophin. Which structure produce HCG?

A. Pituitary Gland

B. Trophoblastic cells of the embryo

C. Uterine deciduas

D. Ovarian follicles

NP1 Nursing Board Exam November 2008 Answer Key 'Foundation of Professional Nursing Practice'

100 Nursing Board Exam test questions of November 2008 Nurse Licensure Examination (NLE)
Nursing Practice 1 – Foundation of Professional Nursing Practice
Fundamentals of Nursing

PART 2 Board Exam test questions 51 - 100

Situation 9: As a nurse, you are aware that proper documentation in the patient chart is your responsibility.

51. Which of the following is NOT a legally binding document but nonetheless very important in the care of all patients in any setting?

A. Bill of rights as provided in the Philippine Constitution

B. Scope of nursing practice as defined in R.A. 9173

C. Board of Nursing resolution adopting the Code of Ethics

D. Patient’s Bill of Rights 

52. A nurse gives a wrong medication to the client. Another nurse employed by the same hospital as a risk manager will expect to receive which of the following communication?

A. Incident Report

B. Oral report

C. Nursing kardex

D. Complain report

53. Performing a procedure on a client in the absence of an informed consent can lead to which of the following charges?

A. Fraud

B. Assault and Battery

C. Harassment

D. Breach of confidentiality

54. Which of the following is the essence of informed consent?

A. It should have a durable power of attorney

B. It should have coverage from an insurance company

C. It should respect the client’s freedom from coercion
D. It should discloses previous diagnosis, prognosis and alternative treatments available for the client.

55. Delegation is the process of assigning tasks that can be performed by a subordinate. The RN should always be accountable and should not lose his accountability. Which of the following is a role included in delegation?

A. The RN must supervise all delegated tasks

B. After a task has been delegated. It is no longer a responsibility of the RN.

C. The RN is responsible and accountable for the delegated task in a adjunct with the delegate.

D. Follow up with a delegated task necessary only if the assistive personnel is not trustworthy.

NP1 Nursing Board Exam November 2008 Answer Key 'Foundation of Professional Nursing Practice'

100 Nursing Board Exam test questions of November 2008 Nurse Licensure Examination (NLE)
Nursing Practice 1 – Foundation of Professional Nursing Practice
Fundamentals of Nursing

PART 1 Board Exam test questions 1 - 50

Situation 1: Nursing is a profession.  The nurse should have a background on the theories and foundation of nursing as it influenced what is nursing today.

1. Nursing is the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response and advocacy in the care of the individuals, families, communities and population. This is the most accepted definition of nursing as defined by the:

A. PNA

B. ANA

C. Nightingale

D. Henderson

2. Advancement in Nursing leads to the development of the Expanded Career Roles. Which of the following is NOT expanded career role for nurse?

A. Nurse practitioner

B. Clinical Nurse Specialist

C. Nurse Researcher

D. Nurse anaesthesiologist

3. The Board of Nursing regulated the Nursing profession in the Philippines and is responsible for the maintenance of the quality of nursing in the country. Powers and duties of the board of nursing are the following EXCEPT:

A.  Issue, suspend revoke certificates of registration

B.  Issue subpoena duces tecum, ad testificandum

C. Open and close colleges of nursing

D. Supervise and regulate the practice

4. A nursing student or a beginning staff nurse who has not yet experienced enough in a situation to make judgments about them is in what stage of Nursing Expertise?

A. Novice

B. Newbie

C. Advanced Beginner

D. Competent

5. Benner’s “Proficient” nurse level is different from the other levels in nursing expertise in the context of having:

A. The ability to organize and plan activities

B. Having attained an advanced level of education

C. A holistic understanding and perception of the client

D. Intuitive and analytic ability in new situations

NP5 Nursing Board Exam June 2008 Answer Key 'Nursing Care of Client with Physiological and Psychosocial Alteration'

100 Nursing Board Exam test questions of June 2008 Nurse Licensure Examination (NLE)
Nursing Practice V – Nursing Care of Client with Physiological and Psychosocial Alteration
Medical and Surgical Nursing / Psychology

PART 2 Board Exam test questions 1 - 50

June 2008

Situation – A vehicle hit some pedestrian while waiting for a bus ride. Some of the victims suffered injuries in different part of the body. The victims were brought to the nearby hospital. One of the victims, Josephine was confirmed to have a fractured left arm. While waiting for plaster cast to be applied, Josephine appears to be anxious.

51. To reduce anxiety, the nurse teaches the procedure to the client, which of the following topics should NOT be included in the teaching plan?

     A. Leave the cast uncovered to promote drying

     B. Bear weight on the plaster for one hour. A stockinet will be placed  

     over the left arm to be placed in the cast.

     C. Handle hardening cast with palm of hands.

     D. Trim and reshape finish cast with knife or cutter.

52. Cast was applied on Josephine’s left arm. In assessing the neurovascular status of the client, which of the following assessment findings should be reported to the physician?

     A. Pain on the left arm

     B. Swelling of the fingers

     C. Skin abrasion on the edges of the plaster cast

     D. Nail bed capillary refill time of 10 seconds

53. One of the victims a sixty year old woman sustained hip fracture. Prior to surgery, a Buck’s extension traction is to be applied. The rationale of traction is primarily based the understanding that Buck’s extension traction:

     A. Reduces muscle spasms and helps to immobilize the fracture

     B. Allows reduction of the fracture site for bone healing.

     C. Secures the fracture site to prevent damage to the muscle tissues

     D. Secures the fracture site for rigid immobilization

54. Philip was placed in skeletal leg traction with an overbed frame. He is not allowed to move from side to side. Which of the following nursing interventions is useful in maintaining.

     A. Assist the client by holding the trapeze and raising hips of the bed.

     B. Check the apparatus that weights hang free and knots in the rope

     are   tied securely.

     C. Suspend a trapeze within easy reach of the client

     D. Support the affected extremity while the weights are removed.

55. To prevent complication when a child is in Buck’s traction, the nurse should:

     A. Clean the extremity and keep the skin dry

     B. Assess any skin and circulatory disturbances

     C. Clean the pin sites as necessary

     D. Provide high fiber small meals.

NP5 Nursing Board Exam June 2008 Answer Key 'Nursing Care of Client with Physiological and Psychosocial Alteration'

100 Nursing Board Exam test questions of June 2008 Nurse Licensure Examination (NLE)
Nursing Practice V – Nursing Care of Client with Physiological and Psychosocial Alteration
Medical and Surgical Nursing / Psychology

PART 1 Board Exam test questions 1 - 50

June 2008

NURSING PRACTICE V - NURSING CARE OF CLIENT WITH PHYSIOLOGICAL AND PSYCHOSOCIAL ALTERATIONS (Part C)

 Situation - Felisa has a ritualistic pattern of constantly washing her hands with soap and water followed by rubbing alcohol.

1. This behavior is categorized as:

     A. delusional                                                            

     B. normal                

     C. neurotic                                     

     D. psychotic

2. A therapeutic intervention in this situation is:

     A. avoid limits on her behavior to release her anxiety

     B. call attention to her ritualistic pattern

     C. provide alternative behaviors to deal with increased anxiety

     D. ignore her behavior totally

3. The anxiety of Felisa is disabling and interferes with her job performance, interpersonal relationships and other activities of daily living. To minimize such problems, she is likely to be given:

     A. diazepam ( Valium )                                             

     B. haloperidol ( Haldol )                                

     C. imipramine Hcl ( Tofranil )

     D. chlorpromazine ( Thorazine )

4. Felisa understands the effects of her medicine when expresses:

     A. “I should watch out for signs of sore lips or sore throat”

     B. “I might have constipation”

     C. “I might feel changes in my body temperature”

     D. “ I should not drive or operate machines”

5. The level of anxiety that Felisa is experiencing is:

     A. Panic                                                                   

     B. Severe                            

     C. Mild

       D.  Moderate

NP4 Nursing Board Exam June 2008 Answer Key 'Nursing Care of Client with Physiological and Psychosocial Alteration'

100 Nursing Board Exam test questions of June 2008 Nurse Licensure Examination (NLE)
Nursing Practice IV – Nursing Care of Client with Physiological and Psychosocial Alteration
Medical and Surgical Nursing / Psychology

PART 2 Board Exam test questions 51 - 100

 Situation  – As a member of the health and nursing team you have a crucial role to play in ensuring that all the members participate actively is the various tasks agreed upon.

51. While eating his meal, Matthew accidentally dislodges his IV lines and bleeds. Blood oozes on the surface of the over-bed table. It is most appropriate that you instruct the housekeeper to clean the table with:

A. Acetone

B. Alcohol

C. Ammonia

D. Bleach

52. You are a member of the infection control team of the hospital. Based on a feedback during the meeting of the committee there is an increased incidence of pseudomonas infection in the Burn Unit (3 out of 10 patients had positive blood and wound culture). What is your priority activity?

A. Establish policies for surveillance and monitoring

B. Do data gathering about the possible sources of infection (observation,

chart review, interview).

C. Assign point persons who can implement policies.

D. Meet with the nursing group working in the burn unit and discuss problem with

them.

53. Part of your responsibility as a member of the diabetes core group is to getreferrals from the various wards regarding diabetic patients needing diabetes education. Prior to discharge today, 4 patients are referred to you. How would you start prioritizing your activities?

A. Bring your diabetes teaching kit and start your session taking into consideration

their distance from your office

B. Contact the nurse in-charge and find out from her the reason for the referral

C. Determine their learning needs then prioritize

D. Involve the whole family in the teaching class

54. You have been designated as a member of the task force to plan activities for the Cancer Consciousness Week. Your committee has 4 months to plan and implement the plan. You are assigned to contact the various cancer support groups in your hospital. What will be your priority activity?

A. Find out if there is a budget for this activity

B. Clarify objectives of the activity with the task force before contacting the

support groups

C. Determine the VIPs and Celebrities who will be invited

D. Find out how many support groups there are in the hospital and get the contact

number of their president

55. You are invited to participate in the medical mission activity of your alumni association. In the planning stage everybody is expected to identify what they can do during the medical mission and what resources are needed. You thought it is also your chance to share what you can do for others. What will be your most important role where you can demonstrate the impact of nursing in health?

A. Conduct health education on healthy life style

B. Be a triage nurse

C. Take the initial history and document findings

D. Act as a coordinator

NP4 Nursing Board Exam June 2008 Answer Key 'Nursing Care of Client with Physiological and Psychosocial Alteration'

100 Nursing Board Exam test questions of June 2008 Nurse Licensure Examination (NLE)
Nursing Practice IV – Nursing Care of Client with Physiological and Psychosocial Alteration
Medical and Surgical Nursing / Psychology

PART 1 Board Exam test questions 1 - 50

June 2008

Situation  – Ensuring safety is one of your most important responsibilities. You will need to provide instructions and information to your clients to prevent complications.

1. Randy has chest tubes attached to a pleural drainage system. When caring for him you should:

A. empty the drainage system at the end of the shift

B. clamp the chest tube when suctioning

C. palpate the surrounding areas for crepitus

D. change the dressing daily using aseptic techniques

2. Fanny, came in from PACU after pelvic surgery. As Fanny’s nurse you know that the sign that would be indicative of a developing thrombophlebitis would be:

A. a tender, painful area on the leg

B. a pitting edema of the ankle

C. a reddened area at the ankle

D. pruritus on the calf and ankle

3. To prevent recurrent attacks on Terry who has acute glumerulonephritis, you should instruct her to:

A. seek early treatment for respiratory infections

B. take showers instead of tub bath

C. continue to take the same restrictions on fluid intake

D. avoid situations that involve physical activity

4. Herbert had a laryngectomy and he is now for discharge. He verbalized his concern regarding his laryngectomy tube being dislodged. What should you teach him first?

A. Recognize that prompt closure of the tracheal opening may occur

B. Keep calm because there is no immediate emergency

C. Reinsert another tubing immediately

D. Notify the physician at once

5. When caring for Larry after an exploratory chest surgery and pneumonectomy, your priority would be to maintain:

A. supplementary oxygen

B. ventilation exchange

C. chest tube drainage

D. blood replacement