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

100 Nursing Board Exam test questions of June 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 – A 61 year old man, Mr. Regalado, is admitted to the private ward for

observation after complaints of severe chest pain. You are assigned to take care of the

client.

51. When doing an initial assessment, the best way for you to identify the client’s priority

problem is to:

A. Interview the client for chief complaints and other symptoms

B. Talk to the relatives to gather data about history of illness

C. Do auscultation to check for chest congestion

D. Do a physical examination while asking the client relevant questions

52. Upon establishing Mr. Regalado’s nursing needs, the next nursing approach would be to:

A. Introduce the client to the ward staff to put the client and family at ease

B. Give client and relatives a brief tour of the physical set up the unit

C. Take his vital signs for a baseline assessment

D. Establish priority needs and implement appropriate interventions

53. Mr. Regalado says he has “trouble going to sleep”. In order to plan your nursing

intervention you will:

A. Observe his sleeping patterns in the next few days

B. Ask him what he means by this statement

C. Check his physical environment to decrease noise level

D. Take his blood pressure before sleeping and upon waking up

54. Mr. Regalado’s lower extremities are swollen and shiny. He has pitting pedal edema.

When taking care of Mr. Regalado, which of the following interventions would be the most

appropriate immediate nursing approach?

A. Moisturize lower extremities to prevent skin irritation

B. Measure fluid intake and output to decrease edema

C. Elevate lower extremities for postural drainage

D. Provide the client a list of food low in sodium

55. Mr. Regalado will be discharged from your unit within the hour. Nursing actions when

preparing a client for discharge include all EXCEPT:

A. Making a final physical assessment before client leaves the hospital

B. Giving instructions about his medication regimen

C. Walking the client to the hospital exit to ensure his safety

D. Proper recording of pertinent data

Situation – Using Maslow’s need theory, Airway, Breathing and Circulation are the

physiological needs vital to life. The nurse’s knowledge and ability to identify and

immediately intervene to meet these needs is important to save lives.

56. Which of these clients has a problem with the transport of oxygen from the lungs to the tissues:

A. Carol with tumor in the brain

B. Theresa with anemia

C. Sonnyboy with a fracture in the femur

D. Brigitte with diarrhea

57. You noted from the lab exams in the chart of M. Santos that he has reduced oxygen in the blood. This condition is called:

A. Cyanosis

B. Hypoxia

C. Hypoxemia

D. Anemia

58. You will do nasopharyngeal suctioning on Mr. Abad. Your guide for the length of

insertion of the tubing for an adult would be:

A. tip of the nose to the base of the neck

B. the distance from the tip of the nose to the middle of the neck

C. the distance from the tip of the nose to the tip of the ear lobe

D. eight to ten inches

59. While doing nasopharyngeal suctioning on Mr. Abad, the nurse can avoid trauma to the area by:

A. Apply suction for at least 20-30 seconds each time to ensure that all secretions

are removed

B. Using gloves to prevent introduction of pathogens to the respiratory system

C. Applying no suction while inserting the catheter

D. Rotating catheter as it is inserter with gentle suction

60. Nurse Suzie is administering 12:00 PM medication in Ward 4. Two patients have to receive Lanoxin. What should Nurse Suzie do when one of the clients does NOT have a readable identification band?

A. Ask the client if she is Mrs. Santos

B. Ask the client his name

C. Ask the room mate if the client is Mrs. Santos

D. Compare the ID band with the bed tag

Situation – During the NUTRITION EDUCATION class discussion a 58 year old man, Mr. Bruno, shows increased interest.

61. Mr. Bruno asks what the “normal” allowable salt intake is. Your best response to Mr.

Bruno is:

A. 1 tsp of salt/day with iodine and sprinkle of MSG

B. 5 gms per day or 1 tsp of table salt/day

C. 1 tbsp of salt/day with some patis and toyo

D. 1 tsp of salt/day but no patis and toyo

62. Your instructions to reduce or limit salt intake include all the following EXCEPT:

A. eat natural food with little or no salt added

B. limit use of table salt and use condiments instead

C. use herbs and spices

D. limit intake of preserved or processed food

63. Teaching strategies and approaches when giving nutrition education is influenced by

age, sex and immediate concerns of the group. Your presentation for a group of young

mothers would be best if you focus on:

A. diets limited in salt and fat

B. harmful effects of drugs and alcohol intake

C. commercial preparation of dishes

D. cooking demonstration and meal planning

64. Cancer cure is dependent on

A. use of alternative methods of healing

B. watching out for warning signs of cancer

C. proficiency in doing breast self-examination

D. early detection and prompt treatment

65. The role of the health worker in health education is to

A. report incidence of non-communicable diseases to community health center

B. educate as many people about warning signs of non-communicable

diseases

C. focus on smoking cessation projects

D. monitor clients with hypertension

Situation  – As you begin to work in the hospital where you are on probation, you are

tasked to take care of a few patients. The clients have varied needs and you are expected to provide care for them.

66. An ambulatory client. Mr. Zosimo, is being prepared for bed. Which of the following nursing actions promote safety for the client?

A. Turning off the lights to promote rest and sleep

B. Instructing the client about the use of call system

C. Raising the side rails

D. Placing the bed in high position

67. Mikka, a 25 year old female client, is admitted with right lower quadrant abdominal pain. The physician diagnosed the client with acute appendicitis and an emergency appendectomy was performed. Twelve hours following surgery, the patient complained of pain. Which of the following is the most appropriate nursing diagnosis?

A. Impaired mobility related to pain secondary to an abdominal incision

B. Impaired movements related to pain due to surgery

C. Impaired mobility related to surgery

D. Severe pain related to surgery

68. You are preparing a plan of care for a client who is experiencing pain related to incisional swelling following laminectomy. Which of the following should be included in the nursing care plan?

A. Encourage the client to log roll when turning

B. Encourage the client to do self-care

C. Instruct the client to do deep breathing exercises

D. Ambulate the client in ward premises every twenty minutes

69. Mr. Lozano, 50 year old executive, is recovering from severe myocardial infarction. For the past 3 days, Mr. Lozano’s hygiene and grooming needs have been met by the nursing staff. Which of the following activities should be implemented to achieve the goal of independence for Mr. Lozano?

A. Involving family members in meeting client’s personal needs

B. Meeting his needs till he is ready to perform self-care

C. Preparing a day to day activity list to be followed by client

D. Involving Mr. Lozano in his care

70. Mr. Ernest Lopez is terminally ill and he choose to be at home with his family. What nursing action are best initiated to prepare the family of Mr. Lopez?

A. Talk with the family members about the advantage of staying in the hospital for

proper care

B. Provide support to the family members by teaching ways to care for their

loved one

C. Convince the client to stay in the hospital for professional care

D. Tell the client to be with his family

Situation  – Myrna, a researcher, proposes a study on the relationship between health

values and the health promotion activities of staff nurses in a selected college

of nursing.

71. In both quantitative and qualitative research, the used of a frame of reference is required. Which of the following items serves as the purpose of a framework?

A. Incorporates theories into nursing’s body of knowledge

B. Organizes the development of study and links the findings to nursing’s body

of knowledge

C. Provides logical structure of the research findings

D. Identifies concepts and relationships between concepts

72. Myrna need to review relevant literature and studies. The following processes are undertaken in reviewing literature EXCEPT:

A. locating and identifying resources

B. reading and recording notes

C. clarifying a research topic

D. using the library

73. The primary purpose for reviewing literature is to:

A. organize materials related to the problem of interest

B. generate broad background and understanding of information related to the

research problem of interest

C. select topics related to the problem of interest

D. gather current knowledge of the problem of interest

74. In formulating the research hypotheses, researcher Myrna should state the research question as:

A. What is the response of the staff nurses to the health values?

B. How is variable “health value” perceived in a population?

C. Is there a significant relationship between health values and health

promotion activities of the staff nurses?

D. How do health values affect health promotion activities of the staff nurses?

75. The proposed study shows the relationship between the variables. Which of the following is the independent variable?

A. Staff nurses in a selected college of nursing

B. Health values

C. Health promotion activities

D. Relationship between health values and health promotion activities

Situation – While working in a tertiary hospital, you are assigned to the medical ward.

76. Your client, Mr. Diaz, is concerned that he can not pay his hospital bills and professional fees. You refer him to a:

A. Nurse supervisor

B. Social worker

C. bookkeeping department

D. physician

77. Mr. Magno has lung cancer and is going through chemotherapy. He is referred by the oncology nurse to a self-help group of clients with cancer to:

A. receive emotional support

B. to be a part of a research study

C. provide financial assistance

D. assist with chemotherapy

78. A diabetic hypertensive client, Mrs. Linao, needs a change in diet to improve her health status. She should be referred to a:

A. nutritionist

B. dietitian

C. physician

D. medical pathologist

79. When collaborating with other health team members, the best description of Nurse Rita’s role is:

A. encourages the client’s involvement in his care

B. shares and implements orders of the health team to ensure quality care

C. she listens to the individual views of the team members

D. helps client set goals of care and discharge

80. Nurse Rita is successful in collaborating with health team members about the care of Mr. Linao. This is because she has the following competencies:

A. Communication, trust, and decision making

B. Conflict management, trust, negotiation

C. Negotiation, decision making

D. Mutual respect, negotiation and trust

Situation – The practice of nursing goes with responsibilities and accountability whether you work in a hospital or in the community setting you main objective is to

provide safe nursing to your clients?

81. To provide safe, quality nursing care to various clients in any setting, the most important tool of the nurse is:

A. critical thinking to decide appropriate nursing actions

B. understanding of various nursing diagnoses

C. observation skills for data collection

D. possession of in scientific knowledge about client needs

82. You ensure the appropriateness and safety of your nursing interventions while caring for various client groups by:

A. creating plans of care for particular clientele

B. identifying the correct nursing diagnoses for clients

C. making a thorough assessment of client needs and problems

D. using standards of nursing care as your criteria for evaluation

83. The effectiveness of your nursing care plan for your clients is determined by

A. the number of nursing procedures performed to comfort the client

B. the amount of medications administered to the client as ordered

C. the number of times the client calls the nurse

D. the outcome of nursing interventions based on plan of care

84. You are assigned to Mrs. Amado, age 49, who was admitted for possible surgey. She complained of recurrent pain at the right upper quadrant of the abdomen 1-2 hours after ingestion of fatty food. She also had frequent bouts of dizziness, blood pressure of 170/100, hot flashes. Which of the above symptoms would be an objective cue?

A. Blood pressure measurement of 170/100

B. Complaint of hot flashes

C. Report of pain after ingestion of fatty food

D. Complaint of frequent bouts of dizziness

85. While talking with Mrs. Amado, it is most important for the nurse to:

A. schedule the laboratory exams ordered for her

B. do an assessment of the client to determine priority needs

C. tell the client that your shift ends after eight hours

D. have the client sign an informed consent

Situation - Eileen, 45 years old is admitted to the hospital with a diagnosis of renal calculi. She is experiencing severe flank pain, nauseated and with a temperature of 39 ⁰C.

86. Given the above assessment data, the most immediate goal of the nurse would be which of the following?          

            A. Prevent urinary complication

            B. maintains fluid and electrolytes

C. Alleviate pain

D. Alleviating nausea

 87. After IVP a renal stone was confirmed, a left nephrectomy was done. Her post operative order includes “daily urine specimen to be sent to the laboratory” . Eileen has a foley catheter attached to a urinary drainage system. How will you collect the urine specimen?

A. remove urine from drainage tube with sterile needle and syringe and empty urine from the

     syringe into the specimen container

            B. empty a sample urine from the collecting bag into the specimen container

C. disconnect the drainage tube from the indwelling catheter and allow urine to flow from catheter int the specimen container.

D. disconnect the drainage the from the collecting bag and allow the urine to flow from the catheter into the specimen container.

88. Where would the nurse tape Eileen’s indwelling catheter in order to reduce urethral irritation?

            A. to the patient’s inner thigh                                   

B. to the patient’s lower thigh                 

C. to the patient’

            D. to the patient lower abdomen

89. Which of the following menu is appropriate for one with low sodium diet?

            A. instant noodles, fresh fruits and ice tea

            B. ham and cheese sandwich, fresh fruits and vegetables

            C. white chicken sandwich, vegetable salad and tea

            D. canned soup, potato salad, and diet soda

90. How will you prevent ascending infection to Eileen who has an indwelling catheter?

            A. see to it that the drainage tubing touches the level of the urine

            B. change he catheter every eight hours

            C. see to it that the drainage tubing does not touch the level of the urine

            D. clean catheter may be used since urethral meatus is not a sterile area  

Situation  – You are assigned to take care of 10 patients during the morning shift. The

endorsement includes the IV infusion and medications for these clients.

91. Mr. Felipe, 36 years old is to be given 2700 ml of D5LR to infuse for 18 hours starting at 8 am. At what rate should the IV fluid be flowing hourly?

A. 100 ml per hour

B. 210 ml per hour

C. 150 ml per hour

D. 190 ml per hour

92. Mr. Atienza is to receive 150 ml/hour of D% W IV infusion for 12 hours for a total of

1800ml. He is also losing gastric fluid which must be replaced every two hours. Between 8 am and 10 am, Mr. Atienza has lost 250 ml of gastric fluid. How much fluid should he

receive at 11 am?

A. 350 ml/hour

B. 275 ml/hour

C. 400 ml/hour

D. 200 ml/hour

93. You are to apply a transdermal patch of nitoglycerin to your client. The following are

important guidelines to observe EXCEPT:

A. Apply to hairless clean area of the skin not subject to much wrinkling

B. Patches may be applied to distal part of the extremities like forearm

C. Change application and site regularly to prevent irritation of the skin

D. Wear gloves to avoid any medication on your hand

94. You will be applying eye drops to Miss Romualdez. After checking all the necessary

information and cleaning the affected eyelid and eyelashes, you administer the ophthalmic drops by instilling the eye drops:

A. directly onto the cornea

B. pressing the lacrimal duct

C. into the outer third of the lower conjunctival sac

D. from the inner canthus going towards the side of the eye

95. When applying eye ointment, the following guidelines apply EXCEPT:

A. squeeze about 2 cm of ointment and gently close but not squeeze the eye

B. apply the ointment from the inner canthus going outward of the affected eye

C. discard the first bead of the eye ointment before application because the

tube is likely to expel more than desired amount of ointment

D. hold the tube above the conjunctival sac, do not let tip touch the conjunctiva

Situation – The staff nurse supervisor requests all the staff nurses to “brainstorm” and

learn ways to instruct diabetic clients on self-administration of insulin. She wants to ensure that there are nurses available daily to do health education classes.

96. The plan of the nurse supervisor is an example of

A. in service education process

B. efficient management of human resources

C. increasing human resources

D. primary prevention

97. When Mrs. Guevarra, a nurse, delegates aspects of the clients care to the nurse-aide

who is an unlicensed staff, Mrs. Guevarra

A. makes the assignment to teach the staff member

B. is assigning the responsibility to the aide but not the accountability for

those tasks

C. does not have to supervise or evaluate the aide

D. most know how to perform task delegated

98. Connie, the new nurse, appears tired and sluggish and lacks the enthusiasm she had six weeks ago when she started the job. The nurse supervisor should

A. empathize with the nurse and listen to her

B. tell her to take the day off

C. discuss how she is adjusting to her new job

D. ask about her family life

99. Process of formal negotiations of working conditions between a group of registered

nurses and employer is

A. grievance

B. arbitration

C. collective bargaining

D. strike

100. You are attending a certification on cardiopulmonary resuscitation (CPR) offered and

required by the hospital employing you. This is

A. professional course towards credits

B. inservice education

C. advance training

D. continuing education

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