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
DIRECTION: Choose the letter of the BEST answer by shading the corresponding letter of your choice on the answer sheet provided. STRICTLY NO ERASURE!
Situation 1: It is Cancer Consciousness Week and you are participating in an Early Cancer Detection Drive
1. Based on the DOH and World Health Organization (WHO) guidelines, the mainstay for early detection method for breast cancer that is recommended for developing countries is:
A. a monthly breast self examination (BSE) and an annual health worker breast examination (HWBE)
B. an annual hormone receptor assay
C. an annual mammogram
D. a physician conduct a breast clinical examination every 2 years
2. The purpose of performing the breast self examination (BSE) regularly is to discover:
A. fibrocystic masses C. areas of thickness or fullness
B. cancerous lumps D. changes from previous BSE
3. If you are to instruct a postmenopausal woman about BSE, when would you tell her to do BSE:
A. on the same day of each month C. on the first day of her menstruation
B. right after the menstrual period D. on the last day of her menstruation
4. During breast self-examination, the purpose of standing in front of the mirror it to observe the breast for:
A. thickening of the tissue C. lumps in the breast tissue
B. axillary D. change in size and contour
5. When preparing to examine the left breast in a reclining position, the purpose of placing a small folded towel under the client’s left shoulder is to:
A. bring the breast closer to the examiner’s right hand
B. tense the pectoral muscle
C. balance the breast tissue more evenly on the chest wall
D. facilitate lateral positioning of the breast
Situation 2: Ensuring safety is one of your most important responsibilities. You will need to provide instruction and information to your clients to prevent complications.
6. LM has chest tube attached to a pleural drainage system. When caring for LM you should:
A. change the dressing daily using aseptic technique
B. empty the drainage system at the end of the shift
C. palpate the surrounding areas for crepitus
D. clamp the chest tube when suctioning
7. After pelvic surgery, the sign that would be indicative of a developing thrombophlebitis would be:
A. a tender, painful area on the leg C. a pitting edema of the ankle
B. pruritus on the calf and ankle D. a reddened area of the ankle
8. To prevent recurrent attacks on FT who has glomerulonephritis, you should instruct her to:
A. continue to take the same restrictions on fluid intake
B. seek early treatment for respiratory infections
C. avoid situations that involve physical activity
D. take showers instead of tub bath
9. GT had a laryngectomy. He is now for discharge. He verbalized his concern regarding his laryngectomy tube being dislodged. What would you teach him FIRST?
A. reinsert another tubing immediately C. recognize that prompt closure of the tracheal opening
B. keep calm because there is no immediate D. notify the physician at once
emergency
10. When caring for TU after an exploratory chest surgery and pneumonectomy, your PRIORITY would be to maintain:
A. chest tube drainage C. ventilation exchange
B. blood replacement D. supplementary oxygen
Situation 3: Severe burn is one of the most devastating kinds of injury one can experience. It can affect any group. You have been ready to provide holistic care for patients with severe burns.
11. A burn that is white, painless, and leathery in texture describes a:
A. second degree burn C. deep partial thickness burns
B. third degree or full thickness burn D. first degree or superficial burns
12. Critically ill patients are at high risk for the following complication during the emergent phase:
A. myocardial infarction C. burn shock
B. neurogenic shock D. contractures
13. The MOST effective method of delivering pain medication during the emergent phase is:
A. intramuscularly C. orally
B. subcutaneously D. intravenously
14. Edema presents a significant problem in burn wounds because:
A. loss of protein prevents tissue repair
B. edema impedes tissue perfusion/oxygenation
C. edema provides a milieu for bacterial proliferation
D. edema can produce a tourniquet effect
15. Which of the following can be a fatal complication of upper airway burns?
A. stress ulcers C. shock
B. hemorrhage D. laryngeal spasms and swelling
Situation 4: You are assigned to take care of four patients with different conditions.
16. KJ, who is to have a kidney transplant asks you how long will he take azathioprime (Imuran), cyclosporine and prednisone? You recognized that KJ understood the teaching when he states, “I must take these medications:
A. until the anastomosis heals C. until the supply is over
B. during the preoperative period D. for the rest of my life
17. After the kidney transplant, you must observe KJ for signs of rejection which includes:
A. fever and weight gain C. polyuria and jaundice
B. hematuria and seizure D. moon face and muscle atrophy
18. FB, 28 years old with chronic renal disease plans to receive a kidney transplant. Recently, FB was told by his physician that he was a poor candidate for transplant because of his hypertension and diabetes mellitus. Now, FB tells you “I want to go off dialysis, I’d rather not live than to be in this treatment the rest of my life”. How would you respond to him?
A. leave the room and allow him to collect his thoughts
B. tell FB that “ We all have days when we don’t feel like going on”
C. tell FB that “ Treatments are only three times a week, you can live with that”
D. take a sit next to him and sit quietly
19. DS signed a consent form for participation in a clinical trial for implantable cardioverter defibrillators. Which statement by DS indicates the need for further teaching before true informed consent can be obtained?
A. “a wire from the generator will be attached to my heart”
B. “the physician will make a small incision in my chest wall and place the generator there”
C. “I wonder if there is another way to protect these bad rhythms”
D. “this implanted defibrillator will protect me from those bad rhythms my heart goes into”
20. KP is participating in a cardiac study in which his physician is directly involved. Which statement by KP indicates a lack of understanding about his rights as a research study participant?
A. “My confidentiality will not be compromised in this study”
B. “ I understand the risk associated in this study”
C. “I can withdraw from the study anytime”
D. “ I’ll have to find a new physician if I don’t complete this study”
Situation 5. You are assigned in the neurology stroke unit. To prepare for this assignment, you should be able to answer the following questions.
21. Which of the following statements can BEST describe/define stroke or brain attack?
A. it occurs when circulation to a part of the brain is disrupted
B. it is usually caused by abuse of prescribed medications
C. it is caused by a cerebral hemorrhage
D. it may be the results of a transient ischemic attack (TIA)
22. Several diagnostic tests may be ordered for proper evaluation. The purpose of each of the following diagnostic examination is correct EXCEPT:
A. Cerebral Angiography – is used to identify collateral blood circulation and may reveal site of rupture or occlusion
B. ECG – may reveal abnormal electrical activity, such as focal slowing and assess amount of brain wave
activity.
C. MRI – may reveal the site of infarction, hematoma and shift of brain structures
D. PET Scanning – may reveal information on cerebral metabolism and blood flow characteristics.
23. Which of the following is the MOST common cause of stroke or brain attack?
A. embolism C. cerebral arterial spasm
B. hemorrhage D. thrombosis
24. To guide you in your assessment, it is also important for you to remember that the clinical features of stroke vary with the following factors EXCEPT:
A. severity of damage C. artery affected
B. gender D. the extent of collateral circulation
25. It is important for you to also teach clients and their families who are at risk to observed primary prevention which includes the following EXCEPT:
A. maintain serum cholesterol level between 220 and 180 mm/dL
B. treat transient ischemic attacks (TIA) early
C. teach preventive health behaviors (consequences of smoking, obesity, alcoholism, drug abuse) to children of patients with stroke
D. screen for systolic hypertension
Situation 6:Foot care among patients with peripheral vascular problems is very important.
26. When teaching a client with peripheral vascular disease about foot care, you should include which instructions:
A. avoid wearing canvas shoes C. avoid use of cornstarch on the foot
B. avoid using a nail clipper to cut toe nails D. avoid wearing cotton socks
27. FT, who has no known history of peripheral vascular disease, comes to the emergency room complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses, paresthesia and a mottled, cyanotic, cold, cadaverous left calf. While the physician determines the appropriate management, you should:
A. shave the affected leg in anticipation of surgery C. keep the affected leg level or slightly dependent
B. place a healing pad around the calf D. elevate the affected calf as high as possible
28. Peripheral neuropathies primarily affect:
A. sensory functions C. optic functions
B. vascular functions D. motor functions
29. Peripheral neuropathy can BEST be controlled by:
A. good glucose control C. vitamin supplement
B. steroid therapy D. nothing, there is no slowing the process
30. In addition to clients with diabetes mellitus you must be aware that acute hypoglycemia can also develop in a client with:
A. hypertension C. liver disease
B. hyperthyroidism D. diabetes insipidus
Situation 7: You are assigned to take care of a group of elderly patients. Pain and urinary incontinence are their common concerns. You should be able to address their concerns in a holistic manner.
31. The WHO analgesic ladder provides the health professional with:
A. specific pain management choices based on severity of pain
B. general pain management choices based on level of pain
C. pharmacologic and nonpharmacologic pain management choices
D. nonpharmacologic interventions based on level of pain
32. As a nurse caring for patients in pain, you should evaluate for opioid side effects which include the following EXCEPT:
A. pruritus C. constipation
B. respiratory depression D. physical dependence
33. Which of the following statements about cancer pain is NOT true?
A. opioids are drugs of choice for severe pain
B. pain associated with cancer and the terminal phase of the disease occurs in majority of patients
C. under treatment of pain is often due to a clinician’s failure or inability to evaluate or appreciate the severity of the client’s problem
D. adjuvant medications such as steroids, anti convulsants, nonsteroidal anti-inflammatory drugs enhance pain perception
34. TR has been on morphine on a regular basis for several weeks. He is now complaining that the usual dose he has been receiving is no longer relieving his pain as effectively. Assuming that nothing has changed in his condition, you would suspect that TR is:
A. becoming psychologically dependent C. needing to have the morphine discontinued
B. developing tolerance to the morphine D. exaggerating his level of pain
35. The guidelines for choosing appropriate nonpharmacologic intervention for pain include all of the following EXPECT:
A. effectiveness for patient C. skill of the clinician health professional
B. pain problem identification D. type of opioid being used
Situation 8: To be able to provide care for patients in the critical areas, you should look into factors that will enhance your ability to provide quality nursing care.
36. Research study show that nurses who work with critically patients as opposed to nurses who work with less acute patient:
A. are more satisfied with their role C. are most acceptable to burn out
B. move a greater support system D. experience greater stress
37. Which of the components of HARDINESS has been linked to burnout?
A. less commitment to work C. a sense of control over the patient
B. perception of change D. sense of control to life
38. Nurses who work with critically ill patients should base their practice on all of the following EXCEPT:
A. recognition and appreciation of a person’s unique and social environmental relationships
B. delegated responsibility
C. thorough knowledge of the interrelatedness of body system
D. appreciation of the collaborative role of all health team members
39. Common aspects of the critical care nursing role include:
A. disaster management C. direct care provider
B. staff liaison D. community referral
40. Which of the following interventions would support your patient’s circadian rhythm cycle?
A. putting a wall clock up on your patient’s room
B. decreasing environmental noise
C. encouraging normal bowel movement
D. dimming light during normal sleeping time
Situation 9: To ensure continuity of care and for legal purposes, you have important responsibilities to accurately document all nursing activities.
41. For the past 24 hours, TD with dry skin and dry mucous membranes has had a urine output of 600 m and a fluid intake of 800 ml. TD’s urine is dark amber. These assessments indicate which nursing diagnosis?
A. Impaired urinary elimination C. Excessive fluid volume
B. Deficient fluid volume D. Imbalanced nutrition: less than body requirement
42. Which document addresses the patient’s right to information, informed consent and treatment refusal?
A. Code for Nurses C. Patient’s Bill of Rights
B. Nursing Practice Act D. Standard of Nursing Practice
43. You are caring for GG with a history of falls. The FIRST PRIORITY when caring for GG who is at risk for falls is:
A. instruct GG not to get out of bed unassisted
B. keep the bedpan available so she does not have to get out of bed
C. placing the call light for easy access
D. keep the bed at the lowest position ever
44. Shortly after being admitted to the CCU for acute MI, JJ reports midsternal chest pain radiating down the left arm. You notice that JJ is restless, slightly diaphoretic, and has a temperature of 37.8 deg C, heart rate of 10 beats/min.; regular, slightly labored respirations at 26 breaths/min and a blood pressure of 150/90 mmHg. Which nursing diagnosis takes HIGHEST PRIORITY?
A. decreased cardiac output C. acute pain
B. anxiety D. risk for imbalanced body temperature
45. FF, has a nursing diagnosis of “Risk for injury related to adverse effects of potassium-wasting diuretics”. What’s the correct written client outcome for this diagnosis?
A. FF states the importance of eating potassium rich foods daily
B. Upon discharge, FF knows which food sources are rich in potassium
C. Upon discharge, FF correctly identifies three potassium rich foods
D. FF knows all the complications of the disease process
Situation 10: You are taking care of LC who develops acute respiratory distress. An endotracheal tube had to be inserted to correct the hypoxia.
46. The primary purpose of the endotracheal tube cuff is to:
A. seal off the oropharynx from the nasopharynx C. seal off the oropharynx from the esophagus
B. seal off the lower airway from the esophagus D. seal off the lower airway from the upper airway
47. Endotracheal tube size indicated on the tube reflects what measurements:
A. the circumference size of the tube C. the internal diameter of the tube
B. the length of the tube D. the length of the person’s airway
48. In adults, an inflated E-T tube cuff is necessary for mechanical ventilation primarily because:
A. it seals off the lower airway from the upper airway
B. it prevents air from getting into the stomach
C. it seals off the nasopharynx from the oropharynx
D. it prevents stomach contents from getting into the lungs
49. Endotracheal tube size indicated on the tube reflects what measurements:
A. the internal diameter of the tube C. the circumference size of the tube
B. the length of the person’s airway D. the length of the tube
50. Which of the following statements is TRUE about securing the artificial airway?
A. artificial airways must be secured directly to the patient
B. the airway is generally sutured in place
C. a nasotracheal tube does not require securing
D. the inflated cuff provides sufficient securing
CLICK HERE PART 2 (51 - 100) 'NP4 Nursing Board Exam December 2006 Answer Key 'Nursing Care of Client with Physiological and Psychosocial Alteration'
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