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_____1. The nurse is developing a plan of care for the client experiencing anxiety following the loss of a job. The client is verbalizing concerns regarding the ability to meet role expectations and financial obligations. The most appropriate nursing diagnosis for this client is.

a. Dysfunctional family process

c. Risk for anxiety

b. Disturbed thought process

d. Ineffective coping

_____2 The active, organized, cognitive process used to carefully examine ones thinking and the thinking of others?

a. Decision Makingb. Critical Thinkingc. Analysis d. Problem Solving

_____3 It involves use of the mind in forming conclusions, making decisions, drawing inferences and reflecting.

a. Decision Makingb. Critical Thinkingc. Analysis d. Problem Solving

_____4. btaining information and using information to reach acceptable solutions when there is a gap between what is occurring and what should be occurring.

a. Decision Makingb. Critical Thinkingc. Analysis d. Problem Solving

_____5 The end point of critical thinking that leads to problem resolution.

a. Decision Makingb. Critical Thinkingc. Analysis d. Problem Solving

_____6.This is used to identify, diagnose and treat human responses to health and illness

a. Nursing Processb. Assessment

c. Diagnosisd. Planning

_____7. his is a statement that describes the clients actual or potential response to a health problem that the nurse is licensed and competent to treat.

a. Assessment

b. Medical Diagnosis c. Nursing Diagnosisd. Planning

_____8 It predominately-identifies a specific disease state. It focuses on the diagnosis and treatment of the disease.

a. Implementationb. Medical Diagnosis c. Nursing Diagnosis d. Planning

_____9.Which of the following is not a subjective data:

a. Anxiety

b. Abdominal

c. dizzinessd. BP140/90mmHg

_____10The following are specific activities during evaluation except:

a. Collecting data

c. Measuring goal attainment

b. Performing nursing interventionsd. Revising or modifying the care plan

_____11. The primary source of data during assessment is the:

a. The patients chart

c. The relatives/significant others

b. The patient

d. The doctor

_____12. Therapeutic communication begins with:

a. Giving initial care

c. Interacting with patient

b. Showing empathy

d. knowing your patient

_____13. The following are independent nursing interventions for a febrile patient except:

a. Administer Paracetamol 500mg. tab every 4 hrs. PRN for temp. 38.5C

b. Advice to Increase fluid intake

c. Promote bed rest

d. Keep the patients clothings clean and dry

_____14. What is the statement that describes the health care needs of the client?

a. Nursing Diagnosis

b. Planningc. Evaluationd. Intervention

_____15. Which of the following statements is the most appropriate for a nurse to make when initiating a painful procedure on a four year old boy?

a. You are a big boy. I know you can handle this

b. You can have your mom hold your hand

c. You are not a baby. I know you wont cry

d. You will get a treat if you are good

_____16. A nurse is in charge of care for a 20-year-old client with leukemia, what is the first step when using the nursing process?

A. Planning

C. Implementation

B. Evaluation

D. Assessment

_____17. The client is an obese male who is stagnant, and refuses to get out of bed. Which of the following measures will prevent the development of a decubitus ulcer?

A. Avoid frequent turning

B. Encourage and assist the client to turn every two hours

C. Encourage the client to smoke cigarette

D. D. Apply heating pad on the area 24 hours

_____18. The nurse is in charge of care for a patient who is being administered oxygen. The nurse observes that the visitor of the patient is pulling out a cigarette, which of the following should the nurse do?

A. Punish the visitor immediately.

B. Inform the visitor of the No Smoking policy and institute the presence of a No Smoking sign at the door or at the head part of the patient

C. Call the police to arrest the visitor.

D. Allow the visitor of the patient to smoke

_____19. The nurse has administered approximately half of an enema solution when the client complains of pain and cramping. Which nursing action is the most appropriate?

A. Ignore the client.

B. Clamp the tubing for 30 seconds and restart the flow at a slower rate.

C. Continue the flow even if the client is complaining of pain.

D. Increase the flow rate to maximum

_____20. What is the statement specifying what is to be done regarding the patients problem, who is to do it, how to do it and when is to be done.

a. Planning

b. Intervention

c. Evaluationd. Nursing diagnosis

_____21. An 11 month old infant is admitted to the hospital with severe diarrhea. Which of the following nursing diagnoses would be appropriate for the nurse to identify as a priority.

a. Pain

c. Altered health maintenance

b. Altered bowel elimination

d. Altered urinary elimination

____22. . What does TPN stand for?

A. Total personal nutrition

C. Total peripheral nutrition

B. Through peripheral nutrition

D. Total Parenteral Nutrition

____23. . Heat application to an area will cause the blood vessels to:

A. Atrophy

C. Constrict

B. Hypertrophy

D. Dilate

____24. . Cold application to an area will cause the blood vessels to:

A. Atrophy

C. Hypertrophy

B. Constrict

D. Dilate

____25. Mang Ambo, a stroke patient is developing a partial thickness skin loss in his sacral area, on which stage of pressure ulcer does partial thickness skin loss belong?

A Stage I

B. Stage II

C. Stage IIID. Stage IV

____26. An elderly client has a stage III pressure ulcer on her sacrum. During assessment of the clients skin, the nurse would expect to find:

A.Non-blanchable erythema of intact skin

B. Ulcer presents a deep crater with full-thickness skin loss involving damage on subcutaneous tissue

C. Abrasion, blister or shallow crate

D. Full-thickness skin loss with extensive destruction and tissue necrosis

____27. Which among the following will enhace sleep for client scomplaining of insomia?

A. Establish regular routine

c. Encourage activity before bedtime

B. Avoid coffee

D. Use the bed mainly for sleep

___28. Nurse Adi is instrucitng patient Fiona to drink Milk, which amongs the following is true regarding the effect of milk in promoting sleep.

A. Milk is a good stimulant that enhancees sleep.

B. Milk contains L-Tryptohan wchi is a natural sedative

C. Milk contains Calcium which enhances sleep

D. All of the above

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