NURSING PRACTICE III – Care of Clients with Physiologic and Psychosocial Alterations (Part A)

SITUATIONAL

Situation 1 – Concerted work efforts among members of the surgical team is essential to the success of the surgical procedure.

1. The sterile nurse or sterile personnel touch only sterile supplies and instruments. When there is a need for sterile supply which is not in the sterile field, who hands out these items by opening its outer cover?

A. Circulating NurseB. AnaesthesiologistC. SurgeonD. Nursing Aide

2. The OR team performs distinct roles for one surgical procedure to be accomplished within a prescribed time frame and deliver a standard patient outcome. While the surgeon performs the surgical procedure, who monitors the status of the client like urine output, blood loss?

A. Scrub NurseB. SurgeonC. AnaesthesiologistD. Circulating Nurse

3. Surgery schedules are communicated to the OR usually a day prior to the procedure by the nurse of the floor or ward where the patient is confined. For orthopedic cases, what department is usually informed to be present in the OR?

A. Rehabilitation departmentB. Laboratory departmentC. Maintenance departmentD. Radiology department

4. Minimally invasive surgery is very much into technology. Aside from the usual surgical team, who else has to be present when a client undergoes laparoscopic surgery?

A. Information technicianB. Biomedical technicianC. ElectricianD. Laboratory technician

5. In massive blood loss, prompt replacement of compatible blood is crucial. What department needs to be alerted to coordinate closely with the patient’s family for immediate blood component therapy?

A. Security DivisionB. ChaiplaincyC. Social Service SectionD. Pathology department

Situation 2 – You are assigned in the Orthopedic Ward where clients are complaining of pain in varying degrees upon movement of body parts.

6. Troy is a one day post open reduction and internal fixation (ORIF) of the left hip and is in pain. Which of the following observation would prompt you to call the doctor?

A. Dressing is intact but partially soiledB. Left foot is cold to touch and pedal pulse is absentC. Left leg in limited functional anatomic positionD. BP 114/78, pulse of 82 beats/minute

7. There is an order of Demerol 50 mg I.M. now and every 6 hours p r n. You injected Demerol at 5 pm. The next dose of Demerol 50 mg I.M. is given:

A. When the client asks for the next doseB. When the patient is in severe painC. At 11 pmD. At 12 pm

8. You continuously evaluate the client’s adaptation to pain. Which of the following behaviors indicate appropriate adaptation?

A. The client reports pain reduction and decreased activityB. The client denies existence of painC. The client can distract himself during pain episodesD. The client reports independence from watchers

9. Pain in ortho cases may not be mainly due to the surgery. There might be other factors such as cultural or psychological that influence pain. How can you alter these factors as the nurse?

A. Explain all the possible interventions that may cause the client to worryB. Establish trusting relationship by giving his medication on timeC. Stay with the client during pain episodesD. Promote client’s sense of control and participation in control by listening to

his concerns

10. In some hip surgeries, an epidural catheter for Fentanyl epidural analgesia is given. What is your nursing priority care in such a case?

A. Instruct client to observe strict bed restB. Check for epidural catheter drainageC. Administer analgesia through epidural catheter as prescribedD. Assess respiratory rate carefully

Situation 3 – Records are vital tools in any institution and should be properly maintained for specific use and time.

11. The patient’s medical record can work as a double edged sword. When can the medical record become the doctor’s/nurse’s worst enemy?

A. When the record is voluminousB. When a medical record is subpoenaed in courtC. When it is missing

D. When the medical record is inaccurate, incomplete, and inadequate

12. Disposal of medical records in government hospitals/institutions must be done in close coordination with what agency?

A. Department of Interior and Local Government (DILG)B. Metro Manila Development Authority (MMDA)C. Records Management Archives Office (RMAO)D. Department of Health (DOH)

13. In the hospital, when you need the medical record of a discharged patient for research you will request permission through:

A. Doctor in chargeB. The hospital directorC. The nursing serviceD. Medical records section

14. You readmitted a client who was in another department a month ago. Since you will need the previous chart, from whom do you request the old chart?

A. Central supply sectionB. Previous doctor’s clinicC. Department where the patient was previously admittedD. Medical records section

15. Records Management and Archives Office of the DOH is responsible for implementing its policies on record disposal. You know that your institution is covered by this policy if:

A. Your hospital is considered tertiaryB. Your hospital is in Metro ManilaC. It obtained permit to operate from DOHD. Your hospital is PhilHealth accredited

Situation 4 – In the OR, there are safety protocols that should be followed. The OR nurse should be well versed with all these to safeguard the safety and quality of patient delivery outcome.

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

A. Assess level of consciousnessB. Verify patient identification and informed consentC. Assess vital signsD. Check for jewelry, gown, manicure, and dentures

17. 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 caseB. In between casesC. According to availability of anaesthesiologistD. According to the surgeon’s preference

18. 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 anesthesiaB. the surgeon and anesthesiologist are in tandemC. 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 anesthesiologist

19. Another nursing check that should not be missed before the induction of general anesthesia is:

A. check for presence underwearB. check for presence denturesC. check patient’s IDD. check baseline vital signs

20. 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 stressB. delayed coagulation timeC. delayed wound healingD. postoperative respiratory function

Situation 5 – Nurses hold a variety of roles when providing care to a perioperative patient.

21. Which of the following role would be the responsibility of the scrub nurse?

A. Assess the readiness of the client prior to surgeryB. Ensure that the airway is adequate C. Account for the number of sponges, needles, supplies, used during the

surgical procedure.D. Evaluate the type of anesthesia appropriate for the surgical client

22. As a perioperative nurse, how can you best meet the safety need of the client after administering preoperative narcotic?

A. Put side rails up and ask the client not to get out of bedB. Send the client to OR with the familyC. Allow client to get up to go to the comfort roomD. Obtain consent form

23. It is the responsibility of the pre-op nurse to do skin prep for patients undergoing surgery. If hair at the operative site is not shaved, what should be done to make suturing easy and lessen chance of incision infection?

A. DrapedB. Pulled

C. ClippedD. Shampooed

24. It is also the nurse’s function to determine when infection is developing in the surgical incision. The perioperative nurse should observe for what signs of impending infection?

A. Localized heat and rednessB. Serosanguinous exudates and skin blanchingC. Separation of the incisionD. Blood clots and scar tissue are visible

25. Which of the following nursing interventions is done when examining the incision wound and changing the dressing?

A. Observe the dressing and type and odor of drainage if anyB. Get patient’s consentC. Wash handsD. Request the client to expose the incision wound

Situation 6 – Carlo, 16 years old, comes to the ER with acute asthmatic attack. RR is 46/min and he appears to be in acute respiratory distress.

26. Which of the following nursing actions should be initiated first?

A. Promote emotional supportB. Administer oxygen at 6L/minC. Suction the client every 30 minD. Administer bronchodilator by nebulizer

27. Aminophylline was ordered for acute asthmatic attack. The mother asked the nurse, what is its indication, the nurse will say:

A. Relax smooth muscles of the bronchial airwayB. Promote expectorationC. Prevent thickening of secretionsD. Suppress cough

28. You will give health instructions to Carlo, a case of bronchial asthma. The health instruction will include the following, EXCEPT:

A. Avoid emotional stress and extreme temperatureB. Avoid pollution like smokingC. Avoid pollens, dust, seafoodD. Practice respiratory isolation

29. The asthmatic client asked you what breathing techniques he can best practice when asthmatic attack starts. What will be the best position?

A. Sit in high-Fowler’s position with extended legsB. Sit-up with shoulders backC. Push on abdomen during exhalationD. Lean forward 30-40 degrees with each exhalation

30. As a nurse, you are always alerted to monitor status asthmaticus who will likely and initially manifest symptoms of:

A. metabolic alkalosisB. respiratory acidosisC. respiratory alkalosisD. metabolic acidosis

Situation 7 – Joint Commission on Accreditation of Hospital Organization (JCAHO) patient safety goals and requirements include the care and efficient use of technology in the OR and elsewhere in the healthcare facility.

31. As the head nurse in the OR, how can you improve the effectiveness of clinical alarm systems?

A. Limit suppliers to a few so that quality is maintainedB. Implement a regular inventory of supplies and equipmentC. Adherence to manufacturer’s recommendationD. Implement a regular maintenance and testing of alarm systems

32. Overdosage of medication or anesthetic can happen even with the aid of technology like infusion pumps, sphygmomanometer and similar devices/machines. As a staff, how can you improve the safety of using infusion pumps?

A. Check the functionality of the pump before useB. Select your brand of infusion pump like you do with your cellphoneC. Allow the technician to set the infusion pump before useD. Verify the flow rate against your computation

33. JCAHOs universal protocol for surgical and invasive procedures to prevent wrong site, wrong person, and wrong procedure/surgery includes the following, EXCEPT:

A. Mark the operative site if possibleB. Conduct pre-procedure verification processC. Take a video of the entire intra-operative procedureD. Conduct ‘time out’ immediately before starting the procedure

34. You identified a potential risk of pre-and postoperative clients. To reduce the risk of patient harm resulting from fall, you can implement the following, EXCEPT:

A. Assess potential risk of fall associated with the patient’s medication regimen

B. Take action to address any identified risks through Incident Report (IR)C. Allow client to walk with relative to the ORD. Assess and periodically reassess individual client’s risk for falling

35. As a nurse, you know you can improve on accuracy of patient’s identification by 2 patient identifiers, EXCEPT:

A. identify the client by his/her wrist tag and verify with family membersB. identify client by his/her wrist tag and call his/her by nameC. call the client by his/her case and bed numberD. call the patient by his/her name and bed number

Situation 8 – Team efforts is best demonstrated in the OR.

36. If you are the nurse in charge for scheduling surgical cases, what important information do you need to ask the surgeon?

A. Who is your internistB. Who is your assistant and anesthesiologist, and what is your preferred

time and type of surgery?C. Who are your anesthesiologist, internist, and assistantD. Who is your anesthesiologist

37. In the OR, the nursing tandem for every surgery is:

A. Instrument technician and circulating nurseB. Nurse anesthetist, nurse assistant, and instrument technicianC. Scrub nurse and nurse anesthetistD. Scrub and circulating nurses

38. While team effort is needed in the OR for efficient and quality patient care delivery, we should limit the number of people in the room for infection control. Who comprise this team?

A. Surgeon, anesthesiologist, scrub nurse, radiologist, orderlyB. Surgeon, assistants, scrub nurse, circulating nurse, anesthesiologistC. Surgeon, assistant surgeon, anesthesiologist, scrub nurse, pathologistD. Surgeon, assistant surgeon, anesthesiologist, intern, scrub nurse

39. When surgery is on-going, who coordinates the activities outside, including the family?

A. Orderly/clerkB. Nurse SupervisorC. Circulating NurseD. Anesthesiologist

40. The breakdown in teamwork is often times a failure in:

A. ElectricityB. Inadequate supplyC. Leg workD. Communication

Situation 9 – Colostomy is a surgically created anus. It can be temporary or permanent, depending on the disease condition.

41. Skin care around the stoma is critical. Which of the following is not indicated as a skin care barriers?

A. Apply liberal amount of mineral oil to the areaB. Use karaya paste and rings around the stomaC. Clean the area daily with soap and water before applying bagD. Apply talcum powder twice a day

42. What health instruction will enhance regulation of a colostomy (defecation) of clients?

A. Irrigate after lunch everydayB. Eat fruits and vegetables in all three mealsC. Eat balanced meals at regular intervalsD. Restrict exercise to walking only

43. After ileostomy, which of the following condition is NOT expected?

A. Increased weightB. Irritation of skin around the stomaC. Liquid stoolD. Establishment of regular bowel movement

44. The following are appropriate nursing interventions during colostomy irrigation, EXCEPT:

A. Increase the irrigating solution flow rate when abdominal cramps is feltB. Insert 2-4 inches of an adequately lubricated catheter to the stomaC. Position client in semi-FowlerD. Hang the solution 18 inches above the stoma

45. What sensation is used as a gauge so that patients with ileostomy can determine how often their pouch should be drained?

A. Sensation of tasteB. Sensation of pressureC. Sensation of smellD. Urge to defecate

Situation 10 – As a beginner in research, you are aware that sampling is an essential elements of the research process.

46. What does a sample group represent?

A. Control groupB. Study subjectsC. General populationD. Universe

47. What is the most important characteristic of a sample?

A. RandomizationB. Appropriate locationC. Appropriate numberD. Representativeness

48. Random sampling ensures that each subject has:

A. Been selected systematicallyB. An equal chance of selectionC. Been selected based on set criteriaD. Characteristics that match other samples

49. Which of the following methods allows the use of any group of research subject?

A. Purposive

B. ConvenienceC. Snow-ballD. Quota

50. You decided to include 5 barangays in your municipality and chose a sampling method that would get representative samples from each barangay. What should be the appropriate method ofor you to use in this care?

A. Cluster samplingB. Random samplingC. Startified amplingD. Systematic sampling

Situation 11 – After an abdominal surgery, the circulating and scrub nurses have critical responsibility about sponge and instrument count.

51. When is the first sponge/instrument count reported?

A. Before closing the subcutaneous layerB. Before peritoneum is closedC. Before closing the skinD. Before the fascia is sutured

52. What major supportive layer of the abdominal wall must be sutured with long tensile strength such as cotton or nylon or silk suture?

A. FasciaB. MuscleC. PeritoneumD. Skin

53. Like sutures, needles also vary in shape and uses. If you are the scrub nurse for a patient who is prone to keloid formation and has low threshold of pain, what needle would you prepare?

A. Round needleB. Atraumatic needleC. Reverse cutting needleD. Tapered needle

54. Another alternative “suture” for skin closure is the use of ____________

A. StapleB. Therapeutic glueC. Absorbent dressingD. Invisible suture

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

A. AnesthesiologistB. SurgeonC. OR nurse supervisorD. Circulating nurse

Situation 12 – As a nurse, you should be aware and prepared of the different roles you play.

56. What role do you play when you hold all client’s information entrusted to you in the strictest confidence?

A. Patient’s advocateB. EducatorC. Patient’s LiaisonD. Patient’s arbiter

57. As a nurse, you can help improve the effectiveness of communication among healthcare givers by:

A. Use of reminders of ‘what to do’B. Using standardized list of abbreviations, acronyms, and symbolsC. One-on-one oral endorsementD. Text messaging and e-mail

58. As a nurse, your primary focus in the workplace is the client’s safety. However, personal safety is also a concern. You can communicate hazards to your co-workers through the use of the following EXCEPT:

A. Formal trainingB. Posters C. Posting IR in the bulletin boardD. Use of labels and signs

59. As a nurse, what is one of the best way to reconcile medications across the continuum of care?

A. Endorse on a case-to-case basisB. Communicate a complete list of the patient’s medication to the next

provider of serviceC. Endorse in writingD. Endorse the routine and ‘stat’ medications every shift

60. As a nurse, you protect yourself and co-workers from misinformation and misrepresentations through the following EXCEPT:

A. Provide information to clients about a variety of services that can help alleviate the client’s pain and other conditions

B. Advising the client, by virtue of your expertise, that which can contribute to the client’s well-being

C. Health education among clients and significant others regarding the use of chemical disinfectant

D. Endorsement thru trimedia to advertise your favorite disinfectant solution

Situation 13 – You are assigned at the surgical ward and clients have been complaining of post pain at varying degrees. Pain as you know, is very subjective.

61. A one-day postoperative abdominal surgery client has been complaining of severe throbbing abdominal pain described as 9 in a 1-10 pain rating. Your

assessment revelas bowel sounds on all quadrants and the dressing is dry and intact. What nursing intervention would you take

A. Medicate client as prescribedB. Encourage client to do imageryC. Encourage deep breathing and turningD. Call surgeon stat

62. Pentoxidone 5 mg IV every 8 hours was prescribed for post abdominal pain. Which will be your priority nursing action?

A. Check abdominal dressing for possible swellingB. Explain the proper use of PCA to alleviate anxietyC. Avoid overdosing to prevent dependence/toleranceD. Monitor VS, more importantly RR

63. The client complained of abdominal distention and pain. Your nursing intervention that can alleviate pain is:

A. Instruct client to go to sleep and relaxB. Advice the client to close the lips and avoid deep breathing and talkingC. Offer hot and clear soupD. Turn to sides frequently and avoid too much talking

64. Surgical pain might be minimized by which nursing action in the O.R.

A. Skill of surgical team and lesser manipulationB. Appropriate preparation for the scheduled procedureC. Use of modern technology in closing the woundD. Proper positioning and draping of clients

65. One very common cause of postoperative pain is:

A. Forceful traction during surgeryB. Prolonged surgeryC. Break in aseptic techniqueD. Inadequate anesthetic

Situation 14 – You were on duty at the medical ward when Zeny came in for admission for tiredness, cold intolerance, constipation, and weight gain. Upon examination, the doctor’s diagnosis was hypothyroidism.

66. Your independent nursing care for hypothyroidism includes:

A. administer sedative round the clockB. administer thyroid hormone replacementC. providing a cool, quiet, and comfortable environmentD. encourage to drink 6-8 glasses of water

67. As the nurse, you should anticipate to administer which of the following medications to Zeny who is diagnosed to be suffering from hypothyroidism?

A. LevothyroxineB. LidocaineC. Lipitor

D. Levophed

68. Your appropriate nursing diagnosis for Zeny who is suffering from hypothyroidism would probably include which of the following?

A. Activity intolerance related to tiredness associated with disorderB. Risk to injury related to incomplete eyelid closureC. Imbalance nutrition to hypermetabolismD. Deficient fluid volume related to diarrhea

69. Myxedema coma is a life threatening complication of long standing and untreated hypothyroidism with one of the following characteristics.

A. HyperglycemiaB. HypothermiaC. HyperthermiaD. Hypoglycemia

70. As a nurse, you know that the most common type of goiter is related to a deficiency of:

A. thyroxineB. thyrotropinC. ironD. iodine

Situation 15 – Mrs. Pichay is admitted to your ward. The MD ordered “Prepare for thoracentesis this pm to remove excess air from the pleural cavity.”

71. Which of the following nursing responsibilities is essential in Mrs. Pichay who will undergo thoracentesis?

A. Support and reassure client during the procedureB. Ensure that informed consent has been signedC. Determine if client has allergic reaction to local anesthesiaD. Ascertain if chest x-rays and other tests have been prescribed and

completed

72. Mrs. Pichay who is for thoracentesis is assigned by the nurse to any of the following positions, EXCEPT:

A. straddling a chair with arms and head resting on the back of the chairB. lying on the unaffected side with the bed elevated 30-40 degreesC. lying prone with the head of the bed lowered 15-30 degreesD. sitting on the edge of the bed with her feet supported and arms and head

on a padded overhead table

73. During thoracentesis, which of the following nursing intervention will be most crucial?

a. Place patient in a quiet and cool roomb. Maintain strict aseptic techniquec. Advice patient to sit perfectly still during needle insertion until it has been

withdrawn from the chestd. Apply pressure over the puncture site as soon as the needle is withdrawn

74. To prevent leakage of fluid in the thoracic cavity, how will you position the client after thoracentesis?

A. Place flat in bedB. Turn on the unaffected sideC. Turn on the affected sideD. On bed rest

75. Chest x-ray was ordered after thoracentesis. When your client asks what is the reason for another chest x-ray, you will explain:

A. to rule out pneumothoraxB. to rule out any possible perforationC. to decongestD. to rule out any foreign body

Situation 16 – In the hospital, you are aware that we are helped by the use of a variety of equipment / devices to enhance quality patient care delivery.

76. You are to initiate an IV line to your patient, Kyle, 5, who is febrile. What IV administration set will you prepare?

A. Blood transfusion setB. MacrosetC. Volumetric chamberD. Microset

77. Kyle is diagnosed to have measles. What will your protective personal attire include?

A. GownB. EyewearC. Face maskD. Gloves

78. What will you do to ensure that Kyle, who is febrile, will have a liberal oral fluid intake?

A. Provide a glass of fruit juice every mealB. Regulate his IV to 30 drops per minuteC. Provide a calibrated pitcher of drinking water and juice at the bedside and

monitor intake and outputD. Provide a writing pad to record his intake

79. Before bedtime, you went to ensure Kyle’s safety in bed. You will do which of the following:

A. Put the lights onB. Put the side rails upC. Test the call systemD. Lock the doors

80. Kyle’s room is fully mechanized. What do you teach the watcher and Kyle to alert the nurses for help?

A. How to lock side railsB. Number of the telephone operatorC. Call systemD. Remote control

Situation 17 – Tony, 11 years old, has ‘kissing tonsils’ and is scheduled for tonsillectomy and adenoidectomy or T and A.

81. You are the nurse of Tony who will undergo T and A in the morning. His mother asked you if Tony will be put to sleep. Your teaching will focus on:

A. spinal anesthesiaB. anesthesiologist’s preferenceC. local anesthesiaD. general anesthesia

82. Mothers of children undergoing tonsillectomy and adenoidectomy usually ask what food to prepare and give their children after surgery. You as the nurse will say:

A. balanced diet when fully awakeB. hot soup when awakeC. ice cream when fully awakeD. soft diet when fully awake

83. The RR nurse should monitor for the most common postoperative complication of:

A. hemorrhageB. endotracheal tube perforationC. osopharyngeal edemaD. epiglottis

84. The PACU nurse will maintain postoperative T and A client in what position?

A. Supine with neck hyperextended and supported with pillowB. Prone with the head on pillow and turned to the sideC. Semi-fowler’s with neck flexedD. Reverse trendelenburg with extended neck

85. Tony is to be discharged in the afternoon of the same day after tonsillectomy and adenoidectomy. You as the RN will make sure that the family knows to:

A. offer osterized feedingB. offer soft foods for a week to minimize discomfort while swallowingC. supplement his diet with Vitamin C rich juices to enhance healingD. offer clear liquid for 3 days to prevent irritation

Situation 18 – Rudy was diagnosed to have chronic renal failure. Hemodialysis is ordered so that an A-V shunt was surgically created.

86. Which of the following action would be of highest priority with regards to the external shunt?

A. Avoid taking BP or blood sample from the arm with the shuntB. Instruct the client not to exercise the arm with the shunt

C. Heparinize the shunt dailyD. Change dressing of the shunt daily

87. Diet therapy for Rudy, who has acute renal failure is low-protein, low potassium and low sodium. The nutrition instructions should include:

A. Recommend protein of high biologic value like eggs, poultry and lean meats

B. Encourage client to include raw cucumbers, carrot, cabbage, and tomatoesC. Allowing the client cheese, canned foods and other processed foodD. Bananas, cantaloupe, orange and other fresh fruits can be included in the

diet

88. Rudy undergoes hemodialysis for the first time and was scared of disequilibrium syndrome. He asked you how this can be prevented. Your response is:

A. maintain a conducive comfortable and cool environmentB. maintain fluid and electrolyte balanceC. initial hemodialysis shall be done 30 minutes only so as not to rapidly

remove the waste from the blood than from the brainD. maintain aseptic technique throughout the hemodialysis

89. You are assisted by a nursing aide with the care of the client with renal failure. Which delegated function to the aide would you particularly check?

A. Monitoring and recording I and OB. Checking bowel movementC. Obtaining vital signsD. Monitoring diet

90. A renal failure patient was ordered for creatinine clearance. As the nurse you will collect…

A. 48 hour urine specimenB. first morning urineC. 24 hour urine specimenD. random urine specimen

Situation 19 – Fe is experiencing left sharp pain and occasional hematuria. She was advised to undergo IVP by her physician.

91. Fe was so anxious about the procedure and particularly expressed her low pain threshold. Nursing health instruction will include:

A. assure the client that the pain is associated with the warm sensation during the administration of the Hypaque by IV

B. assure the client that the procedure painlessC. assure the client that contrast medium will be given orallyD. assure the client that x-ray procedure like IVP is only done by experts

92. What will the nurse monitor and instruct the client and significant others post IVP?

A. Report signs and symptoms for delayed allergic reactionB. Observe NPO for 6 hours

C. Increased fluid intakeD. Monitor intake and output

93. Post IVP, Fe should excrete the contrast medium. You instructed the family to include more vegetables in the diet and:

A. increase fluid intakeB. barium enemaC. cleansing enemaD. gastric lavage

94. The IVP reveals that Fe has small renal calculus that can be passed out spontaneously. To increase the chance of passing the stones, you instructed her to force fluids and do which of the following?

A. Balanced dietB. Ambulate moreC. Strain all urineD. Bed rest

95. The presence of calculi in the urinary tract is called

A. ColelithiasisB. NephrolithiasisC. UreterolithiasisD. Urolithiasis

Situation 20 – At the medical-surgical ward, the nurse must also be concerned about drug interactions.

96. You have a client with TPN. You know that in TPN like blood transfusion, these should be no drug incorporation. However the MD’s order read; incorporate insulin to present TPN. Will you follow the order?

A. No, because insulin will induce hyperglycemia in patients with TPNB. Yes, because insulin is chemically stable with TPN and can enhance blood

glucose levelC. No, because insulin is not compatible with TPND. Yes, because it was ordered by the MD

97. The RN should also know that some drugs have increased adsorption when infused in the PVC container. How will you administer drugs such as insulin, nitroglycerine hydralazine to promote better therapeutic drug effects?

A. Administer by fast dripB. Inject the drugs as close to the IV injection siteC. Incorporate to the IV solutionsD. Use volumetric chamber

98. One patient had a ‘runaway’ IV of 50% dextrose. To prevent temporary excess of insulin or transient hyperinsulin reaction what solution you prepare in anticipation of the doctor’s order?

A. Any IV solution available to KVOB. Isotonic solution

C. Hypertonic solutionD. Hypotonic solution

99. How can nurses prevent drug interaction including adsorption?

A. Always flush with NSS after IV administrationB. Administering drugs with more diluentsC. Improving on preparation techniquesD. Referring to manufacturer’s guidelines

100. In insulin administration, it should be understood that our body normally releases insulin according to our blood glucose level. When is insulin and glucose level highest?

A. After excitementB. After a good night’s restC. After an exerciseD. After ingestion of food