NP 4 Flashcards by Zan lee

Situation: After an 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 the circulating
nurse

d. The scrub nurse and the circulating
nurse

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The layer of the abdomen is divided into 5.
Arrange the following from the first layer going
to the deepest layer:
Fascia
Muscle
Peritoneum
Subcutaneous/Fat
Skin
a. 5,4,3,2,1
b. 5,4,1,3,2
c. 5,4,2,1,3
d. 5,4,1,2,3

d. 5,4,1,2,3

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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

b. Before peritoneum is closed

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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. Anaesthesiologists
b. Surgeon
c. OR nurse supervisor
d. Circulating nurse

b. Surgeon

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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

c. X-RAY and Incidence report

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c. X-RAY and Incidence report

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To obtain specimen for sputum culture and
sensitivity, which of the following instruction is
best?
a. Upon waking up, cough deeply and
expectorate into container
b. Cough after pursed lip breathing
c. Save sputum for two days in covered
container
d. After respiratory treatment, expectorate
into a container

a. Upon waking up, cough deeply and
expectorate into container

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The best time for collecting the sputum
specimen for culture and sensitivity is:
a. Before retiring at night
b. Anytime of the day
c. Upon waking up in the morning
d. Before meals

c. Upon waking up in the morning

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When suctioning the endotracheal tube, the
nurse should:
a. Explain procedure to patient; insert
catheter gently applying suction.
Withdrawn using twisting motion
b. Insert catheter until resistance is met,
and then withdraw slightly, applying
suction intermittently as catheter is
withdrawn
c. Hyperoxygenate client insert catheter
using back and forth motion
d. Insert suction catheter four inches into
the tube, suction 30 seconds using twirling motion as catheter is withdrawn

b. Insert catheter until resistance is met,
and then withdraw slightly, applying
suction intermittently as catheter is
withdrawn

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The purpose of NGT IMMEDIATELY after an
operation is:
a. For feeding or gavage
b. For gastric decompression
c. For lavage, or the cleansing of the
stomach content
d. For the rapid return of peristalsis

b. For gastric decompression

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Situation - Mr. Santos, 50, is to undergo cystoscopy due
to multiple problems like scantly urination, hematuria
and dysuria.
11. You are the nurse in charge in Mr. Santos. When
asked what are the organs to be examined
during cystoscopy, you will enumerate as
follows:
a. Urethra, kidney, bladder, urethra
b. Urethra, bladder wall, trigone, ureteral
opening
c. Bladder wall, uterine wall, and urethral
opening
d. Urethral open

b. Urethra, bladder wall, trigone, ureteral
opening

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In the OR, you will position Mr. Santos who is
cystoscopy in:
a. Supine
b. Lithotomy
c. Semi-fowler
d. Trendelenburg

b. Lithotomy

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After cystoscopy, Mr. Santos asked you to
explain why there is no incision of any kind.
What do you tell him?
a. “Cystoscopy is direct visualization and
examination by urologist”.
b. “Cystoscopy is done by x-ray
visualization of the urinary tract”.
c. “Cystoscopy is done by using lasers on
the urinary tract”.
d. “Cystoscopy is an endoscopic procedure
of the urinary tract”.

d. “Cystoscopy is an endoscopic procedure
of the urinary tract”.

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Within 24-48 hours post cystoscopy, it is normal
to observe one the following:
a. Pink-tinged urine
b. Distended bladder
c. Signs of infection
d. Prolonged hematuria

a. Pink-tinged urine

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Leg cramps are NOT uncommon post cystoscopy. Nursing intervention includes:
a. Bed rest
b. Warm moist soak
c. Early ambulation
d. Hot sitz bath

b. Warm moist soak

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Situation – Mang Felix, a 79 year old man who is brought
to the Surgical Unit from PACU after a transurethral
resection. You are assigned to receive him. You noted
that he has a 3-way indwelling urinary catheter for
continuous fast drip bladder irrigation which is
connected to a straight drainage.
16. Immediately after surgery, what would you
expect his urine to be?
a. Light yellow
b. Bright red
c. Amber
d. Pinkish to red

d. Pinkish to red

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The purpose of the continuous bladder irrigation
is to:
a. Allow continuous monitoring of the fluid
output status
b. Provide continuous flushing of clots and
debris from the bladder
c. Allow for proper exchange of
electrolytes and fluid
d. Ensure accurate monitoring of intake
and output

b. Provide continuous flushing of clots and
debris from the bladder

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Mang Felix informs you that he feels some
discomfort on the hypogastric area and he has to
void. What will be your most appropriate action?
a. Remove his catheter then allow him to
void on his own
b. Irrigate his catheter
c. Tell him to “Go ahead and void. You
have an indwelling catheter.”
d. Assess color and rate of outflow, if
there is changes refer to urologist for
possible irrigation.

d. Assess color and rate of outflow, if
there is changes refer to urologist for
possible irrigation

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You decided to check on Mang Felix’s IV fluid
infusion. You noted a change in flow rate, pallor
and coldness around the insertion site. What is
your assessment finding?
a. Phlebitis
b. Infiltration to subcutaneous tissue
c. Pyrogenic reaction
d. Air embolism

b. Infiltration to subcutaneous tissue

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Knowing that proper documentation of assessment findings and interventions are
important responsibilities of the nurse during
first post-operative day, which of the following is
the LEAST relevant to document in the case of
Mang Felix?
a. Chest pain and vital signs
b. Intravenous infusion rate
c. Amount, color, and consistency of
bladder irrigation drainage
d. Activities of daily living started

d. Activities of daily living started

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Situation: Melamine contamination in milk has brought
worldwide crisis both in the milk production sector as
well as the health and economy. Being aware of the
current events is one quality that a nurse should possess
to prove that nursing is a dynamic profession that will
adapt depending on the patient’s needs.
21. Melamine is a synthetic resin used for
whiteboards, hard plastics and jewellery box
covers due to its fire retardant properties. Milk
and food manufacturers add melamine in order
to:
a. It has a bacteriostatic property leading
to increase food and milk life as a way of
preserving the foods
b. Gives a glazy and more edible look on
foods
c. Make milks more tasty and creamy
d. Create an illusion of a high protein
content on their products

d. Create an illusion of a high protein
content on their products

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Most of the milks contaminated by Melamine
came from which country?
a. India
b. China
c. Philippines
d. Korea

b. China

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Which government agency is responsible for
testing the melamine content of foods and food
products?
a. DOH
b. MMDA
c. NBI
d. BFAD

d. BFAD

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Infants are the most vulnerable to melamine
poisoning. Which of the following is NOT a sign
of melamine poisoning?
a. Irritability, Back ache, Urolithiasis
b. High blood pressure, fever
c. Anuria, Oliguria or Hematuria

d. Fever, Irritability and a large output of
diluted urine

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25. What kind of renal failure will melamine poisoning cause? a. Chronic, Prerenal b. Chronic, Intrarenal c. Acute, Postrenal d. Acute, Prerenal

c. Acute, Postrenal

Situation: Leukemia is the most common type of childhood cancer. Acute Lymphoid Leukemia is the cause of almost 1/3 of all cancer that occurs in children under age 15. 26. The survival rate for Acute Lymphoid Leukemia is approximately: a. 25% b. 40% c. 75% d. 95%

c. 75%

27. Whereas acute nonlymphoid leukemia has a survival rate of: a. 25% b. 40% c. 75% d. 95%

b. 40%

28. The three main consequence of leukemia that cause the most danger is: a. Neutropenia causing infection, anemia causing impaired oxygenation and thrombocytopenia leading to bleeding tendencies b. Central nervous system infiltration, anemia causing impaired oxygenation and thrombocytopenia leading to bleeding tendencies c. Splenomegaly, hepatomegaly, fractures d. Invasion by the leukemic cells to the bone causing severe bone pain

a. Neutropenia causing infection, anemia causing impaired oxygenation and thrombocytopenia leading to bleeding tendencies

29. Gold standard in the diagnosis of leukemia is by which of the following? a. Blood culture and sensitivity b. Bone marrow biopsy c. Blood biopsy d. CSF aspiration and examination

b. Bone marrow biopsy

Adriamycin,Vincristine,Prednisone and L asparaginase are given to the client for long term therapy. One common side effect, especially of adriamycin is alopecia. The child asks: “Will I get my hair back once again?” The nurse best respond is by saying: a. “Don’t be silly, ofcourse you will get your hair back” b. “We are not sure, let’s hope it’ll grow” c. “This side effect is usually permanent, But I will get the doctor to discuss it for you” d. “Your hair will regrow in 3 to 6 months but of different color, usually darker and of different texture”

d. “Your hair will regrow in 3 to 6 months but of different color, usually darker and of different texture”

Situation: Breast Cancer is the 2nd most common type of cancer after lung cancer and 99% of which, occurs in woman. Survival rate is 98% if this is detected early and treated promptly. Carmen is a 53 year old patient in the high risk group for breast cancer was recently diagnosed with Breast cancer. 31. All of the following are factors that said to contribute to the development of breast cancer except: a. Prolonged exposure to estrogen such as an early menarche or late menopause, nulliparity and childbirth after age 30 b. Genetics c. Increasing Age d. Prolonged intake of Tamoxifen (Nolvadex)

32. Protective factors for the development of breast cancer includes which of the following except: a. Exercise b. Breast feeding c. Prophylactic Tamoxifen d. Alcohol intake

d. Alcohol intake

33. A patient diagnosed with breast cancer has been offered the treatment choices of breast conservation surgery with radiation or a modified radical mastectomy. When questioned by the patient about these options, the nurse informs the patient that the lumpectomy with radiation: a. reduces the fear and anxiety that accompany the diagnosis and treatment of cancer b. has about the same 10-year survival rate as the modified radical mastectomy c. provides a shorter treatment period with a fewer long term complications d. preserves the normal appearance and sensitivity of the breast.

d. preserves the normal appearance and sensitivity of the breast

34. Carmen, who is asking the nurse the most appropriate time of the month to do her selfexamination of the breast. The MOST appropriate reply by the nurse would be: a. the 26th day of the menstrual cycle b. 7 to 8 days after conclusion of the menstrual period c. during her menstruation d. the same day each month

b. 7 to 8 days after conclusion of the menstrual period

35. Carmen being treated with radiation therapy. What should be included in the plan of care to minimize skin damage from the radiation therapy? a. Cover the areas with thick clothing materials b. Apply a heating pad to the site c. Wash skin with water after the therapy d. Avoid applying creams and powders to the area

d. Avoid applying creams and powders to the area

36. 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

a. a monthly breast self-examination (BSE) and an annual health worker breast examination (HWBE)

37. The purpose of performing the breast selfexamination (BSE) regularly is to discover: a. fibrocystic masses b. areas of thickness or fullness c. cancerous lumps d. changes from previous BSE

d. changes from previous BSE

38. 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 b. on the first day of her menstruation c. right after the menstrual period d. on the last day of her menstruation

a. on the same day of each month

39. During breast self-examination, the purpose of standing in front of the mirror it to observe the breast for: a. thickening of the tissue b. lumps in the breast tissue c. axillary lymphnodes d. change in size and contour

d. change in size and contour

40. 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

c. balance the breast tissue more evenly on the chest wall

Situation – Radiation therapy is another modality of cancer management. With emphasis on multidisciplinary management you have important responsibilities as nurse. 41. Albert is receiving external radiation therapy and he complains of fatigue and malaise. Which of the following nursing interventions would be most helpful for Albert? a. Tell him that sometimes these feelings can be psychogenic b. Refer him to the physician c. Reassure him that these feelings are normal d. Help him plan his activities

d. Help him plan his activities

43. Albert is admitted with a radiation induced thrombocytopenia. As a nurse you should observe the following symptoms: a. Petechiae, ecchymosis, epistaxis b. Weakness, easy fatigability, pallor c. Headache, dizziness, blurred vision d. Severe sore throat, bacteremia, hepatomegaly

a. Petechiae, ecchymosis, epistaxis

44. What nursing diagnosis should be of highest priority? a. Knowledge deficit regarding thrombocytopenia precautions b. Activity intolerance c. Impaired tissue integrity d. Ineffective tissue perfusion, peripheral, cerebral, cardiovascular, gastrointestinal, renal

c. Impaired tissue integrity

45. What intervention should you include in your care plan? a. Inspect his skin for petechiae, bruising, GI bleeding regularly b. Place Albert on strict isolation precaution c. Provide rest in between activities d. Administer antipyretics if his temperature exceeds 38C

a. Inspect his skin for petechiae, bruising, GI bleeding regularly

Situation: Burn are cause by transfer of heat source to the body. It can be thermal, electrical, radiation or chemical. 46. A burn characterized by Pale white appearance, charred or with fat exposed and painlessness is: a. Superficial partial thickness burn b. Deep partial thickness burn c. Full thickness burn d. Deep full thickness burn

c. Full thickness burn

7. Which of the following BEST describes superficial partial thickness burn or first degree burn? a. Structures beneath the skin are damage b. Dermis is partially damaged c. Epidermis and dermis are both damaged d. Epidermis is damaged

b. Dermis is partially damaged

48. A burn that is said to be “WEEPING” is classified as: a. Superficial partial thickness burn b. Deep partial thickness burn c. Full thickness burn d. Deep full thickness burn

c. Full thickness burn

Immediately following the radiation teletherapy, Albert is a. Considered radioactive for 24 hrs b. Given a complete bath c. Placed on isolation for 6 hours d. Free from radiation

d. Free from radiation

49. During the Acute phase of the burn injury, which of the following is a priority? a. wound healing b. emotional support c. reconstructive surgery d. fluid resuscitation

a. wound healing

50. While in the emergent phase, the nurse knows that the priority is to: a. Prevent infection b. Prevent deformities and contractures c. Control pain d. Return the hemodynamic stability via fluid resuscitation

d. Return the hemodynamic stability via fluid resuscitation

51. The MOST effective method of delivering pain medication during the emergent phase is: a. intramuscularly b. orally c. subcutaneously

d. intravenously

52. When a client accidentally splashes chemicals to his eyes, The initial priority care following the chemical burn 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

c. irrigate with water for 15 minutes or longer

53. Which of the following can be a fatal complication of upper airway burns? a. stress ulcers b. shock c. hemorrhage d. laryngeal spasms and swelling

d. laryngeal spasms and swelling

54. When a client will rush towards you and he has a 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

a. log roll on the grass/ground

55. Once the flames are extinguished, it is most important to: a. cover clientwith a warm blanket b. give him sips of water c. calculate the extent of his burns d. assess the Sergio’s breathing

d. assess the Sergio’s breathing

56. During the first 24 hours after the thermal injury, you should asses Sergio for: a. hypokalemia and hypernatremia b. hypokalemia and hyponatremia c. hyperkalemia and hyponatremia d. hyperkalemia and hypernatremia

c. hyperkalemia and hyponatremia

57. A client who sustained deep partial thickness and full thickness burns of the face, whole anterior chest and both upper extremities two days ago begins to exhibit extreme restlessness. You recognize that this most likely indicates that the client is developing: a. Cerebral hypoxia b. metabolic acidosis c. Hypervolemia d. Renal failure

a. Cerebral hypoxia

58. A 165 lbs trauma client was rushed to the emergency room with full thickness burns on the whole face, right and left arm, and at the anterior upper chest sparing the abdominal area. He also has superficial partial thickness burn at the posterior trunk and at the half upper portion of the left leg. He is at the emergent phase of burn. Using the parkland’s formula, you know that during the first 8 hours of burn, the amount of fluid will be given is: a. 5,400 ml b. 9, 450 ml c. 10,800 ml d. 6,750 ml

a. 5,400 ml

59. The doctor incorporated insulin on the client’s fluid during the emergent phase. The nurse knows that insulin is given because: a. Clients with burn also develops Metabolic acidosis b. Clients with burn also develops hyperglycemia c. Insulin is needed for additional energy and glucose burning after the stressful incidence to hasten wound healing, regain of consciousness and rapid return of hemodynamic stability d. For hyperkalemia

d. For hyperkalemia

60. The IV fluid of choice for burn as well as dehydration is: a. 0.45% NaCl b. Sterile water c. NSS d. D5LR

d. D5LR

Situation: ENTEROSTOMAL THERAPY is now considered a specialty in nursing. You are participating in the OSTOMY CARE CLASS. 61. You plan to teach Fermin how to irrigate the colostomy when: a. The perineal wound heals And Fermin can sit comfortably on the commode b. Fermin can lie on the side comfortably, about the 3rd postoperative day c. The abdominal incision is closed and contamination is no longer a danger d. The stools starts to become formed, around the 7th postoperative day

d. The stools starts to become formed, around the 7th postoperative day

62. When preparing to teach Fermin how to irrigate colostomy, you should plan to do the procedure: a. When Fermin would have normal bowel movement b. At least 2 hours before visiting hours c. Prior to breakfast and morning care d. After Fermin accepts alteration in body image

a. When Fermin would have normal bowel movement

When observing a return demonstration of a colostomy irrigation, you know that more teaching is required if Fermin: a. Lubricates the tip of the catheter prior to inserting into the stoma b. Hangs the irrigating bag on the bathroom door cloth hook during fluid insertion c. Discontinues the insertion of fluid after 500 ml of fluid has been instilled d. Clamps of the flow of fluid when felling uncomfortable

b. Hangs the irrigating bag on the bathroom door cloth hook during fluid insertion

64. You are aware that teaching about colostomy care is understood when Fermin states, “I will contact my physician and report: a. If I have any difficulty inserting the irrigating tub into the stoma.” b. If I noticed a loss of sensation to touch in the stoma tissue.” c. The expulsion of flatus while the irrigating fluid is running out.” d. When mucus is passed from the stoma between the irrigations.”

a. If I have any difficulty inserting the irrigating tub into the stoma.”

65. You would know after teaching Fermin that dietary instruction for him is effective when he states, “It is important that I eat: a. Soft food that is easily digested and absorbed by my large intestines.” b. Bland food so that my intestines do not become irritated.” c. Food low in fiber so that there are fewer stools.” d. Everything that I ate before the operation, while avoiding foods that cause gas”.

d. Everything that I ate before the operation, while avoiding foods that cause gas”

Situation: Based on studies of nurses working in special units like the intensive care unit and coronary care unit, it is important for nurses to gather as much information to be able to address their needs for nursing care. 66. Critically ill patients frequently complain about which of the following when hospitalized? a. Hospital food b. Lack of privacy c. Lack of blankets d. Inadequate nursing staff

b. Lack of privacy

67. Who of the following is at greatest risk of developing sensory problem? a. Female patient b. Transplant patient c. Adoloscent d. Unresponsive patient

d. Unresponsive patient

68. Which of the following factors may inhibit learning in critically ill patients? a. Gender b. Educational level c. Medication d. Previous knowledge of illness

c. Medication

69. Which of the following statements does not apply to critically ill patients? a. Majority need extensive rehabilitation b. All have been hospitalized previously c. Are physically unstable d. Most have chronic illness

b. All have been hospitalized previously

70. Families of critically ill patients desire which of the following needs to be met first by the nurse? a. Provision of comfortable space b. Emotional support c. Updated information on client’s status d. Spiritual counselling

b. Emotional support

Situation: Johnny, sought consultation to the hospital because of fatigability, irritability, jittery and he has been experiencing this sign and symptoms for the past 5 months. 71. His diagnosis was hyperthyroidism, the following are expected symptoms except: a. Anorexia b. Fine tremors of the hand c. Palpitation d. Hyper alertness

a. Anorexia

72. She has to take drugs to treat her hyperthyroidism. Which of the following will you NOT expect that the doctor will prescribe? a. Colace (Docusate) b. Tapazole (Methimazole) c. Cytomel (Liothyronine) d. Synthroid (Levothyroxin

a. Colace (Docusate)

73. The nurse knows that Tapazole has which of the following side effect that will warrant immediate withholding of the medication? a. Death b. Hyperthermia c. Sore throat d. Thrombocytosis

c. Sore throat

74. You asked questions as soon as she regained consciousness from thyroidectomy primarily to assess the evidence of: a. Thyroid storm b. Damage to the laryngeal nerve c. Mediastinal shift d. Hypocalcaemia tetany

b. Damage to the laryngeal nerve

75. Should you check for haemorrhage, you will: a. Slip your hand under the nape of her neck b. Check for hypotension c. Apply neck collar to prevent haemorrhage d. Observe the dressing if it is soaked with blood

a. Slip your hand under the nape of her neck

76. Basal Metabolic rate is assessed on Johnny to determine his metabolic rate. In assessing the BMR using the standard procedure, you need to tell Johnny that: a. Obstructing his vision b. Restraining his upper and lower extremities c. Obstructing his hearing d. Obstructing his nostrils with a clamp

d. Obstructing his nostrils with a clamp

77. The BMR is based on the measurement that: a. Rate of respiration under different condition of activities and rest b. Amount of oxygen consumption under resting condition over a measured period of time c. Amount of oxygen consumption under stressed condition over a measured period of time d. Ratio of respiration to pulse rate over a measured period of time

b. Amount of oxygen consumption under resting condition over a measured period of time

78. Her physician ordered lugol’s solution in order to: a. Decrease the vascularity and size of the thyroid gland b. Decrease the size of the thyroid gland only c. Increase the vascularity and size of the thyroid gland d. Increase the size of the thyroid gland only

a. Decrease the vascularity and size of the thyroid gland

79. Which of the following is a side effect of Lugol’s solution? a. Hypokalemia b. Enlargement of the Thryoid gland c. Nystagmus d. Excessive salivation

d. Excessive salivation

80. In administering Lugol’s solution, the precautionary measure should include: a. Administer with glass only b. Dilute with juice and administer with a straw c. Administer it with milk and drink it d. Follow it with milk of magnesia

b. Dilute with juice and administer with a straw

Situation: Pharmacological treatment was not effective for Johnny’s hyperthyroidism and now, he is scheduled for Thyroidectomy. 81. Instruments in the surgical suite for surgery is classified as either CRITICAL, SEMI CRITICAL and NON CRITICAL. If the instrument are introduced directly into the blood stream or into any normally sterile cavity or area of the body it is classified as: a. Critical b. Non Critical c. Semi Critical d. Ultra Critical

a. Critical

82. Instruments that do not touch the patient or have contact only to intact skin is classified as: a. Critical b. Non Critical c. Semi Critical d. Ultra Critical

b. Non Critical

83. If an instrument is classified as Semi Critical, an acceptable method of making the instrument ready for surgery is through: a. Sterilization b. Disinfection c. Decontamination d. Cleaning

b. Disinfection

84. While critical items and should be: a. Clean b. Sterilized c. Decontaminated d. Disinfected

b. Sterilized

85. As a nurse, you know that intact skin acts as an effective barrier to most microorganisms. Therefore, items that come in contact with the intact skin or mucus membranes should be: a. Disinfected b. Clean c. Sterile d. Alcoholized

a. Disinfected

86. You are caring for Johnny who is scheduled to undergo total thyroidectomy because of a diagnosis of thyroid cancer. Prior to total thyroidectomy, you should instruct Johnny to: a. Perform range and motion exercise on the head and neck b. Apply gentle pressure against the incision when swallowing c. Cough and deep breathe every 2 hours d. Support head with the hands when changing position

d. Support head with the hands when changing position

87. As Johnny’s nurse, you plan to set up emergency equipment at her bedside following thyroidectomy. You should include: a. An airway and rebreathing tube b. A tracheostomy set and oxygen c. A crush cart with bed board d. Two ampules of sodium bicarbonate

b. A tracheostomy set and oxygen

88. Which of the following nursing interventions is appropriate after a total thyroidectomy? a. Place pillows under your patient’s shoulders. b. Raise the knee-gatch to 30 degrees c. Keep you patient in a high-fowler’s position. d. Support the patient’s head and neck with pillows and sandbags

d. Support the patient’s head and neck with pillows and sandbags

89. If there is an accidental injury to the parathyroid gland during a thyroidectomy which of the following might Leda develops postoperatively? a. Cardiac arrest b. Respiratory failure c. Dyspnea d. Tetany

d. Tetany

90. After surgery Johnny develops peripheral numbness, tingling and muscle twitching and spasm. What would you anticipate to administer? a. Magnesium sulfate b. Potassium iodide c. Calcium gluconate d. Potassium chloride

c. Calcium gluconate

Situation: Budgeting is an important part of a nurse managerial activity. The correct allocation and distribution of resources is vital in the harmonious operation of the financial balance of the agency. 91. Which of the following best defines Budget? a. Plan for the allocation of resources for future use b. The process of allocating resources for future use c. Estimate cost of expenses d. Continuous process in seeing that the goals and objective of the agency is met

a. Plan for the allocation of resources for future use

92. Which of the following best defines Capital Budget? a. Budget to estimate the cost of direct labour, number of staff to be hired and necessary number of workers to meet the general patient needs b. Includes the monthly and daily expenses and expected revenue and expenses c. These are related to long term planning and includes major replacement or expansion of the plant, major equipment and inventories. d. These are expenses that are not dependent on the level of production or sales. They tend to be time-related, such as salaries or rents being paid per month

c. These are related to long term planning and includes major replacement or expansion of the plant, major equipment and inventories.

94. Which of the following accurately describes a Fixed Cost in budgeting? a. These are usually the raw materials and labour salaries that depend on the production or sales b. These are expenses that change in proportion to the activity of a business c. These are expenses that are not dependent on the level of production or sales. They tend to be time-related, such as rent d. This is the summation of the Variable Cost and the Fixed Cost

c. These are expenses that are not dependent on the level of production or sales. They tend to be time-related, such as rent

95. Which of the following accurately describes Variable Cost in budgeting? a. These are related to long term planning and include major replacement or expansion of the plant, major equipments and inventories. b. These are expenses that change in proportion to the activity of a business c. These are expenses that are not dependent on the level of production or sales. They tend to be time-related, such as rent d. This is the summation of the Variable Cost and the Fixed Cost

b. These are expenses that change in proportion to the activity of a business

Situation – Andrea is admitted to the ER following an assault where she was hit in the face and head. She was brought to the ER by a police woman. Emergency measures were started. 96. Andrea’s respiration is described as waxing and waning. You know that this rhythm of respiration is defined as: a. Biot’s b. Cheyne stokes c. Kussmaul’s d. Eupnea

b. Cheyne stokes

97. What do you call the triad of sign and symptoms seen in a client with increasing ICP? a. Virchow’s Triad b. Cushing’s Triad c. The Chinese Triad d. Charcot’s Triad

b. Cushing’s Triad

98. Which of the following is true with the Triad seen in head injuries? a. Narrowing of Pulse pressure, Cheyne stokes respiration, Tachycardia b. Widening Pulse pressure, Irregular respiration, Bradycardia c. Hypertension, Kussmaul’s respiration, Tachycardia d. Hypotension, Irregular respiration, Bradycardia

b. Widening Pulse pressure, Irregular respiration, Bradycardia

99. In a client with a Cheyne stokes respiration, which of the following is the most appropriate nursing diagnosis? a. Ineffective airway clearance b. Impaired gas exchange c. Ineffective breathing pattern d. Activity intolerance

c. Ineffective breathing pattern

100. You know the apnea is seen in client’s with cheyne stokes respiration, APNEA is defined as: a. Inability to breathe in a supine position so the patient sits up in bed to breathe b. The patient is dead, the breathing stops c. There is an absence of breathing for a period of time, usually 15 seconds or more d. A period of hypercapnea and hypoxia due to the cessation of respiratory effort inspite of normal respiratory functioning

c. There is an absence of breathing for a period of time, usually 15 seconds or more