Situation

3 of 5 points

Nurse Helen is aware that, although each individual is unique, they also share common characteristics.
She is tasked with personality disorders. Given the case of Vanya, a client with borderline personality
disorder, Nurse Helen takes on her role as a psychiatric nurse.

1. Nurse Helen was about to administer an oral medication to Vanya diagnosed with a borderline
personality disorder. However, Vanya responds to this by saying "Just leave it on the table. I will take it
when I finish combing my hair." The best response from Nurse Helen would be to _____________.

1/1

A. Reinforce this assertive action by Mariel. Leave the medication on the table as requested.

B. Respond to Manel, "I'm worried that you might not take it. I will come back later."

C. Say to Mariel, “I must watch you take the medication. Please take it now.”

D. Ask Mariel, "Why don’t you want to take your medication now?"

2. Along with her long-standing history of self-mutilation and suicide attempts, Vanya reveals feelings of
depression and anger with life. Treatment was initiated by the psychiatrist with the use of a medication.
Which type of medication should Nurse Helen expect to be prescribed?

0/1

A. Escitalopram (Lexapro)

B. Phenelzine (Nardil)

C. Alprazolam (Xanax)

D. Haloperidol (Haldol)

3. During the weekend, Vanya’s boyfriend, Xylo, visited her beyond visiting hours. When the security
guard prohibited him from entering the hospital, he threatened the staff, ripped art off the walls, and
thrown objects. With protocols in place, the security guard used force to stop Xylo. Soon, he was
detained in the police community precinct. The most appropriate nursing diagnosis for Xylo would be
______________.

1/1
A. Disturbed sensory perception-auditory

B. Risk for other-directed violence

C. Ineffective denial

D. Ineffective coping

4. Vanya used manipulation to get her needs met. The staff decides to apply limit-setting interventions.
What is the correct rationale for this action?

1/1

A. It provides an outlet for feelings of anger and frustration.

B. It respects the patient's wishes so assertiveness will develop.

C. External controls are necessary while internal controls are developed.

D. Anxiety is reduced when staff members assume responsibility for the patient's behavior.

5. Given the behavior of Vanya or Xylo, limit setting be most essential if either of them
___________________________.

0/1

A. Clings to the nurse and asks for advice about inconsequential matters.

B. Flirts with and is provocative with staff members of the opposite sex.

C. Displays hypervigilant behavior and refuses to attend unit activities.

D. Urges a suspicious patient to hit anyone who stares.

Situation

2 of 3 points

Greta, 54-years old and a known hypertensive (controlled), was seen in her ophthalmologist's office
for a routine eye examination. Her last examination was five (5) years ago. Reports of significant visual
field loss was determined to be caused by wide-angle glaucoma. Nurse Jenny was tasked to assist the
patient in her care.
6. Laser trabeculoplasty as a form of treatment was suggested to Greta. Which of the following nursing
measures should receive priority in the client's plan of care after eye surgery?

1/1

A. Prevent increase in intraocular pressure (IOP) and signs of infection

B. Instruct on the importance of follow-up

C. Instruct on how to perform the Valsalva maneuver

D. Management of pain through patient-controlled analgesia (PCA)

7. Nurse Jenny will administer Betaxolol HCl (Betoptic) to the client. As a precaution, which of the
following would she interpret as a serious adverse reaction?

1/1

A. Photophobia

B. Blurred vision

C. Drop in blood pressure

D. Exacerbation of asthma

8. Which assessment finding is essential for Nurse Jenny to report for a client who works in the evening
and takes Pilocarpine (Pilocar)?

0/1

A. Hypotension

B. Urinary retention

C. Constipation

D. Decreased dark adaptation

Situation

2 of 5 points
Data collection is imperative to gather information relevant to the research purpose, thereby, making
this as one of the most time-consuming phase during research. Nurse Rico studies a variety of
techniques to explore the study variables.

9. Nurse Rico intends to apply a set of structured interview questions during data collection. He knows
that one major disadvantage of using a structured-interview method is __________________.

0/1

A. The same questions may not be asked of all interviewees

B. The answers are not recorded in the interviewee's own words

C. The questions are all asked in the same order

D. The interviews are often too long

10. When selecting a research design, Nurse Rico understands that by utilizing ethnography, he will have
__________________________.

1/1

A. An interview with cultural minority

B. An interview with a foreign-born but English-speaking person

C. A type of descriptive qualitative study or someone's experiences

D. A type of quantitative study

11. Nurse Rico is aware that the major advantage of observation over interview is that _____________.

1/1

A. Observation may be recorded and scrutinized later

B. Observations enable the recording of actual behaviors, rather than subjects' interpretations

C. Observation is scientific, unlike interviews which necessary involve personal interactions

D. Observations are unbiased and do not elicit reactions in human subjects.

12. Participant observation may be defined as:

0/1

A. The observation of participants in the study

B. The observation of the researcher’s input to a study

C. Participation in a group while studying it

D. The study of observational and clinical techniques

13. One of the major problems associated with the use of participant observation as a research strategy
is that:

0/1

A. It is more expensive than experimental approaches to implement.

B. It does not allow "in-depth" study of any phenomena

C. The results cannot be replicated

D. May cause unrest among samples

Situation

2 of 5 points

Two weeks ago, Alice began to exhibit manic behavior. She appears to be jumping from one topic to
another and is very talkative. Excited as she was, she has not eaten or slept for 3 days. Nurse Queenie
was assigned in the psychiatric ward when an incident occurred involving Alice and another patient.

14. While inside the psychiatric ward, Alice threatens to hit another patient. The most appropriate
response from Nurse Queenie would be?

1/1

A. "Stop that. No one did anything to provoke an attack by you."

B. "If you do that one more time, you will be secluded immediately."

C. "Do not hit anyone. If you are unable to control yourself, we will help you."

D. "You know we will not let you hit anyone. Why do you continue this behavior?"
15. Nurse Queenie plans to establish a nursing diagnosis which applies to Alice. With the nursing
diagnosis of imbalanced nutrition: less than body requirements, related to insufficient caloric intake and
hyperactivity as evidenced by 5-pound weight loss in 4 days, the most appropriate outcome for the
patient will be to:

0/1

A. Ask staff for assistance with feeding within 4 days

B. Drink six servings of a high-calorie, high-protein drink each day

C. Consistently sit with others for at least 30 minutes at mealtime within 1 week

D. Consistently wear appropriate attire for age and sex within 1 week while in the psychiatric unit

16. Alice develops mania after discontinuing lithium. New prescriptions are written to resume lithium
twice daily and begin olanzapine (Zyprexa). Nurse Queenie understands that the addition of Olanzapine
to the medication regimen will:

0/1

A. Minimize the side effects of lithium

B. Bring hyperactivity under rapid control

C. Enhance the antimanic actions of lithium

D. Provide long-term control of hyperactivity

17. During a manic episode, Nurse Queenie will initiate what initial nursing intervention as a priority?

1/1

A. Allow the patient to act out his or her feelings.

B. Set limits on the patient’s behavior as necessary.

C. Provide verbal instructions to the patient to remain calm.

D. Restrain the patient to reduce hyperactivity and aggression.

18. Desmond, diagnosed with bipolar disorder, has been hospitalized for 7 days. He has taken lithium 6
times daily. Throughout confinement, Nurse Sky observed increased agitation, pressured speech, poor
personal hygiene, hyperactivity, and bizarre clothing. What is the Nurse Sky’s best intervention?

0/1

A. Educate the patient about the proper ways to perform personal hygiene and coordinate clothing.

B. Continue to monitor and document the patient's speech patterns and motor activity.

C. Ask the health care provider to prescribe an increased dose and frequency of lithium.

D. Consider the need to check the lithium level. The patient may not be swallowing medications.

Situation

3 of 3 points

Mila is set undergo cataract removal of the left eye. Nurse Kiara is assigned to assist her in the process.
The following question applies.

19. Which drug should Nurse Kiara anticipate from the surgeon to administer given the situation?

1/1

A. Atropine Sulfate (Tropin)

B. Glycopyrrolate (Robinul)

C. Acetazolamide (Diamox)

D. Pralidoxime (Protopam)

20. Nurse Kiara should instruct Mila on activities that can impact her intraocular pressure. After an eye
surgery all of the following activities greatly increases the client's intraocular pressure, EXCEPT?

1/1

A. Sneezing, coughing and blowing the nose

B. Straining to have a bowel movement

C. Wearing tight shirt collars

D. Sexual intercourse
21. On one hand, Nurse Kiara also knows that increased intracranial pressure (ICP) is manifested by
which earliest sign?

1/1

A. Abnormal respiratory pattern

B. Rising systolic and widening pulse pressure

C. Contralateral hemiparesis and ipsilateral dilation of the pupils

D. Progression from restlessness to confusion and disorientation to lethargy

Situation

0 of 1 points

Nurse Coraline is tasked to manage the case of Mr. Tirso, a 62-year-old patient, who was brought to
the hospital due to right sided weakness and slurring of speech.

22. Nurse Coraline takes the pharmacologic regimen into consideration for the Mr. Tirso. Which
statement is incorrect in the management of a client with cerebrovascular accident (CVA)?

0/1

A. Osmotic diuretics and corticosteroids are given to decrease cerebral edema

B. Anticonvulsants are given to prevent seizures

C. Thrombolytics are most useful within three hours of an occlusive CVA

D. Aspirin is used in the acute management of a complete ischemic stroke.

Situation

2 of 5 points

Kendrick, a 20-year-old fine arts student thinks that his roommate is trying to poison him. He was
admitted in the psychiatric ward because this has affected his performance in school and his
classmates were afraid that he might hurt them. Nurse Maya is assigned during his stay. The following
questions apply.

23. Kendrick refused all hospital meals for 3 days already. Nurse Maya is planning on ways in order to
feed him. Which intervention is most likely to be acceptable to the patient?
0/1

A. Allow Evan to have supervised access to food vending machines

B. Allow Evan to telephone a local restaurant to deliver meals

C. Offer to taste each portion on the tray for Evan

D. Begin tube feedings or total parenteral nutrition for Evan

24. Kendrick blurted out "The voices are bothering me. They yell and tell me I'm bad. I have got to get
away from them." The most appropriate response from Nurse Maya would be _____________.

0/1

A. "Do you hear the voices often?"

B. "Do you have a plan for getting, away from the voices?"

C. "I will stay with you. Focus on what we are talking about, not the voices."

D. "Forget the voices. Ask some other patients to sit and talk with you.

25. Kendrick has taken fluphenazine (Prolixin) 5 mg orally twice daily for 3 weeks. Suddenly, Nurse Maya
observes a shuffling, propulsive gait, mask-like face, and drooling. This is collectively termed as
_____________.

0/1

A. Neuroleptic malignant syndrome

B. Hepatocellular effects

C. Pseudo-Parkinsonism

D. Akathisia

26. Kendrick began showing violent tendencies. He received several doses of haloperidol (Haldol). Two
hours later the nurse notices the patient's head rotated to one side in a stiffly fixed position while the
lower jaw is thrust forward, and the patient is drooling. Which intervention by the nurse is indicated?

1/1
A. Administer diphenhydramine (Benadryl) 50 mg IM from the PRN medication administration record.

B. Reassure the patient that the symptoms will subside. Practice relaxation exercises with the patient.

C. Give trihexyphenidyl (Artane) 5 mg orally at the next regularly scheduled medication administration
time.

D. Administer atropine sulfate 2 mg subcutaneously from the PRN medication administration record.

27. Kendrick is receiving an antipsychotic, risperidone (Risperdal). He reports severe muscle stiffness at
10:30 AM. By noon, he is diaphoretic, drooling, and has difficulty swallowing. By 4:00 PM, vital signs are
body temperature, 39°C; pulse, 110 beats per minute; respirations, 26 breaths per minute; and blood
pressure, 150/90 mm Hg. Nurse Maya can best interpret this as ____________________ and will take
action by _____________________.

1/1

A. Agranulocytosis. Institute reverse isolation.

B. Tardive dyskinesia. Withhold the next dose of medication.

C. Cholestatic jaundice. Begin a high-protein, low fat diet.

D. Neuroleptic malignant syndrome. Immediately notify the health care provider.

Situation

1 of 2 points

Juliet, 42 years old, began developing weakness of the facial muscles and extremities as well as
drooping of eyelids. Diagnostics were done and it confirmed the presence of Myasthenia Gravis.

28. Nurse Paula chooses which nursing diagnosis considered as the highest priority when caring for a
client with Myasthenia Gravis?

1/1

A. Pain related to neuromuscular dysfunction

B. High risk for injury related to muscle weakness

C. Ineffective coping related to illness

D. Ineffective airway clearance related to muscle weakness

29. Pyridostigmine bromide (Mestinon) therapy is started for Juliet. The Mestinon dosage is frequently
changed during the first week. While the dosage is being adjusted, the nurse’s intervention is to:

0/1

A. Administer the medication exactly on time.

B. Administer the medication with food.

C. Evaluate the clients muscle strength an hour after medication.

D. Evaluate the clients emotional side effect between doses.

Situation

5 of 5 points

Leo and Sean are best friends. Their friendship dates back to elementary school days. While Sean was
bullied, Leo is always ready to defend him. Even in periodic tests, Leo will make a cheat sheet for both
of them to help Sean get a passing rate. When the parents of Sean separated, Leo was there to
support him. But things changed when Leo had a romantic affair with Ysavelle. Sean felt his best friend
left him. He felt alone but not for long, for he found what he considered to be his new best friend - a
friend that will never leave him, a friend through thick and thin, who will stick with him for better or
worse.

30. After all this, Sean engaged in habits such as consuming “shabu”. He also drank alcohol. Nurse Jess
receives him at 02AM in the morning. She would expect alcohol withdrawal symptoms to begin at what
time?

1/1

A. Between 0800 and 1000 today (6 to 8 hours after drinking stopped)

B. Between 0200 tomorrow and hospital day 2 (24 to 48 hours after drinking stopped)

C. About 0200 on hospital day 3 (72 hours after drinking stopped)

D. About 0200 on hospital day 4 (96 hours after drinking stopped)

31. When working with Sean who is beginning treatment for alcohol abuse, the most therapeutic
approach by Nurse Jess would be?

1/1
A. Empathetic, supportive

B. Strong, confrontational

C. Skeptical, guarded

D. Cool; distant

32. Nurse Jess will prioritize which nursing intervention when giving care to Sean who is withdrawing
from a central nervous system (CNS) stimulant such as amphetamine (shabu)?

1/1

A. Make physical contact by frequently touching Sean

B. Offer intellectual activities requiring concentration

C. Avoid manipulation by denying the Sean’s requests

D. Observe for depression and suicidal ideation

33. Leo has impregnated Ysavelle. During her pregnancy, she drinks 8 to 12 ounces of alcohol daily. Nurse
Jess will plan for the delivery of an infant who is likely to be ________________.

1/1

A. Jaundiced

B. Dependent on alcohol

C. Healthy but underweight

D. Microcephalic and cognitively impaired

34. Leo has been having marital problems. He began to abuse heroin. Which assessment findings will the
nurse expect in an individual who has just injected heroin?

1/1

A. Anxiety, restlessness, paranoid delusions

B. Heightened sexuality, insomnia, euphoria

C. Muscle aching, dilated pupils, tachycardia

D. Drowsiness, constricted pupils, slurred speech

Situation

3 of 4 points

Clara, a 30-year-old female social worker has had a variety of vague complaints for the past 6 months.
The physician suspects multiple sclerosis and plans to complete neurologic assessment. Nurse Willy
assists the physician throughout the process.

35. When testing the trigeminal nerve, Nurse Willy should expect the physician to evaluate which
assessment finding?

1/1

A. Ocular muscle movement

B. Shrugging of the shoulders

C. Smiling and frowning

D. Corneal sensation

36. Clara is suspected of having multiple sclerosis. Nurse Willy anticipates her to complain about the
common initial symptom associated with multiple sclerosis. Which of the following is considered as the
earliest sign of MS?

1/1

A. Diarrhea

B. Headaches

C. Skin infection

D. Visual disturbances

37. Nora has been admitted with relapsing-remitting multiple sclerosis (MS). Which of the following
should be the focus of the nursing assessment and history?

1/1

A. Level of consciousness
B. Evoked potentials of the optic pathways

C. Bladder function

D. Rate of ascending paralysis

38. Which intervention or rationale should Nurse Willy suggest to help the client with MS to avoid
episodes of urinary incontinence?

0/1

A. Limit fluid intake to 1,000 mL/day

B. Administer prophylactic antibiotics as ordered

C. Provides the precursor of dopamine

D. Inhibit the activity of acetylcholine

Situation

1 of 1 points

Rose, 54-years old, has had menopause 8 years ago. Lately, she has been prone to injuries and
fractures which led her to consult the doctor.

39. Nurse Terrence knows that the prevalent observable changes that occurs with osteoporosis is seen in
which of the following bones?

1/1

A. Facial bones

B. Long bones

C. Vertebral column

D. Joints of the hands and feet

Situation

4 of 6 points

Elnix, 48 years of age, has been diagnosed with Parkinson’s disease. Nurse Andrea provides health
education to Elnix and his family regarding his disease and management.
40. The correct rationale behind the administration of levodopa (L-dopa) to Elnix is that this drug will
___________________________.

1/1

A. Activates enzymes to degrade dopamine

B. Blocks the release of dopamine

C. Provides the precursor of dopamine

D. Inhibits the synthesis of dopamine

41. A client is being switched from levodopa to carbidopa-levodopa (Sinemet). The nurse should monitor
for which of the following possible complications during medication changes and dosage adjustment?

1/1

A. Confusion

B. Symptoms of diabetes

C. Vital sign fluctuation

D. Jaundice

42. A client with Parkinson’s disease complains of “choking” when he swallows. Which intervention will
approve the client’s ability to swallow.

0/1

A. Withholding liquids until after meals

B. Providing semi-liquid foods when possible

C. Providing a fully liquid diet

D. Offering small, more frequent meals

43. Nora has been admitted with relapsing-remitting multiple sclerosis (MS). Which of the following
should be the focus of the nursing assessment and history?
1/1

A. Level of consciousness

B. Evoked potentials of the optic pathways

C. Bladder function

D. Rate of ascending paralysis

44. What would Nurse Lilian suggest as an appropriate intervention for Nora in order to avoid episodes
of urinary incontinence?

1/1

A. Limit fluid intake to 1000 mL/day

B. Administer prophylactic antibiotics as ordered

C. Insert an indwelling urinary catheter

D. Establish a regular voiding schedule

45. A client with Alzheimer’s disease. What color should you repaint the hallway to provide safety?

0/1

A. Black and white

B. Cream and White

C. Blue and Green

D. Red and Yellow

Situation

5 of 5 points

Darlene, a psychiatric nurse, deals with different cases of psychiatric disorders in the psychiatric ward.

46. Marilyn, a 40-year-old client, comes to the clinic with superficial cuts on the left wrist. The patient
paces around the room sobbing but cringes when approached and responds to questions with only
shrugs or monosyllables. What is Darlene’s best initial statement?
1/1

A. “Everything is going to be alright. You are here at the clinic, and the staff will keep you safe.”

B. “I see you are feeling upset. I am going to stay and talk with you to help you feel better”.

C. “You need to try to stop crying so we can talk about your problems”.

D. “Let’s set some guideline and goals for you visit here”.

47. Marilyn suddenly exclaimed, "I'm in a terrible situation. I don't know what to do." Nurse Darlene can
initially assume that the patient is:

1/1

A. suicidal.

B. anxious and fearful.

C. misperceiving reality.

D. potentially homicidal.

48. While Marilyn was anxious, Nurse Darlene held her hand for one minute. Which type of touch is this?

1/1

A. Love/ Intimacy

B. Friendship/Warmth

C. Social/Polite

D. Functional/Professional

49. When Marilyn recovered, she realized that Nurse Darlene was the daughter of her enemy a few years
ago. This prompted Marilyn to tell Nurse Darlene to back off, and to stop invading her personal space. In
terms of proxemics, all are correct statements, EXCEPT?

1/1

A. Public space is 12 ft and beyond

B. Social space is 4 to 12ft

C. Personal space is 6 to 8ft

D. Intimate space is 1.5 ft and less

50. Upon discharge, Marilyn began to take a CNS depressant to cope with problems. All of the following
are considered as CNS depressants, EXCEPT?

1/1

A. Heroin

B. Codeine

C. Barbiturates

D. LSD

Situation

5 of 5 points

Tricia, a 34-year-old female client, assisted by her boyfriend Gerry is admitted in the emergency room.
She was hyperventilating, her palms placed over her chest while experiencing hand tremors.
Furthermore, she is having diaphoresis. When asked what hap pened to her, she was unable to explain
herself clearly.

51. Nurse Chesca wishes to teach Nina alternative coping strategies. Nurse Chesca will initially perform
which action?

1/1

A. Verify the patient's learning style.

B. Create outcomes and a teaching plan.

C. Lower the patient’s current, anxiety level.

D. Assess how the patient uses defense mechanisms.

52. As Tricia’s anxiety went down, she verbalized, "I feel undone." An appropriate response for the nurse
would be:

1/1
A. "Why do you suppose you are feeling anxious?"

B. "What would you like me to do to help you?"

C. "I'm not sure I understand. Give me an example."

D. "You must get your feelings under control before we can continue."

53. The next day, Nurse Chesca saw Tricia with a high level of motor activity. She runs from chair to chair
and cries, "They’re coming! "They’re coming!”. Tricia does not follow instructions or respond to verbal
interventions from start. The initial nursing intervention of highest priority for Nurse Chesca would be to
__________________.

1/1

A. provide for patient safety.

B. increase environmental stimuli.

C. respect the patient's personal space.

D. encourage the clarification of feelings.

54. Tricia experiences episode of severe anxiety. Which of the following is most appropriate to
administer as a PRN anxiolytic medication?

1/1

A. Buspirone (BuSpar)

B. Lorazepam (Ativan)

C. Amitriptyline (Elavil)

D. Desipramine (Norpramin)

55. When Tricia was discharged, she has been unable to leave her home that week because of severe
anxiety, and she says, "I know it does not make sense, but I just can't bring myself to leave my apartment
alone." Which nursing intervention is appropriate for Nurse Chesca to initiate?

1/1

A. Teach the person to use positive self-talk.

B. Assist the person to apply for disability benefits.

C. Ask the person to explain why the fear is so disabling.

D. Advise the person to accept the situation and use a companion.

Situation

3 of 5 points

A finance director, Mr. Enrile, 55 was brought to the hospital for diagnostic workup after he had
experienced seizure in his office. Nurse Henry was assigned to him.

56. Just as Nurse Henry was entering the room, the patient who was sitting on his chair begins to have
seizure. Which of the following must the nurse do FIRST?

1/1

A. Ease the patient to the floor

B. Lift the patient and put him on the bed

C. Insert a padded tongue depressor between his jaws.

D. Restraint patient's body movement

57. Mr. Enrile is scheduled for CT scan the next day, noontime. The appropriate preparation for Nurse
Henry would be to ______________.

0/1

A. Shampoo hair thoroughly to remove oil and dirt

B. Instruct the patient to keep his head still instead

C. Give a cleansing enema and give fluids until 8 AM

D. Shave scalp and securely attach electrodes to it

58. Mr. Enrile is placed on seizure precaution. None of the following are absolute contraindications,
EXCEPT?

0/1
A. Obtain his oral temperature.

B. Encourage to perform his own personal hygiene.

C. Allow him to wear his own clothing.

D. Encourage him to be out of bed

59. The usual behavior of a post-seizure patient would be described by which of the following
statements?

1/1

A. Most comfortable walking and moving about.

B. Becomes restless and agitated.

C. Sleeps for a period of time

D. Say he is thirsty and hungry

60. Nurse Henry is aware that the patient on seizure is ALWAYS placed in what position?

1/1

A. Modified Trendelenburg

B. Side lying

C. Supine

D. Low fowler’s

Situation

4 of 5 points

In his field of work as a mental health nurse, Nurse Krizel utilizes evidence-based practices to advocate
for mental health issues and shed a light on discussions among her clients, family and community. The
following questions apply.

61. Nurse Krizel understands the characteristic of an evidenced based nursing care. This is exemplified by
which of the following?
1/1

A. Clinical nursing care is based on intensive practice.

B. Nursing care is based on traditional style

C. Result oriented intervention is delivered to the patient

D. Nursing care based on integration of research

62. Nurse Krizel differentiates qualitative from quantitative research. Which among the following is a
characteristic of qualitative research design?

0/1

A. Data gathered are based on numeric values

B. The researcher determines the cause and effect: relationship.

C. Data gathered or based on narrative descriptions.

D. Data are capable of inferential statistics

63. A research study entitled “Investigation on the effects of osteoporosis in the incidence of bone
fractures among elderly patients". Nurse Krizel would identify which of the following as the independent
variable of the study?

1/1

A. Elderly patients

B. Age of patients affected by osteoporosis

C. Osteoporosis

D. Fractures

64. Nurse Krizel intends to conduct a study on the effectiveness of ROM exercises aimed at improving
joint flexibility, activity function and pain among stroke survivors. Some patients received a 4-week
exercise program, whereas others did not. Groupings were assigned randomly. What type of research
design is involved?

1/1
A. Quasi experimental design

B. Non-experimental design

C. Correlational coefficient

D. Experimental research

65. Nurse Krizel selects which of the following as the variable that is being controlled or manipulated?

1/1

A. Exercise intervention

B. Morbidity

C. the deviation of exercise

D. Activity function, pair, joint flexibility

Situation

3 of 5 points

Nelia, a 45-year-old clinical instructor is discussing topics in psychiatric nursing in her assigned group.
The following concepts are covered in their conversation.

66. One patient blurted out, "Please don't share information about me with the other people." To
promote confidentiality, the most appropriate response by Nurse Nelia would be _________________.

0/1

A. "I won’t share information with others without your permission, but I will share information about
you with other staff members involved in your care."

B. "A therapeutic relationship is just between the nurse and the patient. It's up to you to tell others what
you want them to know."

C. "It really depends on what you choose to tell me. I will be glad to disclose at the end of each session
what I will report to the team.”

D. "I cannot tell anyone about you. It will be as though I am talking about my own problems, and we can
help each other by keeping it between us.
67. During the first interaction with a patient diagnosed with a psychiatric disorder, which focal issues
should Nurse Nelia address?

1/1

A. Trust, congruence, attitudes, and boundaries

B. Goals, resistance, unconscious motivations, and diversion

C. Relationship parameters, the contract, confidentiality, and termination

D. Transference, countertransference, intimacy, and developing resources

68. Which health education must be rightfully included by Nurse Nelia for a patient prescribed with
Alprazolam (Xanax)?

0/1

A. Report drowsiness

B. Eat a tyramine-free diet

C. Avoid alcohol beverages

D. Adjust dose and frequency based on anxiety level

69. The initial nursing intervention to be done by Nurse Nelia for a patient experiencing panic attack
would be to ___________________________.

1/1

A. Administer an anxiolytic medication.

B. Provide calm, brief, directive communication.

C. Gather show of force in preparation for gaining physical control.

D. Teach relaxation techniques

70. Nurse Nelia determines which finding indicates that a patient with moderate-to-severe anxiety has
successfully lowered the anxiety level to mild. In this case, the patient _______________.

1/1
A. Asks, What's the matter with me?"

B. Stays in a room alone and paces rapidly

C. Can concentrate on what the nurse is saying.

D. States “don't want a thing to eat. My stomach is upset."

Situation

0 of 2 points

Gary has been working at the Eye Center of Los Islas Medical Center for 4 years since he came back to
the country from abroad. The following questions apply.

71. Nurse Gary would determine all of the following assessment findings to be abnormal in an older
adult client, EXCEPT?

0/1

A. Hordeolum

B. Exophthalmos

C. Presbyopia

D. Tinnitus

72. What would be the priority action of Nurse Gary when he encounters a client with a penetrating eye
injury from a visible foreign body?

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A. Patch both eyes

B. Immobilize the foreign body and cover the eye

C. Irrigate the eye with copious amounts of water

D. Administer carbonic anhydrase inhibitors as prescribed

Situation

1 of 3 points
Nurse Jamila works in the Neurologic Institute of John Hopkins Hospital. After spending quite some
time in the institution, she was able to acquire valuable knowledge and useful skills in the
management of patients with neurologic disorders.

73. Nurse Jamila attends to a family of a patient diagnosed with meningitis. She knows that the following
clinical manifestations would be unexpected in meningitis, except? (Select all that apply)

1. Headache

2. Dysphagia

3. Nuchal Rigidity

4. Fever

5. Dysarthria

6. Vomiting

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A. 1, 3, 4, 6

B. 2, 4, 5, 6

C. 1, 2, 3, 6

D. 2, 3, 4, 6

74. The family of the patient are curious about how meningitis develops. Nurse Jamila’s response should
be based on an understanding that meningitis is _____________________________.

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A. A fatal form of polyneuritis.

B. A cerebrospinal infection

C. A collection of pus in the brain tissue

D. A rare progressive loss of motor-neurons

75. In order to reduce risks for meningitis, what would be the best instruction by Nurse Jamila to an
older adult client?

1/1

A. Avoid being in any situations in which there are large crowds.

B. Get pneumococcal pneumonia, influenza, and meningococcal vaccinations.

C. Drink at least 2,000 mL fluids per day.

D. Exercise 15 to 30 minutes most days of the week.

Situation:

4 of 5 points

Rita, 52 years old, with an 8-year history of controlled diabetes mellitus came in to the clinic for a
routine blood glucose screening. Nurse Zach assists her during the process. The following questions
apply.

76. Rita claims that before being diagnosed with DM, she was experiencing excessive urination and
excessive thirst. Nurse Zach should first assess for which of the following symptom?

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A. Weakness

B. Weight loss

C. Vision changes

D. Excessive hunger

77. Nurse Zach would place which of the following underlying factors at great risk for developing DM?

1/1

A. Obesity
B. Kapampangan descent

C. A grandparent with DM

D. Delivery of a neonate weighing more than 10 lbs

78. Which of the following fasting blood glucose levels is considered within normal limits?

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A. 70 to 125 mg/dl

B. 130 to 135 mg/dl

C. 135 to 140 mg/dl

D. 140 to 145 mg/dl

79. Rita says she slipped on a throw rug while going to a bathroom at night. As the nurse, Nurse Zach will
determine which of the following factors needs assessment?

1/1

A. If the home is safe

B. if the client is confused

C. if the client hit her head

D. if the client has a urinary tract infection

80. Rita also Lakes 8 ounces of magnesium sulfate solution. The calibrations on the measuring device are
in milliliters. How many should the nurse give?

0/1

A. 8 ml
B. 80 ml

C. 240 ml

D. 480 ml

Situation:

1 of 4 points

Fred was rushed to the ED for developing slurred speech and left sided weakness of the body. Nurse
Tracy attempts to deliver the most efficient care possible for the client having a stroke. The following
questions apply.

81. Nurse Tracy correctly explains to a Fred’s family that the reason a stroke on the right side of the brain
results on paralysis on the left side of the body is because the pyramidal pathways cross over the end of
which of the following?

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A. Medulla

B. Thalamus

C. Pons

D. Midbrain

82. Nurse Tracy would expect which of the following clinical manifestations for Fred, diagnosed to have a
cerebrovascular accident involving the left side of the brain? (Select all that apply)

1. Paralyzed right side

2. Aphasia

3. Left-sided neglect

4. Paralyzed left side

5. Depression

6. Denial of deficits

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A. 1, 2, 5

B. 5, 1, 3

C. 1, 5, 6

D. 2, 4, 6

83. Should a client with brain attack arrive on comatose, which clinical indicator will Nurse Tracy most
likely identify?

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A. Twitching motions

B. Purposeful motions

C. Urinary incontinence

D. Unresponsiveness to pain

84. When a client experiences a brain attack, in which position should the nurse initially place the client?

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A. Prone position

B. Supine position

C. Fowler’s position

D. Trendelenburg position

Situation:

1 of 5 points

Robin, 33, and Mariel, 35, recently got married. The couple had a grand wedding celebration attended
by their closest friends and families. It was a dream come true for Mariel. They had three children. But
one day, Robin met Melissa, and they had an affair that they kept secret--but not for long, for Mariel
soon discovered about them through her friend. Because of this, she became severely depressed,
particularly when Robin chose to live with Melissa.

85. In the psychiatric ward, Mariel repeatedly says, "No one cares about me. I'm not worth anything."
Which response by the Nurse Sandro would be the most helpful?

0/1

A. "Things will look brighter soon. Everyone feels down once in a while."

B. "The staff here cares about you and we will try to help you get better."

C. "It is difficult for others to care about you when you repeatedly say negative things about yourself."

D. "I’ll sit with you for 10 minutes now and return for 10 minutes at lunchtime and again at 2:30 this
afternoon."

86. On the second day of her confinement, Mariel has been self-neglectful, slept poorly, lost weight, and
repeatedly says, "No one cares about me anymore. I'm not worth anything." What do you think would
be an appropriate initial outcome for Nurse Sandro to consider when using the nursing diagnosis:
Situational low self-esteem, related to feelings of abandonment?

1/1

A. Verbalize realistic positive characteristics about self by (date).

B. Consent to take antidepressant medication regularly by (date)

C. Initiate social interaction with another person daily by (date).

D. Identify two personal behaviors that alienate others by (date).

87. Nurse Sandro wants to reinforce positive self-esteem for Mariel diagnosed with major depressive
disorder. Today, she is wearing a new shirt and has neat clean hair. Which remark is the most
appropriate?

0/1

A. You look nice this morning."

B. "You are wearing a new shirt.”

C. "I like the shirt you’re wearing."

D. "You must be feeling better today."

88. Two weeks ago, Mariel says to Nurse Sandro, "My life does not have any happiness in it anymore. I
once enjoyed holidays, but now, they’re just another day.” How would the nurse document the
complaint?

0/1

A. Vegetative symptom

B. Anhedonia

C. Euphoria

D. Anergia

89. For a patient diagnosed with major depressive disorder (MDD) receiving imipramine (Tofranil) 200
mg every night. Which assessment finding would prompt Nurse Sandro to collaborate with health care
provider regarding potentially hazardous anticholinergic side effect of this drug.

0/1

A. Dry mouth

B. Bradycardia

C. Nasal congestion

D. Urinary retention

Situation:

4 of 6 points

Valerie works in the orthopedic department of Cleveland Clinic. She is tasked with providing nursing
care to patients with musculoskeletal problems. The following questions apply.
90. Nurse Valerie evaluates if Nora understood the discharge instructions after a total hip replacement
when she states, “I should avoid ___________________________.”

1/1

A. "Climbing stairs"

B. "Stretching exercises"

C. "Sitting in a low chair"

D. "Lying prone for 30 minutes."

91. Nurse Valerie is keen on the prevention of pressure injuries among her patients who are undergoing
treatment and rehabilitation. She will place which client at greatest risk for the development of a
pressure ulcer?

0/1

A. A 52-year-old obese female, two days post-op for a knee replacement, who has an indwelling urinary
catheter

B. A 74-year-old thin male, who is awaiting surgery for a fractured left hip

C. A 91-year-old emaciated female with a blood sugar of 160 mg/dL, who is sitting in a wheelchair

D. A 67-year-old obese male, who has cellulitis of his right lower leg

92. Which of the following dietary guidelines should the nurse provide to a client with a fracture?

1/1

A. Three large, high calorie meals

B. High fiber foods and 2000 to 3000 ml fluids daily

C. Low-protein and low-fat foods

D. Limit milk and milk products to two servings daily

93. Nurse Valerie is giving a discharge instruction to Manny, who will be initiating the use of crutches on
his own. Nurse Valerie would be incorrect if she provides which instruction
*

1/1

A. Your elbows should be slightly flexed when walking.

B. Never rest the axilla in the axilla bars.

C. Watch your crutches carefully when walking

D. Place the crutches 6-10 inches diagonally in front of the foot

94. Nurse Valerie plans to ambulate Matilda during her morning care. When walking with the client with
crutches, Nurse Valerie should be on:

1/1

A. Behind the patient

B. Affected side of the patient

C. Unaffected side of the patient

D. Either side

95. Nurse Valerie is assisting a Hector, a 45-year-old client with a left short leg cast on crutches who
wants to go down to the cafeteria. The correct method to go down with crutches is by moving
____________________________.

0/1

A. The affected leg first.

B. The unaffected leg first.

C. The affected leg and crutches first

D. The unaffected leg and crutches

Situation:

2 of 5 points

Mr. Khalid is discussing about the scope of nursing practice delineated in the Republic Act 9173 or the
Philippine Nursing Act of 2002.

96. Which among the following basic qualifications is not required for Mr. Khalid to be admitted as a
clinical faculty at Medina College of Nursing?

0/1

A. Master's degree in public health

B. Nursing master’s degree in nursing

C. One-year clinical experience

D. Licensed IV therapy nurse

97. The nursing profession is a lifelong journey with many opportunities for further learning. Which
among the following shows that Mr. Khalid is maintaining continual learning to maintain competence?
*

0/1

A. Attending continuing professional education

B. Attending and finishing his MAN

C. Membership with the Philippine Nurses Association

D. Apply as a clinical Instructor or participate in research.

98. The following choices are among the minimum required qualifications of a chief nurse at San Miguel
Primary Hospital, except?

*
0/1

A. Completion of MAN

B. 5 years experience as a nurse manager

C. Two years experience general nursing service

D. GSC completion

99. Mr. Khalid is aware that the present composition of the Professional Regulatory Board of Nursing
(BON) comprises of __________________.

1/1

A. 1 chairman, two member

B. 1 chairman 6 members

C. 1 chairman 7 members

D. 1 chairman 4 members

100. Mr. Khalid determines which institution has the right to close a nursing school who failed to comply
with the minimum academic requirements.

1/1

A. Professional Regulation Commission (PRC)

B. Commission on Higher Education (CHED)

C. Professional Regulatory Board of Nursing (PRBON)

D. Philippine Nurses Association (PNA)