NURSING PRACTICE I – Foundation of PROFESSIONAL Nursing Practice 51-75
Situation – A 61 year old man, Mr. Regalado, is admitted to the private ward for
observation after complaints of severe chest pain. You are assigned to take care of the
client.
51. When doing an initial assessment, the best way for you to identify the client’s priority
problem is to:
A. Interview the client for chief complaints and other symptoms
B. Talk to the relatives to gather data about history of illness
C. Do auscultation to check for chest congestion
D. Do a physical examination while asking the client relevant questions
52. Upon establishing Mr. Regalado’s nursing needs, the next nursing approach would be to:
A. Introduce the client to the ward staff to put the client and family at ease
B. Give client and relatives a brief tour of the physical set up the unit
C. Take his vital signs for a baseline assessment
D. Establish priority needs and implement appropriate interventions
53. Mr. Regalado says he has “trouble going to sleep”. In order to plan your nursing
intervention you will:
A. Observe his sleeping patterns in the next few days
B. Ask him what he means by this statement
C. Check his physical environment to decrease noise level
D. Take his blood pressure before sleeping and upon waking up
54. Mr. Regalado’s lower extremities are swollen and shiny. He has pitting pedal edema.
When taking care of Mr. Regalado, which of the following interventions would be the most
appropriate immediate nursing approach?
A. Moisturize lower extremities to prevent skin irritation
B. Measure fluid intake and output to decrease edema
C. Elevate lower extremities for postural drainage
D. Provide the client a list of food low in sodium
55. Mr. Regalado will be discharged from your unit within the hour. Nursing actions when
preparing a client for discharge include all EXCEPT:
A. Making a final physical assessment before client leaves the hospital
B. Giving instructions about his medication regimen
C. Walking the client to the hospital exit to ensure his safety
D. Proper recording of pertinent data
Situation – Using Maslow’s need theory, Airway, Breathing and Circulation are the
physiological needs vital to life. The nurse’s knowledge and ability to identify and
immediately intervene to meet these needs is important to save lives.
56. Which of these clients has a problem with the transport of oxygen from the lungs to the tissues:
A. Carol with tumor in the brain
B. Theresa with anemia
C. Sonnyboy with a fracture in the femur
D. Brigitte with diarrhea
57. You noted from the lab exams in the chart of M. Santos that he has reduced oxygen in the blood. This condition is called:
A. Cyanosis
B. Hypoxia
C. Hypoxemia
D. Anemia
58. You will do nasopharyngeal suctioning on Mr. Abad. Your guide for the length of
insertion of the tubing for an adult would be:
A. tip of the nose to the base of the neck
B. the distance from the tip of the nose to the middle of the neck
C. the distance from the tip of the nose to the tip of the ear lobe
D. eight to ten inches
59. While doing nasopharyngeal suctioning on Mr. Abad, the nurse can avoid trauma to the area by:
A. Apply suction for at least 20-30 seconds each time to ensure that all secretions
are removed
B. Using gloves to prevent introduction of pathogens to the respiratory system
C. Applying no suction while inserting the catheter
D. Rotating catheter as it is inserter with gentle suction
60. Nurse Suzie is administering 12:00 PM medication in Ward 4. Two patients have to receive Lanoxin. What should Nurse Suzie do when one of the clients does NOT have a readable identification band?
A. Ask the client if she is Mrs. Santos
B. Ask the client his name
C. Ask the room mate if the client is Mrs. Santos
D. Compare the ID band with the bed tag
Situation – During the NUTRITION EDUCATION class discussion a 58 year old man, Mr. Bruno, shows increased interest.
61. Mr. Bruno asks what the “normal” allowable salt intake is. Your best response to Mr.
Bruno is:
A. 1 tsp of salt/day with iodine and sprinkle of MSG
B. 5 gms per day or 1 tsp of table salt/day
C. 1 tbsp of salt/day with some patis and toyo
D. 1 tsp of salt/day but no patis and toyo
62. Your instructions to reduce or limit salt intake include all the following EXCEPT:
A. eat natural food with little or no salt added
B. limit use of table salt and use condiments instead
C. use herbs and spices
D. limit intake of preserved or processed food
63. Teaching strategies and approaches when giving nutrition education is influenced by
age, sex and immediate concerns of the group. Your presentation for a group of young
mothers would be best if you focus on:
A. diets limited in salt and fat
B. harmful effects of drugs and alcohol intake
C. commercial preparation of dishes
D. cooking demonstration and meal planning
64. Cancer cure is dependent on
A. use of alternative methods of healing
B. watching out for warning signs of cancer
C. proficiency in doing breast self-examination
D. early detection and prompt treatment
65. The role of the health worker in health education is to
A. report incidence of non-communicable diseases to community health center
B. educate as many people about warning signs of non-communicable
diseases
C. focus on smoking cessation projects
D. monitor clients with hypertension
Situation – As you begin to work in the hospital where you are on probation, you are
tasked to take care of a few patients. The clients have varied needs and you are expected to provide care for them.
66. An ambulatory client. Mr. Zosimo, is being prepared for bed. Which of the following nursing actions promote safety for the client?
A. Turning off the lights to promote rest and sleep
B. Instructing the client about the use of call system
C. Raising the side rails
D. Placing the bed in high position
67. Mikka, a 25 year old female client, is admitted with right lower quadrant abdominal pain. The physician diagnosed the client with acute appendicitis and an emergency appendectomy was performed. Twelve hours following surgery, the patient complained of pain. Which of the following is the most appropriate nursing diagnosis?
A. Impaired mobility related to pain secondary to an abdominal incision
B. Impaired movements related to pain due to surgery
C. Impaired mobility related to surgery
D. Severe pain related to surgery
68. You are preparing a plan of care for a client who is experiencing pain related to incisional swelling following laminectomy. Which of the following should be included in the nursing care plan?
A. Encourage the client to log roll when turning
B. Encourage the client to do self-care
C. Instruct the client to do deep breathing exercises
D. Ambulate the client in ward premises every twenty minutes
69. Mr. Lozano, 50 year old executive, is recovering from severe myocardial infarction. For the past 3 days, Mr. Lozano’s hygiene and grooming needs have been met by the nursing staff. Which of the following activities should be implemented to achieve the goal of independence for Mr. Lozano?
A. Involving family members in meeting client’s personal needs
B. Meeting his needs till he is ready to perform self-care
C. Preparing a day to day activity list to be followed by client
D. Involving Mr. Lozano in his care
70. Mr. Ernest Lopez is terminally ill and he choose to be at home with his family. What nursing action are best initiated to prepare the family of Mr. Lopez?
A. Talk with the family members about the advantage of staying in the hospital for
proper care
B. Provide support to the family members by teaching ways to care for their
loved one
C. Convince the client to stay in the hospital for professional care
D. Tell the client to be with his family
Situation – Myrna, a researcher, proposes a study on the relationship between health
values and the health promotion activities of staff nurses in a selected college
of nursing.
71. In both quantitative and qualitative research, the used of a frame of reference is required. Which of the following items serves as the purpose of a framework?
A. Incorporates theories into nursing’s body of knowledge
B. Organizes the development of study and links the findings to nursing’s body
of knowledge
C. Provides logical structure of the research findings
D. Identifies concepts and relationships between concepts
72. Myrna need to review relevant literature and studies. The following processes are undertaken in reviewing literature EXCEPT:
A. locating and identifying resources
B. reading and recording notes
C. clarifying a research topic
D. using the library
73. The primary purpose for reviewing literature is to:
A. organize materials related to the problem of interest
B. generate broad background and understanding of information related to the
research problem of interest
C. select topics related to the problem of interest
D. gather current knowledge of the problem of interest
74. In formulating the research hypotheses, researcher Myrna should state the research question as:
A. What is the response of the staff nurses to the health values?
B. How is variable “health value” perceived in a population?
C. Is there a significant relationship between health values and health
promotion activities of the staff nurses?
D. How do health values affect health promotion activities of the staff nurses?
75. The proposed study shows the relationship between the variables. Which of the following is the independent variable?
A. Staff nurses in a selected college of nursing
B. Health values
C. Health promotion activities
D. Relationship between health values and health promotion activities
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