Professional Documents
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Answer: B. Touch serves as a connection between the nurse and the patient.
Rationale: Therapeutic touch allows the nurse to comfort patients on a caring level,
connecting with them on a humanistic level away from the medical proceures and
techniques that are often experienced. In addition, therapeutic touch allows the nurse to
communicate non-verbally a variety of feelings to the patient, including warmth,
reassurance and trust. Therapeutic touch can also be used more formally as a named
technique, such as massage or healing touch, to help the nurse in a variety of physical,
emotional and spiritual aids.
Book source: The Essential Concepts of Nursing: Building Blocks for Practice by John
R. Cutcliffe, Hugh P. McKenna, page 298
3. You are asked to teach the client, Mr. Lapuz, who has right sided weakness the use of
cane. Which observation will indicate that Mr. Lapuz is using the cane properly?
A.
B.
C.
D.
The cane and one foot or both feet are on the floor at all times
He advances the cane followed by the left leg
Client keeps the cane on the right side along the weak leg
Client leans to the left side which is stronger
Answer:
Rationale:
Book source:
4. George, a 43 year old executive is scheduled for cardiac bypass surgery. While being
prepared for the surgery, he says to the nurse I am not going to have the surgery. I may
die because of the risk. Which response by the nurse is most appropriate?
A. Without the surgery you will most likely die sooner.
B. There are always risks involved with surgery.
C. There is a client in the other room who had successful surgery and you can talk to
him.
D. This must be very frightening for you. Tell me how you feel about the surgery.
Answer: D. This must be very frightening for you. Tell me how you feel about the
surgery.
Rationale: The OR environment can seem cold, stark and frightening to the patient, who
may be feeling isolated and apprehensive. Introducing yourself, addressing the patient by
name frequently, verifying details, providing explanations, and encouraging an answering
questions provided sense of professionalism and friendliness that can help the patient feel
safe and secure. When discussing what the patient can expect surgery, the nurse uses
basic communication skills, such as touch and eye contact, to reduce anxiety. Telling the
patient who else will be present in the OR, how long the procedure is expected to take
and other details helps the patient prepare for the experience and gain sense of control.
Book source: Brunner & Suddarths Textbook of Medical-Surgical Nursing 12th Edition
by Suzanne C. Smeltzer, Brenda G. Bare, et.al Copyright 2010. Page 457
5. A client is ordered to take Lasix, a diuretic, to be taken orally daily. Which of the
following is an appropriate instruction by the nurse?
A.
B.
C.
D.
Book source: Leadership and Nursing Care Management By Diane Huber page 98
8. While going on evening round, Nurse Edna saw Mrs. Pascual meditating and afterwards
started singing prayerful hymns. What is the BEST response of Edna?
A.
B.
C.
D.
Answer:
Rationale:
Book source:
9. A client asks for advice on low cholesterol food. You advise the client to eat the
following:
A.
B.
C.
D.
Answer:
Rationale:
Book source:
10. The code of ethics for nurses has an interpretative statement that provides:
A. continuity of care for the improvement of the client
B. guide for carrying out nursing responsibilities that provide quality care and for the
ethical obligation of the profession
C. standards of care in carrying out nursing responsibilities
D. identical care to all clients in any setting
Answer: B. guide for carrying out nursing responsibilities that provide quality care and
for the ethical obligation of the profession
Rationale: Code of ethics is a formal statement of a groups ideals and values. It is a set
of ethical principles that (a) is shared by members of the group, (b) reflects their moral
judgments over time, and (c) serves as a standard for their professional action.
Book source: Kozier and Erbs Fundamentals in Nursing, 8th Edition page 85
11. Which of the following situation would possibly cause a nurse to be sued due to
negligence?
A. Nurse gave a client wrong medication, and an hour later, client complained of
dyspnea
B. While preparing a medication, the nurse notices that instead of 1 tablet, she put two
tablets in the clients medication cup
C. AS the nurse was about to administer medication, the client questioned why the
medication is still given when in fact the physician discontinued it
D. Nurse administered 2 tablets of analgesic instead of 1 tablet as prescribed. Patient
noticed the error and complained.
Answer:
Rationale:
Book source:
12. Your nurse supervisor asks you who among the following clients is most susceptible to
getting infection if admitted to the hospital?
A.
B.
C.
D.
Answer:
Rationale:
Book source:
14. The nurse is in the hospital canteen and hears two staff nurses talking about the client
confined in Room 612. They mentioned his name and discussed details of his condition.
Which of the following actions should the nurse take?
A. Approach the two nurses and tell them that their actions are inappropriate
especially in a public place
B. Wait till the nurses finish the discussion and report the situation to the supervisor
C. Say nothing to avoid embarrassing the staff nurses
D. Remain quiet and ignore the discussion
Answer:
Rationale:
Book source:
15. The son of Mr. Rosario, a 76 years old man, reports to the nurse in the community health
center that his father has been getting out of bed at night and walks around the house in
the early hours of the morning causing him to fall and injure himself. Which instruction
would you give?
A.
B.
C.
D.
16. You are to administer an intramuscular injection to Dulce, 1 year old girl. The most
appropriate site to administer the drug is:
A. Dorso gluteal region
B. Ventral forearm
C. vastus lateralis
D. gluteal region
C. 60 drops
D. 32 drops
Answer: A. 42 drops
Rationale: (1000mL/hr)(20drops per minute)
(60 minutes)(8 hours)
Book source: Focus on Nursing Pharmacology by Amy M. Karch 5th Edition page 58
19. Mr. Lagro is to receive 1 liter of D5LR to run for 12 hours. The drop factor of the IV
infusion set is 10 drops per minute. Approximately how many drop per minutes should
the IV be regulated?
A. 13-14 drops
B. 17-18 drops
C. 10-12 drops
D. 15-16 drops
C.
D.
2 capsule
capsule