Title RECALLS 3 - NP5 - SC ✅

14. In case a patient falls, the nurse FIRST responsibility is to _______. A. assess the patient's injury B. write an incident report C. report the incident to the head nurse. D. notify the physician at once 15. In healthcare facility, a planned program of loss prevention and liability control refers to _______. A. quality assurance B. critical pathways C. risk management D. peer review Situation: Mark, a 25 year old student suddenly had convulsive movements with loss of consciousness during their lecture. After the episode he was rushed to the nearest hospital. 16. A nurse is conducting physical assessment, which of the following is INAPPROPRIATE action in this stage? A. Insert intravenous cannula B. Assess patient's lifestyle C. Assess patient source of stress D. Identify the patient's daily activity 17. Mark is scheduled for an EEG after having a seizure for the first time. What is the BEST patient preparation instruction before the procedure? A. "Avoid thinking and personal matters for 12 hours before thetest." B. "Do not shampoo your hair for 24 hours before the test. " C. "Do not eat anything for 12 hours before the test.” D. "Avoid stimulants and alcohol for 24 to 48 hours before the test." 18. Which of the following manifestation should the nurse APPROPRIATELY observe during generalized seizures? A. Loss of consciousness, dilated pupils, and muscular stiffening B. Jerking movements of all extremities. C. Facial grimace with patting and smacking. D. Vacant stare with a brief loss of consciousness 19. What is the FIRST Priority which the nurse must observe in caring forpatient with seizure? A. Safety B. Airway C. Nutrition D. Mobility 20. Phenytoin (Dilantin) has been prescribed for a patient. Based on an understanding of the medicine, what is the APPROPRIATE nursinginstruction of the nurse? A. Give Dilantin intramuscularly B. Administer good oral hygiene C. Dilute IV Dilantin with 5% dextrose D. Maintain a Dilantin level of 30-50 ug/ml Situation: Gloria is a nurse researcher in the Department of Health. She is assigned to conduct research on patient safety practices of nurses in the psychiatric unit. She is given 6 months to conduct the study. 21. After formulating and delimiting the research problem, which following will be a PRIORTTY action of Gloria? A. Develop the theoretical framework of the study B. Formulate the hypothesis C. Plan the research design of the study D. Conduct a literature search on the topic 22. Gloria decides to include only nurses who have a minimum three year’s experience as psychiatric nurses. Which of the following terms refer to this? A. Concept B. Variable C. Limitation D. Delimitation 23. The statement “The length of service is not associated with the degree of patient safety practices of staff nurses" is an example of a/an ________. A. Variable B. Assumption C. Hypothesis D. Theory 24. Which of the following research designs is MOST APPROPRIATE for thisstudy if the aim is to find a relationship between two variables in thestudy? A. Phenomenological study B. Experimental C. Exploratory D. Correlational 25. She plans to interview the Psyche Nurse Manager about the patient safetypractices of the nurses. What type of sampling includes those who happens to be in the conference room where the activity is scheduled? A. Random B. Purposive C. Convenience D. Quota Situation: Belle is a 30-year-old single mother who is dependent on her family for support. Her diagnosis is mild mental retardation withpost-traumatic disorder with depressive episodes related to her mother's death. Her current symptoms include depressed mood with irritability, difficulty tolerating frustration, difficulty falling asleep, increased appetite and weight gain, hypervigilance, and worry that something terrible will happen to her child. 26. A cognitive assessment of Belle indicated that according to Piaget'stheory she was functioning at the concrete operational stage. Which of these behaviors would the nurse observe in Belle? A. Thinks logically and sees possibilities. B. Understands only her own viewpoint. C. Feels her own reasoning should agree with the reasoning ofothers. D. Makes and tests hypothesis. 27. Belle has difficulty tolerating frustration. The GOAL of the nurse is toassist Belle to ________. A. increase her self-esteem A. cope with anxiety B. recognize her needs C. mobilize her resources 28. Which of the following historical data MOST probably led to apost-traumatic stress disorder? A. Unstable relationship with ex-fiancé. B. Suicide of her mother. C. No gang-relationship with peers 29. Given her problems of hyper vigilance and worry that something terrible will happen to her child, nursing interventions should be aimed at addressing her needs for _________. A. love and belongingness B. biological integrity C. psychological security D. self-esteem 30. In terms of social support therapy, which of these is the MOST APPROPRIATE and therapeutic? A. with appropriate support, lives in the community, eitherIndependently or in a supervised setting. B. Individualized relationship with a caregiver. C. High structured environment with constant aid and supervision. D. Vocational training with moderate supervision but not beyond second grade academic challenges. Situation: The following scenarios are potential routines that could checkwork ethics of a professional nurse. 31. A patient asks to be discharged from the health care facility against medical advice(AMA). What should the nurse do? A. Notify the physician. B. Prevent the patient from leaving. C. Have the patient sign an AMA form. D. Call a security guard to help detain the patient. 32. A nursing assistant in assigned to provide morning care to a patient. How should the nurse document care given by the nursing attendant? A. "Morning care rendered". B. "Morning care rendered by Grace Go, NA" C. "Morning care provided by G.G., nursing assistant". 2 | Page
D. "Morning care refused to be given by nursing assistant. 33. A nurse administers the wrong intravenous fluid to a patient. She shouldaccomplish which of the following documents to be submitted to herimmediate supervisor? A. Patient Kardex B. Incident report C. Progress report D. Endorsement record 34. When developing a care plan for a patient with a do-not-resuscitateorder, the nurse should NOT Include which intervention on the care plan? A. Allow access to individuals who can provide spiritual care. B. Administer pain medications as ordered by physician. C. Provide usual routine nursing care as ordered by physician. D. Administer lethal doses of medication as patient request. 35. A patient is to undergo a laminectomy in the morning. The physician asksthe nurse to witness the patient's signing of the consent form. What isthe BEST action the nurse? A. Provide emotional support for the patient while the patient signs the consent. B. Make sure the physician explains the risks of undergoing the procedure. C. Make sure the physician thoroughly describes the procedure. D. Make sure the patient is competent, awake and alert before he/she signs the consent form. Situation: Charge Nurse Tessie works at the surgical ward. She ensures g record management is implemented in her unit at all times. 36. A patient is having elective surgery under general anesthesia. Who is responsible for obtaining the informed consent? A. Surgeon B. Nurse C. Nurse anesthetist D. Anesthesiologist 37. Which statement by the patient indicates that the he understands the explanation of the surgeon? A. "I refuse to sign the consent form; another family member can sign for me." B. “Now I know what alternative treatments and procedure are.” C. "If I refuse to sign the consent form, other treatment will be withdrawn.” D. "I can't refuse the procedure after the consent is signed." 38. The wait secretary who transcribes the physicians order asks them to interpret an order because she cannot read the writing. The nurseBEST action in to _______. A. Clarify the order with the pharmacies B. clarify the order by calling the physician C. interpret the order according to the patient’s previous medication record D. clarify the order with junior staff 39. The physician orders to transfuse 500ml packed RBC blood postoperatively. The nurse must check the name on the label of the blood with the name on the patient’s _____. A. Medication administration record B. Wristband in the presence of another nurse C. Medical Chart D. Wristband 40. The patient's wife is so anxious about the condition of her husband. The MOST appropriate INITIAL intervention for the nurse to make is to _____. A. Describe her husband's medical treatment since admission B. reassure her that the important fact is her presence C. explain the nature of the injury and reassure her that husband's condition is stable D. allow her to verbalize her feelings and concern Situation: Quality and safety are rooted in the daily work of a health care professional. Nurses in the Orthopedic Unit attend monthly quality assurance meetings. The following questions were discussed. 41. Who should be involved in quality improvement measures? A. Everyone B. Management staff C. Professional staff D. Consumers 42. To start a nursing improvement project, what is the FIRST step that nurses most keep in mind? A. Implement plan to correct the problem B. Determine the nursing standards C. Determine findings if warrant correction D. Collect data, determine if standards are set 43. To achieve organized work flow in the unit the staff must be aware of the head nurse's role. What is the PRIMARY purpose of supervision delegation? A. Enhances the delivery of quality nursing care B. Influences organization's approach in personnel evaluations C. Improves staff attendance in seminars D. Assigns any staff to do the tasks or project. 44. To ensure quality nursing care to a patient in skin traction, what is the PRIORITY Intervention that a nurse has to assess frequently? A. Signs of infection around the pin site. B. Signs of skin breakdown C. Urinary incontinence D. Presence of bowel sounds 45. The nursing team plans to do chart audit project on post-op patients who had developed pressure sores at the Orthopedic unit over the past year to present. What type of audit is? A. Retrospective B. Process C. Concurrent D. Outcome. Situation: Incidence of drug abuse has greatly increased over time. Korino has been using drugs for the past three years. 46. You are a Drug Abuse Treatment and Rehabilitation Center Nurse. During the assessment of a newly admitted Person Who Uses Drugs(RWUDS) named Korino, which of the following is the MOST APPROPRIATE question to ask? A. Ask Korino how long he thought that he could take drugs without someone finding it. B. Ask Korino why he started taking illegal drugs. C. Do not ask any questions for fear Korino will deny and may become assaultive. D. Ask Korino about the amount of drug used and its effect and how long he had been using. 47. Upon data collection he had been falling three times in his math class and Korino was known for substance dependence for three years. What is the MOST APPROPRIATE nursing diagnosis for him? A. Alteration in perception. B. Alteration in social interaction. C. Ineffective individual coping. D. Impaired judgement. 48. Korino has been using meperidine and codeine for personal consumption.Which of the following does the nurse understand as the effect of these drugs? A. Increases sexual stimulation. B. Relieves pain by increasing pain threshold. C. Decrease craving for alcoholic intake. D. Heightens concentration and alertness 49. Which assessment by the nurse would cause a concern for Meperidine overdose? A. Respiration rate of 12 bpm. B. Hypercapnia C. Dryness of the skin. D. Pinpoint pupils. 50. What drug should the nurse prepare for administration to reverse all signs of toxicity? A. Digibind (Digoxin) B. Naloxone (Narcan) C. Atropine sulfate D. Diazpam (Valium) 3 | Page
Situation: Effective communication is a core skill for nurses that a professional nurse must apply in their daily routine for patient care, colleagues and family. 51. The nurse asks the patient, "What do you fear MOST about your surgery tomorrow? This is an example of which communication technique? A. Providing general leads B. Summarizing C. Seeking clarification D. Presenting reality 52. The patient made the following statement to the nurse, “My doctor just told me that he cannot save my leg and that I need to have an above-the-knee-amputation." Which response by the nurse is MOST APPROPRIATE? A. "Tell me more." B. “Dr. Benito is an excellent surgeon." C. "If I were you, I will get a second opinion. " D. "Are you in pain?" 53. A nurse is communicating with the attending physician about medical intervention prescribed for a patient-post spine surgery. Which statement is INDICATIVE of a collaborative relationship? A. "Can we talk about Mrs. Santos?" B. "I am worried about Mrs. Santos' blood pressure. It is not decreasing even with the new antihypertensive medication." C. "That new medication you prescribed for Mrs. Santos is ineffective." D. "We do not need to talk about Mrs. Santos' blood pressure." 54. An 80-years-old male, admitted for emergency suturing of the foreheads sustained from accident tall while gardening under local sedation. He was just received in the ward. Which nursing intervention is APPROPRIATE to facilitate effective communication with this patient? A. Talk to the patient when fully awake and inform him and family events which may occur post-surgery. B. Provide the patient with instructional materials about discharge. C. Tell the patient, "You are fine, nothing to worry." D. Ask the patient, "Do you know where you are?" 55. The nurse who uses appropriate therapeutic listening skills will which BESTbehavior? A. Presume an understanding of the patient's needs. B. React quickly to the message. C. Reassure the patient that everything will be fine. D. Absorb both the content, and the feeling which patient is conveying. Situation: Effective teamwork and collaboration in nursing is achieved when individuals work together in harmony, processes and goals arealigned towards achieving safe quality patient care. 56. Which of the following actions is INAPPROPRIATE for a nurse leader to apply in a work setting? A. Ask staff members of their opinion on the matter. B. Modifies his own behavior favoring the needs of individual staff. C. Gives equal consideration to each staff members D. Plans and organizes group activities of staff members. 57. In problem solving, the head nurse must know what is the MAJOR characteristic of negotiation? A. Be positive in your approach since optimism gives further favorable results. B. Harmony is possible even when strategies are not well planned. C. It is not important to get anything in writing since the truth will prevail. D. Resources tend to involve too many individuals in the decision-making process. 58. Applying multidisciplinary approach of patient care, which among the members of the multidisciplinary team that the nurse would MOST likely collaborate with when the patient is at risk of fall due to an impaired gait? A. Podiatrist B. Physical therapist C. Speech therapist D. Nutritionist 59. The nurse manager has implemented a change in the method of the nursing delivery system from functional to team nursing. A nursing is resistant to the change and is not taking an active part in facilitating the process of change. Which is the BEST approach in dealing with the nurse? A. Exert coercion on the nurse B. Provide a positive reward system for the nurse C. Talk and encourage verbalizing feelings of the change. D. Ignore the resistance of the nurse 60. Which among the members of the multidisciplinary team that the nurse would be BEST to collaborate with when the patient can benefit the use of leg prosthesis? A. Occupational therapist B. Physical therapist C. Podiatrist D. Pharmacist Situation: Karen in seventeen years old, grade twelve, active in gymnastics. She is five feet and seven inches tall, weighs eighty five pounds. Her family doctor diagnosed her with anorexia nervosa. 61. Which of the following statements should Nurse Cora consider as TRUEwith anorexia nervosa? A. Thinness is equated with vanity among peers. B. Eating disorders are not major health problems C. Cultures linking beauty to thinness increase risk of the illness. D. Anorexia nervosa is not considered as a mental disorder. 62. Karen is being assessed for eating disorder. Which option is suggestive of anorexia nervosa? A. Lack of knowledge about food and nutrition B. Guilt and shame about eating patterns C. Refusal to talk about food-related topics D. Unrealistic perception of body size 63. Nurse Cora is working with Karen. Even though Karen has been eating all her meals and snacks, her weight has remained unchanged for a week. Which nursing intervention is APPROPRIATE for Karen? A. Supervise Karen closely for 2 years after meals and snacks. B. Supervise Karen closely 2 hours before and after meals. C. Increase the daily caloric intake from 1500 to 2000 calories. D. Increase the daily caloric intake from 1800 to 3000 calories . 64. One morning, as Nurse Cora entered Karen's room, she noticed that the patient was engaging in rigorous push-ups. Which nursing action MOST APPROPRIATE? A. Allow her to complete her exercise program. B. Tell her that she is not allowed to exercise rigorously. C. Interrupt her and offer to take her for a walk. D. Interrupt her and explain that exercise is not needed. 65. Which of the following is the INITIAL goal for treating the severely malnourished patient with anorexia nervosa? A. Nutritional rehabilitation B. Correction of body image disturbance C. Weight restoration D. Correction of electrolyte imbalances Situation: Annie is a 38-year-old-woman with three children. She has a history of otosclerosis. She is admitted for ear surgery. 66. While taking nursing history on Annie, what will be the response of the patient that indicates her present condition? A. She frequent experience vertigo, nausea and nystagmus when sitting. B. She has ear pain and discharge from the left ear when travelling. C. She has had impaired hearing since birth. D. Her hearing loss has become worse with each succeeding pregnancy. 67. Annie states. "I'm afraid to let my children out of my sight now that I can't hear them. What is the nurse's BEST response? 4 | Page