Tiêu đề RECALLS 13 - NP3 - SC ✅

D. She is having discomforts and crying because of abdominal distention” Situation 3 – Juaning, 58 year old is admitted for a suspected heart failure. He has shortness of breath, mild chest pain, tachypea and presence of crackles on the bases of both lungs. Your head nurse (HN) instructed you to prepare nitroglycerin to be administered by Intravenous route. You validated from your head nurse why such medication is going to be given to patient Juaning. 11. The HN as part of her teaching function provided you this APPROPRIATE response. This is to _______. A. “reduce after load” B. “increase preload” C. “increase after load” D. “reduce preload” 12. When doing a health teaching to a patient, the FIRST step is to determine ____________. A. readiness to learn B. adaptation to learning styles C. learning needs D. capacity to learn 13. You are assigned to do a health education class on Thursday morning with several patients for possible discharge. You have a diabetic patient for discharge. He is taking a medication Carvedilol. Which one of the following instructions must be EMPHASIZED during your discharge teaching? A. Observe skin care because the drug can decrease tissue perfusion B. Monitor blood sugar level because the drug can cause hyperglycemia C. Monitor pulse rate, sugar levels because the drug may mask hypoglycemia D. Check pulse rate every 6 hours because the drug can cause palpitation 14. You are teaching a group of patients who are undergoing hemodialysis regarding their dietary plan. You should explain to them that intake of protein is necessary because it __________. A. reduces demand for liver functioning B. increases nitrogenous waste products C. maintains osmotic pressure D. induces frequent urination 15. There is a doctor’s order for your patient with heart failure to be discharged after two days. The diet order is for him to limit his sodium intake to only 2 g. Identify which of the following breakfast selection should be included in your plan. A. Orange juice, bacon, fried egg, and steamed rice. B. Orange juice, fried salted fish, and steamed rice. C. Orange juice, toast bread, poached egg and jam. D. Orange juice, pouched egg, brown rice and ham. Situation 4 - Ms. Maribel is the Nurse director in a Level 3 private hospital in Metro Manila. In the past months she has been encountering staffing problems so she is worried that she cannot comply with the expectations of her stakeholders as a Premiere health institution in the country that can deliver Safe and Quality care. 16. In the Strategic plan process, which of the following questions is addressed to be able to arrive at a specific vision-mission in a nursing business plan? 1) What business are we in now? 2) What business do we want to be? 3) What do our customers expect of us now? 4) What will be the expectations of our customers in the future? 5) Who are our customers? A. 2, 3 & 4 B. 1,2,3,4 & 5 C. 1 & 2 D. 1, 3 & 4 17. The hallmark of Nursing shortage is BEST described as ___________. A. Predetermined standards of group of patients with the available nursing staff B. Situation related to recruitment and retention of nursing personnel C. Use of nursing models to forecast availability of nursing personnel D. Discrepancy between the supply and demand of nursing graduates 18. In the light of the brainstorming session of the team leaders, the issue of managing performance of personnel was raised into the discussion. Which of the following is the sequence in the performance appraisal? 1. Assess the institutional and personal goals 2. Assess progress of the staff 3. Evaluate progress 4. Establish objectives and time frame A. 4, 1, 2, & 3 B. 1, 3, 4 & 2 C. 2, 3, 1 & 4 D. 1, 4, 2 & 3 19. Prioritization and delegation of personnel can also be of help to the professional nurses in staffing problem. Cases have been raised by the team members such as; if you have a plan of care for a diabetic patient which of the following interventions can be delegated to the experienced nursing attendant? A. Discuss with the patient and family on insulin therapy B. Perform wound care for a diabetic foot C. Administer metformin for his diabetes D. Teach the patient to perform daily foot care 20. Likewise a clinical situation in the ward is when a patient is attached to a Naso-gastric tube (NGT), which of the following nursing measure can be delegated to a nursing attendant? A. Removing the nasogastric tube as ordered B. Performing oral care every 4 hours and PRN C. Securing the safety of the nasogastric tube with a tape D. Disconnect the suction to accompany patient to the toilet Situation 2 – Eddie Wao, 71 years old, a former car dealer has been chronically-ill due to Emphysema. He was in and out of the hospital for the past 2 years. He decided to have a living will so he asked his eldest daughter to contact their lawyer. 21. Which of the following conditions is APPROPRIATE to have a living will? When a patient is __________. A. on a stage of drowsiness and receiving sedatives B. incapacitated but conscious and in a terminal condition C. with family members who are around and can make decisions for him D. in a critical condition and receiving lifesaving drugs 22. Which of the following actions of the Nurse can be classified as intentional tort? A. Refusing a patient to sign a waiver so he can go home. B. Failure to instruct the nursing aid to put up the side rails of an older patient resulting to fall. C. Administering a blood transfusion to a wrong patient. D. Failure to report to the physicial the untoward reaction of a drug. 23. A Nurse is assigned in the ICU unit for almost 3 years and has attended several patients who have died under her shift. She was emotionally affected with this situation but remains to be silent every time she reports for duty. The BEST way for the Nurse to cope with this feeling is to ________. A. consult a psychologist regarding this feeling B. discuss this feeling with the other members of the staff C. neglect this behavior and go out with friends D. request the supervisor to transfer her to another unit 24. A patient is admitted in your unit because of rectal bleeding and need a blood transfusion. Being a Jehovah’s witness, he refused the order of the physician. The wife secretly talked with the Nurse and the physician to administer the blood transfusion after taking his sleeping pills. What is the BEST action of the health care professionals in this situation. 2 | Page
A. Refer the case to the minister so he can convince the patient B. Proceed with giving of blood transfusion as this is highly needed C. Refuse the suggestion of the wife for the husband might be awake D. Talk with the wife that she is violating the husband’s request 25. A waitress in a nearby bar was admitted because she was suspected to be suffering from HIV. The waitress is single, but with a boyfriend working in the Middle East. During the shift report of the nurses, the outgoing morning shift was discussing the case in a very loud voice and being heard by some patients in the ward. The Nurse, can be charged for_________. A. Breach of confidentiality B. Oral defamation C. Injustice D. Non-maleficence Situation 5 - Nurse Joy is assigned in the Female Medical ward, caring for patients with varying health conditions. She believes that documentation is an essential aspect of the nursing process and vital for the role as a Nurse especially on record keeping and reporting. 26. When Nurse Joy indicates basic care information, skills and referral services that the patients may need before being released from the health facility is an entry of what documentation in the chart? A. Multidisciplinary notes B. Physician orders C. Discharge Plan D. Nurses notes 27. In coming up with her formulated nursing diagnosis for her patient Ms. Dina, who is suffering from hemolytic anemia, you will expect Nurse Joy to write in the Nursing care plan which one of the following PRIORITIES? A. Ineffective airway clearance R/T poor gas exchange. B. Activity Intolerance R/T to fatigue. C. Poor tolerance to heat R/T increased metabolism. D. Imbalanced Nutrition: less body weight. 28. The physician on duty (POD) ordered a specific diet for patient Dina. Which of the following diet prescriptions will Nurse Joy transmit to dietary department? A. High protein, high caloric diet. B. High fiber, less fat, high protein diet. C. High fats, high protein diet. D. High carbohydrate, less fiber, low protein diet. 29. Marimar, 55 yr old is another patient of Nurse Joy who is having an asthmatic attack, with extreme dyspnea and presence of sternal retraction. The physician who was making his rounds examined the patient and ordered the drug of choice that will relieve patient’s problems. Which of the following will be likely be written by the physician, carried out and recorded by the Nurse in the Medication chart? A. Nor-epinephrine B. Epinephrine C. Prednisone D. Albuterol 30. Nurse Joy is preparing for her shift report with the members of her team in the ward, when she was approached by her junior nurse who raised this concern regarding a physician order. Which of the following orders should I question if this has been written by a doctor? A. twenty four hour ambulatory EKG for a hypertensive patient B. stress test monitoring for an obese adult C. a high dose of insulin for a diabetic adolescent D. blood transfusion for an anemic elderly Situation 6 - Nicolo, 32 years old, single, who is an electrical engineer is scheduled to undergo left leg amputation because of an abscess from a non-healing wound. He is a Juvenile Diabetic. 31. On admission the nurse started to gather his health history, but the client appears uneasy and uncomfortable to share information about his condition. What is the BEST approach of the nurse in this situation? A. Assure him that the information he is going to share will be treated confidentially. B. Tell him, you have encouraged similar problems in the past C. Continue getting his data in a professional manner D. Ask him if he wants to be interviewed at a later time 32. The parents of Nicolo came to visit him. They feel very anxious about their son’s condition. You were asked by the parents what they can do to help their son. Your BEST response is __________. A. “Don’t show him that you are anxious, it will just aggravate his condition.” B. “I am sure anything you will do for him will be appreciated.” C. “Allow him to do activities that interest him for the meantime.” D. “Don’t worry, he will be able to adapt to his condition in due time.” 33. After surgery, Nicolo was transferred to the Post Anesthesia unit (PACU). His vital signs were stable and he was responsive. After two hours, he was transferred to his room. The Ward Nurse received the patient. The BEST nursing approach to do REALITY orientation to Mr. Timmy is _______. A. “Good afternoon, Mr. Nicolo. Do you know where you are?” B. “Mr. Nicolo, you just had your surgery, and you are back to your room.” C. “Thanks God, you had a successful operation. Your parents are here.” D. “Good afternoon, Mr. Nicolo, did you have a good sleep during the operation.” 34. On the 3 rd day, after the operation, you observed that Mr. Nicolo was very quiet, and when approached, he said to the nurse. “I am really concerned with my future!” The nurse’s BEST response is __________. A. “You’re upset, what are you thinking about your future?” B. “We have our hospital chaplain, do you want to see him?” C. “Do you want to discuss your concerns to your parents?” D. “Tell me more about your concerns about your future.” 35. As the nurse of Mr. Nicolo, what is your PRIORITY goal for him? A. Plan for early rehabilitation. B. Arrange for his counselor to spend time with him. C. Create options for his future. D. Self-acceptance of his leg amputation. Situation 7 – Patient Dolores, a 60 year-old was brought to the Emergency Room due to severe pain caused by burns on her arms and legs after her house caught fire. She was crying and moaning. She was diagnosed by the doctor to have 3 rd degree burns. Nurse Tala started to conduct her health assessment and patient was subsequently admitted. 36. Nurse Tala formulated and documented in the chart her nursing diagnosis on Patient Dolores. A PRIORITY nursing diagnosis she wrote is, PAIN R/T _________. A. Exposed nerve endings B. Burn injury C. anxiety D. inflammation 37. Nurse Tala gives pain reliever to Patient Dolores before a procedure is done. Which of the following route should be avoided? A. Intramuscular injections B. Inhalations C. Topical medications D. Oral medications 38. Nurse Tala evaluates Patient Dolores a day after incurring the burn. Which of the following nursing interventions is APPROPRIATE at this time? A. Apply topical anesthesia on the site of burn B. Administer oxygen via nasal mask C. Evaluate the intensity of pain D. Administer pain reliever through injection 3 | Page