Tiêu đề RECALLS 3 - NP2 - SC ✅

2 | Page B. Include a significant other in helping the patient understand the need for rest. C. Instruct the patient that the baby's health is more important than her studies at this time. D. Ask her why she is not complying with the prescription of bed rest. 12. Patient Sienna who seems to be irritated with the nurse said "I don't want to talk with you because you're only a nurse. I will wait for my doctor." Which of the following should the nurse say in response to the patient? A. Your doctor prescribed this for us to do nursing care. B. I understand. I should call your doctor. C. I'm angry with the way you dismiss me. D. So then you would prefer to speak with your doctor? 13. Nurse Mauve is now on ethical dilemma. This occurs when ______. A. a decision had to be made quickly under stressful situation B. choices are unclear C. there is a conflict between the nurse's decision and that of his/her superior D. there is a conflict of two or more ethical principles 14. Despite the reaction of the patient, which of the ethical' principles that the nurse is responsible of providing all patients with caring attention and information? A. Beneficence. B. Nonmaleficence. C. Veracity D. Advocacy 15. Nurse Mauve should plan to initiate which action to provide a safe environment? A. Take the patient's vital signs every 4 hours. B. Encourage visits from family and friends for psychosocial support. C. Maintain fluid and sodium restrictions. D. Take off the room lights and draw the window shades. Situation: Nurse Nanie is admitting five-year-old Krini due to cough, respiratory distress, anxiety and signs of dehydration. The working diagnosis is pneumonia. 16. Nurse Nanie is aware that history taking and physical exam are critical to the diagnostic process and often provide more information than can gained by broad testing strategies. History taking includes the following, EXCEPT ____________. A. History of present illness. B. Religious Affiliation C. Social & Family history D. Past medical history 17. The objective of taking the history of present illness is to illicit chronologic description and duration of the chief complaint. Which of the following questions would try to answer what Nurse Nanie wishes to illicit? 1. History of immunizations. 2. Aggravating and alleviating factors 3. Duration of disease onset 4. Any treatment and response to treatment A. 1, 2 & 3 B. 2,3 & 4 C. 1, 2, 3 & 4 D. 1, 2 & 3 18. Past medical history section of Krini contains the following, but NOT ___________. A. Prenatal history. B. Child hood illness C. Current history D. Birth history 19. Which of the following statements is TRUE? A. History taking must be long regardless if the child appears to be well. B. No proper history can be obtained without observation of child and the mother. C. Nurse Nanie should refrain from asking about the illness of other members of the family. D. An example of what can be elicited from a social history is how the disease started. 20. In order not to frighten small children, it is best to examine things that are uncomfortable or frightening to them last so as not to lose their cooperation. This means the LAST thing do child which of the following, EXCEPT _________. A. Inspection of the throat with a throat stick. B. Inspection of the ears with an otoscope C. Auscultation of the heart D. Undressing the child Situation: Ximena a Christian 29-year-old pregnant woman was admitted to the hospital with a complaint of moderate hypogastric pain. She intends to visit the clinic for her first prenatal check-up and informs nurse Parker that she did not realize she's pregnant until a week ago. As a result, she has been on a diet, weightlifting at the health gym. 21. Patient Ximena was seen by the physician and was ordered for a medication that is larger than the standard dose. What should the nurse do? A. Give the drug as prescribed. B. Inform the supervisor. C. Give the average dose of the medication. D. Discuss the prescription with the physician. 22. The patient refuses to take the medication because it causes diarrhea. Nurse Parker explains the action of the drug but the patient vehemently refuses the medication. What should be the INITIAL action of the nurse? A. Discuss with a family member the need for the patient to take the medication. B. Document the patient's refusal to take the medication. C. Notify the physician of the patient's refusal to take the medication. D. Explain again to the patient the consequences of refusing to take the medication. 23. As a strong believer of her faith and the need for spiritual guidance, patient Ximena requests that she wants that clergy will visit her. How did nurse Parker function when she initiated the visit? A. Dependently B. Collegially C. Interdependently D. Independently 24. Patient Ximena sought referral to an abortion clinic from the nurse. She reasons out that her pregnancy a burden to her work and daily routines. What should be the BEST RESPONSE of the nurse? A. It will cause discrimination from friends and relatives. B. Inform her that abortion is morally and legally wrong by virtue of the law. C. It will cause infection. D. It is against any religion. 25. The incoming nurse on duty reported, the nurse is administering a medication, the patient says, "This pill looks different from the one I had taken before." What is the APPROPRIATE action of the nurse? A. Explain the purpose of the medication. B. Encourage the patient to take the medication. C. Check the original medication prescription. D. Ask what the other pill looked like. Situation: A newly hired nurse is assigned in the OB ward. She was supervised by a senior nurse. 26. She was asked by the nurse supervisor about her concern and what are the considered ideal fetal positions for a healthy delivery? A. Right occipitoposterior with no flexion. B. Right occipitoposterior with full flexion. C. Left transverse anterior in moderate flexion D. Left sacroanterior with full flexion 27. The physician ordered sonography. The nurse informs the ultrasound unit in charge and prepares the patient for the procedure. The patient asks the importance of the procedure, the nurse's CORRECT response is A. to determine diameters of the fetal skull B. increase sensitivity for common bile duct of the fetus C. useful to a visualized cystic duct of the fetus D. to assess fetus’ well-being 28. The newly hired nurse asks for advice from the supervisor. The supervisor notices that the newly hired nurse felt uneasy

4 | Page 43. Oxytocin drip was started to induce labor. Which assessment findings should cause the nurse to IMMEDIATELY discontinue the oxytocin infusion? (Select all that apply) I. Fatigue and drowsiness II. Early decelerations of the fetal heart rate. III. Uterine hyperstimulation IV. Late decelerations of the fetal heart rate A. III and IV B. II and III C. I and III D. I and II 44. Simultaneous with the oxytocin drip (left arm) is the prescribed intravenous (IV) lidocaine (Xylocaine). Nurse Aurora should dilute the concentrated solution of lidocaine (right arm) with which solution? A. 5 percent Dextrose in water B. Normal saline 0.99 percent C. Normal saline 0.45 percent. D. Lactated Ringer's 45. Take home medications given to Patient Lily includes digitalis therapy which was given to patient since she was pregnant. Which of the following would the nurse anticipate with patient's drug therapy? A. Switching to a more potent drug. B. Continuation of the same dosage. C. Need for change in medication. D. Addition of diuretic to the regimen. Situation: The indication of tracheostomy in children has changed substantially in the last two decades. Nurse Robert is taking care of Patient Irma, an eight year old female child, who was admitted to the Pediatric Ward due to pneumonia. The child is hooked to a tracheostomy tube. Nurse Robert is quite anxious in taking care of this patient being her first day of duty in the Pediatric Ward. 46. When preparing the patient for suctioning, what is the FIRST step? A. Perform hand hygiene B. Gather equipment C. Assess lung sounds, heart rate and rhythm D. Check physician's order and patient care plan 47. Patient Irma will be placed in which of the following position? Select all that apply. 1. Fowler 2. Semi-Fowler 3. Supine 4. Sim A. 1, 2 & 3 B. 2 only C. 1 & 2 D. 1 only 48. Usually the common indication (s) for the tracheostomy in Patient Irma's condition is which of the following? (Select all that apply.) 1. Prolonged intubation. 2. Sepsis 3. Hypoventilation associated with neurologic disorders. 4. Severe Sleep Obstructive Apnea Syndrome (SOAS) A. 2 only B. 1 & 2 C. 1, 2, 3 & 4 D. 1 only. 49. The PRIORITY nursing objective when caring a patient with a tracheostomy is ______. A. To increase tissue oxygenation B. To provide patent airway C. To decrease tissue oxygenation D. To improve ventilation 50. The TOP nursing expected outcome when performing suctioning is ______. A. Lessened amount of secretions leading to decreased frequency of suctioning. B. Secretions removed without complication. C. Tube-fed patient does not aspirate feeding. D. Prevention of occurrence of hypoxemia and bradycardia. Situation: Sonny, 11 years old, is admitted due to bronchitis. Upon admission, he manifested the following signs and symptoms: cough, production of mucus (sputum), yellowish in color, fatigue, shortness of breath, slight fever and chills and chest discomfort. The physician orders 4L/min oxygenation. 51. The first standard step in oxygen therapy that the nurse should do is _______. A. assess client's condition B. gather all the equipment and supplies C. prepare the client for the oxygen treatment D. check the chart for ordered flow rate and oxygen delivery method 52. In planning for Sonny's oxygen therapy, the nurse should consider which of the following, EXCEPT _____. A. need for a humidifier. B. length of tubing C. determine the age of Excel. D. manner of administering oxygen, continuous or intermittent. 53. Which of the following is the PRIORITY action of the nurse for Sonny who in on oxygen therapy? A. Check the flow. B. Connect the flow meter to the pipe in oxygen outlet. C. Turn on the oxygen. D. Attach the humidifier and connecting tubing to the oxygen delivery device. 54. What PRIORITY precautionary measure should be done by the nurse during the oxygen therapy? A. Humidifier's water should be checked regularly. B. No Smoking sign. C. Oxygen tank should have belt. D. Limit visitors. 55. One evening, Sonny complained of dyspnea despite continuous oxygen therapy. What should be the FIRST action of the nurse? A. Reassess the client. B. Give PRN medication. C. Assess the patency of the tubing. D. Refer client to the physician. Situation: The senior nurse Reese, is planning to revisit and implement a change in the management system for the Obstetric Unit. This would be a pilot unit as planned by the administration. Many problems have occurred one of which is the present documentation system, and the charge nurse determines that a change is required. 56. What should be the INITIAL STEP in the process of change for the senior nurse. A. set goals and priorities regarding the change process. B. Plan strategies to implement the change. C. Identify potential solutions and strategies for the change. D. Identify the inefficiency that needs improvement or correction. 57. Nurse Reese is preparing the patient assignment for the day and needs to assign patients to a midwife and nursing assistant. Which patient should the nurse assign to the midwife because of patient needs that cannot be met by the nursing assistant? A patient requiring _______. A. dressing change of post caesarian surgery B. collecting of urine specimen for urinalysis testing. C. performing range-of-motion exercises twice a day D. taking of vital signs measurement every hours 58. Because of the scarcity of nurses in the hospital settings, different service delivery models were proposed. Which situation represents the primary nursing care delivery model? A. The nursing aide is assigned to make beds and other errands while the nurse is to give medications B. The nurse develops a plan of care for patients and collaborates with other team members. C. The nurse performs all tasks needed by the individual patient to optimize health. D. The nurse provides care to 4 patients while the nursing aide is to care for 2 patients. 59. One of the post-caesarian patients has a private duty nurse and is responsible for providing holistic care to her patient