July 2011 Nurse Licensure Examination Result - July 2011 Nurse Board Exam Result

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July 2011 Nurse Licensure Examination Result

July 2011 Nurse Board Exam Result


I. Physiology of Breast milk production

As soon as delivery of the placenta is over there will be an abrupt decrease on
Estrogen and Progesterone
> this will stimulate the APG to secrete PROLACTIN.

note: Be aware that sucking also stimulates Prolactin secretion as this will stimu
ate the
nerves and impulse will travel from the nipple to the Hypothalamus

N will act on the acini cells (alveolar cells) of the breast to produce milk. This milk
is called FOREMILK and is stored in the lactiferous sinus. FOREMILK is conti
ously being

What happens next?

When the baby sucks on the breast of the mother
OXYTOCIN is stimulated and oxytocin will
act on 2 organs.

1. Breast (Let down reflex)

2. Uterus (promotes Involutions)

TOCIN will cause the mammary gla
nds to contract and push the milk forward making it
available for the baby.

What will stimulate the

Let Down reflex?

1. Sucking of the baby

2. Sound of the baby's cry

note: After the Let Down Reflex a new milk will be formed and this is called HINDMILK and
this contains more FATS that is needed for the growing newborn



4 days present

content: decrease fats, increase IgA, dec CHO, dec CHON, inc minerals,
inc fat soluble

2. Transitional milk


14 days

content: inc lactose, inc water soluble vit., inc minerals

3. Mature milk

14 & up

inc fats (linoleic acid)

resp for devt of brain & integrity of skin

inc CHO


easily digested, baby not constipated.

esp of sour milk smelling odor of

Lactose intolerance

deficiency of enzyme LACTASE that digest LACTOSE

Decrease CH


Difference with cow's milk

Cows milk

inc fats



has curd that’s hard to digest.

Inc minerals

traumatic effect on kidneys of babies. Can trigger stone formation.

Inc phosphorusnote:

Note Baby who are brea
stfed are least likely to develop tetany. It is seen that botlle fed
infants have more difficulty in regulating calcium and phosporus. Because cow's milk have
more fat contents, this fatty acids may bind with calcium in the GIT causing more decrease
in cal

Note: Breast feeding can be iniated

if had Cesarian Section

after 4 hours


Advantages of Breast feeding

1. Economical

2. Always available

3. Breastfed babies have higher IQ than bottle fed babies.

4. It facilitates rapid involution


Decrease incidence of breast cancer.

6. Has antibodiesI(gA), lactoferrin, lyzozymes and interferon (inhibit and/or destroy
pathogenic bacteria and viruses)

7. Has lactobacillius bifidus

interferes with attack of pathogenic bacteria in GIT

8. Has macropha

Store milk

plastic storage container

Store milk

good for 6 months from freezer

put rm temp. don’t heat


1. Possibility of transfer HEP B, HIV, cytomegalo virus.

2. No iron

3. Father can’t feed & bond as well

Proper breast feeding t

1. Be in a comfortable position

(Most appropriate is Upright sitiing for this position avoids tension)

2. Entire body of teh baby should be turned towards the mother's breast.

3. Initiate feeding by stimulating the Rooting reflex

by touching the side of lips/cheeks then
baby will turn to stimulus. Disappear by 6 weeks

by 6 weeks baby can focus. Reflex will be

Purpose rooting

to look for food.

Sucking Mechanism (breas

a. Lips of the infant should clamp a C

b. The tounge thrusts forward to grasp nipple and areola

c. The nipple is brought against the ahrd palate as the tounge pulls the areola into the

d. the gums compresses the areola, squezing milk at the
back of the throat

Sucking mechanism (bottle)

The large rubber nipple strikes the soft palate and interferes with the action of the tounge.
The tounge moves forwards against the gum to control overflow of milk in the espphagous
(same reason why dental ma
locllusion is prone to bottle fed babies, because they thrust
their tounge FORWARD cau
sing problem in the formation of

the dental arch)

4. Burp or Bubble the baby

during and after feeding to allow escape of air (preventing
colic). Sit infant on lap, flexe
d forward, then rub or pat the back (note: avoid jarring the

Criteria of Effective Sucking

a.) Baby’s mouth is hiked up to areola

b.) Mom experiences after pain.

c.) Other nipple is also flowing with milk.

NOTE: Make sure that the mother feeds t
he baby at the same breast she last feed her baby.
THis is to facilitated complete emptying of the breast and thereby promote complete filling
of milk.

Contra Indications in Breast Feeding:

a. Maternal Conditions:

1. HIV, CMV, Hepa B

2. Recieving Coumadin
, Lithium or Methotrexate

3. has breast cancer

4. has herpes lesion on breast

b.Newborn Condition

Inborn errors of metabolism
ch as

Erythrobastosis Fetalis

incompatibility, Hydrops Fetalis, Phenylketonuria, Galactosemia, Tay Sachs disease

ems experienced in Breastfeeding :

3RD day changes in breast post partuma.1

1)Engorged breast

feeling of fullness & tension in breast.

sometimes accompanied by
fever known as MILK FEVER.

Mgt:Warm compress

for breastfeeding momCold compress

for bott
le feeding & wear supportive bra.

When is involution of breast

4 weeks

b.) Sore nipple

cracked with painful nipple

Mgt: 1.) exposure to air

remove bra & wear dress, if not, expose to 20 Watt bulbavoid
wearing plastic liner bra
will create moisture,
cotton only

c.) Mastitis

inflammation of breast : staphylococcus aureus


1. Improper breast emptying

2. Unhealthy sexual practices


manually express inflamed breastfeed on unaffected breast

give antibiotics

can still feed on unaffected breast

Type of stools with different milk products:

1. Transitional stool


green loose & shiny, like diarrhea to the untrained eye

2. Breastfed stool


golden yellow, soft, mushy with sour milk smell, frequently passed


recur every feeding

3.. Bottlefed stool


pale yellow, formed hard with typical offensive odor, seldom passed, 2

3 x/day


with food added
brown & odorous


1. To confirm proper placement of tracheal tube through 5
point a
uscultation, which of the
following observations are appropriate? Check all that apply.

__ check breath sounds in the left and right lateral chest and lung bases

__ auscultate breath sounds in the left and right anterior sides of the chest

__ listen for g
astric bubbling noises front the epigastrium

__ ensure equal and adequate chest expansion bilaterally

2. Which of the following is true about an oropharyngeal airway?

a. it eliminates the need to position the head of the unconscious patient

b. it elimina
tes the possibility of an upper airway obstruction

c. it is of no value once a tracheal tube is inserted

d. it may stimulate vomiting or laryngospasm if inserted in the semiconscious patient

3. Which of the following is an indication for tracheal

a. difficulty encountered by qualified rescuers in ventilating an apneic patient with a bag
mask device

b. a respiratory rate of less than 20 breaths per minute in a patient with severe chest pain

c. presence of premature ventricular contracti

d. to provide airway protection in a responsive patient with an adequate gag reflex

4. Which of the following is the most important step to restore oxygenation and ventilation
for the unresponsive, breathless submersion (near drowning) victim?

a. att
empt to drain water from breathing passages by performing the Heimlich maneuver

b. begin chest compressions

c. provide cervical spine stabilization because a diving accident may have occurred

d. open the airway and begin rescue breathing as soon as possibl
e even in the water

5. You respond with 2 other rescuers to a 50 year old man who is unresponsive, pulseless,
and not breathing. What tasks would you assign the other rescuers while you set up the

a. one rescuer should call rescue assistance and the

others rescuer should begin CPR

b. both rescuers should help set up the AED and provide CPR

c. one rescuer should open the airway and begin rescue breathing, and the second rescuer
should begin chest compressions

d. recruit additional first responders to

6. An AED hangs on the wall suddenly a code is called, you grab the AED and run to the
room where the resuscitation is ongoing. A colleague has begun CPR and confirms that the
patient is in pulseless arrest. As you begin to attach the AED, you see a
medication patch on the victim’s upper right chest, precisely where you were going to place
an AED electrode pad. What is your most appropriate action?

a. ignore the medication patch and place the electrode pad in the usual position

b. avoid t
he medication patch and place the second electrode pad on the victim’s back

c. remove the medication patch, wipe the area dry, and place the electrode pad in the
correct position

d. place the electrode pad on the victim’s right abdomen

7. A patient who ha
s Ventricular Fibrillation has failed to respond to 3 shocks. Paramedics
started an IV and inserted a tracheal tube, confirming proper placement. Which of the
following drugs should this patient receive first?

a. Amiodarone 300 mg IV push

b. Lidocaine 1 t
o 1.5 mg/kg IV push

c. Procainamide 30 mg/min up to a total dose of 17 mg/kg

d. Epinephrine 1 mg IV push

8. After giving epinephrine 1 mg IV and a fourth shock, a patient remains in VF. You want to
continue to administer epinephrine at appropriate doses a
nd intervals if the patient remains
in VF. Which epinephrine dose is recommended under these conditions?

a. give the following epinephrine dose sequence, each 3 minutes apart: 1 mg, 3 mg, and 5

b. give a single high dose of epinephrine: 0.1 to 0.2 mg/k

c. give epinephrine 1 mg IV, then in 5 minutes start vasopressin 40 U IV every 3 to 5

d. give epinephrine 1 mg IV; repeat 1 mg every 3 to 5 minutes

9. Which of the following therapies is the most important intervention for VF/pulseless VT
with t
he greatest effect on survival to hospital discharge?

a. Epinephrine

b. Defibrillation

c. Oxygen

d. Amiodarone

10. A 60 yr old man persists in VF arrest despite 3 stacked shocks at appropriate energy
levels. Your code team, however, has been unable to st
art an IV or insert a tracheal tube.
Therefore administration of IV or tracheal medications will be delayed. What is the most
appropriate immediate next step?

a. deliver additional shocks in an attempt to defibrillate

b. deliver a precordial thump

c. perf
orm a venous cut
down to gain IV access

d. administer intramuscular epinephrine 2 mg

11. A 75 year old homeless man is in cardiac arrest with pulseless VT at a rate of 220 bpm.
After CPR, 3 shocks in rapid succession, 1mg IV epinephrine, plus 3 more
shocks, the man
continues to be in polymorphic pulseless VT. He appears wasted and malnourished. The
paramedics recognize him as a chronic alcoholic known in the neighborhood. Because he
remains in VT after 6 shocks, you are considering an antiarryhthymic.

Which of the following
agents would be most appropriate for this patient at this time?

a. Amiodarone

b. Procainamide

c. Magnesium

d. Diltiazem

12. You are called to assist in the attempted resuscitation of a patient who is demonstrating
PEA. As you hurr
y to the patient’s room, you review the information you learned in the
ACLS course about management of PEA. Which one of the following about PEA is true?

a. chest compressions should be administered only if the patient with PEA develops a
ventricular rate

of less than 50 bpm

b. successful treatment of PEA requires identification and treatment of reversible causes

c. atropine is the drug of choice for treatment of PEA, whether the ventricular rate is slow or

d. PEA is rarely caused by hypovolemia, so f
luid administration is contraindicated and
should not be attempted

13. For which of the following patients with PEA is sodium bicarbonate therapy (1 mEq/kg)
most likely to be most effective?

a. the patient with hypercarbic acidosis and tension pneumothor
ax treated with

b. the patient with a brief arrest interval

c. the patient with documented severe hyperkalemia

d. the patient with documented severe hypokalemia

14. Which of the following is the correct initial drug and dose for treatment o
f asystole?

a. epinephrine 2mg IV

b. atropine 0.5 mg IV

c. lidocaine 1mg/kg IV

d. epinephrine 1mg IV

15. You are considering transcutaneous pacing for a patient in asystole. Which of the
following candidates would be most likely to respond to such a paci
ng attempt?

a. the patient in asystole who has failed to respond to 20 minutes of BLS and ACLS therapy

b. the patient in asystole following blunt trauma

c. the patient in asystole following a defibrillatory shock

d. the patient who has just arrived in the

emergency department following transport and
CPR in the field for persistent asystole after submersion


1. Which individual is at greatest risk for developing hypertension?

A) 45 year
old African American attorney

B) 60 year
old Asian American shop owner

C) 40 year
old Caucasian nurse

D)55 year
old Hispanic teacher

The correct answer is A: 45 year
old African American attorney The incidence of
hypertension is greater among African Americans than other groups in the

US. The
incidence among the Hispanic population is rising.

2. A child who ingested 15 maximum strength acetaminophen tablets 45 minutes ago is
seen in the emergency department. Which of these orders should the nurse do first?

A) Gastric lavage PRN

B) Ace
tylcysteine (mucomyst) for age per pharmacy

C) Start an IV Dextrose 5% with 0.33% normal saline to keep vein open

D) Activated charcoal per pharmacy

The correct answer is A: Gastric lavage PRN Removing as much of the drug as possible is
the first step in
treatment for this drug overdose. This is best done by gastric lavage. The
next drug to give would be activated charcoal, then mucomyst and lastly the IV fluids.

3. Which complication of cardiac catheterization should the nurse monitor for in the initial
24 hours after the procedure?

A) angina at rest

B) thrombus formation

C) dizziness

D) falling blood pressure

The correct answer is B: thrombus formation Thrombus formation in the coronary arteries is
a potential problem in the initial 24 hours after a car
diac catheterization. A falling BP occurs
along with hemorrhage of the insertion site which is associated with the first 12 hours after
the procedure.

4. A client is admitted to the emergency room with renal calculi and is complaining of
moderate to sever
e flank pain and nausea. The client’s temperature is 100.8 degrees
Fahrenheit. The priority nursing goal for this client is

A) Maintain fluid and electrolyte balance

B) Control nausea

C) Manage pain

D) Prevent urinary tract infection

The correct answer is

C: Manage pain The immediate goal of therapy is to alleviate the
client’s pain.

5. What would the nurse expect to see while assessing the growth of children during their
school age years?

A) Decreasing amounts of body fat and muscle mass

B) Little change

in body appearance from year to year

C) Progressive height increase of 4 inches each year

D) Yearly weight gain of about 5.5 pounds per year

The correct answer is D: Yearly weight gain of about 5.5 pounds per year School age
children gain about 5.5 pound
s each year and increase about 2 inches in height.

6. At a community health fair the blood pressure of a 62 year
old client is 160/96. The client
states “My blood pressure is usually much lower.” The nurse should tell the client to

A) go get a blood press
ure check within the next 48 to 72 hours

B) check blood pressure again in 2 months

C) see the health care provider immediately

D) visit the health care provider within 1 week for a BP check

The correct answer is A: go get a blood pressure check within the

next 48 to 72 hours The
blood pressure reading is moderately high with the need to have it rechecked in a few days.
The client states it is ‘usually much lower.’ Thus a concern exists for complications such as
stroke. However immediate check by the provid
er of care is not warranted. Waiting 2
months or a week for follow
up is too long.

7. The hospital has sounded the call for a disaster drill on the evening shift. Which of these
clients would the nurse put first on the list to be discharged in order to ma
ke a room
available for a new admission?

A) A middle aged client with a history of being ventilator dependent for over 7
years and admitted with bacterial pneumonia five days ago

B) A young adult with diabetes mellitus Type 2 for over 10 years and admitted

antibiotic induced diarrhea 24 hours ago

C) An elderly client with a history of hypertension, hypercholesterolemia and lupus, and was
admitted with Stevens
Johnson syndrome that morning

D) An adolescent with a positive HIV test and admitted for acute

cellulitus of the lower leg
48 hours ago

The correct answer is A: A middle aged client with a history of being ventilator dependent
for over 7 years and admitted with bacterial pneumonia five days ago The best candidate for
discharge is one who has had a

chronic condition and is most familiar with their care. This
client in option A is most likely stable and could continue medication therapy at home.

8. A client has been newly diagnosed with hypothyroidism and will take levothyroxine
(Synthroid) 50 mcg/d
ay by mouth. As part of the teaching plan, the nurse emphasizes that
this medication:

A) Should be taken in the morning

B) May decrease the client's energy level

C) Must be stored in a dark container

D) Will decrease the client's heart rate

The correct an
swer is A: Should be taken in the morning Thyroid supplement should be
taken in the morning to minimize the side effects of insomnia

9. A 3 year
old child comes to the pediatric clinic after the sudden onset of findings that
include irritability, thick mu
ffled voice, croaking on inspiration, hot to touch, sit leaning
forward, tongue protruding, drooling and suprasternal retractions. What should the nurse do

A) Prepare the child for x
ray of upper airways

B) Examine the child's throat

C) Collect a sp
utum specimen

D) Notify the healthcare provider of the child's status

The correct answer is D: Notify the health care provider of the child''s status These findings
suggest a medical emergency and may be due to epiglottises. Any child with an acute onset
of an inflammatory response in the mouth and throat should receive immediate attention in
a facility equipped to perform intubation or a tracheostomy in the event of further or
complete obstruction.

10. In children suspected to have a diagnosis of diabete
s, which one of the following
complaints would be most likely to prompt parents to take their school age child for

A) Polyphagia

B) Dehydration

C) Bed wetting

D) Weight loss

The correct answer is C: Bed wetting In children, fatigue and bed wet
ting are the chief
complaints that prompt parents to take their child for evaluation. Bed wetting in a school
age child is readily detected by the parents

11. A client comes to the clinic for treatment of recurrent pelvic inflammatory disease. The
nurse r
ecognizes that this condition most frequently follows which type of infection?

A) Trichomoniasis

B) Chlamydia

C) Staphylococcus

D) Streptococcus

The correct answer is B: Chlamydia Chlamydial infections are one of the most frequent
causes of salpingitis or

pelvic inflammatory disease.

12. An RN who usually works in a spinal rehabilitation unit is floated to the emergency
department. Which of these clients should the charge nurse assign to this RN?

A) A middle
aged client who says "I took too many diet pill
s" and "my heart feels like it is
racing out of my chest."

B) A young adult who says "I hear songs from heaven. I need money for beer. I quit
drinking 2 days ago for my family. Why are my arms and legs jerking?"

C) An adolescent who has been on pain medica
tions for terminal cancer with an
initial assessment finding of pinpoint pupils and a relaxed respiratory rate of 10

D) An elderly client who reports having taken a "large crack hit" 10 minutes prior to walking
into the emergency room

The correct answer i
s c: An adolescent who has been on pain medications for terminal
cancer with an initial assessment finding of pinpoint pupils and a relaxed respiratory rate of
10 Nurses who are floated to other units should be assigned to a client who has minimal
ted immediate complications of their problem. The client in option C exhibits opoid
toxicity with the pinpoint pupils and has the least risk of complications to occur in the near

13. When teaching a client with coronary artery disease about nutrit
ion, the nurse should

A) Eating 3 balanced meals a day

B) Adding complex carbohydrates

C) Avoiding very heavy meals

D) Limiting sodium to 7 gms per day

The correct answer is C: Avoiding very heavy meals Eating large, heavy meals can pull
blood a
way from the heart for digestion and is dangerous for the client with coronary artery

14. Which of these findings indicate that a pump to deliver a basal rate of 10 ml per hour
plus PRN for pain break through for morphine drip is not working?

The client complains of discomfort at the IV insertion site

B) The client states "I just can't get relief from my pain."

C) The level of drug is 100 ml at 8 AM and is 80 ml at noon

D) The level of the drug is 100 ml at 8 AM and is 50 ml at noon

The correc
t answer is C: The level of drug is 100 ml at 8 AM and is 80 ml at noon The
minimal dose of 10 ml per hour which would be 40 ml given in a 4 hour period. Only 60 ml
should be left at noon. The pump is not functioning when more than expected medicine is
t in the container.

15. The nurse is speaking at a community meeting about personal responsibility for health
promotion. A participant asks about chiropractic treatment for illnesses. What should be the
focus of the nurse’s response? A) Electrical energy

B) Spinal column manipulation

C) Mind
body balance

D) Exercise of joints

The correct answer is B: Spinal column manipulation The theory underlying chiropractic is
that interference with transmission of mental impulses between the brain and body org
produces diseases. Such interference is caused by misalignment of the vertebrae.
Manipulation reduces the subluxation.

16. The nurse is performing a neurological assessment on a client post right CVA. Which
finding, if observed by the nurse, would war
rant immediate attention?

A) Decrease in level of consciousness

B) Loss of bladder control

C) Altered sensation to stimuli

D) Emotional lability

The correct answer is A: Decrease in level of consciousness A further decrease in the level
of consciousness w
ould be indicative of a further progression of the CVA.

17. A child who has recently been diagnosed with cystic fibrosis is in a pediatric clinic where
a nurse is performing an assessment. Which later finding of this disease would the nurse not
expect to
see at this time?

A) Positive sweat test

B) Bulky greasy stools

C) Moist, productive cough

D) Meconium ileus

The correct answer is C: Moist, productive cough Option c is a later sign. Noisy respirations
and a dry non
productive cough are commonly the firs
t of the respiratory signs to appear in
a newly diagnosed client with cystic fibrosis (CF). The other options are the earliest findings.
CF is an inherited (genetic) condition affecting the cells that produce mucus, sweat, saliva
and digestive juices. Norm
ally, these secretions are thin and slippery, but in CF, a defective
gene causes the secretions to become thick and sticky. Instead of acting as a lubricant, the
secretions plug up tubes, ducts and passageways, especially in the pancreas and lungs.
tory failure is the most dangerous consequence of CF.

18. The home health nurse visits a male client to provide wound care and finds the client
lethargic and confused. His wife states he fell down the stairs 2 hours ago. The nurse should

A) Place a call t
o the client's health care provider for instructions

B) Send him to the emergency room for evaluation

C) Reassure the client's wife that the symptoms are transient

D) Instruct the client's wife to call the doctor if his symptoms become worse

The correct a
nswer is B: Send him to the emergency room for evaluation This client requires
immediate evaluation. A delay in treatment could result in further deterioration and harm.
Home care nurses must prioritize interventions based on assessment findings that are i
n the
client''s best interest.

19. Which of the following should the nurse implement to prepare a client for a KUB
(Kidney, Ureter, Bladder) radiograph test?

A) Client must be NPO before the examination

B) Enema to be administered prior to the examination

C) Medicate client with Lasix 20 mg IV 30 minutes prior to the examination

D) No special orders are necessary for this examination

The correct answer is D: No special orders are necessary for this examination No special
preparation is necessary for this

20. The nurse is giving discharge teaching to a client 7 days post myocardial infarction. He
asks the nurse why he must wait 6 weeks before having sexual intercourse. What is the
best response by the nurse to this question?

A) "You need to re
gain your strength before attempting such exertion."
B) "When you can
climb 2 flights of stairs without problems, it is generally safe."

C) "Have a glass of wine to relax you, then you can try to have sex."

D) "If you can maintain an active walking program
, you will have less risk."

The correct answer is B: "When you can climb 2 flights of stairs without problems, it is
generally safe." There is a risk of cardiac rupture at the point of the myocardial infarction for
about 6 weeks. Scar tissue should form a
bout that time. Waiting until the client can tolerate
climbing stairs is the usual advice given by health care providers.

21. A triage nurse has these 4 clients arrive in the emergency department within 15
minutes. Which client should the triage nurse se
nd back to be seen first?

A) A 2 month old infant with a history of rolling off the bed and has buldging fontanels with

B) A teenager who got a singed beard while camping

C) An elderly client with complaints of frequent liquid brown colored stools

) A middle aged client with intermittent pain behind the right scapula

The correct answer is B: A teenager who got singed a singed beard while camping This
client is in the greatest danger with a potential of respiratory distress, Any client with singed
acial hair has been exposed to heat or fire in close range that could have caused damage to
the interior of the lung. Note that the interior lining of the lung has no nerve fibers so the
client will not be aware of swelling.

22. While planning care for a
toddler, the nurse teaches the parents about the expected
developmental changes for this age. Which statement by the mother shows that she
understands the child's developmental needs?

A) "I want to protect my child from any falls."

B) "I will set limits on

exploring the house."

C) "I understand the need to use those new skills."

D) "I intend to keep control over our child."

The correct answer is C: "I understand the need to use those new skills." Erikson describes
the stage of the toddler as being the time

when there is normally an increase in autonomy.
The child needs to use motor skills to explore the environment.

23. The nurse is preparing to administer an enteral feeding to a client via a nasogastric
feeding tube. The most important action of the nurse


A) Verify correct placement of the tube

B) Check that the feeding solution matches the dietary order

C) Aspirate abdominal contents to determine the amount of last feeding remaining in

D) Ensure that feeding solution is at room temperature


correct answer is A: Verify correct placement of the tube Proper placement of the tube
prevents aspiration.

24. The nurse is caring for a client with a serum potassium level of 3.5 mEq/L. The client is
placed on a cardiac monitor and receives 40 mEq KCL
in 1000 ml of 5% dextrose in water
IV. Which of the following EKG patterns indicates to the nurse that the infusions should be
discontinued? A) Narrowed QRS complex

B) Shortened "PR" interval

C) Tall peaked T waves

D) Prominent "U" waves

The correct answe
r is C: Tall peaked T waves A tall peaked T wave is a sign of
hyperkalemia. The health care provider should be notified regarding discontinuing the

25. A nurse prepares to care for a 4 year
old newly admitted for rhabdomyosarcoma. The
nurse sh
ould alert the staff to pay more attention to the function of which area of the body?

A) All striated muscles

B) The cerebellum

C) The kidneys

D) The leg bones

The correct answer is A: All striated muscles Rhabdomyosarcoma is the most common
soft tissue sarcoma. It originates in striated (skeletal) muscles and can be found
anywhere in the body. The clue is in the middle of the word and is “myo” which typically
means muscle.

26. The nurse anticipates that for a family who practices Chinese med
icine the priority goal
would be to

A) Achieve harmony

B) Maintain a balance of energy

C) Respect life

D) Restore yin and yang

The correct answer is D: Restore yin and yang For followers of Chinese medicine, health is
maintained through balance between
the forces of yin and yang.

27. During an assessment of a client with cardiomyopathy, the nurse finds that the systolic
blood pressure has decreased from 145 to 110 mm Hg and the heart rate has risen from 72
to 96 beats per minute and the client complains

of periodic dizzy spells. The nurse instructs
the client to A) Increase fluids that are high in protein

B) Restrict fluids

C) Force fluids and reassess blood pressure

D) Limit fluids to non
caffeine beverages

The correct answer is C: Force fluids and rea
ssess blood pressure Postural hypotension, a
decrease in systolic blood pressure of more than 15 mm Hg and an increase in heart rate of
more than 15 percent usually accompanied by dizziness indicates volume depletion,
inadequate vasoconstrictor mechanisms,

and autonomic insufficiency.

28. A client has a Swan
Ganz catheter in place. The nurse understands that this is intended
to measure

A) Right heart function

B) Left heart function

C) Renal tubule function

D) Carotid artery function

The correct answer is
B: Left heart function The Swan
Ganz catheter is placed in the
pulmonary artery to obtain information about the left side of the heart. The pressure
readings are inferred from pressure measurements obtained on the right side of the
circulation. Right

heart function is assessed through the evaluation of the central
venous pressures (CVP).

29. A nurse enters a client's room to discover that the client has no pulse or respirations.
After calling for help, the first action the nurse should take is

A) Sta
rt a peripheral IV

B) Initiate closed
chest massage

C) Establish an airway

D) Obtain the crash cart

The correct answer is C: Establish an airway Establishing an airway is always the primary
objective in a cardiopulmonary arrest.

30. A client is receiving

digoxin (Lanoxin) 0.25 mg. Daily. The health care provider has
written a new order to give metoprolol (Lopressor) 25 mg. B.I.D. In assessing the client
prior to administering the medications, which of the following should the nurse report
immediately to t
he health care provider?

A) Blood pressure 94/60

B) Heart rate 76

C) Urine output 50 ml/hour

D) Respiratory rate 16

The correct answer is A: Blood pressure 94/60 Both medications decrease the heart rate.
Metoprolol affects blood pressure. Therefore, the h
eart rate and blood pressure must be
within normal range (HR 60
100; systolic B/P over 100) in order to safely administer both

31. While assessing a 1 month
old infant, which finding should the nurse report

A) Abdominal respirati

B) Irregular breathing rate

C) Inspiratory grunt

D) Increased heart rate with crying

The correct answer is C: Inspiratory grunt Inspiratory grunting is abnormal and may be a
sign of respiratory distress in this infant.

32. The nurse practicing in a m
aternity setting recognizes that the post mature fetus is at
risk due to

A) Excessive fetal weight

B) Low blood sugar levels

C) Depletion of subcutaneous fat

D) Progressive placental insufficiency

The correct answer is D: Progressive placental insufficien
cy The placenta functions less
efficiently as pregnancy continues beyond 42 weeks. Immediate and long term effects may
be related to hypoxia.

33. The nurse is caring for a client who had a total hip replacement 4 days ago. Which
assessment requires the nu
rse’s immediate attention? A) I have bad muscle spasms in my
lower leg of the affected extremity.

B) "I just can't 'catch my breath' over the past few minutes and I think I am in
grave danger."

C) "I have to use the bedpan to pass my water at least every 1

to 2 hours." D) "It seems
that the pain medication is not working as well today."

The correct answer is B: "I just can''t ''catch my breath'' over the past few minutes and I
think I am in grave danger." The nurse would be concerned about all of these com
However the most life threatening is option B. Clients who have had hip or knee surgery are
at greatest risk for development of post operative pulmonary embolism. Sudden dyspnea
and tachycardia are classic findings of pulmonary embolism. Muscle spas
ms do not require
immediate attention. Option C may indicate a urinary tract infection. And option D requires
further investigation and is not life threatening.

34. A client has been taking furosemide (Lasix) for the past week. The nurse recognizes
finding may indicate the client is experiencing a negative side effect from the

A) Weight gain of 5 pounds

B) Edema of the ankles

C) Gastric irritability

D) Decreased appetite

The correct answer is D: Decreased appetite Lasix causes a loss of
potassium if a
supplement is not taken. Signs and symptoms of hypokalemia include anorexia, fatigue,
nausea, decreased GI motility, muscle weakness, dysrhythmias.

35. A client who is pregnant comes to the clinic for a first visit. The nurse gathers data
bout her obstetric history, which includes 3 year
old twins at home and a miscarriage 10
years ago at 12 weeks gestation. How would the nurse accurately document this

A) Gravida 4 para 2

B) Gravida 2 para 1

C) Gravida 3 para 1

D) Gravida 3 par
a 2

The correct answer is C: Gravida 3 para 1 Gravida is the number of pregnancies and Parity
is the number of pregnancies that reach viability (not the number of fetuses). Thus, for this
woman, she is now pregnant, had 2 prior pregnancies, and 1 viable b
irth (twins).

36. The nurse is caring for a client with a venous stasis ulcer. Which nursing intervention
would be most effective in promoting healing?

A) Apply dressing using sterile technique

B) Improve the client's nutrition status

C) Initiate limb com
pression therapy

D) Begin proteolytic debridement

The correct answer is B: Improve the client''s nutrition status The goal of clinical
management in a client with venous stasis ulcers is to promote healing. This only can be
accomplished with proper nutrit
ion. The other answers are correct, but without proper
nutrition, the other interventions would be of little help.

37. A nurse is to administer meperidine hydrochloride (Demerol) 100 mg, atropine sulfate
(Atropisol) 0.4 mg, and promethizine hydrochloride
(Phenergan) 50 mg IM to a pre
operative client. Which action should the nurse take first?

A) Raise the side rails on the bed

B) Place the call bell within reach

C) Instruct the client to remain in bed

D) Have the client empty bladder

The correct answer is

D: Have the client empty bladder The first step in the process is to
have the client void prior to administering the pre
operative medication. The other actions
follow this initial step in this sequence: 4 3 1 2

38. Which of these statements best describ
es the characteristic of an effective reward
feedback system?

A) Specific feedback is given as close to the event as possible

B) Staff are given feedback in equal amounts over time

C) Positive statements are to precede a negative statement

D) Performance g
oals should be higher than what is attainable

The correct answer is A: Specific feedback is given as close to the event as possible
Feedback is most useful when given immediately. Positive behavior is strengthened through
immediate feedback, and it is eas
ier to modify problem behaviors if the standards are
clearly understood.

39. A client with multiple sclerosis plans to begin an exercise program. In addition to
discussing the benefits of regular exercise, the nurse should caution the client to avoid
vities which

A) Increase the heart rate

B) Lead to dehydration

C) Are considered aerobic

D) May be competitive

The correct answer is B: Lead to dehydration The client must take in adequate fluids before
and during exercise periods.

40. During the evaluat
ion of the quality of home care for a client with Alzheimer's disease,
the priority for the nurse is to reinforce which statement by a family member?

A) At least 2 full meals a day is eaten.

B) We go to a group discussion every week at our community center

C) We have safety bars installed in the bathroom and have 24 hour alarms on the

D) The medication is not a problem to have it taken 3 times a day.

The correct answer is C: We have safety bars installed in the bathroom and have 24 hour
alarms on t
he doors. Ensuring safety of the client with increasing memory loss is a priority
of home care. Note all options are correct statements. However, safety is most important to

60 Item Medical Surgical Nursing : Musculoskeletal
Examination Answers

1. A client is 1 day postoperative after a total hip replacement. The client should be placed
in which of the following position?

a. Supine

b. Semi Fowler's

c. Orthopneic

d. Trendelenburg

2. A client who has had a plaster of Paris cast applied to his f
orearm is receiving pain
medication. To detect early manifestations of compartment syndrome, which of these
assessments should the nurse make?

a. Observe the color of the fingers

b. Palpate the radial pulse under the cast

c. Check the cast for odor and dr

d. Evaluate the response to analgesics

3. After a computer tomography scan with intravenous contrast medium, a client returns to
the unit complaining of shortness of breath and itching. The nurse should be prepared to
treat the client for:

a. An
anaphylactic reaction to the dye

b. Inflammation from the extravasation of fluid during injection.

c. Fluid overload from the volume of the infusions

d. A normal reaction to the stress of the diagnostic procedure.

4. While caring for a client with a newly

applied plaster of Paris cast, the nurse makes note
of all the following conditions. Which assessment finding requires immedite notification of
the physician?

a. Moderate pain, as reported by the client

b. Report, by client, the heat is being felt under
the cast

c. Presence of slight edema of the toes of the casted foot

d. Onset of paralysis in the toes of the casted foot

5. Which of these nursing actions will best promote independence for the client in skeletal

a. Instruct the client to call
for an analgesic before pain becomes severe.

b. Provide an overhead trapeze for client use

c. Encourage leg exercise within the limits of traction

d. Provide skin care to prevent skin breakdown.

6. A client presents in the emergency department after falling from a roof. A fracture of the
femoral neck is suspected. Which of these assessments best support this diagnosis.

a. The client reports pain in the affected leg

b. A large hematoma is visible
in the affected extremity

c. The affected extremity is shortenend, adducted, and extremely rotated

d. The affected extremity is edematous.

7. The nurse is caring for a client with compound fracture of the tibia and fibula. Skeletal
traction is applied. Wh
ich of these priorities should the nurse include in the care plan?

a. Order a trapeze to increase the client's ambulation

b. Maintain the client in a flat, supine position at all times.

c. Provide pin care at least every hour

d. Remove traction weights fo
r 20 minutes every two hours.

8. To prevent foot drop in a client with Buck's traction, the nurse should:

a. Place pillows under the client's heels.

b. Tuck the sheets into the foot of the bed

c. Teach the client isometric exercises

d. Ensure proper body


9. Which nursing intervention is appropriate for a client with skeletal traction?

a. Pin care

b. Prone positioning

c. Intermittent weights

d. 5lb weight limit

10. In order for Buck's traction applied to the right leg to be effective, the c
lient should be
placed in which position?

a. Supine

c. Sim's

b. Prone d. Lithotomy

11. An elderly client has sustained intertrochanteric fracture of the hip and has just returned
from surgery where a nail plate was inserted for internal fixation. The cli
ent has been
instructed that she should not flex her hip. The best explanation of why this movement
would be harmful is:

a. It will be very painful for the client

b. The soft tissue around the site will be damaged

c. Displacement can occur with flexion


It will pull the hip out of alignment

12. When the client is lying supine, the nurse will prevent external rotation of the lower
extremity by using a:

a. Trochanter roll by the knee

b. Sandbag to the lateral calf

c. Trochanter roll to the thigh

d. Footb

13. A client has just returned from surgery after having his left leg amputated below the
knee. Physician's orders include elevation of the foot of the bed for 24 hours. The nurse
observes that the nursing assistant has placed a pillow under the clie
nt's amputated limb.
The nursing action is to:

a. Leave the pillow as his stump is elevated

b. Remove the pillow and elevate the foot of the bed

c. Leave the pillow and elevate the foot of the bed

d. Check with the physician and clarify the orders

14. A
client has sustained a fracture of the femur and balanced skeletal traction with a
Thomas splint has been applied. To prevent pressure points from occurring around the top
of the splint, the most important intervention is to:

a. Protect the skin with loti

b. Keep the client pulled up in bed

c. Pad the top of the splint with washcloths

d. Provide a footplate in the bed

15. The major rationale for the use of acetylsalicylic acid (aspirin) in the treatment of
rheumatoid arthritis is to:

a. Reduce fever


Reduce the inflammation of the joints

c. Assist the client's range of motion activities without pain

d. Prevent extension of the disease process

16. Following an amputation, the advantage to the client for an immediate prosthesis fitting

a. Ability
to ambulate sooner

b. Less change of phantom limb sensation

c. Dressing changes are not necessary

d. Better fit of the prosthesis

17. One method of assessing for sign of circulatory impairment in a client with a fractured
femur is to ask the client to:

. Cough and deep breathe

b. Turn himself in bed

c. Perform biceps exercise

d. Wiggle his toes

18. The morning of the second postoperative day following hip surgery for a fractured right
hip, the nurse will ambulate the client. The first intervention is to

a. Get the client up in a chair after dangling at the bedside.

b. Use a walker for balance when getting the client out of bed

c. Have the client put minimal weight on the affected side when getting up

d. Practice getting the client out of bed by having
her slightly flex her hips

19. A young client is in the hospital with his left leg in Buck's traction. The team leader asks
the nurse to place a footplate on the affected side at the bottom of the bed. The purpose of
this action is to:

a. Anchor the trac

b. Prevent footdrop

c. Keep the client from sliding down in bed

d. Prevent pressure areas on the foot

20. When evaluating all forms of traction, the nurse knows the direction of pull is controlled
by the:

a. Client's position

b. Rope/pulley system

. Amount of weight

d. Point of friction

21. When a client has cervical halter traction to immobilize the cervical spine counteraction
is provided by:

a. Elevating the foot of the bed

b. Elevating the head of the bed

c. Application of the pelvic girdle


Lowering the head of the bed

22. After falling down the basement steps in his house, a client is brought to the emergency
room. His physician confirms that his leg is fractured. Following application of a leg cast, the
nurse will first check the client's

toes for:

a. Increase in the temperature

b. Change in color

c. Edema

d. Movement

23. A 23 year old female client was in an automobile accident and is now a paraplegic. She
is on an intermittent urinary catheterization program and diet as tolerated. The
priority assessment should be to observe for:

a. Urinary retention

b. Bladder distention

c. Weight gain

d. Bower evacuation

24. A female client with rheumatoid arthritis has been on aspirin grain TID and prednisone
10mg BID for the last two years
. The most important assessment question for the nurse to
ask related to the client's drug therapy is whether she has

a. Headaches

b. Tarry stools

c. Blurred vision

d. Decreased appetite

25. A 7 year old boy with a fractured leg tells the nurse that he i
s bored. An appropriate
intervention would be to

a. Read a story and act out the part

b. Watch a puppet show

c. Watch television

d. Listen to the radio

26. On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid
arthritis. Wh
ich of the following would be the nurse most likely to asses:

a. Limited motion of joints

b. Deformed joints of the hands

c. Early morning stiffness

d. Rheumatoid nodules

27. After teaching the client about risk factors for rheumatoid arthritis, which of

following, if stated by the client as a risk factor, would indicate to the nurse that the client
needs additional teaching?

a. History of Epstein
Barr virus infection

b. Female gender

c. Adults between the ages 60 to 75 years

d. Positive testing for
human leukocyte antigen (HLA) DR4 allele

28. When developing the teaching plan for the client with rheumatoid arthritis to promote
rest, which of the following would the nurse expect to instruct the client to avoid during the
rest periods?

a. Proper body


b. Elevating the part

c. Prone lying positions

d. Positions of flexion

29. After teaching the client with severe rheumatoid arthritis about the newly prescribed
medication methothrexate (Rheumatrex 0), which of the following statements indicate
s the
need for further teaching?

a. "I will take my vitamins while I am on this drug"

b. "I must not drink any alcohol while I'm taking this drug"

c. I should brush my teeth after every meal"

d. "I will continue taking my birth control pills"

30. When co
mpleting the history and physical examination of a client diagnosed with
osteoarthritis, which of the following would the nurse assess?

a. Anemia c. Weight loss

b. Osteoporosis
d. Local joint pain

31. At which of the following times would the nurse inst
ruct the client to take ibuprofen
(Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal

a. At bedtime
c. Immediately after meal

b. On arising d. On an empty stomach

32. When preparing a teaching plan
for the client with osteoarthritis who is taking celecoxib
(Celebrex), the nurse expects to explain that the major advantage of celecoxib over
diclofenac (Voltaren), is that the celecoxib is likely to produce which of the following?

a. Hepatotoxicity

b. R
enal toxicity

c. Gastrointestinal bleeding

d. Nausea and vomiting

33. After surgery and insertion of a total joint prosthesis, a client develops severe sudden
pain and an inability to move the extremity. The nurse interprets these findings as
indicating w
hich of the following?

a. A developing infection

b. Bleeding in the operative site

c. Joint dislocation

d. Glue seepage into soft tissue

34. Which of the following would the nurse assess in a client with an intracapsular hip

a. Internal rotati
c. Shortening of the affected leg

b. Muscle flaccidity d. Absence of pain the fracture area

35. Which of the following would be inappropriate to include when preparing a client for
magnetic resonance imaging (MRI) to evaluate a rupture disc?

a. Inform
ing the client that the procedure is painless

b. Taking a thorough history of past surgeries

c. Checking for previous complaints of claustrophobia

d. Starting an intravenous line at keep
open rate

36. Which of the following actions would be a priority for

a client who has been in the
postanesthesia care unit (PACU) for 45 minutes after an above the knee amputation and
develops a dime size bright red spot on the ace bondage above the amputation site?

a. Elevate the stump

b. Reinforcing the dressing

c. Call
ing the surgeon

d. Drawing a mark around the site

37. A client in the PACU with a left below the knee amputation complains of pain in her left
big toe. Which of the following would the nurse do first?

a. Tell the client it is impossible to feel the pain

b. Show the client that the toes are not there

c. Explain to the client that the pain is real

d. Give the client the prescribed narcotic analgesic

38. The client with an above the knee amputation is to use crutches until the prosthesis is
being adjusted.
In which of the following exercises would the nurse instruct the client to
best prepare him for using crutches?

a. Abdominal exercises

b. Isometric shoulder exercises

c. Quadriceps setting exercises

d. Triceps stretching exercises

39. The client with an
above the knee amputation is to use crutches until the prosthesis is
properly lifted. When teaching the client about using the crutches, the nurse instructs the
client to support her weight primarily on which of the following body areas?

a. Axillae

b. Elb

c. Upper arms

d. Hands

40. Three hours ago a client was thrown from a car into a ditch, and he is now admitted to
the ED in a stable condition with vital signs within normal limits, alert and oriented with
good coloring and an open fracture of the rig
ht tibia. When assessing the client, the nurse
would be especially alert for signs and symptoms of which of the following?

a. Hemorrhage

b. Infection

c. Deformity

d. Shock

41. The client with a fractured tibia has been taking methocarbamol (Robaxin), whe
teaching the client about this drug, which of the following would the nurse include as the
drug's primary effect?

a. Killing of microorganisms

b. Reduction in itching

c. Relief of muscle spasms

d. Decrease in nervousness

42. A client who has been takin
g carisoprodol (Soma) at home for a fractured arm is
admitted with a blood pressure of 80/50 mmHg, a pulse rate of 115bpm, and respirations of
8 breaths/minute and shallow, the nurse interprets these finding as indicating which of the

a. Expect
ed common side effects

b. Hypersensitivity reactions

c. Possible habituating effects

d. Hemorrhage from GI irritation

43. When admitting a client with a fractured extremity, the nurse would focus the
assessment on which of the following first?

a. The are
a proximal to the fracture

b. The actual fracture site

c. The area distal to the fracture

d. The opposite extremity for baseline comparison

44. A client with fracture develops compartment syndrome. When caring for the client, the
nurse would be alert for
which of the following signs of possible organ failure?

a. Rales c. Generalized edema

b. Jaundice
d. Dark, scanty urine

45. Which of the following would lead the nurse to suspect that a client with a fracture of
the right femur may be developing a fat em

a. Acute respiratory distress syndrome

b. Migraine like headaches

c. Numbness in the right leg

d. Muscle spasms in the right thigh

46. The client who had an open femoral fracture was discharged to her home, where she
developed, fever, night
sweats, chills, restlessness and restrictive movement of the
fractured leg. The nurse interprets these finding as indicating which of the following?

a. Pulmonary emboli

b. Osteomyelitis

c. Fat emboli

d. Urinary tract infection

47. When antibiotics are no
t producing the desired outcome for a client with osteomyelitis,
the nurse interprets this as suggesting the occurrence of which of the following as most

a. Formation of scar tissue interfering with absorption

b. Development of pus leading to isch

c. Production of bacterial growth by avascular tissue

d. Antibiotics not being instilled directly into the bone

48. Which of the following would the nurse use as the best method to assess for the
development of deep vein thrombosis in a client with a

spinal cord injury?

a. Homan's sign

c. Tenderness

b. Pain d. Leg girth

49. The nurse is caring for the client who is going to have an arthogram using a contrast
medium. Which of the following assessments by the nurse are of highest priority?

a. Allergy

to iodine or shellfish

b. Ability of the client to remain still during the procedure

c. Whether the client has any remaining questions about the procedure

d. Whether the client wishes to void before the procedure

50. The client immobilized skeletal leg t
raction complains of being bored and restless. Based
on these complaints, the nurse formulates which of the following nursing diagnoses for this

a. Divertional activity deficit

b. Powerlessness

c. Self care deficit

d. Impaired physical mobility

1. The nurse is teaching the client who is to have a gallium scan about the procedure. The
nurse includes which of the following items as part of the instructions?

a. The gallium will be injected intravenously 2 to 3 hours before the procedure

b. The proc
edure takes about 15 minutes to perform

c. The client must stand erect during the filming

d. The client should remain on bed rest for the remainder of the day after the scan

52. The nurse is assessing the casted extremity of a client. The nurse assesses f
or which of
the following signs and symptoms indicative of infection?

a. Coolness and pallor of the extremity

b. Presence of a "hot spot" on the cast

c. Diminished distal pulse

d. Dependent edema

53. The client has Buck's extension applied to the right l
eg. The nurse plans which of the
following interventions to prevent complications of the device?

a. Massage the skin of the right leg with lotion every 8 hours

b. Give pin care once a shift

c. Inspect the skin on the right leg at least once every 8 hours

d. Release the weights on the right leg for range of motion exercises daily

54. The nurse is giving the client with a left cast crutch walking instructions using the three
point gait. The client is allowed touchdown of the affected leg. The nurse tells th
e client to
advance the:

a. Left leg and right crutch then right leg and left crutch

b. Crutches and then both legs simultaneously

c. Crutches and the right leg then advance the left leg

d. Crutches and the left leg then advance the right leg

55. The cli
ent with right sided weakness needs to learn how to use a cane. The nurse plans
to teach the client to position the cane by holding it with the:

a. Left hand and placing the cane in front of the left foot

b. Right hand and placing the cane in front of the

right foot

c. Left hand and 6 inches lateral to the left foot

d. Right hand and 6 inches lateral to the left foot

56. The nurse is repositioning the client who has returned to the nursing unit following
internal fixation of a fractured right hip. The nur
se uses a:

a. Pillow to keep the right leg abducted during turning

b. Pillow to keep the right leg adducted during turning

c. Trochanter roll to prevent external rotation while turning

d. Trochanter roll to prevent abduction while turning

57. The nurse h
as an order to get the client out of bed to a chair on the first postoperative
day after a total knee replacement. The nurse plans to do which of the following to protect
the knee joint:

a. Apply a knee immobilizer before getting the client up and elevate

the client's
surgical leg while sitting

b. Apply an Ace wrap around the dressing and put ice on the knee while sitting

c. Lift the client to the bedside change leaving the CPM machine in place

d. Obtain a walker to minimize weight bearing by the client on

the affected leg

58. The nurse is caring for the client who had an above the knee amputation 2days ago. The
residual limb was wrapped with an elastic compression bandage which has come off. The
nurse immediately:

a. Calls the physician

b. Rewrap the stu
mp with an elastic compression bandage

c. Applies ice to the site

d. Applies a dry sterile dressing and elevates it on a pillow

59. The nurse has taught the client with a below the knee amputation about prosthesis and
stump care. The nurse evaluates that
the client states to:

a. Wear a clean nylon stump sock daily

b. Toughen the skin of the stump by rubbing it with alcohol

c. Prevent cracking of the skin of the stump by applying lotion daily

d. Using a mirror to inspect all areas of the stump each day

. The nurse is caring for a client with a gout. Which of the following laboratory values
does the nurse expect to note in the client?

a. Uric acid level of 8 mg/dl

b. Calcium level of 9 mg/dl

c. Phosphorus level of 3 mg/dl

d. Uric acid level
of 5 mg/dl

SITUATION : Epidemiology and Vital statistics is a very important tool that a nurse
could use in controlling the spread of disease in the community and at the same
time, surveying the impact of the disease on the population and prevent it’s future

1. It is concerned with the study of factors that influence the occurrence and
distribution of diseases, defects, disability or death which occurs in groups or
aggregation of individuals.

A. Epidemiology

B. Demographics

C. Vital Statistics

Health Statistics

2. Which of the following is the backbone in disease prevention?

A. Epidemiology

B. Demographics

C. Vital Statistics

D. Health Statistics

3. Which of the following type of research could show how community expectations
can result in

the actual provision of services?

A. Basic Research

B. Operational Research

C. Action Research

D. Applied Research

4. An outbreak of measles has been reported in Community A. As a nurse, which of
the following is your first action for an Epidemiologic
al investigation?

A. Classify if the outbreak of measles is epidemic or just sporadic

B. Report the incidence into the RHU

C. Determine the first day when the outbreak occurred

D. Identify if it is the disease which it is reported to be

5. After the
epidemiological investigation produced final conclusions, which of the
following is your initial step in your operational procedure during disease outbreak?

A. Coordinate personnel from Municipal to the National level

B. Collect pertinent laboratory spec
imen to confirm disease causation

C. Immunize nearby communities with Measles

D. Educate the community in future prevention of similar outbreaks

6. The main concern of a public health nurse is the prevention of disease,
prolonging of life and promoting p
hysical health and efficiency through which of the

A. Use of epidemiological tools and vital health statistics

B. Determine the spread and occurrence of the disease

C. Political empowerment and Socio Economic Assistance

D. Organized Community

7. In order to control a disease effectively, which of the following must first be

1. The conditions surrounding its occurrence

2. Factors that do not favor its development

3. The condition that do not surround its occurrence

4. Factors
that favors its development

A. 1 and 3

B. 1 and 4

C. 2 and 3

D. 2 and 4

8. All of the following are uses of epidemiology except:

A. To study the history of health population and the rise and fall of disease

B. To diagnose the health of the community
and the condition of the people

C. To provide summary data on health service delivery

D. To identify groups needing special attention

9. Before reporting the fact of presence of an epidemic, which of the following is of
most importance to determine?


Are the facts complete?

B. Is the disease real?

C. Is the disease tangible?

D. Is it epidemic or endemic?

10. An unknown epidemic has just been reported in Barangay Dekbudekbu. People
said that affected person demonstrates hemorrhagic type of fever. You

designated now to plan for epidemiological investigation. Arrange the sequence of
events in accordance with the correct outline plan for epidemiological investigation.

1. Report the presence of dengue

2. Summarize data and conclude the final picture

of epidemic

3. Relate the occurrence to the population group, facilities, food supply and carriers

4. Determine if the disease is factual or real

5. Determine any unusual prevalence of the disease and its nature; is it epidemic,
sporadic, endemic or pande

6. Determine onset and the geographical limitation of the disease.

A. 4,1,3,5,2,6

B. 4,1,5,6,3,2

C. 5,4,6,2,1,3

D. 5,4,6,1,2,3

E. 1,2,3,4,5,6

11. In the occurrence of SARS and other pandemics, which of the following is the
most vital role of a
nurse in epidemiology?

A. Health promotion

B. Disease prevention

C. Surveillance

D. Casefinding

12. Measles outbreak has been reported in Barangay Bahay Toro, After conducting
an epidemiological investigation you have confirmed that the outbreak is fac
You are tasked to lead a team of medical workers for operational procedure in
disease outbreak. Arrange the correct sequence of events that you must do to
effectively contain the disease

1. Create a final report and recommendation

2. Perform nasoph
aryngeal swabbing to infected individuals

3. Perform mass measles immunization to vulnerable groups

4. Perform an environmental sanitation survey on the immediate environment

5. Organize your team and Coordinate the personnels

6. Educate the community on d
isease transmission

A. 1,2,3,4,5,6

B. 6,5,4,3,2,1

C. 5,6,4,2,3,1

D. 5,2,3,4,6,1

13. All of the following are function of Nurse Budek in epidemiology except

A. Laboratory Diagnosis

B. Surveillance of disease occurrence

C. Follow up cases and contacts

D. Refer cases to hospitals if necessary

E. Isolate cases of communicable disease

14. All of the following are performed in team organization except

A. Orientation and demonstration of methodology to be employed

B. Area assignments of team members

Check team’s equipments and paraphernalia

D. Active case finding and Surveillance

15. Which of the following is the final output of data reporting in epidemiological
operational procedure?

A. Recommendation

B. Evaluation

C. Final Report

D. Preliminary

16. The office in charge with registering vital facts in the Philippines is none other
than the





17. The following are possible sources of Data except:

A. Experience

B. Census

C. Surveys

D. Research

18. This
refers to systematic study of vital events such as births, illnesses,
marriages, divorces and deaths

A. Epidemiology

B. Demographics

C. Vital Statistics

D. Health Statistics

19. In case of clerical errors in your birth certificate, Where should you go
to have it


B. Court of Appeals

C. Municipal Trial Court

D. Local Civil Registrar

20. Acasia just gave birth to Lestat, A healthy baby boy. Who are going to report
the birth of Baby Lestat?

A. Nurse

B. Midwife

C. OB Gyne

D. Birth Att

21. In reporting the birth of Baby Lestat, where will he be registered?

A. At the Local Civil Registrar

B. In the National Statistics Office

C. In the City Health Department

D. In the Field Health Services and Information System Main Office

22. Deejay, The birth attendant noticed that Lestat has low set of ears,
Micrognathia, Microcephaly and a typical cat like cry. What should Deejay do?

A. Bring Lestat immediately to the nearest hospital

B. Ask his assistant to call the nearby pediatricia

C. Bring Lestat to the nearest pediatric clinic

D. Call a Taxi and together with Acasia, Bring Lestat to the nearest hospital

23. Deejay would suspect which disorder?

A. Trisomy 21

B. Turners Syndrome

C. Cri Du Chat

D. Klinefelters Syndrome

24. Dee
jay could expect which of the following congenital anomaly that would
accompany this disorder?





26. Which presidential decree orders reporting of births within 30 days after its

A. 651

B. 541

C. 996

D. 825

25. These rates are referred to the total living population, It must be presumed that
the total population was exposed to the risk of occurrence of the event.

A. Rate

B. Ratio

C. Crude/General Rates

D. Specific Rate

26. These are used to describe the r
elationship between two numerical quantities or
measures of events without taking particular considerations to the time or place.

A. Rate

B. Ratios

C. Crude/General Rate

D. Specific Rate

27. This is the most sensitive index in determining the general h
ealth condition of a
community since it reflects the changes in the environment and medical conditions
of a community

A. Crude death rate

B. Infant mortality rate

C. Maternal mortality rate

D. Fetal death rate

28. According to the WHO, which of the fol
lowing is the most frequent cause of
death in children underfive worldwide in the 2003 WHO Survey?

A. Neonatal

B. Pneumonia

C. Diarrhea


29. In the Philippines, what is the most common cause of death of infants according
to the latest

A. Pneumonia

B. Diarrhea

C. Other perinatal condition

D. Respiratory condition of fetus and newborn

30. The major cause of mortality from 1999 up to 2002 in the Philippines are

A. Diseases of the heart

B. Diseases of the vascular system

C. Pn

D. Tuberculosis

31. Alicia, a 9 year old child asked you “ What is the common cause of death in my
age group here in the Philippines? “ The nurse is correct if he will answer

A. Pneumonia is the top leading cause of death in children age 5 to

B. Malignant neoplasm if common in your age group

C. Probability wise, You might die due to accidents

D. Diseases of the respiratory system is the most common cause of death in

32. In children 1 to 4 years old, which is the most common cause o
f death?

A. Diarrhea

B. Accidents

C. Pneumonia

D. Diseases of the heart

33. Working in the community as a PHN for almost 10 years, Aida knew the
fluctuation in vital statistics. She knew that the most common cause of morbidity
among the Filipinos is

A. Diseases of the heart

B. Diarrhea

C. Pneumonia

D. Vascular system diseases

34. Nurse Aida also knew that most maternal deaths are caused by

A. Hemorrhage

B. Other Complications related to pregnancy occurring in the course of
labor, delivery and puer

C. Hypertension complicating pregnancy, childbirth and puerperium

D. Abortion

SITUATION : Barangay PinoyBSN has the following data in year 2006

1. July 1 population : 254,316

2. Livebirths : 2,289

3. Deaths from maternal cause : 15

4. Death from

CVD : 3,029

5. Deaths under 1 year of age : 23

6. Fetal deaths : 8

7. Deaths under 28 days : 8

8. Death due to rabies : 45

9. Registered cases of rabies : 45

10. People with pneumonia : 79

11. People exposed with pneumonia : 2,593

12. Total number of deaths from all causes : 10,998

The following questions refer to these data

35. What is the crude birth rate of Barangay PinoyBSN?

A. 90/100,000

B. 9/100

C. 90/1000

D. 9/1000

36. What is the cause specific death rate from cardio
vascular diseases?

A. 27/100

B. 1191/100,000

C. 27/100,000

D. 1.1/1000

37. What is the Maternal Mortality rate of this barangay?

A. 6.55/1000

B. 5.89/1000

C. 1.36/1000

D. 3.67/1000

38. What is the fetal death rate?

A. 3.49/1000

B. 10.04/1000


D. 3.14/100,000

39. What is the attack rate of pneumonia?

A. 3.04/1000

B. 7.18/1000

C. 32.82/100

D. 3.04/100

40. Determine the Case fatality ratio of rabies in this Barangay

A. 1/100

B. 100%

C. 1%

D. 100/1000

41. The following are all
functions of the nurse in vital statistics, which of the
following is not?

A. Consolidate Data

B. Collects Data

C. Analyze Data

D. Tabulate Data

42. The following are Notifiable diseases that needs to have a tally sheet in data
reporting, Which one is

A. Hypertension

B. Bronchiolitis

C. Chemical Poisoning

D. Accidents

43. Which of the following requires reporting within 24 hours?

A. Neonatal tetanus

B. Measles

C. Hypertension

D. Tetanus

44. Which Act declared that all communicable disease
be reported to the nearest
health station?

A. 1082

B. 1891

C. 3573

D. 6675

45. In the RHU Team, Which professional is directly responsible in caring a sick
person who is homebound?

A. Midwife

B. Nurse


D. Physician

46. During epidemics, which

of the following epidemiological function will you have
to perform first?

A. Teaching the community on disease prevention

B. Assessment on suspected cases

C. Monitor the condition of people affected

D. Determining the source and nature of the epidemic

47. Which of the following is a POINT SOURCE epidemic?

A. Dengue H.F

B. Malaria

C. Contaminated Water Source

D. Tuberculosis

48. All but one is a characteristic of a point source epidemic, which one is not?

A. The spread of the disease is caused by

a common vehicle

B. The disease is usually caused by contaminated food

C. There is a gradual increase of cases

D. Epidemic is usually sudden

49. The only Microorganism monitored in cases of contaminated water is

A. Vibrio Cholera

B. Escherichia Coli

. Entamoeba Histolytica

D. Coliform Test

50. Dengue increase in number during June, July and August. This pattern is called

A. Epidemic

B. Endemic

C. Cyclical

D. Secular


Field health services and information system provides summary data
on health service delivery and selected program from the barangay level up to the
national level. As a nurse, you should know the process on how these information
became processed and cons

51. All of the following are objectives of FHSIS Except

A. To complete the clinical picture of chronic disease and describe their
natural history

B. To provide standardized, facility level data base which can be accessed for more
in depth

C. To minimize recording and reporting burden allowing more time for patient care
and promotive activities

D. To ensure that data reported are useful and accurate and are disseminated in a
timely and easy to use fashion

52. What is the fundamenta
l block or foundation of the field health service
information system?

A. Family treatment record

B. Target Client list

C. Reporting forms

D. Output record

53. What is the primary advantage of having a target client list?

A. Nurses need not to go back

to FTR to monitor treatment and services to
beneficiaries thus saving time and effort

B. Help monitor service rendered to clients in general

C. Facilitate monitoring and supervision of services

D. Facilitates easier reporting

54. Which of the following
is used to monitor particular groups that are qualified as
eligible to a certain program of the DOH?

A. Family treatment record

B. Target Client list

C. Reporting forms

D. Output record

55. In using the tally sheet, what is the recommended frequency in

activities and services?

A. Daily

B. Weekly

C. Monthly

D. Quarterly

56. When is the counting of the tally sheet done?

A. At the end of the day

B. At the end of the week

C. At the end of the month

D. At the end of the year

57. Target clien
t list will be transmitted to the next facility in the form of

A. Family treatment record

B. Target Client list

C. Reporting forms

D. Output record

58. All but one of the following are eligible target client list

A. Leprosy cases

B. TB cases

Prenatal care

D. Diarrhea cases

59. This is the only mechanism through which data are routinely transmitted from
once facility to another

A. Family treatment record

B. Target Client list

C. Reporting forms

D. Output record

3 Or the report

for environmental health activities is prepared how

A. Daily

B. Weekly

C. Quarterly

D. Yearly

61. Nurse Budek is preparing the reporting form for weekly notifiable diseases. He
knew that he will code the report form as





62. In preparing the maternal death report, which of the following correctly codes
this occurrence?





63. Where should Nurse Budek bring the reporting forms if he is

in the BHU

A. Rural health office

B. FHSIS Main office

C. Provincial health office

D. Regional health office

64. After bringing the reporting forms in the right facility for processing, Nurse
Budek knew that the output reports are solely pro
duced by what office?

A. Rural health office

B. FHSIS Main office

C. Provincial health office

D. Regional health office

65. Mang Raul entered the health center complaining of fatigue and frequent
syncope. You assessed Mang Raul and found out that he is

severely malnourished
and anemic. What record should you get first to document these findings?

A. Family treatment record

B. Target Client list

C. Reporting forms

D. Output record

66. The information about Mang Raul’s address, full name, age, symptoms