1. Nurse Suzie is administering 12:00 PM medication in Ward 4.

Two patients
have to receive Lanoxin. What should Nurse Suzie when one of the client
does NOT have a readable identification band?
A.
B.
C.
D.

Ask the client if she is Mrs. Santos

Ask the client his name
Ask the roommate if the client is Mrs. Santos
Compare the ID band with the bed tag

2. Lizette, a head nurse in a surgical unit, hears one of the staff nurses say she
does not touch any client assigned to her unless she performs nursing
procedures or conducts physical assessment. To guide the staff nurse in the
use of touch, which of the following would be BEST response of Lizette?
A. Use touch when the situation calls for it.
B. Touch serves as a connection between the nurse and the
patient.
C. Use touch with discretion.
D. Touch is used in physical assessment.
3. You are asked to teach the client, Mr. Lapuz, who has right sided weakness
the use of cane. Which observation will indicate that Mr. Lapuz is using the
cane properly?
A.
B.
C.
D.

The cane and one foot or both feet are on the floor at all times
He advances the cane followed by the left leg
Client keeps the cane on the right side along the weak leg
Client leans to the left side which is stronger

4. George, a 43 year old executive is scheduled for cardiac bypass surgery.

While being prepared for the surgery, he says to the nurse I am not going to
have the surgery. I may die because of the risk. Which response by the nurse
is most appropriate?
A. Without the surgery you will most likely die sooner.
B. There are always risks involved with surgery.
C. There is a client in the other room who had successful surgery and you
can talk to him.
D. This must be very frightening for you. Tell me how you feel
about the surgery.
5. A client is ordered to take Lasix, a diuretic, to be taken orally daily. Which of
the following is an appropriate instruction by the nurse?
A. Report to the physician the effects of the medication on urination.
B. Take the medicine early in the morning
C. Take a full glass of water with the medicine

D. Measure frequency of urination in 24 hours.

6. Nurse Glenda gets a call from the neighbour who tells her that his 3 years old
daughter has been vomiting and has fever and asks for advice. Which of the
following is the most appropriate action of the nurse?
A. Observe the child for an hour. If the child does not improve, refer to the
physician in the neighbourhood.
B. Recommend to bring the child immediately to the hospital.
C. Assess the child, recommend observation and administer acetaminophen.
If symptoms continue, bring to the hospital.
D. Tell the neighbour to observe the child and give plenty of fluids. If the child
does not improve, bring the child to the hospital.
7. Wilfred, 30 years old male, was brought to the hospital due to injuries
sustained from a vehicular accident. While being transported to the X-ray
department, he straps accidentally broke and the client fell to the floor hitting
to his head. In this situation, the nurse is:
A. Not responsible because of the doctrine of respondent superior
B. Free from any negligence that caused harm to the patient
C. Liable along with the employer for the use of a defective
equipment that harms the client
D. Totally responsible for the negligence
8. While going on evening round, Nurse Edna saw Mrs. Pascual meditating and
afterwards started singing prayerful hymns. What is the BEST response of
Edna?
A. Ignore the incidence
B. Report the incidence to the head nurse
C. Respect the clients action as this provides structure and support
to the client
D. Call her attention so she can go to sleep
9. A client asks for advice on low cholesterol food. You advise the client to eat
the following:
A.
B.
C.
D.

Chicken liver, cow liver, eggs

Lean beef and pork, egg white, fish
Balut, salted eggs, duck and chicken egg
Pork liempo, cow brain, lungs and kidney

10.The code of ethics for nurses has an interpretative statement that provides:
A. continuity of care for the improvement of the client
B. guide for carrying out nursing responsibilities that provide
quality care and for the ethical obligation of the profession
C. standards of care in carrying out nursing responsibilities
D. identical care to all clients in any setting

11.Which of the following situation would possibly cause a nurse to be sued due
to negligence?
A. Nurse gave a client wrong medication, and an hour later, client
complained of dyspnea
B. While preparing a medication, the nurse notices that instead of 1 tablet,
she put two tablets in the clients medication cup
C. AS the nurse was about to administer medication, the client questioned
why the medication is still given when in fact the physician discontinued it
D. Nurse administered 2 tablets of analgesic instead of 1 tablet as
prescribed. Patient noticed the error and complained.
12.Your nurse supervisor asks you who among the following clients is most
susceptible to getting infection if admitted to the hospital?
A.
B.
C.
D.

Diabetic client type 2

Client with chronic obstructive pulmonary disease (COPD)
Client with second degree burn
Client with psoriasis

13.Mr. Chris Martinez has been confined for three days. His wife helped take care
of him and he has observed her to be too involved in his care. He
complained to the head nurse about this. Which of the following would be the
BEST response of the nurse?
A. Dont worry. I will call the attention of your wife.
B. Your wife is just trying to help because she is worried about you.
C. What are your thoughts about your wifes involvement in your
care?
D. Your wife can assist you well in your care and recovery.
14.The nurse is in the hospital canteen and hears two staff nurses talking about
the client confined in Room 612. They mentioned his name and discussed
details of his condition. Which of the following actions should the nurse take?
A. Approach the two nurses and tell them that their actions are
inappropriate especially in a public place
B. Wait till the nurses finish the discussion and report the situation to the
supervisor
C. Say nothing to avoid embarrassing the staff nurses
D. Remain quiet and ignore the discussion
15.The son of Mr. Rosario, a 76 years old man, reports to the nurse in the
community health center that his father has been getting out of bed at night
and walks around the house in the early hours of the morning causing him to
fall and injure himself. Which instruction would you give?
A. Apply restraints during night hours only

B. Advise hospitalization to prevent future accidents

C. Keep a radio or TV for company and to orient the client
D. Have someone check on the client frequently at night
SITUATIONAL
Situation 1 Preparation and administration of medications is a nursing function
that cannot be delegated. It is important that the nurse has a deep understanding
of this responsibility that is meant to save patients lives.
16.You are to administer an intramuscular injection to Dulce, 1 year old girl.
The most appropriate site to administer the drug is:
A. Dorso gluteal region
B. Ventral forearm

C.
D.

vastus lateralis
gluteal region

17.An infant is ordered to receive 500ml of D 5NSS for 24 hours. The intravenous
drip is running at 60 drops/minute. How many drops per minute should the
flow rate be?
A. 60 drops per minute
B. 21 drops per minute

C.

30 drops per minute

D. 15 drops per minute

18.Following surgery, Henry is to receive 20 mEq (milliequivalent) of potassium

chloride to be added to 1000 ml of D5W to run for 8 hours. The intravenous
infusion set is calibrated at 20 drops per millilitre. How many drops per
minute should the rate be to infuse 1 liter of D 5W for 8 hours?
A. 42 drops
B. 20 drops

D.

C. 60 drops
32 drops

19.Mr. Lagro is to receive 1 liter of D5LR to run for 12 hours. The drop factor of
the IV infusion set is 10 drops per minute. Approximately how many drop per
minutes should the IV be regulated?
A. 13-14 drops
B. 17-18 drops

C.

10-12 drops
D. 15-16 drops

20.The physician ordered Nembutal Na gr XX. The bottle contains

100mg/capsule. How many capsule will be administered to the client?
A. 1 capsule
B. 1 capsule

C.

2 capsule
D. capsule