PREBOARD EXAM NP: 4 MS Situation 1 Concerted work efforts among members of the surgical team is essential to the success

s of the surgical procedure. 1. The sterile nurse or sterile personnel touch only sterile supplies and instruments. W hen there is a need for sterile supply which is not in the sterile field, who hands out these items by opening its outer cover? a. b. c. d. Circulating nurse Anesthesiologist Surgeon Nursing aide

2. The OR team performs distinct roles for one surgical procedure to be accomplished within a prescribed time frame and deliver a standard patient outcome. W hite the surgeon performs the surgical procedure, who monitors the status of the client like urine output, blood loss? a. b. c. d. Scrub nurse Surgeon Anesthesiologist Circulating nurse

3. Surgery schedules are communicated to the OR usually a day prior to the procedure by the nurse of the floor or ward where the patient is confined. For orthopedic cases, what department is usually informed to be present in the OR? a. b. c. d. Rehabilitation department Laborator y department Maintenance department Radiology department

4. Minimally invasive surger y is ver y much into technology. Aside from the usual surgical team who else to be present when a client undergoes laparoscopic surgery? a. b. c. d. Information technician Biomedical technician Electrician Laborator y technicial

5. In massive blood loss, prompt replacement of compatible blood is crucial. W hat department needs to be alerted to coordinate closely with the patients family for immediate blood component therapy? a. b. c. d. Security Division Chaplainc y Social Service Section Pathology department

Situation 2 You are assigned in the Orthopedic W ard where clients are complaining of pain in varying degrees upon movement of body pa rts.

6. Troy is a one day post open reduction and internal fixation (ORIF) of the left hip and is in pain. W hich of the following observation would prompt you to call the doctor? a. b. c. d. Dressing is intact but partially soiled Left foot is cold to touch and pedal pulse is absent Left leg in limited functional anatomic position BP 114/78, pulse of 82 beats/minute

7. There is an order of Demerol 50 mg I.M. now and every 6 hours p r n. You injected Demerol at 5 pm. The next dose of Demerol 50 mg I.M. is given: a. b. c. d. W hen the client asks for the next dose W hen the patient is in severe pain At 11pm At 12pm

8. You continuously evaluate the clients adaptation to pain. W hich of the following behaviors-indicate appropriate adaptation? a. b. c. d. The The The The client client client client reports pain reduction and decreased activity denies existence of pain can distract himself during pain episodes reports independence from watchers

9. Pain in Ortho cases may not be mainly due to the surgery. There might be other factors such as cultural or ps ychological that influence pain. How can you alter these factors as the nurse? a. Explain all the possible interventions that may cause the client to worry. b. Establish trusting relationship by giving his medication on time c. Stay with the client during pain episodes d. Promote clients sense of control and participation in pain control by listening to his concerns 10. In some hip surgeries, an epidural catheter for Fentanyl epidural analgesia is given. W hat is your nursing priority care in such a case? a. b. c. d. Instruct client to observe strict bed rest Check for epidural catheter drainage Administer analgesia through epidural catheter as prescribed Assess respirator y rate carefully

Situation 3 Records are vital tools in any institution and should be properly maintained for specific use and time. 11. The patients medical record can work as a double-edged swords. W hen can the medical record become the doctors/nurse worst enem y? a. b. c. d. W hen W hen W hen W hen the record is voluminous a medical record is subpoenaed in court it is missing the medical record is inaccurate, incomplete, and inadequate

12. Disposal of medical records in government hospitals/institutions must be done in close coordination with what agenc y? a. b. c. d. Department of Interior and Local Government (DILG) Metro Manila Development Authority (MMDA) Records Management Archives Office (RMAO) Depart of Health (DOH)

13. In the hospital, when you need-the medical record of a discharged patient for research, you will request permission through: a. b. c. d. Doctor in charge The hospital director The nursing Service Medical records section

14. You readmitted a client who was in another department a month ago. Since you will need the previous chart, from whom do you request the old chart? a. b. c. d. Central supply section Previous doctors clinic Department where the patient was previously admitted Medical records section

15. Records Management and Archives Offices of the DOH is responsible for implementing its policies on record, disposal. You know that your institution is covered by this polic y it; a. b. c. d. Your hospital is considered tertiary Your hospital is in Metro Manila It obtained permit to operate from DOH Your hospital is Philhealth acc redited

Situation 4 In the OR, there are safety protocols that should be followed. The OR nurse should be well versed with all these to safeguard the safety and quality to patient delivery outcome. 16. W hich of the following should be given highest priority when receiving patient in the OR? a. b. c. d. Assess level of consciousness Verify patient identification and informed consent Assess vital signs Check for jewelr y, gown, manicure and dentures

17. Surgeries like I and D (incision and drainage) and debribement are relatively short procedures but considered dirty cases. W hen are these; procedures best scheduled? a. b. c. d. Last case In between cases According to availability of anesthesiologist According to the surgeons preference

18. OR nurses should be aware that maintaining the clients safety is the overall goal of nursing care during the intraoperative phase. As the circulating nurse, you make certain that throughout the procedure a. the surgeon greets his client before induction of anesthesia b. the surgeon and anestheriologist are in tandem c. strap made of strong non-abrasive material are fastened securely around the joints of the knees and ankles and around the 2 hands around an arm board d. client is monitored throughout the surgery by the as sistant anesthesiologist 19. Another nursing check that should not be missed before the induction of general anesthesia is: a. b. c. d. check check check check for presence underwear for presence dentures patients blood studies baseline vital signs

20. Some different habits and hobbies affect postoperative respiratory function. If your client smokes 3 packs of cigarettes a day for the part 10 years, you will anticipate increased risk for: a. b. c. d. perioperative anxiety and stress delayed coagulation time delayed wound healing postoperative respirator y function

Situation 5 Nurses hold a variety of roles when providing care to a perioperative patient. 21. W hich of the following role would be the responsibility of the scrub nurse? a. Assess the readiness of the client prior to surgery b. Ensure that the airway is adequate c. Account for the number of sponges, needles, supplies, Used during the surgical procedure d. Evaluate the type of anesthesia appropriate for the surgical client 22. As a perioperative nurse, how can you best meet the safety need of the client after administering preoperative narcotic? a. b. c. d. Put side rails up and ask client not to get out of bed Send the client to ORD with the family Allow client to get up to go to the comfort room Obtain consent form

23. It is the responsibility of the pre-op, nurse to do skin prep for patients undergoing surgery. If hair at the operative site is not shaved, what should be done to make suturing eas y and lessen chance of incision infection? a. Draped b. Pulled

c. Clipped d. Shampooed 24. It is also the nurses function to determine when infection is developing in the surgical incision. The perioperative nurse should observe for what signs of impending infection? a. b. c. d. Localized heat and redness Serosanguinous exudates and skin blanching Separation of the incision Blood clots and scar tissue are visible

25. W hich of the following nursing intervention is done when examining the incision wound and changing the dressing? a. b. c. d. Observe the dressing and t ype and odor of drainage if any Get patients consent W ash hands Request the client to expose the incision wound

Situation 6 Carlo, 16 years old, comes to the ER with acute asthmatic attack. RR is 46/min and he appears to be in acute respiratory distress. 26. W hich of the following nursing actions should be initiated first? a. b. c. d. Promote emotional support Administer oxygen at 6L/min Suction the client ever y 30 min Administer bronchodilator by nebulizer

27. Aminophylline was ordered for acute asthmatic attack. The mother asked the nurse, what its indication the nurse will say is: a. b. c. d. Relax smooth muscles of the bronchial airway Promote expectoration Prevent thickening of secretions Suppress cough

28. You will give health instructions to Carlo, a case of bronchial asthma. The health instruction will include the following EXCEPT: a. b. c. d. Avoid emotional stress and extreme temperature Avoid pollution like smoking Avoid pollens, dust seafood Practice respirator y isolation

29. The asthmatic client asked you what breathing technique he can best practice when asthmatic attack starts. W hat will be the best position? a. b. c. d. Sit in high- Fowlers position with extended legs Sit-up with shoulders back Push on abdomen during exhalation Lean forward 30-40 degrees with each exhalation

30. As a nurse you are always alerted to monitor status asthmaticus who will likely and initially manifest s ymptoms of: a. b. c. d. metabolic alkalosis respirator y acidosis respirator y alkalosis metabolic acidosis

Situation 7 Joint Commission on Accreditation of Hospital Organization (JCAHP) patient safety goals and requirements include the care and efficient use of technology in the OR arid elsewhere in the healthcare facility. 31. As the head nurse in the OR, how can you improve the effectiveness of clinical alarm systems? a. b. c. d. limit suppliers to a few so that quality is maintained implement a regular inventor y of supplies and equipment Adherence to manufacturers recommendation Implement a regular maintenance and testing of alarm systems

32. Over dosage of medication or anesthetic can happen even with the aid of technology like infusion pump, sphymomanometer, and similar devices/machines. As a staff, how can you improve the safety of using infusion pumps? a. Check the functionality of the pump before use b. Select your brand of infusion pump like you do with your cellphone C. Allow the technician to set the; infusion pump before use d. Verify the flow rate against your computation 33. JCAHOs universal protocol for surgical and invasive procedures to prevent wrong site, wrong person, and wrong procedures/surgery includes the following EXCEPT: a. b. c. d. Mark the operative site if possible Conduct pre-procedure verification process Take a video of the entire intra-operative procedure Conduct time out immediately before starting the procedure

34. You identified a potential risk of pre and post operative clients. To reduce the risk of patient harm resulting from fall, you can implement the following EXCEPT: a. Assess potential risk of fail associated with the patients the following EXCEPT: medication regimen b. Take action to address any identified risks through Incident Report (IR) c. Allow client to walk with relative to the OF? d. Assess and p eriodically reassess individual clients risk for falling 35. As a nurse you know you can improve on accurac y of patients identification by 2 patient identifiers, EXCEPT: a. identify the client by his/her wrist tag and verify with family members b. identify client by his/her wrist tag and call his/her by name

c. call the client by his/her case and bed number d. call the patient by his/her name and bed number Situation 8 Team efforts is best demonstrated in the OR 36. If you are the nurse in charge for scheduling surgical cases, what important information do you need to ask the surgeon? a. W ho is your internist b. W ho is your assistant and anesthesiologist, and what is your preferred time and type of surgery? c. W ho are your anesthesiologist, internist, an d assistant d. W ho is your anesthesiologist. 37. In the OR, the nursing tandem for every surgery is: a. b. c. d. Instrument technician and circulating nurse Nurse anesthetist, nurse assistant, and instrument technician Scrub nurse and nurse anesthetist Scrub and circulating nurses

38. W hile team effort is needed in the OR for efficient and quality patient care delivery, we should limit the number of people in the room for infection control. W ho comprise this team? a. b. c. d. Surgeon, Surgeon, Surgeon, Surgeon, anesthesiologist, scrub nurse, radiologist, orderly assistants, scrub nurse, circulating nurse, anesthesiologist assistant surgeon, anesthesiologist, scrub nurse, pathologist assistant surgeon, anesthesiologist, intern, scrub nurse

39. W hen surger y is on-going, who coordinates the activities outside, including the family? a. b. c. d. Orderly/clerk Nurse supervisor Circulating nurse Anaesthesiologist

40. The breakdown in teamwork is often times a failure in: a. b. c. d. Electricity Inadequate supply Leg work Communication

Situation 9 Colostomy is a surgically created anus - It can be temporary or permanent, depending on the disease condition. 41. Skin care around the stoma is critical. W hich of the following is not indicated as a skin care barriers? a. Apply liberal amount of mineral oil to the area b. Use karaya paste and rings around the stoma

c. Clean the area daily with soap and water before applying bag d. Apply talcum powder twice a day 42. W hat health instruction will enhance regulation of a colostom y (defecation) of clients? a. b. c. d. Irrigate after lunch everyday Eat fruits and vegetables in all three meals Eat balanced meals at regular intervals Restrict exercise to walking only

43. After ileostom y, which of the following condition is NOT expected? a. b. c. d. increased weight Irritation of skin around the stoma Liquid stool Establishment of regular bowel movement

44. The following are appropriate nursing interventions during colostom y irrigation EXCEPT: a. b. c. d. Increase the irrigating solution flow rate when abdominal cramps is felt Insert 2-4 inches of an adequately lubricated catheter to the stoma Position client in semi-Fowler Hand the solution 18 inches above the stoma

45. W hat sensation is used as a gauge so that patients with ileostom y can determine how often their pouch should be drained? a. b. c. d. Sensation of taste Sensation of pressure Sensation of smell Urge to defecate

Situation 10 As a beginner in research, you are aware that sampling is an essential element of the research process. 46. W hat does a sample group represent? a. b. c. d. Control group Study subjects General population Universe

47. W hat is the most important characteristics of a sample? a. b. c. d. Randomization Appropriate location Appropriate number Representativeness

48. Random sampling ensures that each subject has:

a. b. c. d.

Been selected s ystematically An equal change of selection Been selected based on set criteria Characteristics that match other samples

49. W hich of the following sampling methods allows the use of any group of research subject? a. b. c. d. Purposive Convenience Snow-bail Quota

50. You decided to include 5 barangays in your municipality and chose a sampling method that would get representative samples from each barangay. W hat should be the appropriate method for you to use in this care? a. b. c. d. Cluster sampling Random sampling Stratifies sampling Systematic sampling

Situation 11 -After an abdominal surgery, the circulating and scrub nurses have critical responsibility about sponge and Instrument count. 51. W hen is the first sponge/instrument count reported? a. b. c. d. Before Before Before Before closing the subcutaneous layer peritoneum is closed dosing the skin the fascia is sutured

52. W hat major supportive layer of the abdominal wall must be sutured with long tensile strength such as cotton or nylon or silk suture? a. b. c. d. Fascia Muscle Peritoneum Skin

53. Like sutures, needles also var y in shape and uses. If you are the scrub nurse for a patient who is prone to keloid formation and has a low threshold of pain, what needle would you prepare? a. b. c. d. Round needle A traumatic needle Reverse cutting needle Tapered needle

54. Another alternative suture for skin closure is the use of _______________:

a. b. c. d.

Staple Therapeutic glue Absorbent dressing invisible suture

55. Like any nursing interventions, counts should be documented. To whom does the scrub nurse report any discrepancy of country so that immediate and appropriate action in instituted? a. b. c. d. Anesthesiologist Surgeon Or nurse supervisor Circulating nurse

Situation 12 As a nurse, you should be aware and prepared of the different roles you play. 56. W hat role do you play, when you hold all clients information entrusted to you in the strictest confidence? a. b. c. d. Patients advocate Educator Patients Liaison Patients arbiter

57. As a nurse, you can help improve the effectiveness of communication among healthcare givers a. b. c. d. Use of reminders of what to do Using standardized list of abbreviations, acron yms, and s ymbols One-on-one oral endorsement Text messaging and e-mail

58. As a nurse, your primary focus in the workplace is the clients safety. However, personal safety is also a concern. You can communicate hazards to your co-workers through the use of the following EXCEPT: a. b. c. d. Formal training Posters Posting IR in the bulletin board Use of labels and signs

59. As a nurse, what is one of the best way to reconcile medications across the continuum of care? a. Endorse on a case-to-case basis b. Communication a complete list of the patients medication to the next provider of service c. Endorse in writing d. Endorse the routine and stat medications every shift

60. As a nurse, you protect yourself and co-workers from misinformation and misrepresentations through the following EXCEPT: a. Provide information to clients about a variety of services that can help alleviate the clients pain and other conditions b. Advising the client, by virtue of your expertise, that which can contribute to the cli ents well-being c. Health education among clients and significant others regarding the use of chemical disinfectant d. Endorsement thru trimedia to advertise your favorite disinfectant solution 61. A one-day postoperative abdominal surgery client has been complaining of severe throbbing abdominal pain described as 9 in a 1-10 pain rating. Your assessment reveals bowel sounds on all quadrants and the dressing is dry and intact. W hat nursing intervention would you take? a. b. c. d. Medicate client as prescribed Encourage client to do imager y Encourage deep breathing and turning Call surgeon stat

62. Pentoxicodone 5 mg IV ever y 8 hours was prescribed for post abdominal pain. W hich will be your priority nursing action? a. b. c. d. Check abdominal dressing for possible s welling Explain the proper use of PCA to alleviate anxiety Avoid overdosing to prevent dependence/tolerance Monitor VS, more importantly RR .

63. The client complained of abdominal and pain. Your nursing intervention that can alleviate pain is: a. b. c. d. Instruct client to go to sleep and relax Advice the client to close the lips and avoid deep breathing and talking Offer hot and clear soup Turn to sides frequently and avoid too much talking

64. Surgical pain might be minimized by which nursing action in the OR: a. b. c. d. Skill of surgical team and lesser manipulation Appropriate preparation For the scheduled procedure Use of modem technology in closing the wound Proper positioning and draping of clients

65. One ver y common cause of postoperative pain is: a. b. c. d. Forceful traction during surger y Prolonged surger y Break in aseptic technique Inadequate anesthetic

Situation 14 You were on duty at the medical ward when Zeny came in for admission for tiredness, cold intolerance, constipation, an d weight gain. Upon examination, the doctors diagnosis was hypothyroidism. 66. Your independent nursing care for hypothyroidism includes: a. b. c. d. administer sedative round the clock administer thyroid hormone replacement providing a cool, quiet, and comf ortable environment encourage to drink 6 -8 glasses of water

67. As the nurse, you should anticipate to administer which of the following medications to Zeny who is diagnosed to be suffering from hypothyroidism? a. b. c. d. Levothyroxine Lidocaine Lipitor Levophed

68. Your appropriate nursing diagnosis for Zeny who is suffering from hypothyroidism would probably include which of the following? a. b. c. d. Activity intolerance related to tiredness associated with disorder Risk to injur y related to incomplete eyelid closure Imbalance nutrition related to hypermetabolism Deficient fluid volume related to diarrhea

69. Myxedema coma is a life threatening complication of long standing and untreated hypothyroidism with one of the following characteristics. a. b. c. d. Hyperglycemia hypothermia hyperthermia hypoglycemia

70. As a nurse, you know that the most common type of goiter is related to a deficienc y a. b. c. d. thyroxine thyrotropin iron iodine

Situation 15 Mrs. Pichay is admitted to your ward. The MD ord ered Prepared for thoracentesis this pm to remove excess air from the pleural cavity. 71. W hich of the following nursing responsibility is essential in Mrs. Pichay who will undergo thoracentesis? a. b. c. d. Support, and reassure client during the procedure Ensure that informed consent has been signed Determine if client has allergic reaction to local anesthesia Ascertain if chest x -rays and other tests have been prescribed and completed

72. Mrs. Pichay who is for thoracentesis is assisted by the nurse to any of the following positions, EXCEPT: a. straddling a chair with arms and head resting on the back of the chair b. lying on the unaffected side with the bed elevated 30 -40 degrees c. lying prone with the head of the bed lowered 15 -30 degrees d. sitting on the edge of the bed with her feet supported and arms and head on a padded overhead table 73. During thoracentesis, which of the following nursing intervention will be most crucial? a. Place patient in a quiet and cool room b. Maintain strict aseptic tec hnique c. Advice patient to sit perfectly still during needle insertion until it has been withdrawn from the chest d. Apply pressure over the puncture site as soon as the needle is withdrawn 74. To prevent leakage of fluid in the thoracic cavity, how wilt you position the client after thoracentesis? a. b. c. d. Place flat in bed Turn on the unaffected side Turn on the affected side On bed rest

75. Chest x-ray was ordered after thoracentesis. W hen you client asks what is the reason for another chest x-ray, you will explain: a. b. c. d. to to to to rule out pneumothorax rule out any possible perforation decongest rule out any foreign: body

Situation 16 In the hospital, you are aware that we are helped by the .use of a variety of equipment/devices to enhance quality patient care delivery; 76. You are initiate an IV line to your patient, Kyle, 5, who is febrile. W hat IV administration set will you prepare? a. b. c. d. Blood transfusion set Macroset Volumetric chamber Microset

77. Kyle is diagnosed to have measles. W hat will your protective personal attire include? a. b. c. d. Gown Eyewear Face mask Gloves

78. W hat will you do to ensure that Kyle, who is febrile, will have a liberal oral fluid intake? a. Provide a glass of fruit ever y meal b. Regulate his IV to 30 drops per minute c. Provide a calibrated pitcher of drinking water and juice at the bedside and monitor intake and output d. Provide a writing pad to record his intake 79. Before bedtime, you went to ensure Kyles safety in bed. You will do which of the following: a. b. c. d. Put the lights on Put the side rails up Test the call s ystem Lock the doors

80. Kyles room is fully mechanized. W hat do you teach the watcher and Kyle to alert the nurse for help? a. b. c. d. How to lock side rails Number of the telephone operator Call s ystem Remote control

Situation 17 Tony, 11 years old, has kissing tonsils and is scheduled for tonsillectom y and adenoidectom y or T and A. 81. You are the nurse of Tony who will undergo T and A in the morning. His mother asked you if Tony will be put to sleep. Your teaching will focus on: a. b. c. d. spinal anesthesia anesthesiologists preference local anesthesia general anesthesia

82. Mothers of children undergoing tonsillectom y and adenoidectom y usually ask what food prepared and give their children after surgery. You as the nurse will say: a. b. c. d. balanced diet when fully awake hot soup when awake ice cream when fully awake soft diet when fully awake

83. The RR nurse should monitor for the most common postoperative complication of: a. b. c. d. hemorrhage endotracheal tube perforation esopharyngeal edema epiglottis

84. The PACU nurse will maintain postoperative T and A client in what position?

a. b. c. d.

Supine with neck hyperextended and supported with pillow Prone with the head on pillow and tuned to the side Semi- Fowlers with neck flexed Reverse trendelenburg with extended neck

85. Tony is to be discharged in the afternoon of the same day after tonsillectom y and adenoidectom y. You as the RN will make sure that the family knows to: a. b. c. d. offer osteorized feeding offer soft foods for a week to minimize discomfort while swallowing supplement his diet with vitamin C rich juices to enhance heating offer clear liquid for 3 days to prevent irritation

Situation 18 Rudy was diagnosed to have chronic renal failure. Hemodialysis is ordered that an A-V shunt was surgically created. 86. W hich of the following action would be of highest priority with regards to the external shunt? a. b. c. d. Avoid taking BP or blood sample from t he arm with shunt Instruct the client not to exercise the arm with the shunt Heparinize the shunt daily Change dressing of the shunt daily

87. Diet therapy for Rudy, who has acute renal failure, is tow-protein, low potassium and sodium. The nutrition instruction should include: a. b. c. d. Recommend protein of high biologic value like eggs, poultry and lean meat Encourage client to include raw cucumbers, carrot, cabbage, and tomatoes Allowing the client cheese, canned foods, and other processed food Bananas, cantaloupe, orange and other fresh fruits can be included in the diet

88. Rudy undergoes hemodialysis for the first time and was scared of disequilibrium syndrome. He asked you how this can be prevented. Your response is: a. maintain a conducive comfortable and cool environment b. maintain fluid and electrolyte balance c. initial hemodialysis shall be done for 30 minutes only so as not to rapidly remove the waste from the blood than from the brain d. maintain aseptic technique throughout the hemo dialysis 89. You are assisted by a nursing aide with the care of the client with renal failure. W hich delegated function to the aide would you particularly check? a. b. c. d. Monitoring and recording I and O Checking bowel movement Obtaining vital signs Monitoring diet

90. A renal failure patient was ordered for creatinine clearance. As the nurse you will collect

a. b. c. d.

48 jour urine specimen first morning urine 24 hour urine specimen random urine specimen

Situation 19 Fe is experiencing left sharp pain and occasional hematuria. She was advised to undergo IVP by her physician. 91. Fe was so anxious about the procedure and particularly expressed her low pain threshold. Nursing health instruction will include: a. assure the client that the pain is asso ciated with the warm sensation during the administration of the Hypaque by IV b. assure the client that the procedure painless c. assure the client that contrast medium will be given orally d. assure the client that x -ray procedure like IVP is only done by experts 92. W hat will the nurse monitor and instruct the client and significant others, post IVP? a. b. c. d. Report signs and s ymptoms for delayed allergic reactions Observe NPO for 6 hours Increase fluid intake Monitor intake and output

93. Post IVP, Fe should excrete the contrast medium. You instructed the family to include more vegetables in the diet and a. b. c. d. increase fluid intake barium enema cleansing enema gastric lavage

94. The IVP reveals that Fe has small renal calculus that can be passed out spontaneously. To increase the chance of passing the stones, you instructed her to force fluids and do which of the following? a. b. c. d. Balanced diet Ambulance more Strain all urine Bed rest

95. The presence of calculi in the urinary tract is called: a. b. c. d. Colelithiasis Nephrolithiasis Ureterolithiasis Urolithiasis

Situation 20 At the medical-surgical ward, the nurse must also be concerned about drug interactions.

96. You have a client with TPN. You know that in TPN, like blood transfusion, there should be no drug incorporation. However, the MDs order read; incorporate insulin to present TPN. W ill you follow the order? a. No, because insulin will induce hyperglycemia in patients with TPN b. Yes, because insulin is chemically stable with TPN and can enhance blood glucose level c. No, because insulin is not compatible with TPN d. Yes, because it was ordered by the MD 97. The RN should also know that some drugs have increased absorption when infused in PVC container. How will you administer drugs such as insulin, nitroglycerine hydralazine to promote better therapeutic drug effects? a. b. c. d. Administer by fast drip Inject the drugs as close to the IV injection site Incorporate to the IV solution Use volumetric chamber

98. One patient has a runaway IV of 50% dextrose. To prevent temporary excess of insulin transient hyperinsulin reaction, what solution should you prepare in anticipation of the doctors order? a. b. c. d. Any IV solution available to KVO Isotonic solution Hypertonic solution Hypotonic solution

99. How can nurse prevent drug interaction including absorption? a. b. c. d. Always flush with NSS after IV administration Administering drugs with more diluents Improving on preparation techniques Referring to manufacturers guidelines

100. In insulin administration, it should be understood that our body normally releases insulin according to our blood glucose level. W hen is insulin and glucose level highest? a. b. c. d. After After After After excitement a good nights rest an exercise ingestion of food

Answers & Rationale PREBOARD EXAM NP: 4 MS

1. 2. 3. 4. 5. 6. 7. 8. 9.

A. Circulating Nurse C. Anesthesiologist D. Radiology department B. Biomedical technician C. Social Service Section B. Left foot is cold to touch and pedal pulse is absent C. At 11 pm C. The client can distract himself during pain episodes D. Promote clients sense of control and participation in control by listening to his concerns

10. D. Assess respiratory rate carefully 11. D. When the medical record is inaccurate, incomplete, and inadequate 12. D. Department of Health (DOH) 13. B. The hospital director 14. D. Medical records section 15. C. It obtained permit to operate from DOH 16. B. Verify patient identification and informed consent 17. A. Last case 18. C. strap made of strong non-abrasive materials are fastened securely around the joints of the knees and ankles and around the 2 hands around an arm board. 19. D. check baseline vital signs 20. D. postoperative respiratory function 21. C. Account for the number of sponges, needles, supplies, used during the surgical procedure. 22. A. Put side rails up and ask the client not to get out of bed 23. C. Clipped 24. A. Localized heat and redness 25. A. Observe the dressing and type and odor of drainage if any 26. D. Administer bronchodilator by nebulizer 27. A. Relax smooth muscles of the bronchial airway 28. D. Practice respiratory isolation 29. D. Lean forward 30-40 degrees with each exhalation 30. C. respiratory alkalosis 31. D. Implement a regular maintenance and testing of alarm systems 32. A. Check the functionality of the pump before use 33. C. Take a video of the entire intra-operative procedure 34. C. Allow client to walk with relative to the OR 35. C. call the client by his/her case and bed number 36. B. Who is your assistant and anesthesiologist, and what is your preferred time and type of surgery? 37. D. Scrub and circulating nurses

38. B. Surgeon, assistants, scrub nurse, circulating nurse, anesthesiologist 39. C. Circulating Nurse 40. D. Communication 41. A. Apply liberal amount of mineral oil to the area 42. C. Eat balanced meals at regular intervals 43. A. Increased weight 44. A. Increase the irrigating solution flow rate when abdominal cramps is felt 45. B. Sensation of pressure 46. C. General population 47. B. Appropriate location 48. B. An equal chance of selection 49. B. Convenience 50. C. Stratified sampling 51. B. Before peritoneum is closed 52. D. Skin 53. B. Atraumatic needle 54. A. Staple 55. B. Surgeon 56. A. Patients advocate 57. B. Using standardized list of abbreviations, acronyms, and symbols 58. C. Posting IR in the bulletin board 59. C. Endorse in writing 60. D. Endorsement thru trimedia to advertise your favorite disinfectant solution 61. A. Medicate client as prescribed 62. D. Monitor VS, more importantly RR 63. D. Turn to sides frequently and avoid too much talking 64. B. Appropriate preparation for the scheduled procedure 65. D. Inadequate anesthetic 66. D. encourage to drink 6-8 glasses of water 67. A. Levothyroxine 68. A. Activity intolerance related to tiredness associated with disorder 69. B. Hypothermia 70. D. iodine 71. D. Ascertain if chest x-rays and other tests have been prescribed and completed 72. D. Orthopneic position 73. C. Advice patient to sit perfectly still during needle insertion until it has been withdrawn from the chest 74. B. Turn on the unaffected side 75. A. to rule out pneumothorax 76. D. Microset 77. C. Face mask 78. C. Provide a calibrated pitcher of drinking water and juice at the bedside and monitor intake and output 79. B. Put the side rails up

80. C. Call system 81. D. general anesthesia 82. D. soft diet when fully awake 83. A. hemorrhage 84. B. Prone with the head on pillow and turned to the side 85. B. offer soft foods for a week to minimize discomfort while swallowing 86. A. Avoid taking BP or blood sample from the arm with the shunt 87. A. Recommend protein of high biologic value like eggs, poultry and lean meats 88. C. initial hemodialysis shall be done 30 minutes only so as not to rapidly remove the waste from the blood than from the brain 89. A. Monitoring and recording I and O 90. C. 24 hour urine specimen 91. A. assure the client that the pain is associated with the warm sensation during the administration of the Hypaque by IV 92. A. Report signs and symptoms for delayed allergic reaction 93. A. increase fluid intake 94. B. Ambulate more 95. D. Urolithiasis 96. B. Yes, because insulin is chemically stable with TPN and can enhance blood glucose level 97. D. Use volumetric chamber 98. B. Isotonic solution 99. D. Referring to manufacturers guidelines 100. D. After ingestion of food