PALMER SET B

By: Kristofer Tom Floresca Labonete, BSN, RN, PNRC-SSI, IHL

1) The hospital will be held liable if in an effort to cut down on expenses and decides to hire
under board nurses and midwives in place of registered nurses and midwives, and these
persons prove to be incompetent. This premise is anchored on a legal doctrine:
a) Respondeat Superior
b) Res Ipsa Loquitur
c) Force Majeur
d) Negligence

Answer: A
Respondeat Superior means “let the master answer for the acts of the subordinate”. Under
this doctrine, the liability is expanded to include the master as well as the employee and not
a shift of liability from the subordinate to the master. (B) Res Ipsa Loquitur defines as the
injury was of such nature that it would not normally occur unless there was a negligent act
on the part of someone. (C) Force Majeur means an irresistible force, one that is unforeseen
or inevitable. (D) Negligence refers to the commission or omission of an act.

2) Under the Good Samaritan Act, a nurse may be held liable for patient abandonment at the
scene of an emergency in which of the following cases?
a) The nurse does not stop to provide assistance.
b) The nurse begins assistance and then abruptly stops.
c) The nurse does not initiate care.
d) The nurse does not perform under the direct order of a physician.

Answer: B
(B)If a nurse chooses to stop and give aid at the scene of an emergency, the Good
Samaritan Act provides the following guidelines. The nurse should give care that any
reasonable, prudent person would consider first aid. Do not do what you don't know. Offer
assistance; do not insist. Do not leave the scene until the injured victim leaves or another
qualified person takes over. (A)There are only a few US states that mandate stopping to
give aid at the scene of any emergency. The Good Samaritan Act covers those who choose
to give aid. (C)The nurse, like anyone else, is only accountable for first aid as described in
the above statement. The nurse should not initiate care if he/she is unsure of the
appropriate care. (D)When acting as a "Good Samaritan," the nurse is not expected to
perform under the direct orders of a physician.

3) Patient Lucero was brought to psychiatric hospital for admission. Which of the following
rights does the client lose by being admitted involuntarily to a psychiatric hospital? The right
to:
a) Send and receive mail.
b) Vote in a national election.
c) Make a will or legally binding contract.
d) Sign out of the hospital against medical advice.

Answer:D
(D) A person who has been involuntarily committed to a psychiatric hospital loses the right
to leave the hospital of his own accord. (A)The person who is involuntarily committed to a
psychiatric hospital does not lose the right to send and receive mail. (B) The person who is
involuntarily committed to a psychiatric hospital does not lose the right to vote. (C)The
 person who is involuntarily committed to a psychiatric hospital does not lose the right to
make a will or contract.

4) A client is admitted to the psychiatric hospital under a voluntary admission status. Under this
type of admission, the client:
a) Can be discharged when the maximum insurance benefits available have been used
b) Loses civil rights for the entire hospital stay
c) Can expect that few restrictive alternatives will apply
d) Cannot refuse to take psychotropic drugs as prescribed by the psychiatrist

Answer: A
This is a true statement since the client was admitted under a voluntary status and is
responsible for the cost of hospitalization (B) This would not be true if the client was
admitted voluntarily. (C)This would not be true if the client was admitted voluntarily. (D) This
would not be true if the client was admitted voluntarily.

5) Nurse Amanda inserted an IV line on her patient. She forgot to chart this intervention.
Legally, nursing care that is not documented:
a) Is care provided even if it is not recorded
b) May be recorded soon after she remembers
c) May be recorded during her next round of duty
d) Is considered care that is not provided

Answer: D
In every intervention a nurse has done, it is her responsibility to document it for future
references. As the client’s chart denotes an up to date record, it would serve as a monitoring
basis on the client’s progress. (A) The legal implication of medical records serves an
evidence in future legal proceeding. (B and C) Recording it as soon as possible is the best
idea since she still remembers the exact thing that had happen.

Situation: Miss Erlinda, a Clinical Instructor is preparing the third year students for their
practicum.

6) Which of the following is true for charting done by nursing students and countersigned by
the clinical instructor?
a) The instructor cannot be liable because the situation is part of the learning experience of
the student
b) The staff nurse is legally accountable to the hospital for the nursing care delivered by the
nursing students
c) The nursing student is legally accountable for all the information she has written in the
progress notes
d) The clinical instructor attests that she has personal knowledge of the information charted
by the student

Answer: D
When a nurse or a clinical instructor countersigns the charting or a nursing student, he/she
attests that she has personal knowledge of information and that such accurate and
authentic. Anyone who countersigns without verification commits herself to possible legal
risks. (A & B) the instructor/nurse is still held liable to her students.
Situation: Patient James has been admitted to the hospital for acid related disorder. Nurse Ling
was assigned to her during morning shift.

7) When should Nurse Ling initiate discharge planning for Mr. James
a) When the client or family demonstrate readiness to learn self care modalities
b) When informed that a date for discharge has been determined
c) Upon admission
d) When the client's condition is stabilized on the assigned unit

Answer: C
With decreased lengths of stay, discharge plans must be incorporated into the initial plan of
care upon admission to the hospital unit. (A) This is needed through out your nursing care to
the patient. (B) Although you don’t have yet the date of discharge, it is important to teach the
patient about his home care procedure as early as possible. (D) Discharge planning must be
included upon admission.

8) Looking at the chart of patient James, which entry on a client's progress notes is the most
complete?
a) Client's urinary output adequate for the past shift
b) Demerol 75mg administered for severe abdominal pain
c) Dark green drainage 100 ml from nasogastric tube this shift
d) Client expresses anxiety about a low salt diet

Answer: C
This data has a complete, accurate and factual entry in client records. (A) Incorrect since it
is lacking of accuracy (measurement of urinary output and its characteristics). (B) Incorrect
because it does not indicate the route of administration and time. (D) Incorrect – subjective
data must be supported by objective data.

9) A client who is terminally ill has been receiving high doses of an opioid analgesic for the
past month. As death approaches and the client becomes unresponsive to verbal stimuli,
what orders would the nurse expect from the health care provider?
a) Decrease the analgesic dosage by half
b) Discontinue the analgesic
c) Continue the same analgesic dosage
d) Prescribe a less potent drug

Answer: C
Continue the same analgesic dosage. Dying patients who have been in chronic pain will
probably continue to experience pain even though unresponsive. Pain medication should be
continued at the same dose, if effective

Situation: Aling Berta was admitted to your institution due to leg casting. As a nurse, you must
be aware of negligence and malpractice acts.

10) Criminal negligence is committed when you:

a) Observed that the legs of Aling Berta are cyanotic and cold to touch yet you failed to
report it
b) Gave a pain medication for Aling Berta without Doctor’s order
c) Don’t know how to give IM injections
d) Ignored Aling Berta because of her religious belief
 Answer: A
The term “negligence” refers to the commission or omission of an act, pursuant to a duty
that a reasonably prudent person in the same or similar circumstances would not do. (B) is
an act of malpractice (C) is an act of incompetence (D) violation to code of ethics.

11) You placed a hot water bag over the leg of Aling Berta as ordered by the doctor. In the next
shift, the head nurse observed severe burns over the leg area. You are liable for negligence
because:
a) You followed the doctor’s order without clarifying
b) You did not observe carefully
c) You did not assess sensation in the leg of the patient
d) You placed hot water bag in a paralyzed area

Answer: B
Failure to foresee harm to the person injured, following from ignorance of the admonition is
considered negligence.

12) You administered Ketorolac 30 mg IV push to Aling Berta even though you don’t have
formal training on IV therapy. You can be held for criminal charges by;
a) Violating Philippine Nursing Act of 1995 Section 28
b) Violating Philippine Nursing Act of 1991 Section 29
c) Violating Philippine Nursing Act of 1995 Section 29
d) Violating Philippine Nursing Act of 1991 Section 28

Answer: D
Nurses must remember that their legal right to give intravenous injection is based on the
Philippine Nursing Act 1991 Section 28 which states that “in the administration of
intravenous injections, special training shall be required according to protocol established.
Any RN without such training and who administers IV injections shall be held liable for a
criminal charge.

13) Which of the following is being employed by nurses making their decisions based on the
belief that they are obligated to promote the client's well-being?
a) Beneficence
b) Autonomy
c) Non maleficence
d) Justice

Answer: A
Beneficence, the obligation to do good, signifies the obligation to promote the client's well-
being. (B) Autonomy signifies the client's right to be self-governing. (C) Non-maleficence
signifies the obligation to minimize or prevent harm. (D) Justice signifies the concept of
fairness

14) Which of the following statements relates to the ethical principle of justice?
a) Fair treatment and fair selection of subjects.
b) Treating subjects as autonomous agents who can make their own decisions.
c) Balancing risks and benefits of a study for the participant.
d) Assurance to participants that they will not be penalized if they withdraw from a study.
 Answer: A
The principle of justice relates to fairness to subjects both in treatment and in the way they
were selected. (B) Treating participants as autonomous agents relates to the principle of
self-determination. (C) Balancing risks and benefits relates to the principle of beneficence.
(D) Freedom from coercion relates to self-determination.

15) A client with autoimmune thrombocytopenia and a platelet count of 8,000/μl develops
epistaxis and melena. Treatment with corticosteroids and immunoglobulins has been
unsuccessful, and the physician recommends a splenectomy. The client states, "I don't need
surgery — this will go away on its own." In considering her response to the client, the nurse
must depend on the ethical principle of:
a) Beneficence.
b) Autonomy.
c) Advocacy.
d) Justice.

Answer: B
Autonomy ascribes the right of the individual to make his own decisions. In this case, the
client is capable of making his own decision and the nurse should support his autonomy.(A
& D) Beneficence and justice aren't the principles that directly relate to the situation. (C)
Advocacy is the nurse's role in supporting the principle of autonomy.

Situation: A case was filed for a committed act by the nurse.

16) The doctor assigned to the dead patient who was also sued together with the nurses was
told to bring with him a copy of the patient’s chart when he takes the stand on the next
hearing. The hearing officer would have to issue what legal order to compel the doctor to
bring the patient’s chart?
a) Subpoena duces tecum
b) Injunction
c) Subpoena
d) Summon

Answer: A
Subpoena duces tecum is served to witness requiring him to bring records, papers and the
like which may be in his possession and which may help clarify the matter in issue.
Subpoena or a court summon is served directing a witness to appear and give testimony on
the date and time ordered. Injunction is a judicial process or order requiring the person or
persons to whom it is directed to do.

17) The nurse was summoned to court to testify and to bring records, papers and documents
pertinent to the case. This is called:
a) Witness
b) Subpoena
c) Subpoena duces tecum
d) Testimony

Asnwer: C
Subpoena duces tecum is served to witness requiring him to bring records, papers and the
like which may be in his possession and which may help clarify the matter in issue.
 Subpoena or a court summon is served directing a witness to appear and give testimony on
the date and time ordered. Witness is the necessity of testimony by any person in a legal
proceeding that is determined by the attorneys.

Situation: Miss Dimagiba was coming home from Kuwait where she worked for 5 years when
found out to have several vials of Morphine in her hand carried luggage. She was right away
detained for interrogation.

18) Under the Narcotic Drug Law, Miss Dimagiba may be held criminally liable because she:
a) Was found to have the drug in her possession
b) Is a patient and is using morphine for pain
c) Is going to administer the drug to a relative who is ordered by a licensed physician to
have the morphine sulfate
d) Is carrying the drug meant to be delivered by a licensed doctor

Answer: A
Nurses who violate this law are in danger of having their license revoked aside from the
imposed fine and/or imprisonment. (B C and D) The situation did not mention about this
accusation.

19) To protect her from legal suit, Miss Dimagiba must see to it that Morphine Sulfate and some
other drugs under the Dangerous Drug Act is ordered by a:
a) Narcotic licensed physician
b) Resident physician
c) Medical intern
d) Registered physician

Answer: A
Controlled Drugs under narcotic drug law must have a “yellow prescription” or a Prescription
coming from a Narcotic license physician. B C and D are not authorized to give prescriptions
to these drugs.

20) If found to be telling the truth, the nurse may be released right away. The fact that Morphine
Sulfate was meant to be given to a relative prescribed by a licensed physician considered to
be a:
a) Justifying circumstances
b) Mitigating circumstances
c) Exempting circumstances
d) Aggravating circumstances

Answer: A
Justifying circumstances acts when there is a reasonable necessity for the means employed
by the person defending himself/herself to prevent such aggression. Mitigating
Circumstances are those which do not constitute justification or excuse of the offense in
question. Exempting Circumstances exempts a person from criminal liability for an imbecile
or an insane person. Aggravating Circumstances are those attending the commission of a
crime and which increase the criminal liability.

21) A patient, G5P5, refused to be injected with her 3rd dose of Depo Provera. The nurse
insisted despite the patient’s refusal and forcibly injected to contraceptive. The nurse can
be sued for which of the following?
 a) Battery
b) Assault
c) Malpractice
d) Negligence

Answer: A
Battery is the execution of a threat or attempt to commit an assault, or the unlawful touching
or striking of another by any means, which results in bodily contact, that is intended, and is
neither consented to nor privileged. Assault is the imminent threat of harmful or offensive
bodily contact. Negligence is an act of commission or omission and Malpractice is an act of
being careless of a professional.

22) A voluntary client in a health care facility decides to leave the unit before treatment is
complete. To detain the client, the nurse refuses to return the client's personal effects. This
is an example of which of the following?
a) False imprisonment
b) Libel
c) Slander
d) Violation of confidentiality

Answer: A
Confining a voluntary client against his will may be considered false imprisonment. Slander
is oral defamation of character. The nurse hasn't given out any information about the client,
so confidentiality hasn't been violated. Libel is defamation by written words, cartoons or such
representations that cause a person to be violated. Slander is an oral defamation of a
person speaking unprivileged or false words. Violation of privacy is violation of the right to
be free from unwarranted publicity.

Situation: R.A. 7164 declares that it is the policy of the state to guarantee the delivery of basic
health services through adequate nursing personnel throughout the country.

23) In relation to quality nursing education, the Board of Nursing ensures that the nursing
schools:
a) Meet the standard of nursing practice
b) Graduate only competent students
c) Should be accredited
d) Comply with school requirements

Answer: A
The Philippine Nursing Act of 1991 states that the scope of nursing practice is to
emphasized the use of the nursing process as a scientific discipline in arriving at an
appropriate nursing action and care. (B C and D) is an incorrect statement and not included
in the act.

24) Nursing licensure tests require official transcript of records from the education department,
except:
a) Graduates from foreign schools
b) Graduates of level II accredited schools
c) Applicant for reexamination
d) When the record of related learning experiences is complete
 Answer: C
Re-takers or reexamination would not already require an official transcript record since it
was already given during you first filing of your licensure. A B and D requires OTR for
application.

25) It is mandated that a specific provision of nursing schools would have:

a) Provision for community learning experience
b) Evidence that the school follows educational standard
c) A 3-year college of nursing development plan
d) Community based curriculum

Answer: D
The four-year Bachelor of Science in Nursing Program offers competency-based community
oriented curriculum to educate future nurse practitioners to assume their roles and
responsibilities in the Philippine Health Care System.

Situation: Darwin, a nursing student, is formulating a nursing research as a requirement for his
subject.

26) While formulating a research problem, he knows that intuition may come during research
process. What is the role of intuition in the research process?
a) Intuition is unscientific and therefore has no role in scientific nursing research.
b) Intuition is easily expressed in a logical manner so that others understand.
c) Intuition may be valuable in linking ideas while interpreting findings.
d) Intuition represents a lack of knowing and should not be used in research.

Answer: C
Intuition, even though it is admittedly not empirical and ‘’scientific’’, has roles in identification
of problems, identification of variables that should be included in a study, and synthesis of
ideas when the researcher is interpreting the findings. This deep personal knowledge is
difficult to bring to consciousness and discuss logically with others.

27) It is important for Darwin to identify his theoretical perspective or framework in relation to the
research problem to be addressed. Which of the following describes the most commonly
used frameworks for nursing research?
a) Testable grand theories from nursing should be used to guide nursing research.
b) Abstract theories from various disciplines are useful in clinical nursing studies.
c) Testable midrange theories from nursing or related disciplines may be used to address
nursing problems.
d) The framework selected is used only to guide development of the study.

Answer: C
Testable mid-range theories from nursing and related disciplines development of nursing
research studies. Nursing as an applied discipline draws knowledge from many other areas.
Frameworks from other disciplines should be evaluated for their applicability to the nursing
studies and modified as needed.

28) As Darwin develops the research problems and purposes of the study, he must be taken
into consideration the feasibility of the study. Which of the following statements best
describes the concept of feasibility?
a) It is related to the capability and clinical usefulness of potential findings in other settings.
 b) It is an evaluation of the cost-benefit ratio between two alternative interventions.
c) It is based on the strength of previous research and of the theory base for the study.
d) It is an evaluation whether the researcher has the ability and resources

Answer: D
Feasibility addresses the question ‘’ Can the study as proposed be carried out?’’ A variety of
components, including ability of the researcher, availability of resources (e.g., time, facilities,
money subjects, cooperation of needed persons), ethical considerations, are included when
establishing whether or not study is feasible at this time.

29) Which of the following statements correctly describes a proposed study that will require use
of a measuring instrument not yet developed?
a) The study is not ethical and should not be done.
b) The study findings will not have clinical relevance for nursing because no measurement
method exists for the study variable.
c) The study will not feasible until a measurement method is developed for the study
variable.
d) The whole idea for the study is flawed and needs further development.

Answer: C
This is an example of a study that cannot be carried out at this time because of the lack of
necessary resource, namely, a way to measure concept. This lack does not mean that the
study is unethical, can never be done, or ought not to be carried out because it would not
make a potentially important contribution to knowledge. It simply means that the researcher
needs to back up a step and work on developing the needed measurement.

30) During his study, Darwin determines the cause and effect interactions, the cause portion of
the interaction is represented by the:
a) Dependent variable.
b) Independent variable.
c) Research variable.
d) Extraneous variables.

Answer: B
The independent variable is one that is manipulated to create an impact or effect on the
dependent or outcome variable.

Situation: Marie is going to conduct a quantitative research for her requirements in her graduate
schooling.

31) Which of the following statements correctly describes the research problem and purposes of
the study in a quantitative study?
a) The type of study, variables and population are specifically identified in the research
problem and are suggested by the purpose statement.
b) Each problem statements provides a basis for one possible purpose.
c) The purpose statement is very specific about what will be studied, whereas the problem
statement is more abstract.
d) The purpose statement should be implied in a study, instead of being specifically written.

Answer: C
 The problem statements may form the basis for several studies, each with a different
specific purpose. Each would address some aspect of the gap in knowledge.

32) Her research study report states that’’ Heart rate was recorded using a cardiac monitor’’.
This statement is an example of :
a) A conceptual definition.
b) Link of the variable to the framework.
c) An operational definition.
d) Intervention or treatment protocol.

Answer: C
The operational definition indicates that heart rate was measured with cardiac monitor.

33) When searching for a good review of literature, Marie encountered The Online Journal of
Nursing Synthesis. This source includes:
a) Individual research reports.
b) Researched-based papers.
c) Meta-analyses.
d) Integrative reviews of research.

Answer: D
The Online Journal of Nursing Synthesis includes all integrative reviews. Reports of
individual’s studies, research-based papers and met-analyses are not included. A meta-
analysis combines the results of several studies that address a set of related research
hypotheses

34) Marie decided to do field testing. She knows that field testing of an intervention protocol is
done in order to:
a) Test the intervention in a naturalistic situation.
b) Obtain repeated measures of outcome variables.
c) Test the intervention in carefully defines sample of people.
d) Test the marketability of the intervention.

Answer: A
Field testing of an intervention takes place in natural, uncontrolled settings. Sample
characteristics are allowed to vary, and the sample is only limited to people who are
experiencing the problem.

35) When formulating a research framework, Marie knows that which of the following about
frameworks in research is true?
a) Frameworks are important in both qualitative and quantitative studies.
b) Quantitative studies based on physiologic principles or scientific theory has no
framework.
c) The framework for qualitative studies is developed before data collection begins.
d) Frameworks in nursing studies usually are clearly expressed in the literature review and
used throughout the study.

Answer: A
Frameworks function in two types of studies. Quantitative studies use frameworks to guide
the developmental, methods, analytical and interpretative components of the study.
 Qualitative studies begin with a philosophical perspective and build theories from the data
collected.

36) Selected behaviors are considered scientific misconduct in conducting a study. Which of the
following types of scientific misconduct involves the intentional representation of the work or
ideas of others as the researcher’s own?
a) Fabrication
b) Irresponsible collaboration.
c) Plagiarism.
d) Selective retaining

Answer: C
Plagiarism is the international representation of the work or ideas of others as one’s own.
Fabrication is falsification of study steps. Selective retaining is a manipulation of data.

37) Bias is a term used to indicate that data in a study are being distorted or slanted away from
reality by some influencing factor. Which of the following statements about bias in research
is true?
a) It is the same as manipulation because the researcher determines the treatment to be
given.
b) The researcher cannot be a source of bias in a study because he or she is in control.
c) Preconceived ideas about what the finding of a study maybe could lead to bias in
interpreting data.
d) Instruments that are valid for measuring the identified variables are a source of bias.

Answer: C
Preconceived ideas or opinions of the researcher, especially if held strongly, may bias the
ways in which the study is conceived and implemented and the findings are interpreted.

38) Which of the following about quasi-experimental designs is true?

a) They are used to establish correlations between variables.
b) They are inferior to give experimental designs.
c) They are an alternative for establishing causality when an experimental study might not
be ethical or feasible.
d) Threats to internal validity cannot be controlled in these studies.

Answer: C
They are alternative for establishing causality when an experimental study might not be
ethical or feasible. The level of control is somewhat less, but many threats to internal validity
may be controlled with these designs. A well-designed and well-implemented quasi-
experimental study has the potential for adding to nursing knowledge and enhancing clinical
practice.

Situation: Nurse Manuel is conducting a research in his unit.

39) Upon defining what an outcome variable is, one of the nurse stated that which of the
following statements about outcome variables is true?
a) Available measuring instruments must be sensitive enough to detect changes over time.
b) The outcome should be apparent immediately after the care is provided.
c) Outcome variables should be identified as desirable by the providers of care.
 d) Outcome variables should be selected on the basis of the ease with which measures
can be obtained.

Answer: A
In order to be reliable for use in outcomes studies, measurement must be sensitive to
changes over time.

40) He knows that statistical analysis of outcome studies focuses on new methods of:
a) Identify statistically significant differences.
b) Analyzing change within an individual subject.
c) Calculating measures of central tendency.
d) Describing the characteristics of persons who tend to be like the general population.

Answer: B
Some outcomes researchers believe that the recommended analysis method of comparing
pre-test scores on outcomes scores and basing the analysis of change on ‘’residual change
score’’ is overly conservative and tends to understate the extent of real change.

41) Large computerized databases were utilized by Nurse Manuel for his study of patient
outcomes. Which of the following statements about such databases is not true?
a) They have standardized sets of data enormous numbers of patients and providers.
b) The are created by providers such as hospitals, health maintenance organizations
(HMOs) and health care professionals or by insurance companies, government agencies
and others not directly involved in providing patient care.
c) Few quality checks are performed on the data leading to privacy concerns.
d) The data include the variables needed to examine much of nursing practice.

Answer: D
Many political and cost issues are involved in the selection of variables included in large
database. Few of the variables needed to examine nursing practice are available in existing
large databases. Nurses have been out of the equation in the selection of variables and are
late in coming to the table to negotiate for inclusion of variables of interest to nursing
practice.

42) The process of describing clinical problems, identifying possible courses of action,
assessing the probability of outcomes and calculating an optimal course of action is referred
to as:
a) Practice pattern profiling.
b) Clinical decision analysis.
c) Consensus knowledge building.
d) Small-area analysis.

Answer: B
Clinical decision analysis is based on four assumptions: (1) decisions can be quantified; (2)
all possible courses of action can be identified and evaluated; (3) the different values of
outcomes, views from the perspective of the physician, patient, prayer and administrator,
can be examined, and (4) the analysis allows selection of an optimal course of therapy.

43) Which of the following statements about clinical guideline panels is true?
a) They are specifically charged with incorporation of available evidence about health
outcomes into recommendations concerning appropriate management.
 b) Membership on these panels is limited to physicians.
c) These panels must focus on development of randomized clinical trials.
d) Development of the recommendations from the panel must be based on objective
biophysiological data.

Answer: A
These panels are charged with development of recommendations for appropriate
management of identified conditions. The panels should be interdisciplinary. Outcomes to
be examined may include clinical outcomes and data from patients.

44) For a study using one independent variable and one dependent variable, a good sample
size would result if:
a) The study had 40 participants and 3 dropped out.
b) The study originally had 30 participants and 15 dropped out.
c) The study had 100 people and one half refused to participate.
d) The study had 500 people at the start and 75 at the end a year later.

Answer: A
The acceptance rate of the sample is high in that less than 10% dropped out.

45) Nonprobability quota sampling is most closely related to which of the following probability
sampling techniques?
a) Simple random sampling.
b) Stratified random sampling.
c) Cluster sampling.
d) Systematic sampling.

Answer: B
In both of these techniques, the number of subjects in each category is determined by the
researcher. The strata or groups may be designed to ensure that the sample reflects
population distribution, or to ensure that equal numbers of persons fit in each category so
that groups compared will be of equal (or nearly equal) size. In quota sampling,
convenience sampling, not random selection is used.

46) A nursing student wants to know about sampling methods. He determined that a sample
should be homogenous because:
a) Difference in the sample is desired.
b) The sample with common characteristics more clearly indicates the impact of a
treatment.
c) The sample should create its own characteristics.
d) Sample size is based in homogeneity.

Answer: B
Only when the sample elements are similar can the researcher be sure that the results are
due to the changes in the variables and not due to chance with changes in people.

47) A clinical instructor wants that the every fifth baby born in a city will be entered into a study,
the sampling method is called:
a) Stratified sampling.
b) Systematic sampling.
c) Random sampling.
 d) Cluster sampling.

Answer: B
Each subject in the sample is entered in the same way in this case, every fifth baby.
Stratified Sampling- technique used when the researcher knows some of the variables in the
population that are critical to achieving representatives. Random sampling is a sample in
which each unit has an equal and independent chance of selection. Cluster sampling is a
sampling technique used when "natural" groupings are evident in a statistical population.

48) Which of the following statements gives the major difference between control groups and
comparison groups in experimental research?
a) Random assignment to groups is needed to have a true to control group.
b) Random selection of subjects for the sample and the random assignment to groups are
hallmarks of true control groups.
c) It is less likely that comparison groups will have preexisting differences that may affect
results.
d) Most studies in nursing use to control groups.

Answer: B
Random selection and random assignment are hallmarks of true control groups. Control
groups are experiments that is conducted for the purpose of determining the effect of a
single variable of interest on a particular system, a scientific control is used to minimize the
unintended influence of other variables on the same system. Comparison group A group
that is not exposed to a particular intervention; changes in this group are used to estimate
what would have happened if the intervention had not been carried out.

Situation: Nurse Laurence is on the process of his research. He knows that sampling techniques
must be included in order to produce a good research.

49) The definition of a set of sampling criteria is:

a) A description of the characteristics of subjects who participated in a study.
b) Designed to ensure that samples for descriptive and correlational studies are very
homogeneous.
c) Designed to limit the effects of the independent variable on the dependent variable.
d) A list of the characteristics essential to be a member of the target population.

Answer: D
The sampling criteria list the characteristics essential for membership in the target
population. The sample is selected from the population that meets the criteria and when the
study is completed, the findings are generalized to this population.

50) When subjects are selected randomly on the basis of their fit in categories of variables
important to the study, the sampling method is referred to as:
a) Cluster sampling.
b) Quota sampling.
c) Systematic sampling.
d) Stratified random sampling.

Answer: D
Stratified Sampling- technique used when the researcher knows some of the variables in the
population that are critical to achieving representatives. Random sampling is a sample in
 which each unit has an equal and independent chance of selection. Cluster sampling is a
sampling technique used when "natural" groupings are evident in a statistical population.
Sytematic sampling is a sampling pattern, also referred to as non-targeted or grid sampling,
which is a statistically based sampling strategy whereby soil sampling points are located at
regular intervals throughout the site area on a grid pattern.

51) When a head nurse relates to people according to the roles, she is referred as a/an:
a) Authority
b) Leader
c) Manager
d) Decision-maker

Answer: B
Leader- a person sets as an example, inspires a groups of constituents to work together to
attain a goal. Authority- permission, a right coupled with the power to do an act or order
others to act Manager- One who has charge of a corporation and control of its business, or
of its branch establishments, divisions, or departments, and who is vested with a certain
amount of discretion and independent judgment

Situation: After three years of working as a staff nurse in a Medical Ward, Miss Anastacia was
promoted as a head nurse of a new unit on the basis of the leadership skills she had
demonstrated with her co-nurses.

52) As a good leader, Miss Anastacia has most likely demonstrated that she can:
a) Be subservient to nursing authorities in the hospital
b) Exert pressure upon her co-workers to achieve objectives
c) Always follow instructions and mandates of the hospital administration
d) Influence her co-workers to work for the achievement of the goals of nursing service

Answer: D
Leadership is the process of influencing the activities of an organized group in its effort
toward goal setting and goal achievement.

53) Miss Anastacia assigned two new team leaders for one month. As a team leader, the initial
activity would be which of the following?
a) Get the patient assignment
b) Organize the work load
c) Evaluate the performance of the staff
d) Document all nursing care rendered by the staff

Answer: B
The initial intervention a team leader would do is to determine if the workload has been
organized. Getting the patient assignment is your next step then followed by documentation
and evaluation.

Situation: The Nursing Service Director of a leading hospital in Manila wants all her patients to
get the care they rightfully deserve. With the permission of the Hospital Board, she asked one
of the best head nurses to organize a unit in such a way that patients are categorized according
to the severity of illness. She wanted this unit to be role model of quality patient care. The
health personnel were assigned in a manner that they meet the needs of the patients
accordingly.

54) Which of the following is the BEST reason for classifying patients according to the severity
of illness from the nursing viewpoint?
a) Overtime work is avoided
b) Staffing requirements are met
c) Professionals and non-professionals are delineated
d) Nursing care of clients is better planned

Answer: D
The primary aim of patient classification is to be able to respond to the constant variation in
the care needs of patients.

55) As a charge nurse of one of the teams, you are responsible to check the charts of the
patient assigned to your team. You noted that a “STAT” medication which you know was
given was not recorded. You are expected to do the following in the order:
1. Call the attention of the medication team
2. Let her explain reason why it was not charted
3. Make her write an incident report
4. Verify from other nurses why it was not charted

a) 4,2,3
b) 4,1,2
c) 2,3,4
d) 1,2,3

Answer: D
Calling the attention of the medication team verifies and recognizes a problem. A Letter of
explanation is demanded for documentation or incidents. Hearing the side of the nurse who
committed the failure woud verify directly. Do not verify from other nurses since this may
cause bias from the real incidence.

56) At a nursing staff meeting, there is discussion of perceived inequities in weekend staff
assignments. As a follow-up, the nurse manager should initially
a) Allow the staff to change assignments
b) Clarify reasons for current assignments
c) Help staff see the complexity of issues
d) Facilitate creative thinking on staffing

Answer: D
Facilitate creative thinking on staffing. The "moving phase" of change involves viewing the
problem from a new perspective, incorporating new and different approaches to the
problem. The manager can facilitate staff’s solving the problem.

57) The hospital is planning to downsize and eliminate a number of staff positions as a cost-
saving measure. To assist staff in this change process, the nurse manager is preparing for
the "unfreezing" phase of change. With this approach and phase the nurse manager should
a) Discuss with the staff how to deal with any defensive behavior
b) Explain to the unit staff why change is necessary
 c) Assist the staff during the acceptance of the new changes
d) Clarify what the changes mean to the community and hospital

Answer: B
Explain to the unit staff why the change is necessary. The first phase of change, unfreezing,
begins with awareness of the need for change. This can be facilitated by the manager who
clearly understands the need and stands behind it. The phase is completed when staff
comprehends the need for change.

58) When meeting with a family who'll learn that their 3-year-old is seriously ill, which action
demonstrates the nurse's role as collaborator of care?
a) Provide the parents with information about financial assistance programs.
b) Inform the family of the diagnosis and recently discovered findings.
c) Coordinate the multidisciplinary services and provide information about them.
d) Refer and consult with other specialties to help in treating the diagnosis.

Answer: C
The nurse can coordinate care when multiple services are involved, explaining the function
of each service (social services, case management, counseling services, and so forth). For
instance, providing parents with information about financial assistance programs is the
responsibility of social services. Informing the family of the diagnosis and recently
discovered findings is a physician's responsibility, as are referring and consulting with other
specialties.

59) The nurse is assigned to care for eight clients. Two nonprofessionals are assigned to work
with the nurse. Which statement is valid in this situation?
a) The nurse may assign the two nonprofessionals to work independently with a client
assignment.
b) The nurse is responsible to supervise assistive personnel.
c) Nonprofessionals aren't responsible for their own actions.
d) Nonprofessionals don't require training before they work with clients.

Answer: B
Assistive personnel may not be assigned to care for clients without the supervision of a
professional nurse. It's essential that assistive personnel understand that they're responsible
for their own actions. Assistive personnel must be adequately trained to perform all tasks
they're assigned to perform.

60) The nurse receives an assignment to provide care to 15 clients. Two of them have had
kidney transplantation surgery within the last 36 hours. The nurse feels overwhelmed with
the number of clients. In addition, the nurse has never cared for a client who has undergone
recent transplantation surgery. What is the appropriate action for the nurse to take?
a) Speak to the manager and document in writing all concerns related to the assignment.
b) Refuse the assignment.
c) Ignore the assignment and leave the unit.
d) Trade assignments with another nurse.

Answer: A
When a nurse feels incapable of performing an assignment safely, the appropriate action is
to speak to the manager or nurse in charge. The nurse should also document the concerns
 in writing and ask that the assignment be changed. In the event that the manager chooses
to leave the assignment as given, the nurse should accept the assignment. The nurse
should never abandon the assigned clients by leaving the workplace or asking another
nurse to care for them. The nurse may, however, refuse to perform a task outside the scope
of practice.

61) The nurse manager has implemented a change in the method of the nursing delivery system
from functional to team nursing. A nursing assistant is resistant to the change and is not
taking an active part in facilitating the process of change. Which of the following would be
the best approach in dealing with the nursing assistant?
a) Ignore the resistance
b) Exert coercion with the nursing assistant
c) Provide a positive reward system for the nursing assistant
d) Confront the nursing assistant to encourage verbalization of feelings regarding the
change

Answer: D
Confrontation is an important strategy to meet resistance head-on. Face-to-face meetings to
confront the issue at hand will allow verbalization of feelings, identification of problems and
issues, and development of strategies to solve the problem. Option A will not address the
problem. Option B may produce additional resistance. Option C may provide a temporary
solution to the resistance but will not address the concern specifically.

62) The nurse manager is planning to implement a change is the nursing unit from team nursing
to primary nursing. The nurse anticipates resistance to the change during the change
process. The primary technique that the nurse would use in implementing this change is
which of the following?
a) Introduce the change gradually
b) Confront the individuals involved in the change process
c) Use coercion to implement the change
d) Manipulate the participants in the change process

Answer: A
The primary technique one can use to handle resistance to change during the change
process is to introduce the change gradually. Confrontation is an important strategy used to
meet resistance when it occurs. Coercion is another strategy that can be used to decrease
resistance to change but is not always a successful technique for managing resistance.
Manipulation usually involves a covert action such as leaving out pieces of vital information
that the participants might negatively receive. Manipulation is not the best method of
implementing a change.

63) A nurse is monitoring a group therapy session. During this session, the members are
identifying tasks and boundaries. The nurse determines that these activities are
characteristic of which stage of group development?
a) Forming
b) Storming
c) Norming
d) Performing

Answer: A
 In the forming or initial stage the members are identifying tasks and boundaries. Storming
involves responding emotionally to tasks and boundaries. Storming involves responding
emotionally to tasks. In the norming stage members express intimate personal opinions and
feelings around personal tasks. In the performing stage members direct group energy
toward the completion of tasks.

64) Groups have a natural history of development. The phase during which group members
discover themselves, and test each other for appropriate and acceptable behavior is known
as:
a) Forming or orientation phase
b) Conflict or storming phase
c) Norming or cohesion phase
d) Working or performing phase

Answer: A
In the forming or initial stage the members are identifying tasks and boundaries. Storming
involves responding emotionally to tasks and boundaries. Storming involves responding
emotionally to tasks. In the norming stage members express intimate personal opinions and
feelings around personal tasks. In the performing stage members direct group energy
toward the completion of tasks.

65) A newly hired charge nurse assesses the staff nurses as competent individually but
ineffective and non-productive as a team. In addressing her concern, the charge nurse
should understand that the usual reason for such a situation is:
a) Unhappiness about the change in leadership.
b) Unexpressed feelings and emotions among the staff.
c) Fatigue from overwork and understaffing.
d) Failure to incorporate staff in decision making.

Answer: B
The usual or most prevalent reason for lack of productivity in a group of competent nurses is
inadequate communication or a situation where the nurses have unexpressed feelings and
emotions. Although the other answers could be contributing to the problematic situation,
they're less likely to be the cause.

66) Who conceptualized the Theory X and Theory Y?

a) Frederick Taylor
b) Elton Mayo
c) Mc Gregor
d) Henry Fayol

Answer: C. Douglas Mc Gregor’s Theory X views the person as lazy, does not like work &
avoids responsibility. Theory Y views human nature positively; people regard work as a
source of satisfaction Taylor: Theory of Scientific Management Elton Mayo is one of the
proponents of the Chicago Hawthorne Studies wherein they tested the effect of lighting to
the productivity of the people. Henry Fayol is the Father of Management Process

67) It is a theory characterized by collective decision-making; long term employment; slower

promotions; indirect supervision; holistic concern; trust; fair treatment; commitment and
loyalty
a) Theory X
 b) Theory Y
c) Theory Z
d) Goal Setting Theory

Answer: C.
Oichi’s Theory Z. Douglas Mc Gregor’s Theory X views the person as lazy, does not like
work & avoids responsibility. Theory Y views human nature positively; people regard work
as a source of satisfaction.

68) Which management style best demonstrates the end of the continuum of management
behaviors referred to by Douglas McGregor as theory Y? The manager
a) is responsible for motivation of employees towards the organizational goals
b) assumes employees are self-motivated and want to work toward organizational and
personal goals
c) takes a hands-off attitude and makes no decisions for employees
d) organizes teams of staff and gives compensation to the team rather than individual
success

Answer: B
Assumes employees are self-motivated and want to work toward organizational and
personal goals McGregor’s theory placed management behaviors on a continuum, with Y
being a set of propositions that describes managers as supporting people who naturally
work for organizational and personal goals

69) A nursing instructor asks the nursing student to describe the definition of a critical path.
Which of the following statements, if made by the student, indicates a need for further
understanding regarding critical paths?
a) “They are developed through the collaborative efforts of all members of the health care
team.”
b) “They provide an effective way to monitor care and for reducing or controlling the length
of a hospital stay for the client.”
c) “They are developed based on appropriate standards of care.”
d) “They are nursing care plans and use the steps of the nursing process.”

Answer: D
Critical paths are not specifically nursing care plans; however, they can take the place of a
nursing care plan and actually map out the desired clinical progress of a client during acute
admission. Options A, B and C appropriately describe the use of a critical path.

70) A newly appointed nurse manager is having difficulties with time management. Which advice
from an experienced manager should the new manager do initially?
a) Set daily goals and establish priorities for each hour and each day.
b) Ask for additional assistance when you feel overwhelmed.
c) Keep a time log of your day in hourly blocks for at least 1 week.
d) Complete each task before beginning another activity in selected instances.

Answer: C
Keep a time log of your day in hourly blocks for at least 1 week. Apply the nursing process
to time management in that assessment of the current activities is the initial step. A baseline
is established for activities and time use so that needed changes can be pinpointed.
71) What type of managers are responsible for the overall operations of nursing services;
establishing objectives, policies, and strategies; represent the organization in community
affairs, business arrangements, and negotiations?
a) Top managers
b) Middle managers
c) First level managers
d) Second level managers

Answer: A.
Middle managers coordinate nursing activities of several units. First level managers are
directly responsible for the actual production of nursing services

72) The efficient coordination of activities in departments like x-ray laboratory, dietary, etc., is
the responsibility of the:
a) Nurse supervisor
b) All nurse managers
c) Head nurse
d) Charge nurse

Answer: C
Head nurse act a collaborator to different members of health team.

73) As a staff nurse under the traditional chief nurse, notwithstanding, you are most expected to:
a) Maintain professional attitudes
b) Observe hospital rules and regulations
c) Adhere strictly too your job description
d) Maintain competence

Answer: C
Job descriptions are set of activities, functions given to you at work.

74) Management by Filipino values advocates the consideration of the Filipino goals trilogy
according to the Filipino priority-values which are:
a) Family goals, national goals, organizational goals
b) Organizational goals, national goals, family goals
c) National goals, organizational goals, family goals
d) Family goals, organizational goals, national goals

Answer: D
Filipinos prioritize their family first, so the family goals come first before organizational goals.
National goals are prioritized next after the organizational goals

75) Whether management at the community or agency level, there are 3 essential types of skill
managers must have, these are:
a) Human relations skills, technical skills, and cognitive skills
b) Conceptual skills, human relation/behavioral skills, and technical skills
c) Technical skills, budget and accounting skills, skills in fund-raising
d) Manipulative skills, technical skills, resource management skills

Answer: B
 Conceptual skills determine the ability of the manager to know the concept of his coverage.
Human relation/behavioral skills is the ability to interact and communicate with co workers
and the like. Technical skills us the knowledge and proficiencies required in the
accomplishment of engineering, scientific, or any specific task.

76) The nurse is assigned to care for an elderly client who is confused and repeatedly attempts
to climb out of bed. The nurse asks the client to lie quietly and leaves her unsupervised to
take a quick break. While the nurse is away, the client falls out of bed. She sustains no
injuries from the fall. Initially, the nurse should treat this occurrence as:
a) A quality improvement issue.
b) An ethical dilemma.
c) An informed consent problem.
d) A risk management incident.

Answer: D
The nurse should treat this episode as a risk management incident; her immediate
responsibility is to fill out an incident report and notify the risk manager. Quality improvement
and ethics aren't the nurse's initial concerns. The facility may choose to look at these types
of problems and make changes to deliver a higher standard of care institutionally. Informed
consent isn't a relevant issue in this incident.

77) The role of the nurse is seen more broadly today. Welfare of the patient is more likely to be
observed if health team members have knowledge of the:
a) Human bill of rights
b) Patient bill of rights
c) Magna Carta for health workers
d) Professional Code of ethics for Nurses

Answer: D
The professional code of ethics: The nurse provides services with respect for human dignity
and the uniqueness of the client, unrestricted by considerations of social or economic status,
personal attributes, or the nature of health problems. The nurse safeguards the client's right
to privacy by judiciously protecting information of a confidential nature. The nurse acts to
safeguard the client and the public when health care and safety are affected by the
incompetent, unethical or illegal practice of any person. The nurse assumes responsibility
and accountability for individual nursing judgements and actions. The nurse maintains
competence in nursing.

78) Which of the following statements about obtaining permission to study children is true?
a) Children aged 7 or older, with normal cognitive development, may be asked to assent to
participating in research.
b) If the child provides assent and is willing to participate in the study, the researcher can
proceed.
c) Children cannot be asked for assent until they are at least 15 years of age.
d) Assent from the child need not be sought if the parents or legal guardians agree to the
study.

Answer: A
CORRECT. Children age 7, who are not cognitively impaired, should be at a stage of
concrete operations and able to give meaningful assent. Researchers should be aware that
state laws differ and that they must comply with the laws of the state in which the data are
 being collected. (B) INCORRECT. Consent must still be obtained from the parent or legal
guardian. If the study involves minimal risk, permission from only one parent may be
sufficient. Researchers should be aware that state laws differ and that they must comply
with the laws of the state in which the data are being collected.(C) INCORRECT. Cognitive
ability, rather than actual age, is the deciding factor, so meaningful assent generally can be
obtained from children at age 7 if they are not cognitively impaired. Researchers should be
aware that state laws differ and that they must comply with the laws of the state in which the
data are being collected. (D) INCORRECT. Parental consent is not sufficient for older
children, because cognitive ability, rather than actual age, is the deciding factor. Meaningful
assent generally can be obtained from children at age 7 if they are not cognitively impaired.
Researchers should be aware that state laws differ and that they must comply with the laws
of the state in which the data are being collected.

79) Nurse Ronald encountered an ethical dilemma during his duty. The most important nursing
responsibility where ethical situations emerge in patient care is:
a) act only when advised that the action is ethically sound
b) not take sides and remain neutral and fair
c) assume that ethical questions are the responsibility of the health team
d) be accountable for his or her own actions

Answer: D.
In any situation where an ethical dilemma arises, it is the nurse’s responsibility to account to
what he had done. He will be the one to answer when a problem arises.

80) A client with mitral valve prolapse is advised to have elective mitral valve replacement.
Because the client is a Jehovah's Witness, she declares in her advance directive that no
blood products are to be administered. As a result, the consulting cardiac surgeon refuses to
care for the client. It would be most appropriate for the nurse caring for the client to:
a) Realize the surgeon has the right to refuse to care for the client.
b) Advise the surgeon to arrange for an alternate cardiac surgeon.
c) Tell the client that she can donate her own blood for the procedure.
d) Inform the client that her decision could shorten her life.

Answer: A
Physicians have an ethical and legal right to refuse to care for any client in a nonemergency
situation when standard medical care isn't acceptable to the client. It isn't the responsibility
of the surgeon to find an alternate. Jehovah's Witnesses don't believe in any kind of
transfusion, homologous or autologous. Informing the client that her decision can shorten
her life is inappropriate in that the statement may be inaccurate and it ignores the client's
right of autonomy.

Situation: Clients and patient in health care have both ethical and legal rights.

81) When a patient wants to know the prognosis of his illness, the best action to take is:
a) Refer to your senior nurse
b) Advise a patient to ask his doctor
c) Give a direct answer
d) Discuss it with the family

Answer: B
 The primary responsibility of the nurse to the patient is to give him/her the kind of care
his/her condition needs regardless of his/her race, creed, color, nationality or status. The
Doctor is the one responsible in telling the prognosis of the patient.

82) Your patient complains when you told her to take home her expensive belongings for
safekeeping. What is the best action to take:
a) Suggest that these be kept in her locked table drawer
b) Bring the matter to the attention of the head nurse
c) Keep in the unit cabinet under lock and key
d) Discuss with her the hospital policy

Answer: D
Hospital policy states that the hospital will not be held for any loss of belongings. Discussing
this to the patient would reiterate the rules. A and C would not ensure safety of the
belongings and B would be done if he is resistant to the policy.

83) The physician has an order to limit visitors for your patient. One morning a relative insisted
to visit him. Your best response is to:
a) Call the security guard
b) Show him the “No Visitors” sign
c) Explain the need for the patient to rest
d) Allow a brief visit

Answer: D
The question stated that only to limit visitor therefore visitors are still allowed yet for a short
period of time.

84) Touching other people without their permission, reading someone else's mail, and using
personal possessions without asking permission are all examples of:
a) Antisocial behavior.
b) Manipulation.
c) Poor boundaries.
d) Passive-aggressive behavior.

Answer: C
The described behaviors indicate poor personal boundaries, which is the inability to
differentiate between self and others. Poor boundaries are symptoms of antisocial and
passive-aggressive behavior. Manipulation is an attempt to control another person.

Situation: Nurses oftentimes encounter various clinical dilemmas in the care of their patients in
special areas of the hospital like ICU and Operating Room

85) One time, a nurse in the ICU was told by the hospital administrator to omit the blood
transfusion ordered by the doctor because the patient is going to die eventually anyway.
What must the nurse do?
a) Follow the doctor’s order and be silent about it
b) Resign from the job as pressured by the administration
c) Report the incident to the doctor and risk her job depending upon the doctor’s decision
d) Obey the order of the hospital administration
 Answer: C
This incident must be reported to the doctor since the physician has the authority over the
treatment of the patient. None the less if the patient refuses the blood administration and
has signed the chart, we cannot give the blood.

86) The dying patient was visited by his spiritual adviser. The private nurse was with the patient
all the time during the chaplain’s visit. When an elder brother came to visit, he asked the
nurse what the sick brother and the chaplain was talking about. What would be the right
thing for the nurse to do?
a) Ask the relative to look for another nurse who may tell him even if it is privileged
communication
b) She should not reveal anything to the visitor because it is privileged communication
c) Tell the elder brother that relatives should keep out of the spiritual affairs of the patient
d) She should reveal some information that concerns the elder brother of the patient

Answer: B
Confidentiality information is also termed as privilege communication because it is given
based on trust. Telling the elder brother would break the confidentiality between you and the
patient.

87) Which of the following should be considered by the nurse before getting the client/patient to
sign the operative consent?
a) Evaluate the client’s level of consciousness and intellectual capability
b) Sedate the client to make sure she is relaxed enough to sign the consent form without
mild anxiety
c) Ascertain that the surgeon has prepared the client explaining the proposed operative
procedure
d) Withhold all medication eight hours prior to obtaining the consent

Answer: C
Surgeon is responsible in explaining the procedure, its complication and expected outcome
to the patient. The nurse acts as a witness to that consent. Prior to operation the nurse
ascertains that it has been explained properly by the surgeon.

88) Assertive behavior involves which of the following elements?

a) Saying what is on your mind at the expense of others
b) Expressing an air of superiority
c) Avoiding unpleasant situations and circumstances
d) Standing up for your rights while respecting the rights of others

Answer: D
The basic element of assertive behavior includes the ability to express your feelings and
thoughts while respecting the rights of others. Options A and B describe aggressive
behavior, and option C describes passive behavior.

89) Nurses must value patient according to patient’s bill of rights. Which statement about value
is correct:
a) Extrinsic value are associated with maintenance of life
b) Most individuals possess many personal values
c) Nurse values are essential to quality care
 d) Govern an individual’s behavior but not their choices

Answer: C
Under patient’s bill of rights, providing quality care and respectful care must be held. IN
doing so, the patient’s care shall be based on needs, the physician’s order and the ailment
and shall involve the patient and/or his/her family so that he/she or any of the family can
participate in his/her cares.

Situation: As a nurse, we must be aware of advance directive. The following pertains to advance
directive and your interventions regarding this issue.

90) A client with terminal breast cancer is being cared for by a long-time friend who is a
physician. The client has identified her twin sister as the agent in her durable power of
attorney. The client loses decision-making capacity, and the twin sister says to the nurse,
"There will be a different physician caring for my sister now. I've dismissed her friend." In
response, the nurse should:
a) Inform the sister that she doesn't have the power to assign a different physician.
b) Ask the dismissed physician if the client ever stated she wanted a different physician.
c) Abide by the wishes of the sister who is the durable power of attorney agent.
d) Politely ignore the sister's statement and continue to call the dismissed physician for
orders.

Answer: C
A durable power of attorney transfers all rights that the individual normally has regarding
health care decisions to the designated agent. It's within the power of the twin sister to
change the physician caring for her terminally ill twin. The dismissed physician has no power
to interfere with the wishes of the durable power of attorney. It would be inappropriate and
unprofessional of the nurse to ignore the wishes of the client's agent.

91) A patient who is admitted to the hospital gives the nurse an advance directive. The nurse
should understand that an advance directive is?
a) A written statement by the patient that defines acceptable care if the patient becomes
incapacitated.
b) The name of the person designated by the patient to make health-related decisions
should the patient become incapacitated.
c) A statement identifying the patient as an organ donor.
d) A written statement authorizing a particular surgical procedure.

Answer: A
(A) An advance directive is a written document that contains directives of the person's
choices regarding end of life care. A person must have the cognitive and communicative
abilities to execute decisions regarding their desires. It includes wishes for treatment options
should the person become unable to do so. (B) A durable power of attorney for healthcare
designates an individual to make medical decisions in case the patient is unable to do so.
(C) A statement identifying the person as an organ donor may be included in an advance
directive, but it is not the only information in an advance directive. This information would
typically be included on an organ donor card. (D) A written statement authorizing a particular
surgical procedure is a consent form.
92) A client asks the nurse to help her make out her will. Which of the following possible
responses by the nurse would be best in this situation?
a) "I'm not a lawyer, but I'll do what I can for you."
b) "You have a long way to go before you'll need to do that. Let's wait on it a while, shall
we?"
c) "I don't believe in getting involved in legal matters, but maybe I can find another nurse
who'll help you"
d) "You need to consult an attorney because I'm not trained in such matters. Is there a
family lawyer I can call for you?"

Answer: D
(D) A will is an important legal document. It is best to have one prepared with the help of an
attorney. (A) It would be unwise to help the client because a nurse is not a lawyer. (B)
Asking the client to delay preparing the will just avoids the problem. (C) It is also not helpful
to seek out another nurse to help the client prepare a will.

93) A patient with terminal cancer has reached the stages of acceptance. She told the nurse
that she wants to sign an advance directive once he went to a cardiac arrest. What of the
following should the nurse do?
a) Seek further advice from other nurses before making any further drastic decision
b) Disregard the patient’s request
c) Continue the all efforts to maintain patient’s life
d) Respect the client’s decision

Answer: D
This pertains to the autonomy of the patient and has the right to have an advance directive
(such as a living will) concerning treatment. Since this decision was made by the patient, we
must respect it.

Situation: Culture must be taken consideration for providing care for the patient.

94) Nurse Bendita is caring for a Japanese patient. Since she is not aware of the culture of the
patient. What would be best for nurse Bendita regarding cultural sensitivity?
a) Being aware of the patient's social standards.
b) Paying attention to environmental cues.
c) Identifying her personal reaction to the patient.
d) Talking with other staff who have interacted with the patient.

Answer: C
(C)In order to provide culturally sensitive care, the nurse must be aware of her own
ethnocultural heritage, both as a person and as a nurse. Becoming aware of one's own
biases and gaining knowledge of other cultures enables the nurse to begin to develop an
attitude in which the patient's culture and healthcare beliefs, values and practices are
respected and incorporated into the plan of care. (A) Many variations in socio-economic
status and social class can be found within any cultural or ethnic group. (B) Environmental
awareness may provide some clues about a patient's culture, health beliefs, values and
practices but it is not the most effective way to increase one's cultural sensitivity. (D)Talking
with others may provide some insight about a patient's culture, health beliefs, values and
practices but it is not the most effective way for the nurse to increase his/her cultural
sensitivity.
95) Which of the following questions would be essential in a cultural assessment of a patient?
a) How many times have you been married?
b) At what times do you take your medications?
c) Do you have any siblings?
d) Are there foods that you cannot eat together?

Answer: D
(D) Ethnic groups tend to vary in their food customs. The nurse should be aware of what
foods can be eaten, what foods are forbidden and what foods mayor may not be eaten
together. (A) While marriage customs vary among ethnic groups, knowledge of the number
of marriages is not essential to patient care. (B) The broader question that should be
addressed in a cultural assessment is the use of folk medicines and herbs. (C) Family
customs regarding health and healthcare rather than the number of siblings are important to
identify in a cultural assessment.

96) A patient who is a Jehovah's Witness is scheduled to have a bowel resection for colon
cancer. When planning care for the patient, the nurse should be aware that
a) the resected colon and surrounding tissue will be officially buried.
b) surgery must be delayed until the curandero visits.
c) Holy Communion should be given on the day of surgery.
d) the patient will most likely refuse any blood transfusion.

Answer: D
(D)The patient will most likely refuse any blood transfusions. Jehovah's Witnesses are
generally opposed to transfusions, including banking their own blood. (A)In Judaism
(orthodox and conservative), amputated limbs, organs or surgically removed tissue should
be made available to the family for burial. (B)In Mexico, the curandero is a spiritual healer
who travels about curing those with ailments caused by witches and sorcerers. It is
assumed that they also cure regular illnesses as well. (C)Episcopalians, Methodists,
Nazarenes, Presbyterians, Catholics and Lutherans all receive communion. Jehovah's
Witnesses do not believe in the concept of Holy Communion.

Situation: Identifying moral principles is included as a nursing responsibility.

97) The nurse assigned to a patient who is in great pain with gouty arthritis and he doesn’t want
to be move. You know as a nurse that he is risked for developing pressure ulcer. Under the
principles of two fold effect, what would be the best action by the nurse?
a) Perform logrolling to the patient.
b) Let the patient remain on is position
c) Report to the doctor about the patient’s response
d) Inform nursing supervisor about the incident.

Answer: A
Two fold effect pertains to situations that which may have both good and bad effects and
that the basis of the action must be under the following: that the action must be morally
good, that the good effect must be willed and the bad effect merely allowed, that the good
effect must not come from an evil action but from the initial action itself directly, and that the
good effect must be greater than the bad effect. In the case of the patient, moving him would
prevent greater problem like bed sores.
98) A client is brought to the emergency room by emergency medical service (EMS) after being
hit by a car, the name of the client is not known and the client has sustained a severe head
injury and multiple fractures and is unconscious. An emergency craniotomy is required.
Regarding informed consent for te surgical procedure, which of the following is the best
action.
a) Obtain a court order for the surgical procedure
b) Transport the victim to the operating room for surgery
c) Call the police to identify the client and locate the family
d) Ask the EMS team to sign the informed consent.

Answer: B
Generally, there are two situations in which informed consent of an adult client is not
needed. One is when an emergency is present and delaying treatment for the purpose of
obtaining informed consent would result in injury or death of the client. (A) will delay
treatment. (C) this is not the best action at that moment, (D) is inappropriate.

99) The nurse as just assisted a client back to bed after a fall. The nurse and physician have
assessed the client and have determined that the client is not injured. After completing the
incident report, the nurse should take which action next?
a) Reassess the client
b) Conduct a staff meeting to describe the fall
c) Document in the nurse’s notes that an incident report was completed
d) Contract the nursing supervisor to update information regarding the fall

Answer: A
The client’s fall should be treated as private information and shared on a ‘need to know”
basis. Communication regarding the event should involve only those participating in the
client’s care. An incident report is a problem-solving document; however, its completion is
not documented in the nurse’s notes.

100) The nursing instructor provides a lecture to nursing students regarding the issue of
client’s rights and asks a nursing student to identify a situation that represents an example
of invasion of client privacy. Which of the following, if identified by the student, indicates an
understanding of a violation of this client right?
a) Performing a procedure without consent
b) Threatening to give a client a medication
c) Telling the client that he or she cannot leave the hospital
d) Observing care provided to the client without he client’s permission

Answer: D
Invasion of privacy takes place with unreasonable intrusion into an individual’s private
affairs. Performing a procedure without consent is an example of battery. Threatening to
give a client a medication constitutes assault. Telling the client that he cannot leave the
hospital constitutes false imprisonment.