NP2

SITUATION: A 15 yeas old client complains of persistent dysmenorrhea.

1. The nurse should encourage her to:

C. Eat a nutritious diet containing iron

2. A client at the women's health clinic tells the nurse she has endometriosis. To best help this client the nurse must understand that endometriosis is characterized by:

C. Painful menstruation and backache

3. A client undergoing treatment for infertility is diagnosed as having endometriosis. Which of the following drugs should the nurse expect to be used for this conditions?

B. Leuprolide (Lupron)

Situation 2: A thin 68-year-old female client is diagnosed with osteoporosis.

4. What should the nurse include in the discharge plan for this client?

C. Instructions relative to diet and exercise

5. When writing a teaching plan about osteoporosis, the nurse should recall that osteoporosis is best described as:

D. Decrease in bone substance

6. Which factor identified by the nurse places the client at increased risk for developing osteoporosis?

C. Prolonged immobility

7. The nurse plans care for a client with osteoporosis to prevent fractures. What type of fracture is the nurse trying to prevent?

B. Pathologic

8. Select all the statements by a 50-year-old obese client that indicate understanding of the strategies to prevent bone loss. "I should:
A. Go on a strict diet."
B. Take 1200 mg of calcium daily."
C. Take 1000 mg of vitamin D daily."
D. Join an aerobics class three times a week."
E . Exercise with free weights two times a week."

C. B & D

Situation 3: After a client has a biopsy for suspected cervical cancer, the laboratory report reveals a stage 0 lesion.
indicative of:
9. The nurse explains that according to the International Federation of Gynecology and Obstetrics, stage 0 is

A. Carcinoma in situ

10. An early manifestation of cancer of the cervix that should prompt a client to seek medical care is:

D. Bloody spotting after intercourse

11. The most common site for cancer cell growth in the cervix is at the:

D. Columnosquamous junction of the internal and external ossa

Situation 4: A client is diagnosed with uterine fibroids and the practitioner advises a hysterectomy.

12. The client expresses concern about having a hysterectomy at age 45 because she has heard from friends that she will undergo severe symptoms of menopause after surgery. The most appropriate response for the nurse is:

D. "Some women occasionally experience exaggerated symptoms of menopause if, an addition to their uterus, their ovaries are removed."

13. After a hysterosalpingo-oophorectomy, a client wants to know whether it would be wise for her to take hormones right away to prevent symptoms of menopause. The most appropriate response by the nurse is:

D. "You should discuss this with your doctor, because it is important to know your concerns."

14. After an abdominal hysterectomy the client returns to the unit with an indwelling catheter. The nurse notes that
the urine in the client's urinary bag has become increasingly sanguineous. The nurse suspects that the client may have:

A. An incisional nick in the bladder

Situation 5: A client's pathology report shows metastatic adenocarcinoma of the breast.

15. The client is to receive doxorubicin (adriamycin) as part of the chemotherapy protocol. This drug modifies the
growth of cancer cells by:

A Inhibiting DNA synthesis

16. A client who had a mastectomy asks about the term ERP-positive. The nurse explains that tumor cells are evaluated for estrogen receptor protein to determine the:

C. Potential response to hormone therapy

17. After a mastectomy, the nurse should position the client's arm on the affected side:

C. On pillows with the hand higher than the arm

18. When encouraging a client to cough and deep breathe after a bilateral mastectomy, the client says, "Leave me alone! Don't you know I'm in pain?" The nurse most therapeutic response should be:

B. Your pain is to be expected, but you must expand your lungs."

Situation 6: A client suspects that she is pregnant, but because she is the only wage earner in her family she is ambivalent about continuing the pregnancy.

19. The nurse recognizes that the client is in crisis and also remembers that pregnancy and birth are considered crises
because:

B. They are periods of change and adjustment to change

20. After the first 3 months of pregnancy, the chief source of estrogen and progesterone is the:

A. Placenta

21. Anticipatory guidance provided by the nurse during the first trimester of pregnancy should be primarily directed toward increasing the pregnant woman's knowledge of:

D. Physical and emotional changes resulting from pregnancy

22. The nurse at the prenatal clinic examines a client and determines that her uterus has risen out of the pelvis and is now an abdominal organ. At what week during pregnancy does this occur?

C. 12th week of pregnancy

Situation 7: A mothers class was conducted by a group of nursing students in Barrio Masangkay, their topic is on fertilization and fetal growth and development.

23. A nursing instructor ask the nursing student to list the function of the amniotic fluid. The students responds correctly by stating which of the following are function of amniotic fluid ? Select all that apply

A. Allows for fetal movement
B. It is a measure of kidney function
C. Surrounds, cushions, and protect the fetus
D. Maintain the body temperature of the fetus
E. Prevents large particles such as bacteria such as bacteria from passing to the fetus
F. Provides an exchange of nutrients and waste products between the mother and the fetus

D. A,B,C,D,E

24. A nurse midwife is assessing a pregnant client for the presence of ballotement, to make this determination the
nurse-midwife does which of the following

C. Palpates the abdomen for fetal movement

25. A nurse is providing instructions to a pregnant client who is scheduled for an amniocentesis. The nurse tells the client that:

B. An inform consent needs to be signed before the procedure.

26. A nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Which of the following are probable signs of pregnancy? Select all that apply.
A. Ballottement
B. Chadwick's sign
C. Uterine enlargement
D. Braxton Hicks contraction
E. Fetal heart rate detected by a non electronic device
F. Outline of fetus via radiography or ultrasonography

B. A,B,C,D

Situation 8: A primiparous mother had her first prenatal visit.

27. A rubella titer result of a 1 day post partum client is less than 1:8, and a rubella virus vaccine Prescribed to be administered before discharge. The nurse provides which information to the client about the vaccine? Select all
that apply. A. Breast-feeding needs to be stopped for 3 months.
B. Pregnancy needs to be avoided for 1 to 3 months
C. The vaccine is administered by the subcutaneous route.
D. A hypersensitivity reaction can occur if the client has an allergy to eggs.
E. Exposure to immunosuppressed individuals needs to be avoided. F. The area of the injection needs to be covered with a sterile gauze for 1 week.

D. B, C, D

Situation 9: A 19-year-old primigravida at 38 week's gestation is admitted to the hospital in active labor that began 8 hours ago. Her mother accompanies her to the labor unit.

28. When the cervix is 6 cm dilated, the client receives a continuous lumbar epidural block. After administration of this anesthesia, it is most important for the nurse to assess the

C. level of anesthesia

29. The nurse performs Leopold's maneuvers. When the client asks what these maneuvers are for, the nurse's best response is to explain that they help determine

A. fetal presentation

30. The nurse formulates a nursing diagnosis for the client in the transitional phase of labor. The most appropriate
diagnosis is

D. Pain related to increasing frequency and intensity of uterine contractions.

31. On admission, the client is breathing rapidly and complains of feeling dizzy and lightheaded. The client's cervix is 5 cm dilated. The nurse determines that she is most likely experiencing effects of

C. hyperventilation.

32. The nurse plans to instruct the client about the gate control theory of pain. Which of the following statements would be appropriate for the nurse to include in the teaching plan?

D. The gating mechanism is in the spinal cord.

33. The nurse explains that according to the gate control theory of pain, a closed gate means that the client should experience

A. No pain.

34. The physician has ordered prostaglandin E₂ gel for the client. The nurse plans to explain to the client that the purpose of the gel is to

C. ripen the cervix.

35. The client complains of severe back pain during labor. The nurse should instruct the client that her severe back pain is most likely due to the fetal occiput being in a position termed

C. Posterior.

36. The client's contractions and fetal heart rate are monitored with external electronic equipment. The nurse determines that there is a variable deceleration pattern on the fetal heart rate. The nurse should first

B. change the client's position.

Situation 10: A 27-year-old primigravida at 34 weeks' gestation is seen insulin-dependent diabetes. the high-risk prenatal clinic. She has

37. While caring for the pregnant diabetic client in labor, the nurse plans to

D monitor blood glucose levels every hour.

38. The fetal presenting part is at- 1 station when the membranes ruptured, the nurse should

D. check for prolapsed umbilical cord.

39. When planning to teach the client how to monitor glucose control and insulin dosage at home, the nurse should explain that the goal of medical management is to maintain blood plasma glucose levels at

C. 90 to 110 mg/dl before meals and snacks.

40. At 37 week's gestation, the client is admitted to the hospital for induction of labor. The nurse should explain to the client that she is being induced before term to prevent.

C. stillbirth.

Situation 11: You are a nurse assigned for nutrition education class in your barangay. The following questions deals with teaching clients with regards to improving their health through health promotion.

41. Mr. Rodriguez asks you what is the normal allowable salt intake in a day. Your best response to Rodriguez is:

b. 5 grams of salt a day or 1 teaspoon of salt a day

42. You would educate Mr. Rodriguez with regards to lowering his salt intake using which of the following instruction EXCEPT:

b. Limit table salt but condiments is advisable

c. Minimize the intake of tocino, longanisa and other processed foods

43. Which of the following is the best method of teaching young mothers with regards to nutrition education?

d. Cooking demonstration and meal planning

44. The cure of cancer would depend on:

b. Early detection and early treatment

45. In health education, which of the following is a role of the Nurse?

b. Educate as many people about warning signs of non-communicable diseases

Situation 12: Nurses and sudden unusual incidence

46. Sandra, an R.N., reports to work looking unkempt. Nancy, another R.N. approaches when she notices her using uncoordinated movements. Sandra's breath reeks of peppermints and Nancy suspects Sandra may be intoxicated.
What is the best initial nursing action for Nancy to take?

a. Call the supervisor and report Sandra

47. As good nurse leader in your ward, you must know how to provide a therapeutic environment. Your initial approach to creating a therapeutic environment for any client should give priority to:

a. Providing for the client's safety

48. You mu must know the proper nursing management for elderly patients. During the day a nurse puts side rails up on the bed of a 78-year-old client who was admitted in your ward and has a hip fracture. The reason for this action is:

a. As a safety measure because of the client's age

49. An elderly client is apprehensive about being hospitalized. The nurse realizes that one of the stresses in the hospital that she must know how to manage is the patient's strangeness of the new environment and activities. Stress of the patient can best be prevented or limited by?

b. Explaining what behavior is expected

50. The civil rights of the client would not be jeopardized in which of the following situation?

c. Giving psychiatric client's letter addressed to the physician

Situation 13: A multiparous client thought to be at 14 weeks' gestation (based on uterine size) visits the prenatal that she is experiencing such severe morning sickness that "she has not been able to keep anything down for a week".

51. Due to the client's excessive vomiting, the nurse assesses the client's urinalysis results for

D. Acetone

52. Because the client states she has been vomiting for 1 week, the nurse should assess for symptoms of

C. Hypokalemia

53. The nurse explains to the client that hyperemesis gravidarum is thought to be related to high levels of the hormone

B. Estrogen

Situation 14: A 38-year-old client about 14 weeks' gestation is admitted to the hospital with diagnosis of complete hydatidiform mole. Hmo

54. Soon after admission, the nurse should assess the client for symptoms of

A. PIH.

Situation 15: Pharmacology in Child Health Nursing

55. A 7-year-old child with cystic fibrosis is receiving an intravenous antibiotic. The medication is supplied in a 125-mL bag of normal saline. It is to be infused over 30 minutes. At what rate should the infusion pump be set to deliver
the medication at the prescribed time?

A. 250 mL/hour

56. An infant is receiving parenteral therapy. The IV orders are 400 mL of D50.45 NS to run in 8 hours. At what rate should the nurse maintain the hourly rate?

D. 50mL/hr

Situation 16: Care of Client with CAST.

57. A 4-month-old infant is in a spica cast. What should the nurse include in the discharge instructions?

A. Obtain a specially design car seat

58. When elevating the head of an infant in a spica cast, the nurse should:

D. Raise the entire mattress at the head of the crib

Situation 17: Care of Clients with Cretinism.

59. A 3-month-old infant has been diagnosed with congenital hypothyroidism. What is the probable effect on the child's future i treatment is not begun in early infancy?

B. More severe mental retardation

C. Development of spastic paralysis

Situation 18: Care of Client with Cleft lip.

60. What should nursing care for an infant after the surgical repair of a cleft lip include?

B. Placing the infant in a semi-sitting position

61. For an infant born with a unilateral cleft lip and palate, feeding will probably be:

C. Achieved with a rubber-tipped syringe or medicine dropper

Situation 19: Care of Client with Pyloric Stenosis.

62. An infant with hypertrophic pyloric stenosis (HPS) is admitted to the pediatric unit. When palpating this infant's abdomen, the nurse expects:

C. An olive-sized mass in the right upper quadrant

63. The nurse should carefully observe the infant with a tentative diagnosis of hypertrophic pyloric stenosis for;

A. Signs of dehydration

64. An infant has had corrective surgery for hypertrophic pyloric stenosis. To reduce vomiting, the nurse should teach the mother that immediately after feeding the infant, she should:

C. Place the infant flat on the right side

Situation 20: Care of Client with PKU.

65. Dietary treatment of children with PKU includes a:

D. Low-phenylalanine diet

66. What should the nurse include in the teaching plan for parents of an infant diagnosed with PKU?

A. Mental retardation occurs if PKU is untreated

SITUATION 19: Breastfeeding is essential in Newborn Care.

67. The nurse should explain to a client that breastfeeding is always contraindicated with:

B. Hepatitis C

68 . The client response that indicates understanding of teaching regarding breast care for the mother who is
breastfeeding is, "I will:

C . Air dry my nipples after feeding."

69. A client who is breastfeeding is being discharged. The client tells the nurse that she is worried because her neighbor's breast "dried up" when she got home and had to discontinue breastfeeding. What should the nurse reply?

C . "This can happen with the excitement of going home, but putting the baby to breast more often should re-establish lactation.

70. To limit the development of hyperbilirubinemia in the breast neonate, the plan of care should include:

D. Encouraging more frequent breastfeeding during the first 2 days after birth

71. The nurse identifies that a woman needs further teaching about breastfeeding her newborn when she:

A. Leans forward to put her breast and in a side-lying position

72. A client asks about the difference between cow's milk and the milk from her breasts. The nurse should respond that cow's milk differs from human milk in that it contains:

D. More protein, more calcium, and fewer carbohydrates

SITUATION 20: At 12 weeks' gestation, a client who is Rh-negative completely expels the products of conception.

73. After determining that she has not been previously sensitized, the nurse should:

A. Administer RhoGAM within 72 hours

74. A client who has type O Rh-positive blood gives birth. The neonate has type B Rh-negative blood. When the nurse assesses the neonate 11 hours after birth, the infant's skin appears yellow. This is most likely caused by:

D. ABO incompatibility

75. The nurse in the newborn nursery observes a yellowish skin color of an infant whose mother had a caesarean birth. The immediate nursing action should be to:

B. Ascertain the age of neonate

76. When observing a newborn for signs of pathologic jaundice, the nurse should be alert for:

D. Jaundice developing between the first 12 and 24 hours

SITUATION 21: Care of the Pre-term Newborn

77. The nurse must continuously monitor a preterm infant's temperature and provide appropriate nursing care
because the preterm infant, unlike the full-term infant, has:

C. A limited supply of brown fat available to provide heat

78. When meeting a preterm infant's hydration needs, the nurse should know that the preterm infant's urinary
function:

B. Results in the loss of large amounts of urine

79. When caring for preterm infants with respiratory distress, the nurse should keep:

B. Them in a high-humidity environment

Situation 22: Nursing Management

80. A nurse who was new to a unit was caring for an elderly patient. The physician on call ordered a treatment that should be given to a patient, but the nurse knows that he is incompetent in the performance of said procedure. The
nurse should?

C. Refuse to perform the treatment

81. A nurse gave a patient the wrong medication. The patient was seriously injured. The patient sued. Who will most likely be held liable?

d. The nurse and the hospital

82. The supervisor of a cardiovascular unit, responsible for checking staffing patterns, assigned a particular staff nurse to work on the unit because that nurse had many years of experience on that unit. That evening, this staff nurse made a treatment error and a patient was injured. Who is liable?

c. The staff nurse and the hospital

83. Nurse A notice that Nurse B was intoxicated while giving care however. Nurse A did not report this fact to the supervisor. That same day, Nurse B made a medication error a patient was injured. Who may be held responsible?

b. Nurse A, Nurse B, and the hospital

84. A patient is terminally ill and has asked a nurse to witness in making a will. Which statement is true?

a. The nurse has a legal obligation to act as a witness to a will

c. The nurse should make sure that the patient is of sound mind, (not under the influence of drugs or alcohol), and understand what he or she is doing

Situation 23: professional nursing practice

85. A client receives a medication that was intended for another person. An appropriate way to document this event in the medical record would be:

a. "Client was given XXX mg of YYY drug in error"

86. The one reason for that client offer, above all others, for suing practitioner for medical negligence is:

a. The care they received was substandard

87. The Confidentiality of medical records is always a valid concern, especially in this age of computerization and fax
machines. Release of medical information to third parties is:

b. Prohibited without informed consent of the client

88. Your nursing license may be in jeopardy. if:

b. You delegate client assessment task to an NA who has been floated to your outpatient clinic for the day

89. Which situation is an example of a nurse malpractice?

a. An infant is injured as a result of incorrect information provided to the parents by the nurse on the use if a child safety restraint in a car

SITUATION 24: A 1-month-old infant is admitted to the pediatric unit with a tentative diagnosis of Hirschsprung's disease (congenital aganglionic megacolon).

90. What procedure will probably be ordered to confirm the diagnosis?

B. Suction biopsy

91. The practitioner orders a tap-water enema for a 6-month-old infant with suspected Hirschsprung's disease. What rationale would cause the nurse to question the order?

B. It could cause a fluid and electrolyte imbalance

92. An order is written for an isotonic enema for a 2-year-old child. What is the maximum amount of fluid the nurse should give to this child without a practitioner's specific order?

A. 100 to 150 mL

SITUATION 26: A 5-month-old infant is brought to the pediatric clinic for a routine monthly examination.

93. What is a common finding that the nurse can identify in most children with symptomatic cardiac malformations?

C. Delayed physical growth.

94. A 2-year-old child has a congenital cardiac malformation that causes right-to-left shunting of blood through the heart. What clinical finding should the nurse expect?

C. Elevated hematocrit

95. Anticipating that a 4-year-old child, scheduled for open-heart surgery, will have chest tubes in place postoperatively the nurse informs the parents that the chest tubes will:

B. Promote drainage of air and fluid

96. After a discussion with the pediatric cardiologist, the parents of an infant with patent ductus arteriosus (PDA) ask the nurse to explain once again what PDA is. The nurse explains that it is:

C. A connection between the pulmonary artery and the aorta

97. The nurse caring for a child with a cardiac malformation associated with left-to-right shunting should be aware that the major characteristics of this type of congenital disorder is:

C. Increased blood flow to the lungs

98. A young child has coarctation of the aorta. What should the nurse expect to identify when taking the child's vital signs?

D. An elevated blood pressure in the arm

99. A 2-week-old boy is admitted with a tentative diagnosis of a ventricular septal defect. The parents report that their baby has had difficulty feeding since he has been home. The nurse explains that:

C. Ineffective sucking and swallowing may be early indications of a heart defect

100.The laboratory analysis for a 5-year-old child admitted for repair of tetralogy of Fallor indicates an elevated RBC count. This polycythemia is a compensatory mechanism for:

A. Tissue 02 need